KHOPOTSO: Brian Hlongwa, MEC for Health in Gauteng, has been in his position for just over half a year. Hlongwa recently called a small informal briefing with a selected group of health journalists. His objective? To showcase the achievements of the provincial health department, including on HIV/AIDS.

BRIAN HLONGWA: We are happy as a province’€¦ in terms of planning; in terms of also preparing personnel to deal with the burden of disease. Over 350 000 people in Gauteng have been assessed’€¦ We’€™re talking public health care ‘€“ people who have come through our system who have been assessed in terms of Voluntary Counselling and Testing. And out of those we have close to 60 000 now who are on treatment’€¦ And out of this 60 000, 10 % – which is 6 000 – are children under the age of six who are on treatment. We are increasing the number of ARV sites. As you know the processes are such that we must have accredited sites. We must prepare them because once people get on to ARVs, it’€™s a life-long thing. It’€™s not a simple issue of dishing out Panado or an aspirin.

KHOPOTSO: Hlongwa could not say how many people were waiting to access ARVs through the public health sector in Gauteng. However, he said the province will continue expanding its anti-AIDS treatment programme, thanks to a beefed up budget.

BRIAN HLONGWA: Our budget – relative to the last financial year – increased by about 48%. In total, we have a budget of R550 million just to deal with the scourge of HIV and AIDS.

KHOPOTSO: It’€™s estimated that there are about 5.5 million people living with HIV in South Africa. Cases of people only presenting in public health facilities when very ill, almost at death’€™s door due to disease, are a daily experience for health care workers in the province. At Natalspruit Hospital on Gauteng’€™s East Rand, medical wards are simply too full to cope with patients with AIDS-related conditions.

MRS SEROTE: Because of the pressure of these HIV-related patients we had to remove one paediatric ward and make it a step-down. And we had to take one female orthopaedic and make it a female medical ward. Yes, they are full in such a way that they over-flow into other wards, disciplines. For instance, at the present moment we do have patients in the Gynae and Obstets that are medical. We’€™ve got patients who are medical, who are mostly HIV-related, into Spinal. That’€™s what we have done. They are all scattered around the hospital because we don’€™t want to be seen as saying we have chased patients away, we say we don’€™t have beds.    

KHOPOTSO: Head of nursing services at the hospital, Mrs Rosina Serote. But even in the face of the stop-gap measures the hospital has employed, the burden of disease is overwhelming. Serote foresees a gloomy future.

MRS SEROTE: It will mean we will turn patients out and say: ‘€œWe don’€™t have any beds within this 784-bedded wards that we have been authorised with’€.      

KHOPOTSO: The provincial Health Department is building a new hospital in nearby Vosloorus to help alleviate the plight of Natalspruit Hospital. However, the MEC for Health believes the solution to the challenge is not to build more hospitals.

BRIAN HLONGWA: The sad reality is that there is no cure for HIV and AIDS’€¦ It’€™s not like the longer we keep you in our beds, the higher your chances of being better. It’€™s not like that ‘€“ much against my wish. We continue to pray. Our scientists continue to’€¦ do research, hopefully, that we are able to deal with this thing once and for all’€¦ Our strategy is to prevent people from getting infected in the first place. That’€™s where we must invest heavily. But (b) ‘€“ those who are infected already ‘€“ we need to provide treatment and care’€¦ So, the issue of ARVs is about really adding life’€¦ But those, unfortunately, who are overwhelmed by the burden of disease, we must still care for them up to their last day. Which is the best way of doing it? It’€™s not hospitals. Imagine if everybody with full-blown AIDS must be kept in hospital ‘€“ there’€™s no bed for any other thing. It’€™s as simple as all that. We won’€™t have enough beds.

KHOPOTSO: Hlongwa is frank and sobering about how he thinks the shortage of beds in public hospitals can be dealt with.  

BRIAN HLONGWA: There are nine million people in this province. And that’€™s (the) 2001 census’€¦ By 2014 there will be about 15 million people in Gauteng. Now with the burden of disease what does it mean? We need to get individuals to be empowered ‘€“ education; to take responsibility for their health; to promote healthy lifestyles. But this idea that Health (Department) can look after you and give you a bed ‘€“ it’€™s a fallacy. It doesn’€™t exist anywhere in the world.

KHOPOTSO: More important than building more hospitals, he says, is to ensure that there is enough personnel to care for patients.  

BRIAN HLONGWA: The issue of health care professionals is a challenge – not only in our province or the country – but worldwide’€¦ These are nurses, these are doctors, these are mid-wives and other allied health workers’€¦ Gauteng is not immune from these challenges. So, the issue of being able, firstly, to improve the working conditions of our staff is a challenge; dealing with staff shortages ‘€“ nurses, in particular. These are the back-bone of the health care system’€¦ We’€™ve set targets for ourselves ‘€“ in terms of the production of nurses we need to increase them by 20% per annum. We have slightly above 18 000 nurses in Gauteng. So, we need 20% of 18 000 delivered every year through our training colleges.