When *Boitumelo Tlholoe visits the Itsoseng Community Clinic in Zone 1, in Ngaka Modiri Molema District Municipality in the North West Province, for antenatal care, she arrives at 7am and only leaves at around 1pm.

She explained that the day begins with a prayer and then the patient files are taken out at reception. Due to the clinic being so small, all patients queue in one section.

“We wait for a long time because there are about four nurses who help about 100 patients in a day. When some of the nurses go for tea and lunch the queue slows down. Because the clinic is so small, patients are not divided into different sections, so we end up waiting for a long time. Although we receive the required care, we hope that something can be done to reduce the long waiting time.”

In a report titled “North West State of Health”, a community-led monitoring organisation known as Ritshidze highlighted the plight of people using public healthcare clinics in the North West.

Increasing risk

Ritshidze says its monitoring takes place on a quarterly basis at 400 clinics and community healthcare centres across 27 districts, in eight provinces in South Africa, including 14 facilities across North West (three in Ngaka Modiri Molema, seven in Bojanala Platinum and four in Dr Kenneth Kaunda).

According to Ritshidze, public healthcare users in the province experience long waiting times, spending hours at a clinic during a visit, and this is especially difficult for people who work or those that attend school. Ritshidze also noted that forcing people living with HIV to spend an extended time at a clinic, simply to collect antiretroviral (ARV) refills, increases the risk of them defaulting on treatment.

Ritshidze’s report shows that five to 13 hours was the average reported waiting time by patients at clinics, while 155 was the average number of patients waiting to receive clinical services on a daily basis. The study shows that 71.4% of patients felt unsafe while waiting for a clinic to open. Most of the of the non-24 hour clinics do not open by 5am as they are supposed to.

In 2018, the North West Provincial Health Department was placed under national administration due to corruption and poor service delivery. However, not much has changed since then as patients across the province continue to complain about failing infrastructure and poor service delivery.

Shortage of medicine

Last year, Health-e News visited Itsoseng Community Healthcare Centre (CHC) where more than 80 women were forced to return home without the necessary vaccines for their children. The provincial health department cited international supplier challenges as the reason for the shortages.

New mothers frustrated with a shortage of immunisation vaccines coupled with a shortage of staff at Itsoseng Community Healthcare centre. https://t.co/7GcSzrvmUM

— Health-e News (@HealtheNews) May 14, 2020

According to the Mayo Clinic, toddlers and infants who miss vaccines, or have delayed vaccine schedules, are more vulnerable to diseases like measles, mumps, rubella and polio. Immunisation at an early age against these and other diseases protects children against subsequent infection or disease. According to the World Health Organisation (WHO), in 2019, at least 19.4-million children across the globe under the age of one did not receive basic vaccinations.

In its report, Ritshidze stated that in North West, 23.5% of patients reported that they or someone they knew left a clinic without the medicines they needed, 79% of facilities reported being out of stock of ARVs, 17% of facilities reported being out of stock of tuberculosis medicine and 71% of facilities reported being out of contraceptives.

Speaking at the release of the North West State of Health report in Mahikeng, *Lerato Molefe, who has been living with HIV for 11 years, said when she visited Motlhabeng Clinic she was given a short supply of ARVs.

Discrimination

“During one visit to Motlhabeng Clinic, l was given less than a month’s supply of ARVs. When I asked why, I was told there is not enough supply. However, because we talk to other patients while we wait, one lady said she received three months’ supply because she knew a nurse there. This means that there is discrimination.”

Molefe added that while nurses do perform blood tests, they do not explain to patients what their results mean. Patients often do not understand their viral load counts because of high levels of illiteracy.

“Blood tests are often done, but they do not explain anything to us about our health status. All they do is fill in the form and we are told to go home,” she said

According to data released by Ritshidze, 13.8% of people living with HIV received one month’s or less supply of ARVs, 59.9% received two months’ supply and only 26.5% received three months’ supply.

A transgender woman, known as Millicent Tebatso, speaking at the launch of the North West State of Health report, explained the challenges that she goes through to receive hormone treatment.

Tebatso said she is forced to travel from Klerksdorp to Chiawelo, in Soweto, because the treatment isn’t available in the North West province. It costs  her roughly  R150 in taxi fare each round trip.

Sent away

She explained that many people who approach the clinic nurses for help or information about hormone treatment are dismissed or just told they need to go to Krugersdorp Hospital, where people are lost in the system. Many people simply give up at that point.

“We need to have these treatments for transgender people in our own province. Hormone treatment is important to make someone like me feel comfortable in my body.

“We need to start normalising treatment for transgender people and the way to start this is to have people from the LGBTQIA+ community employed at clinics and for them to be seen in the community. People need to see posters of two men or two women in a relationship in a government office or a clinic, otherwise this is something they only see on TV,” she said.

Tebatso added that members of the LGBTQIA+ community are often discriminated against when trying to access lubricants, and are often ridiculed or questioned about their gender. She said security guards also ask her why her ID document identifies her as a male when she looks like a female, adding that she has grown tired of explaining herself.

According to Ritshidze’s report, only three facilities in the province offer sex workers lubricant. Only three facilities offer men-sleeping-with-men (MSM) -friendly HIV testing and counselling. Only one facility offers hormone therapy for trans people and none of the facilities offer specific services for substance abuse.

The provincial health department said it has received the report and will look into its recommendations. – Health-e News

*Not their real names