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Beat It! 2002 Episode 10

In this episode of Beat It! the Support Group discussed their experiences within the public healthcare sector. Dr Nombulelo shared necessary information on the treatment of herpes. In the Special Report we looked at nurses and the burden they carry because of the HIV epidemic.

Vuyani Jacobs: Hi, molweni {IsXhosa} [hello], I’m Vuyani Jacobs. Welcome to Beat It! – the only programme for people living with HIV/AIDS.

Nombeko Mpongo: Zipartners zethu, nezihlobo nezizalwana zethu. NdinguNombeko Mpongo. {IsiXhosa} [Our partners, friends and family. I am Nombeko Mpongo.]

Vuyani Jacobs: This week on Beat It! we are looking at our public health services. Our Support Group talks about getting proper treatment at public health facilities.

Nombeko Mpongo: And Doctor Nombulelo is talking to us about herpes and HIV.

Vuyani Jacobs: And our special report takes us to hospitals where dedicated nurses are making a huge difference to the quality of HIV/AIDS treatment in our clinics and hospitals.

Nombeko Mpongo: So let’s join the Support Group to share some of their experiences.

Healthcare services

Vuyani Jacobs: Access to treatment and to healthcare services is not a privilege, it’s a right. It is enshrined within the Constitution itself. On Fridays, the branches of the Treatment Action Campaign have actually volunteered to go to all MOUs (Midwife Obstetric Units). We shall go there to clean and we shall go and teach and talk about HIV/AIDS. Today we’ll be cleaning here at the MOU in Site B. We are making sure that we are mobilizing communities and we are doing that, basically, by educating women helping the nurses because we know that in healthcare services there’s been a lot of talk that they’ve got so much to do. So we are taking off the burden. Many people’s illnesses are not diagnosed in early stages. We need to take control of how we are living our lives, we as ordinary HIV positive people because you can treat TB, herpes can be treated, skin problems can also be treated. A lot of things that are associated with HIV/AIDS can be treated effectively. It’s not the choice from the health service to offer us this service, it’s a right of all South Africans to have access to this kind of services. Let people in Cofimvaba say to the nurse, listen I can’t take this panado because I don’t have a headache. I’m sick of TB, let me be given a TB treatment. Or I’m sick of thrush, let me be given a tablet that’s going to be cleaning, an antibiotic for oral thrush. Let us be given specific medication for specific ailments. And then that would be a good thing because it’s a right, it’s not about the choice or a priviledge, it’s a right.

Beat It! Support Group

Prudence Mabele: in 1991, I had severe headaches that made me go to different doctors; they were suspecting this or the other. At the end I was admitted at Tygerberg Hospital where they did lung puncture test and every other test. And my results came back and the doctor who saw me told me that I had AIDS and I’m going to die. That was how I was given my results; there was no pre test or post test counselling. I didn’t know what to do. But as the time went on, I then had a toothache, which I was forced to go back to the same hospital to sort it out. One of the things that happened, my file had a red sticker which said HIV positive and then that was when the dentist saw that, he just put me in one of the consulting rooms and started calling Stellenbosch University students, those student doctors. They were coming in looking at me like I’m a monkey. So this is how the services are and how can we try and improve and what will you do if you were me in that scenario?

Corné Fourie: Ek was getoets in die gevangenis en omdat dit ook ’n klein geslote gemeenskap is, is dit ook nie ’n onderwerp wat hulle baie oor gesels niemet die gevolg dat toe ek na die dokter toe gaan, want ek het nie leeker gevoel nie, ek het gehoes en ek het gewig verloor toe toets hulle my vir tuberculosis dit was seker omtrent ’n maand na die hele proses begin het van toetse vat en so toe roep hulle my die Donderdag oggend in en die suster het daar gestaan en die diokter het daar gesit en hy het vir my gesê: “Sit.” En ek het gesit en hy het vir my gesê: “Ek is nou jammer date k die een is wat vir jou vertel maar jy is HIV positief.” Maar hulle het my nie terug geroep na die hospital afdeling om vir my te sê: “Kyk hier dit is wat jy nou gaan kry en dit is wat jy nou moet doe nom jou, om na jouself te kyk, met ander woorde ook geen berading na die uitslag van die toets gekry het nie. En toe ek uit die gevangenis uitkom, toe ek nou meer rondom HIV/AIDS begin uitvind en meer kennis en opleiding kry, in verband met die hele topic toe kom ek agter maar die mense is eintlik ongeleterd. Hulle weet nie wat aan gaan nie. En toe ek nou begin training kry en begin, toe gaan ek terug na die gevangenis toe en ek gaan sê vir hulle dit is die policy wat julle moet doen rondom pre en post test counselling. {Afrikaans} [I was tested in prison. And because it’s such a small, closed community, HIV is not discussed widely. Consequently, when I went to the doctor because of my coughing and weight loss, they tested me for TB. About a month after the process of blood tests started, they called me in. The sister was standing and the doctor was sitting, and he told me to sit, so I sat down. He said: “I’m sorry to have to be the one to tell you, but you are HIV positive.” I wasn’t called back to the hospital section to tell me what I’m going to get or what I have to do to look after myself. So I received no counselling after getting my results. After my release from prison, as I learnt more about HIV/AIDS, I realised that those people in prison are uneducated. They don’t know what’s going on. Once I started getting training I went back to the prison to tell them what policy they have to follow on pre and post test counselling.]

