The audio is in isiZulu. Please see English summary below.
MABUTHO: Ngokusho koyinhloko yenhlangano yaseFrance, i Medecins Sans Frontieres noma iDoctors Without Borders, kuleli uDr Eric Goemaere abahlengikazi bangadlala indima ebalulekile ukulwisana negciwane lesandulelangculaza kuleli uma kungasuswa imigoqo ebavimbela ukuba banikezele ngama ARVs kulabo abaphila negciwane lesandulelangculaza njengoba kwenzeka kwamanye amazwe angomakhelwane bakuleli kubalwa iLesotho kanye neMalawi. Uthi bake bazama ukuqeqesha abahlengikazi esifundazweni saseMpumalanga Kapa eLusikisiki namaphethelo ukuthi banikezele ngama ARVs kodwa akwangaba impumelelo ngenxa yokuthi, yathi ingahamba endaweni inhlangano yakhe iziphathimandla emnyangweni wezempilo zatshela abahlengikazi kwezikabhoqo ukuthi umthetho kawubavumeli ukuba banikezela ngama ARVs. Nokwaholela ekuvalweni kwezizinda ezisiza abanegciwane kwemanye ama clinic.
DR ERIC GOEMAERE: As soon as we disappeared, instructions were given that ‘no, you are not allowed to initiate treatment, the doctor is going to initiate treatment’. Well, they could not find the doctor to do the job that we were doing before. Some clinics even had to close down their HIV care.
MABUTHO: Ngokomthetho iNursing act ka 1978 abahlengikazi abaqeqeshwe ngokwezinga elithile banganikezela ngemithi kodwa kumele bagunyazwe ngumqondisi jikelele emnyangweni wezempilo futhi kube ngukuthi udokotela noma usokhemisi akekho eduzane ukuthi enze lomsebenzi. Nokho uDr Goemaere uthi ngokubona ukwanda kwesibalo sabantu abadinga ama ARVs babe sebezama ukuthi baxoxisana neziphathimandla zomnyango wezempilo ngaloludaba kodwa kwanhlanga zimuka nomoya ngoba batshelwa ukuthi umthetho awuvumi ukuba abahlengikazi banikezele ngama ARVs. Khonamanjalo Dr Pheello Lethola waseLesotho nokuyizwe lapho umthetho wakhona ukuvumela ukuthi abahlengikazi banikezele ngama ARVs uthi lokhu ukubona kuwusizo kakhulu ezweni lakubo ngoba vele babhekene nenkinga yokuntuleka kodokotela. Uthi ukube uma kungayekelelwa kodokotela ukunikezela ngama ARVs lokho kungasho ukulahleka kwemiphufumulo eminingi ngokungenasidingo ikakhulukazi ezindaweni zasemakhaya lapho bebancane khona odokotela.
DR PHEELLO LETHOLA: In Lesotho there is only about 89 doctors for a population of 1.8 million people. If we were to rely solely on these doctors to provide HIV AIDS care then a lot of people will be left to die especially in the mountains and in the rural areas where there is even few doctors.
MABUTHO: Uthi selokhu luqalile loluhlelo lokuthi abahlengikazi banikezele ngama ARVs ezweni lakubo lubonakala lunezithelo ezinhle njengoba siye sakhula kakhulu isibalo sabantu abafakwa ngaphansi kwaloluhlelo lwama ARVs.
DR PHEELLO LETHOLA: Unlike in South Africa where the nurses are not fully allowed to prescribe ARVs, the government in Lesotho realizes that we do need nurses if we are to scale up access to ARV treatment.
MABUTHO: Nokho uDr Lethola uyavuma ukuthi loluhlelo luthanda ukuphazamiseka ngenxa yokwentuleleka kwabahlengikazi ezweni lakubo nathi kudalwa ukwanda kwesibalo sabahlengikazi ababulawa igciwane kanye nalabo abashiya umsebenzi wabo bayosebenza kuleli kanye naseNgilande.
DR PHEELLO LETHOLA: The major challenge, though, that the project is facing is the shortage of professional nurses. Why is that so? Because nurses are dying from HIV/AIDS, secondly, there is a high attrition of nurses from the public sector to the private sector within Lesotho, to South Africa and to the UK.
MABUTHO: UMn Bhungani Mzolo osemnyangweni wezokuxhumanisa emnyangweni wezempilo ukuqinisekisile ukuthi abahlengikazi kabavunyelwe ukunikezela ngama ARVs kodwa uthi ngezinye izikhathi labo abasezingeni elithile ngokwemfundo yabo bayaye bavunyelwe ukunikezela ngama ARVs ngaphansi kwezimo ezithile kulandelwe imigomo eqinile.
Call to remove restrictions on nursing practice
The French humanitarian group, Medecins Sans Frontieres (MSF) or Doctors Without Borders is calling upon the South African government to remove restrictions which prohibit nurses from prescribing antiretroviral treatment from the scope of nursing practice.
According to Dr Eric Goemaere, head of mission, MSF South Africa, nurses playan important role in the fight against HIV/AIDS in countries such as Lesotho and Malawi. Goemaere says unlike in South Africa where nurses are prohibited to prescribe antiretrovirals, nurses in Lesotho and Malawi have no such restrictions placed on them.
He says the MSF had a successful treatment program in Lusikisiki, Eastern Cape province – where more than 2,000 people with AIDS were put on treatment from 2003 to last year. Nurses were integral to the effort, he said. But after his organization handed the program to the government, nurses were told to stop prescribing ARVs because ‘it was outside their scope’.
‘As soon as we disappeared, instructions were given that ‘no, you are not allowed to initiate treatment, the doctor is going to initiate treatment’. Well, they could not find the doctor to do the job that we were doing before. Some clinics even had to close down their HIV care,’ he said.
According to the South African Nursing Act of 1978, only nurses with relevant qualifications may be allowed to prescribe medicines under restrictive conditions ‘ which stipulate that before they ‘can perform such act they should have been authorized by the Director of hospital services of such provincial administration, the medical officer of health of such local authority or the medical practitioner in charge of such organization’. The act further says nurses ‘may perform such act only whenever the services of medical practitioner or pharmacists, as the circumstances may require, are not available’.
Lesotho follows a different approach. Dr Pheello Lethola from the tiny mountainous southern African country, says allowing nurses to prescribe ARVs, has been very fruitful because they have a serious problem of shortage of doctors in her country.
‘In Lesotho there are only about 89 doctors for a population of 1.8 million people. If we were to rely solely on these doctors to provide HIV/AIDS care then a lot of people will be left to die, especially in the mountains and in the rural areas where there are even few doctors,’ said Dr Lethola. She says since nurses started prescribing ARVs in Lesotho there has been an increase on the number of HIV/AIDS patients who are accessing ARVs.
‘Unlike in South Africa where the nurses are not fully allowed to prescribe ARVs, the government in Lesotho realizes that we do need nurses if we are to scale up access to ARV treatment. This approach has been proven to work. The results have been very positive,’ she said.
However, Dr Lethola does admit that the shortage of nurses is posing a serious threat to the project. ‘The major challenge, though, that the project is facing is the shortage of professional nurses. Why is that so? Because nurses are dying from HIV/AIDS, secondly there is a high attrition of nurses from the public sector to the private sector within Lesotho to South Africa and to the UK.’
Meanwhile, Bhungani Mzolo from the Health department’s communication desk confirmed that nurses are not fully allowed to prescribe ARVs. He, however, said that under certain demanding circumstances nurses with relevant qualifications may be allowed to prescribe, when pharmacists and medical practitioners are not available, but may do so under very strict guidelines.