From trauma to Aids

‘€œHello, can I have a bed for a female?’€ the harassed nurse barks down the phone. ‘€œOh, you are full as well?’€ She shrugs, replacing the receiver and looks helplessly at the young woman who has been wheeled into Tambo Memorial Hospital’€™s casualty ward.


Unable to stand, her body weak from incessant coughing, the woman stares blankly at the nurse who sets up a drip to relieve her dehydration.


‘€œWe get so many patients with AIDS-related illnesses in casualty because they can’€™t walk to the clinic, so the ambulance picks them up,’€ says Nurse D, her well-groomed appearance belying the 12 hours she has just worked at the Boksburg hospital.


Most of the beds in casualty are already occupied by a racially diverse group of patients reflecting the hospital’€™s community of 800 000 residents from Gauteng’€™s Brakpan, Actonville, Benoni and Boksburg.  


Five years ago when Health-e first visited the hospital, casualty was over-burdened by alcohol related cases. Today the pressure is primarily related to HIV and AIDS.


Over the past two years Tambo Memorial has received a shake-up in the form of Dr Vis Naidoo, the chief executive officer tasked with overhauling the administration of the hospital after years of clinical and administrative botch-ups.

Naidoo’€™s ‘€œout of the office’€ policy makes him a hard man to pin down as he believes in walking around the hospital to check on everything.


On the way to the ARV clinic, he explains that before he arrived health professionals all worked in silos. ‘€œWe are more integrated now. I also don’€™t believe in people working from their office. You have to be at the coalface of what’€™s happening.’€


But despite the positive developments, the 540-bed hospital is struggling to cope with the patient load brought on by HIV.


 ‘€œThe problem is with primary health care (clinics),’€ explains Naidoo. ‘€œFailure to treat patients at primary health care results in our casualty being clogged up.’€


HIV is also resulting in a revolving door syndrome ‘€“ with between 10 and 15 percent of discharged patients are being re-admitted for various opportunistic infections.


In the women’€™s medical ward two doctors are completing their ward rounds.

‘€œOf the 32 patients here today 26 of them are sick because of opportunistic infections,’€ says a professional nurse while restocking a trolley.


‘€œIt is very sad that most of them don’€™t know their HIV status.’€


Opening up a big blue registration book, she points out the HIV infection rates in a column. ‘€œLast night we had 3 positives in this ward. When a patient is admitted to the medical ward that appears to have opportunistic infection, a doctor will refer them to the ARV clinic for testing. Most of the women who are already sick, don’€™t know their status,’€ said the nurse.


But ARV treatment seems to be having an impact: ‘€œBefore we used to have 10 people dying in a week. Now we only have three or four,’€ adds the nurse.


Stepping into the Enthonjeni Clinic is like entering another world, that is no more than a few meters outside the hospital wards. A bright sign over the door and stuffed animals hanging from the window gives it a cheerful ambience compared to the medical ward. Healthy patients line up on chairs in the   newly built clinic where 1100 people are on ARV treatment, the youngest of whom is 14 years old.


‘€œWe have a fashion parade now with all our patients who have been on ARVs who are healthy,’€ laughs Nurse Ruth Zulu, project manager of the clinic.


Giggling over coffee in the canteen where the room still smells of fresh paint, the nurses’€™ camaraderie is a far cry from the harassed and defeated look of those working in the medical wards.


‘€Our first patient, Sipho was here and I looked at his card. You know his CD 4 count was one when he got here ‘€“ today it is way above 300,’€ proclaims Sister Rose Zondo.

According to the nurses, many of the critically ill patients do not know that they are HIV positive and 80% of those who test are positive.


‘€œWhen we first started we wanted to reduce the number of patients dying in the hospital and also reduce the cost. We reduce the burden and frustration on nurses and manage to save lives and encourage couples to come forward. This is better than it was,’€ says an upbeat Zulu.


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