Mathew Damane: The way I was tested, I didn’t like it, you know. I didn’t ask what is this test for, you know. They said to me, no we should do a blood test not knowing what is it for. Then I just gave up my arm, they drew the blood and I found that I’m HIV positive. After that they said to me we should repeat the test to make sure that this is true. The second result was also positive, you know. Out of all this thing, I didn’t receive counselling. There’s a big difference between people who got counselling and those who didn’t get counselling, you know.

Busisiwe Maqungo: In my case, the counselling made a very big difference unlike you guys who never got counselling because comparing my case with Mathew’s who never got counselling and he stayed in denial for a very long time and he might have infected many people because of his denial which came because he never got counselling. In my case I got counselling, I got the chance to ask the social worker what should I do now, what should I do to keep myself healthy, how to look after my child, what is expected of me as this HIV person? I got all the answers and she even offered whenever I need to talk, she was available.

Nomandla Yako: I think iNGO’s nazo ziyafuneka zithathe amanyathelo kulento like uWola Nani into ayezayo uvolontiya eRed Cross Hospital. Unecounsellors zakhe eziyi-four ndingomnye wazo. So senza kungcono coz idoctors azinachance yokunika abantu i-counselling, i-social zi-busy abantwana bayagula, i-social workers nazo zi-busy zezinye izinto: iirape, child abuse intoni. So neNGOs ezi zifane ukuba zincedisane kunye nezibhedlele njengo Wolanani. And senza i-difference enkulu because abantu at least bayancoma uba ababantu bayayazi into abeyenzayo. At least siphuma sivile, siyamkele nalento, bas’bonisa ngeendlela zonke. And logovernment wethu ufanele a-employe i- counsellors for ezibhedlele. {IsXhosa} [I think NGOs must also play a role in this. For example, Wola Nani at the Red Cross Hospital, they have four counsellors, of whom I am one. We make the situation better because doctors don’t have the chance to counsel people. They are busy with sick patients. Social workers are also busy with other things: rape, child abuse and so on. So NGOs must come to the assistance of hospitals. We make a difference and the people appreciate our service. When they leave they understand and they are satisfied with all the information. Our government must employ counsellors for the hospitals.]

Prudence Mabele: At Positive Women Network, where I belong, we have trained 15 counsellors which each and every counsellor is placed in different townships, in different hospitals and clinics and day clinics, where everyone is helping with counselling, also being sort of watchdogs to the doctors, to the nurses if we are all doing the right thing. And in that way we work as a team and we improve healthcare system for everybody. The only thing is volunteers; people are expected to be just volunteering so we have to find the resources to help them get to those places.

