Defend Truth


The paradox of improving healthcare and unabated social violence


Busani Ngcaweni is Director-General of the National School of Government, South Africa.

A severely wounded society like ours requires a great deal of social re-engineering and economic liberation.

If you thought democratic indifference was an upper middle-class and elite phenomenon, wait until you enter the hallways of Osindisweni Hospital, nested in the sugarcane plantations about 15km from King Shaka International Airport.

Osindisweni reminds you that there are working-class people who can sever ties with class solidarity, much to the defiance of politics and sociology theories we learnt at school – that the working class tends to care more and act in group interest than other classes with a propensity to be driven predominantly by self-interest.

The filth and carelessness I witnessed recently at Osindisweni is nauseating, from the entrance hall to the general ward where my elderly aunt was admitted.

One or two outsourced cleaning staff on duty seemed to do better cleaning their data bundles than the hospital floors. The security guard wasn’t bothered that she had directed us to the neonatal section even though we had explained that we were looking for ugogo. Perhaps she had seen Janet Jackson on social media and thought miracles could happen in KwaZulu-Natal too.

In the end we found gogo in a dormitory-type ward. She said she was feeling better and complimented the nurses, although one suspects the Health Ombudsman might be uncomplimentary about infection control standards.

We just wished she could immediately get out of this depressing place, recalling her own historical refrain that Osindisweni is a hospital where people “come back dead”, not healed as its name suggests. She thinks Ghandi Hospital in Phoenix is the best as it has managed her heart condition for over 15 years when private doctors had given her two years. She believes the two days spent “next to a talking computer at the hotel-like Chief Albert Luthuli Hospital has a lot to do with my long life. Those nurses punched computers like children playing with cellphones”.

But this story doesn’t begin here. It starts in 2014 at about 20:00. The then 74-year-old gogo was nauseous. She had collapsed twice that day. In fact, she had been seriously ill since noon, but as rural people often do, those around her moved in slow motion, believing it would pass, although gogo was clearly deteriorating.

Many people in such rural communities die due to general apathy about health emergencies. Often they say “uzoba right, mushayiseni ngomoya nim’phuzise amanzi” (she will be okay, give her fresh air and water). Others would say “we can’t call the ambulance because even if it comes it would be too late and the person will be dead”. After all, emergency medical services (EMS) are a post-apartheid phenomenon in rural South Africa and still a rare sight in some regions.

The emergency services were eventually called and arrived within 15 minutes – a significant milestone for this deep rural area in the north of Durban. I got there a few minutes later while gogo was being wheeled into the ambulance – all coincidental.

Two young and friendly paramedics were in attendance. They had stabilised the old lady and told her she was “looking younger and healthier”. She didn’t believe them but nodded in appeasement. They took her to Osindisweni District Hospital about 22km away. I followed with the grandchildren.

We arrived just before 22:00 (meandering gravel roads prolong the distance). Two nurses, senior and trainee doctors were in attendance. Two general assistants and a porter were also doing their rounds in the hallways. A few senior citizens in wheelchairs and moving beds looked on with curiosity as we fiddled with paperwork.

The cleaning lady was polishing the floors so well you’d swear kuza abakhwenyana – a tongue-in-cheek reference to unusually thorough cleaning that takes place on the eve of lobola negotiators visiting the would-be bride’s homestead.

Stretchers and wheelchairs need urgent fixing at this hospital. The volume of the television in the corridor was at full blast with security guards enjoying kwaito music. No ailing person could rest in this noise.

One of the senior sisters in attendance was visibly irate. It can’t be overload, “there is no overload at all tonight”, the cleaner tells us. The sister could just be tired. It’s been a stressful year, especially in the trauma unit.

The young Indian doctor treating gogo was cool. He spoke isiZulu fluently, which excited us very much for there wouldn’t be any misunderstanding in the diagnosis and prescription.

The doctor and the young general assistant were interested in both the medical history and symptoms of the new patient. They performed tests. Like the young paramedics, they reassured her she’d be fine. They put her on treatment to reduce high blood pressure and dehydration. To my surprise, she gave them her medical records, explaining the chronic medication she was receiving from Gandhi hospital. She had internalised this protocol from her previous visitations to public health facilities.

Whatever the procedure and circumstance, I can’t believe these people are so lax when it comes to using gloves even as they handle medical equipment – especially the auxiliary nurse. What happened to the rules about infection control? She just free-styled throughout the procedures she performed, with bare hands.

We had been there for about two hours as treatment was administered in a paint-hungry room. We had all read the news about how the province’s capital budget had been misspent.

Tired, and reassured by the doctor that she would be fine, we waited patiently for her to be admitted or discharged.

Meanwhile the mind wondered towards a conclusion that, all things being equal, healthcare is improving in rural South Africa.

I made that assertion because a few years ago another relative died here at Osindisweni, under similar circumstances (blood pressure, shortness of breath and dehydration caused by vomiting). Nobody cared. It was just routine. The ambulance never came. Another villager drove her to hospital. Because she did not make it, most people in her neighbourhood became cynical of EMS and this hospital.

But on this chilly Friday night we were treated humanely, as were other patients.

