Northern Cape ‘ the Spaces Between
Sister Pierrette Rossouw’s smile turns to a mock frown when she explains how she has ended up in the small Northern Cape dorp of Garies.
‘You know, they say that when you come to Garies you cry, but when you have to leave you cry again,’ she says with a chuckle.
Garies, about 240km from the Namibian border, is a welcome stop on the long, dry trek from Cape Town to Namibia. The dorp ‘s main features are a rundown hotel, a spanking new police station and a farmer’s co-operative. Employment in the region is scarce. Surrounding sheep and goat farms offer few jobs, as do the granite mines.
The Northern Cape is not for the fainthearted. The landscape is harsh, distances between towns are vast and temperatures vary dramatically from 40 deg C in the day to below freezing at night.
But those who have settled in the many one-horse towns in the province are determined to stay and many professionals, especially health workers, are returning to their place of birth after completing their post school training.
Sister Roussouw has worked at the Garies Clinic for 11 years. Her nurses’ shoes are well worn, an indication of the many hours she has spent on her feet.
Rossouw and her colleague, Zinnie de Klerk, see an average of 57 patients a day. The number includes visits in mobile clinics they run to remote villages.
Known for its vastness (it comprises almost 30% of the South Africa), the Northern Cape is home to about 900 000 people.
It has a low population density (only 2,3 people per sq km while the national average is 34) and 70 percent of residents live in urban areas.
Towns experience a constant influx from rural areas, as workers on sheep, raisin and wine farms in the region prefer to live in small urban centres where health services and schools are more accessible.
Although employment is above the national average, the Northern Cape Health Department estimates that 80 percent of the population is not covered by medical insurance. The primary causes of death in the region are respiratory and cardiovascular disease and tuberculosis.
‘We have about 24 TB patients at any one time,’ says Rossouw adding diabetes and high blood pressure to the list of most common ailments.
As with other clinics in the province, Garies offers the total Primary Health care package that has seen a decline in unnecessary referrals to district hospitals.
‘Recent calculations showed that of 974 patients we saw in Garies clinic, the doctor (who visits every day) only saw 94 and most were for chronic medication prescriptions,’ she says proudly.
District Health Manager for Namakwa, Gavin Chester is clear: ‘Since we’ve introduced primary health care-trained nurses to the clinics, the drop in referrals to the hospitals has been big.’
Many doctors working in the Northern Cape are Cuban, but Chester says they are quick to pick up on Afrikaans, the most widely spoken language in Namakwa’s smaller towns.
Rossouw can’t remember when last a child died in the small hospital in Garies that will soon be replaced by a new one to be built with funds raised by former president Nelson Mandela.
‘There is no doubt that there has been a significant improvement in the mortality rates in our area,’ she adds.
The Northern Cape recorded 29 maternal deaths in 2000 and 24 in 2001.
This is compounded by the high number of teenage pregnancies in the province ‘ almost one in five women aged between 15 and 19 years. In an effort to address this and other challenges unique to young people, two youth centres have been opened in Kimberley and Upington to provide clinical services such as relationship counselling and education on safer sex, contraceptives, teenage pregnancy, HIV/AIDS and other STDs and termination of pregnancy services.
Because of the vast distances between towns and referral centres, transporting patients to health centres for specialist services is a major challenge. Residents in far-flung outposts pay exorbitant transport fees to access the closest health centre. Ambulances in the province log thousands of kilometers as they try to meet the demand of transporting patients.
Sister Riana de Waal arrived at the Pofadder Clinic in August last year. Like many others, she returned after leaving the desert town five years ago.
‘We refer many patients to Springbok, but we refer as far away as Kimberley (800km) or Bloemfontein (975km),’ she says.
In the case of a referral, the ambulance driver, who lives in the town, is contacted via his cell phone.
‘A big problem is that there is not always a staff member to accompany the patient. Sometimes, in emergencies, we have to use the flying ambulance service (operated by the Red Cross),’ she says.
It is perhaps not surprising that De Waal’s wish list has an extra ambulance at the top.
Although more than R5-million has been spent on new ambulances and patient transport vehicles there is 0,18 vehicles per 1 000 patients in the province. Ambulances in the Northern Cape travel around 13-million km a year, transporting about 150 000 patients.
The past financial year saw average provincial expenditure on health increase by 10,9%. Meanwhile, the 2003/4 health budget in the Northern Cape has gown by a healthy 22,1%. The per capita spending on health in the province is budgeted at R1 042, placing it among the top five provinces.
The introduction of community service has also, for the first time, seen a permanent doctor located in Pofadder and other small towns to serve the clinics and community hospitals.
Dental services, occupational therapy and physiotherapy were also introduced to the province with community service for these professions.
Statistics from Government’s Intergovernmental Fiscal Review reveal that the province has a doctor for every 823 patients. This compares favourably with other provinces. There is one professional nurse per 1 079 patients.
Specialists are flown into Springbok from Kimberley and Bloemfontein every five weeks. An oncologist visits the hospital every three months, but chemotherapy is offered at Springbok hospital.
Health workers agree that the disturbingly high level of alcohol and drug abuse in the province requires urgent psychosocial intervention.
‘We try to do the best we can, but even if we are able to stabilize the patients, they return to the socio-economic conditions that cause many of their problems in the first place,’ says Stanley Basson, a nurse in Pofadder.
Substance abuse has resulted in almost 30% of all children in the province displaying signs of stunted growth. De Aar has one of the highest Foetal Alcohol Syndrome rates in the world.
The Northern Cape has one psychiatrist who visits a town like Pofadder only once a year to consult with the chronic patients.
A patient who lives in Pofadder and who needs to be certified and admitted to the psychiatric hospital in Kimberley, over 900km away, has to be seen by doctors in either Kakamas or Springbok. This means an ambulance has to be booked and the patient is taken by road to one of the two towns, both about 140km away.
At present one Northern Cape resident accesses primary health care services at an average of 2,8 times a year. With these figures the province is heading towards the desirable national figure of 3,5 visits per year.
The biggest challenge in providing health care in the Northern Cape are the vast distances and the socio-economic problems.
Northern Cape Statistics
- Maternal mortality rate (the number of women who die as a result of childbearing during the pregnancy or within 42 days of delivery or termination of pregnancy in one year, per 100 000 live births) ‘ 168 per 100 000
- Infant mortality rate (the number of children less that one year old who die in a year, per 1000 live births) 46 per 1 000
- Persons in poverty: 41,4%
- Funtional literacy: 61,4%
- Unemployment rate: 28,8%
- TB incidence: 635 per 100 000
- Prevalance of disability: 5,7%
- HIV prevalence: 15,1%
- Stunting: 29,6%
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