Nomandla Yako: iMSF clinics ezikhona eKhayelitsha. Eligama ligama lesiFrench, lithetha ukuthi Medecins Sans Frontìéres. Nge-English Doctors Without Borders. Ngesixhosa ngoogqirha bangaphandle abanceda naphi na. Bajikeleza kulo lonke ihlabathi. So bavule iproject phaya eKhayelitsha bezivolontiya, kukhona iiclinics zeHIV and azikho apha ngaphakathi esbhedlele, zisecaleni. Umntu ukhululekile ukuthi angaya eclinic, naba baneentloni. And bathetha kakuhle abantu, ba-treata izifo ezingenelelayo i-HIV. At least if uye phayana uziva ungaphilanga, awunohlala imini yonke uphinde ugoduke ngaphandle kwamayeza. At least ugoduka unayo into onayo and if bayakubona uba awubingcono, kukhon kengoku bakubhekiselela esibhedlele. Kwezinye ii-clinics zikarhulumente zingazi-treatiyo ezizifo zingenelelayo. Usuke uhlale imini yonke, usuke ugoduke late unganikwanga into yonyanga. Kufane noba ubunangayanga. So bendinga nqwenela nakwezinye iindawo urhulumente abene clinics zakhe nazo ezisecaleni ezizawuthi abantu baye bekhululekile zinyange ezizifo zingenelelayo ngoba ndiye ndibone kwezinye iindawo kubi, umntu uyaya ekliniki akancedakali, akafumenanga lunyango and aka khange aphatheke kakuhle. Ndiyacinga zilunge kakhulu ezikliniki sinazo eKhayelitsha. Bendikwa nqwenela nezinye iindawo zifane nathi. {IsiXhosa} [The MSF clinics that are available in Khayelitsha…It’s a French term: Medecins Sans Frontìéres. In English it’s: Doctors Without Borders. In Xhosa, it means foreign doctors who help all over. They go all over the world. So they started a project in Khayelitsha where they volunteer. There are HIV clinics that are not inside the hospital, but next to it. Everybody is free to go to the clinic, even those who are shy. They handle people well and treat HIV opportunistic diseases. If you feel unwell and you go there, you won’t stay the whole day without getting medication. At least you go home with something and if they see that you are serious, they refer you to the hospital. Unlike the government clinics that don’t treat opportunistic illnesses. You spend the whole day and go home late without any medication. So I wish the government would have its own clinics, separate clinics where people would be free to go for the treatment of opportunistic illnesses. I often see in other places where a person goes to the clinic doesn’t get help, isn’t treated well. I think the clinics in Khayelitsha are very good and I wish other places can be like us.]

Busisiwe Maqungo: Like, mna ndicing’ba ndifun’uvumelana noNomandla xa esithi bekufanele ezikliniki zibe all over because kaloku ababantu kwezi-government institutions abakhathali abanayo inkathalo and especially xa beyazi uba unengculaza. Bavele bacing’ba seyebhubhile lo, akusekho yakhe. eMSF clinics umzekelo, once uye pha uyayazi bazoya exactly kulanto unayo. If une-rash bazaw’treata la-rash, if une-herpes bazaw’treata exactly lento unayo and it goes away, nje ngokhaw’leza. So nyani nyani ba-fortunate abantu baseKhayelitsha because iseKhayelitsha kuphela apha eSouth Africa, kwezinye iindawo azikho. And mna I’m fortunate enough because I’m not even from Khayelitsha but I go to these clinics. Nge-lucky nje yam. {IsiXhosa} [I agree with Nomandla when she says, clinics like the MSF clinic must be all over because if you go to government institutions, the people there do not care especially if they know you have HIV/AIDS. They just say: “That one is already dead, there’s nothing we can do.” Meanwhile, in the MSF clinics, they treat what is bothering you at that time. If you have a rash, they treat that rash, if you have herpes, they treat exactly what is wrong with you and it goes away. It all happens really quickly. Really, the people of Khayelitsha are fortunate because it’s only Khayelitsha in South Africa. In other places there are none. And I’m fortunate enough because I’m not even from Khayelitsha but I go to these clinics. I’m just lucky.]

Prudence Mabele: In many clinics in the township, we’re having problems when it comes to seeing those doctors and then they give us medicines such as panado that wouldn’t even cure the symptoms and then at the end, you end up seeing any private doctor that gives you a script where you go and buy tablets outside. Things like Ciprobay, you can’t get it still in some of our clinics and Bactrim, you have to go outside.

Vuyani Jacobs: You are back with Beat It! No clinic should be sending people away without HIV treatment. They should all have basic medicines like Bactrim, Diflucan, Acyclovir and other drugs.

Nombeko Mpongo: Talking of Acyclovir, that’s Doctor Nombulelo’s topic when she talks to us about treating herpes. Let’s listen to the doctor.