As we warmed the cold benches of Osindisweni, waiting for feedback, a middle-aged woman came rushing in with a teenager who had a steak knife stuck in his skull. Doctors rushed to help. It was clearly a rare case, this one: wondering how they’ll remove a steak knife from a skull.

The woman shed no tear as she waited for the doctors to update her on the teenager’s condition. She then decided to volunteer the story to us. Her son was stabbed by an uncle. There was an argument in the household and he became violent towards his nephew.

Suddenly her voice changed and she declared: “I am going to take revenge. I am going to kill my mother.” Another benchwarmer enquired: “Why kill your mother because it’s your brother who did this?”

She exclaimed: “I’ll kill her because it is her son who did this. Why did she give birth to such a cruel person who did this to my son? If I kill her, my brother will come to the funeral. Then I catch him because tonight I know he’ll run to Inanda squatter camps and we won’t find him…’

So this fellow will run to my township, which features in the top five of murder and violent crimes national stats…

Disturbed by this, we took leave of the benches to wait in the car, visibly shaken. I have seen people die during political violence. I have seen the worst car accidents in my days as uscabha (taxi conductor). But not this: a knife stuck in the skull of a helpless teenager.

It became evident to me that not even the national health insurance could resolve this. Neither could the police. Yes, the doctors and nurses were hard at work. Our patient had stabilised.

Clearly the health system can’t cope with such levels of violence in our society. On such occasions, overstretched health workers have to leave their stations to intervene in such anomalous situations.

This is the South African story, of that of post-colonial Africa, where a library is built, burnt, and a march held to demand another. And you think violent colonialism and murderous apartheid were some sick jokes that can be erased in two decades.

We are just so accustomed to violence that it’s the natural response to family feuds and other disagreements, as witnessed in this case.

Dire socio-economic conditions drive the rage we see in our communities and determine the health outcomes. They rob people of agency; hence they die of preventable or curable diseases.

Additional staff and healthcare facilities can bandage wounds, but only a new psyche can stop the bloodshed. A severely wounded society like ours requires a great deal of social re-engineering and economic liberation. It requires that we intensify interventions designed to promote economic inclusion and social cohesion, in addition to providing quality basic services.

If what I saw that night did not shock me because I grew up experiencing political violence, why would I expect the health workers to care when their lived experience is that of dealing with the aftermath of violence every evening, and especially on weekends? What makes them superwomen engineered to be immune from the trauma of witnessing the aftermath of violence?

Mind you: some of these health workers are parents and partners to people who may not really appreciate what is going on at work. And yet they are still expected to perform as wives and husbands, mothers and fathers. Better still: how do we change our culture and cleanse it of violent behaviour, the notion that we must stage a war to end all wars?

In the four hours I spent at that hospital, there were nine emergencies – four of them injuries, one a girl child with an allergic reaction, and the rest were aged women needing rehydration and oxygen. How does the health system cope under these circumstances? How many more ambulances are needed to service all these avoidable emergencies?

A few years ago Statistics South Africa reported that after each Soweto Derby, the number of unnatural deaths increases either due to stabbing at taverns or through road accidents mainly involving jaywalking pedestrians. A month after reading that report I lost my cousin just after the Soweto Derby. He was hit by a bus ferrying fans celebrating an Orlando Pirates win over Kaiser Chiefs.

Although such things as homicide remain high, especially among back males (like this young person who came to the hospital), fewer people are dying of AIDS and more TB cases are successfully managed. All of these are signs of a stabilising healthcare system. Yet lifestyle diseases are on the rise.

Sadly, this recent experience was nothing like that of the memorable events of 2014.

No teenager was rushed in with stab wounds, but either the cleaning company has changed or the service level agreement has been torn. The conduct of security guards remains the same – they just don’t appear to care.

The infection control manual might still be in the locker room – it just doesn’t make sense that health workers could risk their lives working in such conditions when there is a cleaning company and nursing assistants who could help elderly patients with soiled clothes. Used bandages are medical waste are not ornaments to decorate the floor.

Maybe the noisy gogo with a fracture from a drunken spree discourages these workers, just like these teenage girls who return to birth second babies.

This is the South African story, the story of change and continuity, the tale of hope, rage, alcohol, apathy and activism, life and death.

Gogo lives. She collects her grant and chronic medication monthly. She feels very much affirmed by Mandela’s children, as she refers to the healthcare workers who treat her at Gandhi hospital.

The stabbing victim most likely died and so the cycle of social violence continues.

This is a paradox of improving healthcare in a violent and unequal society, the latter negating advancements in the former. It is also a paradox of service and care providers who consider themselves purely as functionaries in a job; who don’t consider themselves as members of communities who pay them to dispense care and compassion to the best of their abilities. No ambulance, patient record or remedy exists for the social injury they inflict on the communities they are meant to serve.

They are depriving poor people of a better life as outlined in the National Development Plan.

The good story South Africa tells so often can do without the chapters induced by such dereliction of duty and disrespect for fellow citizens. It could be more captivating if social violence abated thus reducing its burden on the overstretched healthcare system. DM

Ngcaweni is editor of Sizonqoba: Outliving AIDS in Southern Africa (AISA, 2016). He works in The Presidency. Views expressed here are private.


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