Doctors' life or death decisions

OVERWORKED Port Elizabeth doctors are being forced to make “life or death” decisions about who gets to use specialised equipment such as dialysis machines.

Their heart-wrenching decisions on who gets treated and who does not stems from the surge in state patients needing treatment for lifestyle diseases such as diabetes, cancer and hypertension as well as the shortage of trained staff and specialised equipment.

Medical Research Council (MRC) manager of the Chronic Diseases of Lifestyle Research Unit, Jean Fourie, said: “These diseases are becoming more prevalent as people follow sedentary lifestyles, like spending hours in front of the TV or computer, and eating food of poor nutritional value or large portion sizes (over eating).”

A recent MRC report states: “The burden of non-communicable diseases is rising in rural communities, disproportionately affecting poor people living in urban settings, and is resulting in an increase in the demand for care for chronic diseases”. South Africa was “in the midst of a health transition” characterised by a rise in non-communicable diseases such as cardiovascular disease, type 2 diabetes, cancer, chronic lung disease, and depression, which were reaching “epidemic proportions”, it stated.

Public health researcher Daygan Eagar, who works at advocacy group, Section27, said hypertension and diabetes-related illnesses now ranked in the top-five leading conditions for admission to hospitals in the province.

In the absence of firm statistics from the health department, studies released by the MRC show that the Bay has about 5000 residents – or 450 per 100000 – in upmarket suburbs dying from such diseases annually.

A further 9400 in the Bay, or 850 per 100000, in poorer areas and townships die each year, studies show.

This, according to the MRC, is more than double South African figures from the mid-1990s.

One of the vital treatments for chronic lifestyle disease is dialysis. Livingstone Hospital has just 20 dialysis machines to treat its current 80 patients.

While the district department says there are no more than five people on the waiting list, medical staff at Livingstone say patients who might be helped by dialysis are being turned away because of the high demand.

“The reality is that patients seek medical help late in their disease, so often they die on the waiting list,” a staff member said.

Livingstone also covers Port Alfred, Graaff-Reinet, Willowmore, the Langkloof, Middelburg and Cradock.

A staff member, who requested anonymity, said the massive demand for dialysis saw staff forced to make “life and death decisions” by obeying the national protocol for who is eligible “to the T”.

“There is not one kidney specialist in the whole Eastern Cape (one is in the process of being appointed) and we need a bigger team of doctors because patients (on dialysis) constantly develop complications,” the staff member said.

Port Elizabeth Hospital Complex acting chief executive Solly Pretorius said there was a severe lack of kidney donors in the Eastern Cape and “a dire shortage of trained nephrologists (specialist kidney physicians), renal technologists and specialised nursing staff in South Africa”.

“Even if there were more dialysis machines and funds, it would be very hard to find additional staff to man them.”

Pretorius said a nephrologist was in the process of being appointed, with a second having expressed interest in relocating to the city.

“Although one or two nephrologists might not translate into more dialysis spots, the care of existing patients will be taken to a new level.

“More importantly, they will be able to contribute to the prevention of the disease through outreach and education of colleagues and clinics in the periphery,” said Pretorius.

A report by the SA Medical Research Council cited a distinct lack of any interventions to stem chronic lifestyle diseases – listed as ischaemic heart disease, strokes, diabetes and smoking-related diseases such as lung cancer and chronic bronchitis – within the state’s primary healthcare facilities.

“Mortality patterns demonstrate that it is crucial that cost-effective interventions to prevent, treat and manage CDL (chronic diseases of lifestyle) must be incorporated into a comprehensive primary health-care strategy,” the report said.