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Happy patients, unhappy hospitals

Vuyo Mvoko

JANE HLONGWANE (28), her face exuberant with the satisfaction of
pregnancy, smiled as she was asked how she felt now that she and her
unborn child could take advantage of free medical care from the
government.

"Happy, really happy..." she said, in search of better words to
describe her pleasure.

Two years ago she couldn't pay a R74 pre-delivery fee and had to leave
the hospital without her first child's birth certificate. Nor could
she afford pre-natal classes. She still cannot believe how fortunate
she was not to have had complications during the birth.

The government this year approved a R500-million budget for free
health service during 1994/95 for pregnant women and children under
the age of six. One of the "presidential lead projects" announced last
month was the approval of a R25-million clinic building programme.

For Rebecca Ngobeni, though, the thrill she expressed over "the
greatest news mothers ever heard this year" brought back a memory too
painful to contemplate.

Her neighbour's son would be alive today, she said, if the state had
been taking care of the pregnant poor and their children. He died of
malnutrition, bronchitis and related sicknesses shortly after birth.

During pregnancy the child's mother went to neither hospital nor
clinic because, Ngobeni said, "she came from one of the poorest
illiterate families in the neighbourhood and could not afford to buy
food or attend pre-natal classes".

Ngobeni's own one-year-old child was "very fortunate" because she had
been working and therefore could afford to take care of herself during
pregnancy and of the child after birth.

Before the introduction of the scheme, she had to pay R40 at the local
Katlehong-based Natalspruit Hospital and is happy that now she can use
the money to take care of the child's other needs.

Welcome as it is, the programme has major problems. One of these is a
shortage of medicines.

Ngobeni complains that the hospital often substitutes other medicine
for medicines that have been prescribed. Conceded sister Ndlovu (not
her real name): "It still happens a lot that doctors' prescriptions
are not available."

For reasons nurses say they do not understand, the dispensary at the
hospital closes at 15h30, often before all the children have received
attention. Nurses said they try to persuade mothers to bring their
children very early in the mornings to avoid such disappointments, but
acknowledge that this is no guarantee of success.

On the day before our visit, even "early bird" mothers were among the
many who left the hospital very late in the afternoon. Some of them
had not yet been unattended to and many were told to come back and
collect medication the following day as the dispensary had closed.

There had been no fewer than 250 children that day, and only five of
the usual nine doctors were in attendance.

Access to free health care is hampered by the overcrowding. Even
mothers like those from the dirt-poor informal settlement areas of
Phola Park, Zonkizizwe and Moleleki Extension 2 manage to pay for
public transport to the hospital, at a cost of R5,40. Parents bring
their children to the hospital for free treatment of even minor
ailments, for satellite "well baby" clinics in the area only offer
immunisation and vaccination. First aid, nowadays, is now neglected by
some mothers, according to nurses. They say even minor cuts that could
be treated with an antiseptic and a clean piece of cloth are brought
to the crowded hospital.

The same applies to diarrhoea cases. In some cases the problem can be
solved by the mother stopping feeding and preparing a certain
recommended rehydration mixture for the child. Overcrowding can result
in seriously ill children being neglected as their mothers, bored by
the waiting, hardly observe changes in the child's condition.

*  Repeated attempts to obtain comment from hospital officials were
unsuccessful.

[South Africa Weekly Mail, 12/23/94]

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