Dr Nombulelo Madala's consulting room

Dr Nombulelo Madala (HIV/AIDS community doctor): Hello again at home. I am Dr Nombulelo, your HIV/AIDS community doctor. We welcome you to our show. Not very long ago, one of the doctors in my district sent a patient to me, an HIV positive lady who had ulcers around the vagina. What was worrying the doctor was that the ulcers were not going away even though he was treating the patient for a few weeks. I diagnosed herpes ulcers. The treatment for herpes is Acyclovir tablets. These tablets are not available in most government clinics and are too expensive for the patient to buy for herself in the chemist. So I told her to send this patient to the local hospital where she got the Acyclovir tablets. After only one week of taking the Acyclovir tablets, the ulcers were gone. Herpes is a common sexually transmitted disease. It’s common in HIV negative and HIV positive people. It starts off with a tingling sensation and then blisters develop, painful blisters and there after it becomes ulcers. The important thing to note is that with HIV positive people when they have the herpes infection, their viral loads actually increase as I explained in earlier episodes; as soon as an HIV positive person gets any infection the body develops an immune response. And it’s these immune cells that become a target for the HI Virus, to get into the cells and multiply some more. Now, what this means is that an HIV positive person who has got a herpes ulcer has got a lot of virus sitting inside that ulcer, that fluid. This is where the condom story comes in. Whether you are HIV negative or HIV positive, you need to use a condom and in a case of the HIV positive person, using a condom helps you avoid getting these sexually transmitted diseases and the effect it has on your viral load. It also helps because if you don’t use a condom then you are possibly going to infect somebody that sleeps with you with both HIV and the sexually transmitted disease that you have, for instance herpes. Now, what’s also important is that you must come in early for treatment. As I mentioned earlier, the treatment for herpes is Acyclovir tablets which are not available in government clinics and are also too expensive for the patients to buy for themselves. We are really urging government as staff members who are looking after HIV positive people that they should make Acyclovir available in our clinics as soon as possible. Bye for now, I will see you next time.

Vuyani Jacobs: This year about 300 000 people will die from AIDS related diseases. We are only just entering the explosion of AIDS death in South Africa. If we don’t get ARV treatment, millions will die in the next ten years. Our nurses play a vital role in running PMTCT programmes, treating many opportunistic infections and even running antiretroviral treatment sites.

Nombeko Mpongo: Organisations like AIDS Consortium give support to these nurses.

Vuyani Jacobs: Let’s meet Sister Roberts at Helen Joseph Hospital and Sister Edna Bokaba at Chris Hani Baragwanath Hospital to see how they respond to the challenges of HIV/AIDS.

Special Report - HIV and an inadequate healthcare system

Sister Edna Bokaba (Chief Professional Nurse, Chris Hani Baragwanath Hospital): First and foremost, we were not exposed to education on HIV/AIDS as nurses. As a member of AIDS Consortium, I’ve been trained on many issues like mother-to-child-transmission. There have been people from oversees to give us the training and many other trainings and the basic facts on HIV/AIDS.

Sister Veliswa Labatala (MSF Clinic, Khayelitsha): Whenever the HIV appears in our nursing medical books, if ever it was mentioned, would be at the end of the chapter giving the impression that nothing could be done except TLC, which you heard about. I therefore now call on nurse colleges and practical fields to restructure the curriculum and give HIV a room as to be able to monitor opportunistic infections effectively in early years of being a student nurse, of course trying to remove an attitude of being a helpless professional nurse.

Zackie Achmat (Treatment Action Campaign): We, here, must make sure that we help nurses, that we produce counsellors, that in April; the month of volunteers, that every one of us must make sure that our hospitals have a proper place for counselling in our community.

Joyce Pekana (Congress of South African Trade Unions, COSATU Second Vice-President): It’s high time that we take a stand up and correct what is happening in the public hospitals because we need to subsidise those public hospitals in order for us to get quality treatment.

Sister Sue Roberts (Helen Joseph Hospital): The AIDS Consortium and our clinic were born more or less at the same time and it was actually very useful to go there to start meeting people that I could network with because when we started the clinic there wasn’t all that much going on about HIV. There one or two people who were working in it and you didn’t know where to turn. So it became a useful resource for referrals and for networking with other people. They are very useful for training for education, for literature, definitely very much a resource still.

Sister Edna Bokaba (Chief Professional Nurse, Chris Hani Baragwanath): A lot of patients have got HIV related illnesses. At any given time, you’ll find that in a ward with 31 beds, you have 25. At the average, it’s 19 but these days we have 25, almost every other day.

Sister Sue Roberts (Helen Joseph Hospital): Stress on hospitals is phenomenal. We diagnose 80 to 90 patients per week in this hospital. We’re a 512 large regional hospital. In addition to those patients per week, we re-admit patients because they come in for opportunistic illnesses and that sort of thing. So there’s a large number of HIV patients being admitted with HIV illnesses. Patients are discharged while they are still sick because there’s such a pressure on the beds.

