Battlefield of the 21st Century
AIDS patients have quietly replaced those with gunshot and stab wounds at the hospital and there are signs that the quality of care is deteriorating as healthcare workers battle to cope.
Shacks surrounding the 784-bed Katlehong hospital are a visible reminder that most of the patients are from impoverished households.
Outside the hospital gates speeding taxis and pavement vendors conduct a brisk trade, but once you enter the hospital it’s a business of life and death.
‘Sorry, sorry, sorry,’ urges a nurse as she pushes a trolley with a body under a sheet down a passage leading from the men’s medical ward.
‘You see? There’s already a death,’ whispers Sister Rosinah Serote, a motherly figure who has been head of nursing at the hospital for the past five years.
Clearly stressed and under pressure, Nombulelo Mabhija, sister in charge of the 38-bed male medical ward fumbles to find a wrist watch.
‘Hmm’¦ Let’s just quickly write the time now,’ she mumbles to herself.
She prints 12.55pm, the time man on the trolley died.
It’s the first death for the day in Ward 16. The previous day, there were seven deaths in the medical wards.
‘It does overwhelm us because really, they are sick. They need to be cared for all the time. They are totally dependent upon us because most of them can hardly walk. They can hardly feed themselves. They can hardly wash themselves, so we have to wash them. We have to take care of them full time,’ explains Mabhija with a stern look.
Shrugging her shoulders, she adds, ‘We cope. Sometimes we are overwhelmed, but we have to be there for the patients.’
Dr George Abraham, acting senior clinical manager of the hospital, believes the issues are straightforward: ‘Number one, our number of patients with HIV-related diseases have increased. Number two, we have been losing staff on a regular basis due to HIV.
‘You’ll find that, on a monthly basis, we lose one to two people because of this HIV problem.’
Abraham, who has worked at Natalspruit for the past 12 years, believes the hospital staff are no different from the community that they serve and that they are often shocked into silence when they discover that they have HIV.
‘I think the main thing is stigma. If I know I’m HIV (positive) I try to hide it until it’s very, very late’¦ It’s a matter of stigma ‘ whether I’m a healthcare worker or not ‘ I live in the same community where people are being labelled as HIV (positive),’ he explains.
Abraham and Serote don’t see the numbers tapering off.
‘Over the years, we used to have problems with our trauma patients’¦ In the early ‘90s we used to have a lot of gunshots and all those things,’ recalls Abraham.
‘Those things have come down. But now we are overwhelmed by medical patients. For example, we used to admit between 10 and 15 medical patients on a daily basis. Now that number has gone up to 40 to 50 patients per day. And most of these patients have HIV-related complications.’
Serote says more than 80% of patients admitted to the hospital’s medical wards are HIV-related. The result is that there are not enough beds to accommodate them, says the motherly figure.
She has also been forced to take staff from other wards to be in a position to roll out anti-retrovirals at the HIV clinic.
‘Because of the pressure of these HIV-related patients we had to remove one paediatric ward and make it a step-down [lower care ward]. And we had to take one female orthopaedic ward and make it a female medical ward. And we had to push orthopaedics somewhere,’ she sighs.
Despite these stop-gap measures, there still are not sufficient beds to cope with the HIV demand.
Serote warns that if the HIV epidemic continues to grow in their community, there will no longer be beds for other conditions except HIV.
‘It’ll mean we will turn patients out and say we don’t have any beds.’
In a separate building away from the main hospital the out-patients HIV clinic, Faranani (a Tshi-Venda word meaning ‘join hands and work together’) is teeming with patients waiting for their turn to see the pharmacist.
Ingrid Linder is the sole pharmacist at Faranani: ‘It’s very, very strenuous’¦ 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.’
Linder says at most, she spends five minutes with her patients and that is not ideal. By11 o’clock, she has already seen 43 patients and more than 50 are waiting.
‘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, time factor. Other people are waiting as well. Hurry up. Be fast. Be quick,’ says Linder.
Abraham confirms that recruiting pharmacists has been tough.
‘We have even said we might be even willing to pay private rates for pharmacists to come and work for us for, maybe, two hours or four hours during those busy hours. Still, we find it difficult to attract people’¦ We go to people who are doing locums in private pharmacies’¦ head hunting. We just go and say: ‘Please can you work for us for two hours so that we pay you at this rate’?
But Abraham has to contend with various perceptions: ‘You know, Natalspruit is a bit off the town so people have a feeling that Katlehong is not safe. Most pharmacists say: ‘No, we wouldn’t want to come to that place’’¦ I can explain to them that I’ve been working for 12 years. I never had a problem. They say: ‘No, I don’t want to take that chance’’.
Serote also laments the dire shortage of staff, particularly professional nurses: ‘Enrolled nurses I’ve got enough, nursing assistants I have filled all the posts. But professional nurses ‘ I’m having about 68 vacant posts’¦ We’ve got a shortage of radiographers as well,’ she adds.
Only around 1 000 patients are on anti-retrovirals out of the 20 000 that have been seen at Faranani and Serote says this is mainly due to the fact that they only have one pharmacist.
Abraham is blunt: ‘The number is going to reach a stage that we won’t be able to cope unless we have enough resources. This year we might see up to 30 000. You need space, you need manpower, you need money, social services. It’s an all-inclusive problem.’
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