Ephraim Marutha has been waiting in a queue at OR Tambo Clinic in Diepsloot north of Johannesburg since 5.15am. By 11am he was still number 11 and had still not been attended to.

Up to October last year, OR Tambo was the only primary health care facility in Diepsloot. A second facility, Diepsloot South, was recently opened, but the patient load has not decreased.

Acting facility manager Sister Mabel Letsoalo says she works long hours to try and serve the more than 82 000 residents of Diepsloot.

Offering child health services, family planning, immunization, treatment for sexually transmitted infections, TB and other chronic diseases, Letsoalo and her three nurses see more than 300 patients every day.

The clinic’€™s only doctor, Dr Richard Lebethe, says he still sees over 30 patients in the four hours he spends at the clinic before going off to two other clinics under his care.

‘€œThe demand for health care is very high,’€ says Lebethe. ‘€œWhen people come to Joburg, their first station is Diepsloot. The majority of people from outside the borders are from Zimbabwe. But we’€™ve even seen people from Pakistan around here.’€

Letsoalo says many of the health problems are the result of poor living conditions, including the biggest problem — tuberculosis.

‘€œThe environment is not conducive for people to live in. I think that can help if the government can really help out by building houses for these people that will improve the environment,’€ says Letsoalo.

‘€œThe spread of TB is encouraged by over-crowding, more especially the squatter camps. Those are the problems where we get more TB clients.’€

Many of the informal settlements have no running water, but get supplies from a water truck. They use buckets for toilets.

Felicia Mathete, chairperson of the health forum at O.R Tambo, says another problem is the lack of space in the clinic.

‘€œWomen get pregnant and during labour they rush to this clinic that does not have a labour ward. That’€™s our big problem. Secondly, there is no ambulance service. They take a long time to arrive when called upon,’€ says Mathete.

Lebethe explains that baby deliveries are supposed to take place in Coronation Hospital, not the clinic.

‘€œEffectively, this place was not made for deliveries, which means every time there’€™s a delivery these people must be able to go to Coronation on time, which doesn’€™t happen. The clinic is exposed to having to do deliveries in here without the appropriate facilities and the appropriate staffing because there are no mid-wives.

‘€œWe should hail the sisters here because they are working beyond their means in every way. They are really pushing themselves.’€

Jabulile Shabalala-Rakosa, deputy director of Primary Health Care in Johannesburg is aware of the huge workload these nurses carry.

‘€œIt is a very huge workload. If you look at our patient complaints, a lot of complaints that come from that region are about long waiting times because nurses have to go through and check every person thoroughly. And this takes massive time and people get very unhappy.’€

Shabalala-Rakosa believes there could be some relief if Diepsloot is able to secure some of the money recently approved by the mayoral committee for extra posts.

In the interim Ephraim Marutha will continue to make an early morning start. ‘€œBecause there’€™s no money, I can’€™t go to a private hospital. I don’€™t have a choice because I don’€™t have money.’€

Meanwhile, in the opposite side of town, 23-year-old Nthabiseng Moloisane also laments the unhealthy living conditions in Drieziek 6, an informal settlement south of Johannesburg.

Nthabiseng Moloisane has lived in a two bed-room shack with six other family members in the settlement for the past eight years.

She and her fellow residents struggle for access to the most basic services.

‘€œWe are using only one tap here. You must come here and take the water and go, it’€™s too far,’€ says Moloisane.

She, like other residents, uses a bucket as a toilet and empties it in a nearby field and the stench is unbearable.

Moloisane explains that they stopped using pit toilets for fear of children falling in when they played nearby.

‘€œSometimes there in the hole they put dead dogs and when it rains the water goes through our houses so the children get sick. Sometimes we just walk inside the water (with the dead animals),’€ says Moloisane.

Relentless rain in Gauteng over the past two months has made matters worse for residents in Orange Farm.

 ‘€œThere are lots of mosquitoes, they did bite my baby on the face and legs,’€ motions Moloisane.

But the councillor for Drieziek 6, Meisie Simango , believes there have been improvements over the last ten years.

‘€œWe found them sitting here without yards, but at the moment everybody’€™s got his one yard, but before it was just a squatter camp,’€ she explains.

According to Simango, the council has been awaiting the outcome of a tender process to start the construction of sewers in Drieziek 6. However, she doesn’€™t know when construction is likely to start or how long it will take.

Richard Mokolo of the Orange Farm Water Crisis Committee does not believe residents should vote: ‘€œMy message to the people is not to participate in these elections to show their frustration of the system.’€

But Moloisane is planning to make her cross. ‘€œI’€™m going to vote because I want changes where I’€™m living because where we are living it’€™s like we are animals. Even animals, they don’€™t stay where we are staying.’€

Johannesburg:

The Johannesburg metro has 98 primary healthcare clinics spread across 11 regions, which treated over 2,5 million patients between July 2004 and June 2005.

One of the biggest health problems in the metro is tuberculosis, with some 12 000 cases being diagnosed during this period.

The majority of cases were reported in Region 10 (most of Soweto) and Region 7 (including Alexandra and Ivory Park). Region 3, the wealthy north encompassing Sandton, Randburg and Sunninghill, had the lowest TB rate.

Immunisation of babies under the age of a year has steadily improved, and it now stands at 83,4%, one of the best rates in the country.