Sister Edna Bokaba (Chief Professional Nurse, Chris Hani Baragwanath): With the number of staff being reduced and the high prevalence of HIV/AIDS, which is also causing more strain on the nurses, people are not interested in their work anymore.

Sister Sue Roberts (Helen Joseph Hospital): The nurses tend to become hard and they tend to treat the patients badly and that’s very unfortunate. Because of the large amount of stress that they’ve got, they become impatient with some of the patients and so say to them: “Why are you here, you know what’s wrong with you?” and that sort of thing, instead of getting in there and helping them. They also have a negative view of HIV because they haven’t been trained. Very few nurses had decent training on HIV and they have a view that if we can’t give antiretrovirals then there must be nothing that we can do. And they see sick patients coming in and they see the patients’ either dying or going out very sick. They never see well patients. So the ward nurses are the ones that really have a major problem, they struggle.

Vusi Nhlapo (National Education, Health and Allied Workers’ Union, NEHAWU, President): There’s very little support for nurses coming from the side of the supporters, both in the public and the private sector. And most nurses, in particular, are suffering from stress because it is very hard to be a nurse in a hospital and looking on everyday where HIV patients are not treated properly. That causes stress and mental unhealthy amongst nurses.

Sister Edna Bokaba (Chief Professional Nurse, Chris Hani Baragwanath): It really affects nursing care for you to come on duty when you know that there’s nothing you are going to give a patient. Access to treatment will make a difference. What is the point of the patient lying in bed, getting food and drips with no treatment? You become frustrated yourself.

Sister Sue Roberts (Helen Joseph Hospital): We don’t have antiretrovirals in the clinic unfortunately. The government doesn’t give us any but we’ve got quite a lot of people who actually get antiretrovirals with the employers paying. And we’ve seen stunning results. Patients who’re sort of money bound and just about dying and we get them on antiretrovirals and in couple of months they are bouncing, full of life, put on weight.

Sister Veliswa Labatala (MSF Clinic, Khayelitsha): I stand in front of you today being a professional nurse, and of course being proud of having to have a chance of being in a position to work with antiretrovirals. Not only has it made a difference to the patients but it has made a difference to myself as a health worker.

Sister Edna Bokaba (Chief Professional Nurse, Chris Hani Baragwanath): The availability of pre treatment will be just part of the treatment for the patient because if they bring treatment but no staff to give the treatment, still the treatment will be lying in the cupboards with nobody to provide the treatment. It’s only two people taking care of these babies and all these babies need intensive care. The nurses are not coping. The pressure of work has put a lot of stress on the nurses. And what is even worse is that nobody appreciates what the nurses are doing under the difficult conditions within which they find themselves. A present scenario is that you’ll find that one nurse that is a professional nurse, one nursing auxiliary, one ward attendant; attending to 60 patients. What type of service is that? We know how frustrated nurses are, doctors are, when a patient comes, she’s raped. She can’t be given AZT because it is not provided. For that person to get AZT, she must go to the pharmacy outside. There’s nothing like that in the hospital. A big hospital like Baragwanath, Nevirapine that is provided in the hospital is not hospital issue, it’s provided by Paediatric Research Unit. And very often you will hear people talking about Nevirapine in Baragwanath that is a private entity. We need treatment and those are the challenges facing nurses. You’ll find nurses are demoralised. Why are they demoralised? You come to work, there’s not treatment. You are just working alone, you are just a piece of nervous wreck. We need to look at what are the basic needs for both the nurse and the patient for us to be able to provide the treatment.

Nombeko Mpongo: We need to unite our efforts in prevention, treatment and care. Organisations like AIDS Consortium in Gauteng play a big part in networking everyone’s efforts.

Vuyani Jacobs: Nurses are a huge resource in making National Treatment Plan work. Treating opportunistic infections, voluntary counselling and testing and ARV therapy can all be handled by nurses. In this way, our health system will be able to handle the impact of HIV/AIDS.

Nombeko Mpongo: And that’s our show for this week, we value your comments and feedback. So please contact us on the number on your screen.

Vuyani Jacobs: We’ll be back with you on e next week.

Nombeko Mpongo: You can catch the repeat broadcast of this programme on Sunday at 11:30 in the morning. Till next week, khumbula sisonke sonqoba {IsiXhosa} [remember together we can Beat It!].

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