By: Samantha Khan-Gillmore
October has been a disastrous month on all fronts. It will probably go down in the annals of history for many reasons. Durban had a devastating storm, displacing hundreds of families and wrecking damage to many properties. Another reshuffling of cabinet shocked the country in the space of six months. A review of the State Capture report is being challenged in court. The Life Esidimeni arbitration process has heard the saddest, moving and most horrific testimony from many stakeholders. The wrenching pain of the testimonies has been difficult to ignore – a complete assault to our psyche and humanity as a nation. The trauma has been heart-breaking and the evidence and experiences life-changing. Nothing ever prepares loved ones for loss but the manner of the loss does play a significant role in the grieving process. I would wager that these families, friends, hospital employees, and management will have sleepless nights for many years to come.
Did we lose faith in the health system or has the health system deserted us as a nation? Have we moved so far away from our sense of humanity, our sense of Ubuntu, that nothing matters anymore? Not even human life? I’m reminded of a law professor who used to ask us students many years ago: ‘Is nothing sacred anymore’? This week was a stark reminder of this question.
In late 1990, I broke my radius and ulna bones in my left arm having fallen down the stairs in high school. The 44 scar stitches remain the opening line for many random conversations in my life. But they are also a reminder for me of the experience of being in the public health system. I was well cared for, provided with the correct treatment, not having to regret going to that specific facility. Perhaps it was because the best orthopaedic surgeon in Kwazulu-Natal at that time operated on my arm or perhaps it was because my mum was, ironically, the head of the orthopaedic department, or could it simply be that the system had fewer challenges than it has today?
Fast forward to January 2017. Two young, energetic, men are driving in the early hours of the morning in the Eastern Cape. They are involved in a serious head-on collision and are immediately taken to the nearest facility for emergency treatment. They arrive at the facility at 4am and were only seen to two days after arrival. Both young men had sustained head injuries, a broken jaw, shoulder, ribs and arm, a badly lacerated tongue, severe bruising and
other cuts and abrasions. They had been advised that they would only receive treatment once transferred to the nearest orthopaedic hospital in the area – a total of 5 days after the accident. A relative rescued them from this deplorable treatment and drove them 200km to the nearest facility in Durban. They have since received excellent care although they had sustained serious long term injuries that doctors in prescribe to the delay in being treated as soon as the accident occurred.
Stories such as these are not unheard of or even an exception anymore. They are fast becoming the norm in an ailing, fragile, vulnerable health system. The provision of the Office of the Health Ombud and the Office of Health Standards Compliance allows for such complaints to be investigated and interrogated. This Office has been in the spotlight through the Life Esidimeni crisis and while the deliberations of that office have been worthwhile to note in terms of levels of accountability, there is still a lot to be done. And many more Life Esidimeni’s to avert.
Health care workers and patients alike are first hand witnesses to the deficiencies in the health system. Understaffing, medicine stock-outs, lack of proper healthcare equipment, abuse of staff are just a few of the many problems wracking the system and making it unpalatable for its core users. Even though much has been introduced to ameliorate these problems, such as the stock visibility system (SVS) to monitor medicine stock-outs, the CCMDD (Central Chronic Medicine Dispensing and Distribution Programme) to deliver medicines at convenient spots for chronic medicine users, to name a few, the problems persist in various deep rural areas. How does a mother or a Gogo walk kilometres to the main road in order to access public transport to take her to the nearest clinic or hospital some 30-40 minutes away? Add the burden of the cost of this transport for disadvantaged community members, the travel time taken to access this service and then still throw in the long waiting queue when she finally arrives at the health facility. And then……add a disabled, heavy, non-responsive child without a wheelchair who cannot walk without the assistance of the mum or Gogo to the equation……Rurality and reality in action.
A few weeks ago I had the opportunity to visit a public health facility with my mother in-law. At 72 she is quick witted, alert, lucid, active in the community, a faithful Catholic but also profoundly deaf. Her medical aid facility is unable to cover the costs of a hearing aid so we sought recourse through the public sector. We were met with queues of people as we entered the hospital. The long waiting lines to open a file and get a patient number was an assault to our sense of patience and tolerance. With the rain falling steadily outside, everyone who would ordinarily have taken a walk outside were all crammed inside a small waiting space. Babies were coughing. Noses were runny. Patients with all ailments in one space and in one queue. That didn’t bother me much until it was our turn to sit in front of the administrator. Questions are asked and answered. We discovered that my mum in-law, a retired school principal from seven years ago, is still on the government system as being an active contributor to our economy. According to the system she has never retired. This does not bother me and I’m still not phased as we struggle through these arbitrary dilemmas. What phases me is this: there are only two administrators for a long sea of faces of mothers and children. What exacerbates this situation is the administrator informing us that she is also the finance officer therefore we have to wait for her to get through administration before she can restart the queue on the finance side. As I sit there, another question emerges: are we doing enough to make this process easier for the most marginalised, the vulnerable, the desperate, the influx of women, children who are the most in need of a health service? Are we really in tune with the needs of our communities? It simply can’t be right that mothers and babies wake in the early hours of the morning only to have to wait hours to be seen by a health professional.
Moira, my mum in-law, reads people’s lips the way that I hear words flowing from mouths. If she was alone at the hospital, she would have shied away from asking the administrator to speak louder, clearer and with greater elocution to read her lips. It might have been an arduous process had I not been there.
Our health system is wracked with so many problems: shortage of human resources, ever-decreasing budget allocations for the provinces most in need, inadequate resources and infrastructure in facilities, as well as low staff morale due to the conditions in which health care professionals work. We need to find definitive answers to these challenges. Health care workers speaking out about health system failures is one. The other more pressing and far more urgent is the kind of leadership we have. We require leadership that allows health care workers to speak out without fear of victimisation or other adverse consequences. When all is said and done, the service to the patient is the ultimate goal and much more needs to be done to ensure that a user walks out better, stronger and with his/her dignity intact each time we enter a health facility.
As Bryan Stevenson, the Executive Director of the Equal Justice Initiative once said: “We are all implicated when we allow other people to be mistreated. An absence of compassion can corrupt the decency of a community, a state, a nation”