Limpopo: snakes in paradise 

NSP REVIEW COMMENT

NSP Review notes the efforts made in certain provinces to improve the health system. In these provinces, MECs are often available, and their spokespeople are responsive. Sadly, in some of the provinces where health systems are under severe strain and part of the problem is the government and political leadership, spokespeople are unresponsive. Limpopo is one province where the leadership are making a concerted effort to fix the health system. We also note the appointment on 27 May of Dr Phophi Ramathuba as the new MEC for Health in Limpopo. We welcome her appointment, and we look forward to working in partnership with her. As the focus on Limpopo in this issue of the NSP Review will show, the province has a long way to go; and it is critical for all parties to work together.

<p class=”intro”>An Eden like Limpopo should be more. The verdant lushness promises so much. But this is no paradise for thousands of the country’s most vulnerable people, who rely on free healthcare that just doesn’t deliver.</p>

Worse still, perhaps, is that as systems continue to fail, and increasingly to put lives in danger, the affected people remain silent. They fill up waiting rooms for long hours without protest. They sleep on benches to still the pain before they get to the front of a queue. They put up with toilets that probably haven’t been cleaned for weeks. They don’t question ‘out of order’ signs on equipment that should be saving their lives but that never changes as the months pass by. It is as if they believe that if something is free, it means they have to ‘take it or leave it’.

Limpopo’s Department of Health has been under National Treasury administration for the past three years. It was one of five Limpopo departments in financial crisis and maladministration by 2011; Cabinet was forced to take this drastic measure at the end of 2011. Handovers from the national authorities back to the province’s five affected departments were completed by the end of March this year.

This year should signify a new phase for the province, but in many regards it is still in catch-up mode.

Stock out of drugs in Limpopo does not often revolve around ARVs. The sustained efforts of the Treatment Action Campaign (TAC) have made them high profile and high priority. But other equally crucial medication for conditions such as TB and high blood pressure sometimes simply doesn’t make it to some of the outlying clinics, where people have patchy transport networks and little money to spend on taxis or to hire private cars.

Many medical personnel are rude, indifferent or power-drunk on the slightest authority. Nurses bark at patients and treat them with little dignity, walking in and out of their consultations and processing people like products on a factory conveyor belt. Those who do speak out against what is wrong, do so on condition of anonymity. At the same time it is fair to say they work with challenges that make it nearly impossible to deliver something that resembles a quality healthcare system.

*Rhulani M has been a nurse for the last four years. She lets out a laugh when asked if her life and career at the small clinic in Giyani where she’s based is what she expected it to be.

“I knew there were going to be challenges, but not like this. Sometimes I don’t even have a Panado to give to a patient. I’m supposed to help people, not turn them away.

“I know when we have ARV stock outs, it means that I may only have enough for 20 people; and if you are number 21, then I have to tell you to try to come back tomorrow or the next day,” she says.

Her medicine cabinet is bare; but the queue waiting to see her and the other two nursing sisters on duty seems never-ending. And, after a gruelling evening on night duty at the clinic, there’s not even the prospect of a hot bath, because there is no hot water in the modest house which serves as the night-duty nurses’ accommodation.

Rhulani’s story is repeated as we travel throughout the province. Yet despite this dire staffing situation, the department wants to increase the number of 24-hour clinics. To the decision-makers in Polokwane, the province’s capital, this may seem like a proactive step; but unless systems are improved, resources bolstered, and more skilled staff are employed, the capacity to respond will be further diluted and more patients will be failed.

According to a statement sent by the Limpopo Department of Health to the TAC in April this year, the department has 18 213 professional nurses and 1 102 medical doctors. This for a population of about 5 million in the province, of which at least between 4.5 and  4.8 million people are completely reliant on public healthcare. Many clinics never have a doctor visit, and patients are referred to the bigger clinics or to hospitals when a nurse deems it necessary.

Patients have to rely on private transport or on planned patient transport to get to hospitals; but that service too is dysfunctional.

Even at hospitals patients are faced with overcrowded wards, dirty linen, and a lack of equipment – from the basics, like surgical gloves, right through to dysfunctional operating theatre equipment.

The Department’s well-worn response to all of this – even in the new, post-national administration ‘baby-sitting’ phase – is to blame it on their service providers. It produces empty statements, like “We are addressing shortfalls through partnerships and appointments of new service providers”.

Disillusioned patients, and the medical staff themselves, are deemed all the more voiceless because they find themselves in that familiar stranglehold of high unemployment, which limits their options. Stats SA’s data from June 2014 show that in the first quarter of that year, the province’s unemployment rate stood at a staggering 39.2 percent. Patients and health workers fear that speaking out may cost them their jobs, pensions, social grants; or even the bad, but free, healthcare they receive. There are, indeed, many snakes that slither in this Eden.