A Tale of Rural Health
11 September 2013
The failing healthcare system in the Eastern Cape affects everyone: urban communities, migrants from Gauteng and Cape Town too sick to work anymore or returning home to retire, and healthcare workers who don’t have the medicines, equipment and a functioning referral system, to offer the care their patients need.
But the greatest impact is undoubtedly felt among the 62% of people living in rural areas. Of the 10 most deprived districts in South Africa, three are rural districts based in the Eastern Cape: Chris Hani, OR Tambo and Alfred Nzo districts.
A failing healthcare system compounds the many socio-economic hardships these communities face on a daily basis, such as high rates of unemployment, lack of clean water and sanitation, inadequate education, and poor nutrition.
What makes the failing healthcare system for all residents of the Eastern Cape a double disgrace are two fundamental barriers to care: the difficulties in accessing public health care in the first place, and the challenges to bring people back into the system after service failures have driven them away, and the lack of healthcare alternatives.
To illustrate, it takes two hours and a R30 taxi drive for Nozipho (60), carer of 1-year-old baby, Ayanda, living on a R1 260 monthly grant, to get to the clinic for her grandchild’s vaccinations. After waiting a few hours, without access to sanitation or running water, she is told the vaccination is out stock and is asked to come back the following week when maybe the vaccines will be there.
A recent study following up 478 babies born in the KSD sub-district of OR Tambo, found that 35% of mothers had similar experiences. By the age of three months, only 48.3%of children surveyed had received the immunisations due at birth, six weeks and 10 weeks.
At one clinic, vaccines are not kept in cold storage (as there is no fridge or electricity), yet the vaccines are given to unsuspecting mothers and children. This is more than a disgrace; this is indicative of a crisis that requires an urgent, immediate intervention.
In another instance, many letters and calls regarding Komga Clinic seem to have fallen on deaf ears. Komga, where the mobile clinic to outlying farming communities is no longer operating; where half of their nurses have left, with no replacements in sight; where the dentist stopped coming; where there is no longer time to take preventative pap smears; where the treatment monitors, assisting the remaining nurses serving the 700 patients on ARVs, were told to go home; where the healthcare workers feel completely powerless.
There are many tales of frustrated healthcare workers soldiering on, or worse, deciding to leave the province. What happens when local leadership is poor, absent, disempowering, and even uses disciplinary tactics to silence competent doctors who want to fix the system, and who expose the health care failures? They are pushed out, and poor management triumphantly carries on, while families continue losing their loved ones to preventable deaths.
Have these conditions become the accepted mode of practice in the Eastern Cape?
As RHAP (Rural Health Advocacy Project) and Coalition Members, we have tried to intervene in different ways: supporting healthcare workers to report challenges to their superiors; writing and calling the Eastern Cape Department of Health to intervene; trying to set up meetings between role players and decision makers. To no avail.
There is a saying in Xhosa that goes ‘Usana olungakhali lufela embelekweni’ – ‘A child who does not cry won’t get help’. In this part of the world, the expectations of the healthcare system are so low, experiences with complaining so fruitless, that people have stopped crying for help.
Healthcare is a human right. We need an outcry for the standards of care everyone deserves, but most of all for the rural communities, to rectify their historic neglect and today’s failures.
Marije Versteeg works for the Rural Health Advocacy Project.