Mrs ROSINAH SEROTE: I’€™ve been here plus-minus five years. The challenge that we are facing is more about HIV and AIDS, which has an impact on our staff. Because of shortage of staff we have to take out staff from our existing establishment to start rolling out antiretroviral drugs.


KHOPOTSO: Head of nursing services at Natalspruit Hospital, Mrs Rosinah Serote. Dr George Abraham, the acting senior clinical manager, tells a similar story.  


Dr GEORGE ABRAHAM: I’€™ve been working here for the past 12 years and over the time services in this hospital, in a way, have deteriorated because of the HIV epidemic. It’€™s two ways: Number 1, our number of patients with HIV-related diseases have increased. Number 2, we have been losing staff on a regular basis due to HIV.  


KHOPOTSO: Natalspruit Hospital does not have enough staff to cope with the HIV/AIDS epidemic. The numbers of patients seen for HIV and AIDS have risen dramatically since the hospital started offering antiretroviral medication in July 2004. Mrs Serote gives us a year-by-year account.    


Mrs ROSINAH SEROTE: When we started in 2004 July until December, our statistics was at 3078, that is, 2 714 adults and 364 paediatrics. And the patients that we put on treatment were about 261. Coming to 2005 January until 2005 December, we have seen 20 350 – though it was half a year, almost – from when we started’€¦ And 1 166 were put on treatment. From January 2006 to April 2006, we have seen so far, 8 433. Adults were 7 455 and paediatrics 978. The total who are on treatment are 391.


UPSOUND ‘€“ Sfx’€¦ (People at AIDS clinic)


KHOPOTSO: At the AIDS out-patients’€™ clinic, called Faranani ‘€“ a Tshi-Venda word, meaning to hold hands to work together – more than a hundred people are waiting for their monthly antiretroviral supplies. There is only one pharmacist to assist the patients at the AIDS clinic. Ingrid Linder has a lot to do, but agrees to a hurried interview.


INGRID LINDER: It’€™s very, very strenuous. I do have assistants that help me ‘€“ three ladies ‘€“ one is on leave for these couple of days’€¦ It’€™s very strenuous to cope with the load. Very often we have to be fast in our dispensing mechanisms and sometimes patients don’€™t get the best quality out of our service. We are pushed for time.


KHOPOTSO: By 11h30, Linder had already seen 43 patients. Over 50 were still awaiting their turn. On average, she says, she spends five minutes with her patients.


INGRID LINDER: Under ideal circumstances that’€™s not how I want to be because pharmacy is a complicated issue, as you can imagine. It’€™s medicine. So, it goes into a body. And it needs to be the correct dose, the correct strength. There are some finer details that you sometimes have to take time and explain to your patient. But you always have that burning issue at the back of your head: Time factor, the time factor. Other people are waiting as well. Hurry up. Be fast. Be quick. And that’€™s not always the ideal scenario that you should have when working with such a complicated issue as HIV/AIDS treatment.


KHOPOTSO: Since April last year, Linder has been the only pharmacist at Natalspruit Hospital’€™s AIDS clinic. The motherly head of nursing services, Mrs Serote, says shortage of staff is a general problem at the hospital.


Mrs ROSINAH SEROTE: We’€™ve got a shortage of staff, particularly professional nurses. Enrolled nurses I’€™ve got enough; nursing assistants I’€™ve filled all the posts. But professional nurses ‘€“ I’€™m having about 68 vacant posts’€¦ We’€™ve got a shortage of radiographers as well, pharmacists as well.


KHOPOTSO: This shortage sometimes forces health care workers to make tough clinical decisions ‘€“ which in turn negatively impact on the patients – says pharmacist Ingrid Linder, unapologetically.


INGRID LINDER: Yesterday, I had the unfortunate situation where I had to turn five mothers away. It was already 16h30. I don’€™t get overtime pay’€¦ So, at 16h30 I said I can do no more. I’€™m exhausted. If I continue like this I might make a dispensing error or I might tell somebody to take the medicine in a wrong manner because of severe tiredness. So, they were very upset. And they told me they don’€™t have money and I’€™m unfair and I must help them until 17h00 or 18h00 or whatever. Tough clinical decisions, you know’€¦ but they have to be made on a daily basis’€¦


KHOPOTSO: The burden of AIDS also extends to the in-patients’€™ unit of the 784-bed Natalspruit Hospital. The numbers are increasing on a daily basis.


Mrs ROSINAH SEROTE: The patients that we admitted yesterday were about 112. We had transfers in and admissions as well’€¦ About 50% were medical patients’€¦ They were pneumonias, TB, meningitis and so on.


KHOPOTSO: HIV is most often the underlying cause, says the acting clinical manager of the hospital, Dr George Abraham.


Dr GEORGE ABRAHAM: When we check on a regular basis we find out that most of these patients are HIV-related because you will see that it’€™s the same patients that come regularly’€¦ Because their immunity is already low they are the ones who get sick much faster’€¦


KHOPOTSO: Medical conditions, mostly AIDS-related and which form 80% of the hospital’€™s admissions, have made the institution’€™s five medical wards seem almost like a death zone. Serote takes out a list detailing the deaths that occurred the day before.


Mrs ROSINAH SEROTE: Yesterday we had 13 deaths. Now from these 13 deaths we always break it up’€¦ Medical is always top on the list. Seven are medical already. Surgical ‘€“ they are two. Paediatrics ‘€“ they are three. Gynae and Obstets is one ‘€“ it’€™s cancer of the cervix.  


KHOPOTSO: Illustrating the effect of AIDS, Serote moves her finger down the first seven deceased patients on her list.


Mrs ROSINAH SEROTE: All these patients ‘€“ it’€™s a terminal already ‘€“ meningitis, pneumonias as well.


UPSOUND ‘€“ Sfx (Chains being undone)


KHOPOTSO: Ward 16 is one of the five medical wards of the hospital. It’€™s always secured by chains to prevent patients with AIDS-related mental disorders from escaping. Sister Nombulelo Mabhija, has been working in this ward – a male medical ward for three years. Earlier in the day she had just seen a patient die in her ward. How does she cope with so much death and suffering?


SISTER NOMBULELO MABHIJA: Sometimes we are overwhelmed, but we have to be there for the patients. We love our job. We wake up every morning, tell yourself you are a nurse. You have to come and nurse these poor patients. So, you are there all the time.