Bay clinics in deep crisis

Brian Hayward and Khanyi Ndabeni

COMMUNITY clinics in Nelson Mandela Bay are failing the people they serve due to a lack of staff and equipment, poor facilities and under qualified staff who regularly misdiagnose patients. The city’s 50 clinics are on average 50% understaffed and have just five full-time doctors to aid the 300-odd nursing staff. There should be 11 doctors and 600 nurses, and private doctors often have to be called in to help.
Some clinics do not have telephones, meaning they cannot even phone for an ambulance. if there is an emergency.

Patients typically wait eight hours to be seen. Many queue from 4.30am, even though clinics open at 8am.
Health researcher Daygan Eagan, of advocacy group Section27, said the city’s clinics were neglecting their mandate.

“In terms of primary health care, it is policy to have larger clinics providing a 24-hour service. The problem is people are circumventing primary health care and swamping hospitals for services they should be getting at clinic level, and very often with conditions which are preventable,” he said.

Although the Motherwell community health centre claims to have a 24-hour emergency unit, The Herald found it had no doctor, meaning patients could not be treated.

In the absence of national government intervention to increase funding, the dire predicament looks set to worsen. Budget cuts by the cash-strapped municipality have seen the building of six desperately-needed clinics in impoverished areas around Nelson Mandela Bay, at a cost of about R20-million, axed for the foreseeable future.

Clinics in Colchester, Langa, Zamenvula, Tshangane, Motherwell, NU29 and Kleinskool are among those overwhelmed due to the population in these areas having almost doubled in recent years.
Clinics should typically service communities of about 20000, but in many areas clinics are serving double that, with staff members saying they often have to turn patients away because of the demand.
A confidential report commissioned by the Health Department, which The Herald has seen, states: “Clinics often have a shortage of space as a result of increased patient volumes and because of the need for increased privacy with HIV counselling”.

A nurse at a Kwazakhele Day Hospital – which functions like a clinic but also performs minor operations such as cataract and tonsil removals – said her colleagues and three doctors treated more than 1000 people daily.

“We get patients from as far as Walmer, Motherwell and sometimes even Grahamstown,” said the nurse, who asked not to be named.

The operation of all the clinics costs about R170-million annually – 80% of which comes from province. Of the city’s 50 clinics, 40 are run by the municipality and the remaining 10 are run by the provincial health department. However, the municipality is paid by the province to operate the 40 clinics on their behalf. Some clinics, such as the one in Malabar, have no staff and open for a few hours one day a week, using staff from other clinics.

Another, in Motherwell NU8 and managed by the provincial department, is still standing empty after being petrol-bombed during the 2009 taxi riots. There are no plans to rebuild it.

One of the city’s biggest wards, ward 41, which includes more than 30000 residents and covers Bethelsdorp, Booysen Park, Chatty and up to Despatch, has just one small clinic which is under-staffed and has no phones.

Clinic community chairman Linda Gqomane said an average of three nurses staffed the clinic instead of a minimum of eight, while a doctor “pops in now and then” to help with cases. Three community care-givers help with dispensing TB medication.

Many residents who spoke to The Herald admitted they had defaulted on their TB or antibiotic medication “because it is too far to walk to the clinic and we have no transport”.

Health care worker Busisiwe Mncanca, who works with charity organisation Mfesane, said it had many cases where TB and ARV patients had defaulted in their treatment.

Staff were also accused of being rude and uncaring.

“It feeds into the idea that they won’t get the treatment they need at clinics,” said Eagar.

“It’s a massive problem. We need to start revitalising primary health care.”

According to metro health head, Dr Mamisa Chabula-Nxiweni, “all vacant, funded positions, have been filled with professional staff”.

Although hospital staff complain that many patients who should be treated at clinics are coming to hospitals, causing bottlenecks, Chabula-Nxiweni said clinics were, in turn, being swamped with patients who had been “down-referred” from hospitals.

“These patient numbers often exceed the capacity of the clinics,” said Chabula-Nxiweni.
She said the city’s clinics were subsidised to the tune of 80% by the department, which amounted to “a huge under-funding when this is measured against the national norms and standards required for

rendering PHC services”.
To address the problem, the municipality was in the process of taking full ownership of the 40 clinics it managed on behalf of the provincial department.

“The plan would be to phase in this improvement in order to add more staff, equipment and facilities, improve patient access to health care where new housing is established and over-crowded housing currently exists,” she said.

Although metro budget cuts saw plans for six new clinics shelved, Chabula-Nxiweni said the municipality had already built new health facilities at the Rocklands and Mabandla clinics, as well as upgraded clinics at Masakhane, New Brighton, Zwide, Kwazakhele and Booysen Park.

“The provincial department has been informed in regard to the need for additional staff,” she said.
Provincial Health spokesman, Sizwe Kupelo, said there were “plans to increase the metro’s clinics budget”. But, “a problem in the health department is that it is under-funded by government”.
“Even though the president (last year) announced a R13-billion budget for the department, the bulk of it

goes towards staff compensation and infrastructure.

“This does not only affect the province, but the whole country. The other challenge is that of many nurses and doctors are leaving the country because they are under-paid.”

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