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Siyayinqoba Beat It! 2004 Episode 23 –

Healthcare workers & HIV

A recent study found that fifteen percent of healthcare workers in South Africa are HIV positive. In this episode of Siyayinqoba Beat It! we found out how this is affecting healthcare services? We also met Alida Wagener, a nurse from Orkney in the North West Province, who became infected with HIV after a needle prick accident.

Jason Wessenaar: Hi, welcome to the Siyayinqoba Beat It Support group. My name is Jason. In the Siyayinqoba Support Group we are all living positively with HIV. Each week we get together to talk about issues that affects our lives with HIV, from living openly to reproductive rights and rights at the work place. USiyayinqoba nguhlelo lwakho lokuphila kangcono neHIV. Uma uphila nengculaza {IsiZulu} [Siyayinqoba is your guide to live better with HIV/AIDS. If you are HIV positive] or you have a partner, friend or a family member is HIV positive this programme is for you. Today we are talking about the impact of HIV and AIDS on the health system. To help us discuss this topic I would like to welcome Fazeela Feyers from Hospice, the Hospital and Services Personel of the Union of South Africa. A recent study found that fifteen percent of healthcare workers in South Africa are HIV positive. How is this affecting the health services?

A positive nurse’s struggle to work

Orkey, North West

Alida Wagener (Healthcare worker): Zerit is ’n kapsule wat jy een twee maal ’n dag drink. In die oggend en in die aand drink ek my een van hierdie. Die Videx drink jy twee twee maal ’n dag; twee in die oggend twee in die aand. {Afrikaans} [Zerit is a capsule that you take twice a day. I take one in the morning and in the evening. Videz you take one a day, one in the morning and two at night.]

Alida Wagener: Dit was ’n besige dag, dit was ’n psykotiese patient, ’n patient met HIV psykose. Ek het die ou ’n intravenous inspuiting gegee. Hy’t geruk en ek het my gekraap in my pols. Ek het my nie verder bekommer nie. Ek het my nie bekommer om die antiretrovirals te kry nie. Want ek het myself net met n bebloede naald raak gesteek. Paar maande daarna, het ek begin lymph nodes in my nek kry. Maar nog steeds, daar was geen vermoede nie. En toe kom ek op biopsie uit, en toe bewys dit dat dit die HIV is die oorsak. Ek het gedink ek gaan drie jaar lewe en dan gaan ek dood gaan. En dis dit. {Afrikaans} It was a busy day. It was a psychotic patient, a person with HIV psychosis. I gave him an intravenous injection. He shuddered and I scratched myself on his wrist. I did not worry any further, I didn’t bother getting antiretrovirals, because I just pricked myself with the bloody needle. A few months later, I got lymph nodes in my neck. Still, I didn’t suspect anything. And when the biopsy result came it showed HIV is the cause. I thought I would live for three years then I’d die. And that’s that.]

Frans Wagener: Ons het al verskeie kere moes gaan baklei by die hospitaal. Die hospital se sekretaresse weier net om vir my te sien. Hy sê part en hend vir sy sekretaresse hy gaan my nie sien nie. So ons is nie een keer nie is ons blygestel in die fyt dat ons in hierdie selfde hospital gegaan en gesê het: “Luister ons het ’n probleem. Ons het ’n krises hier. My vrou gaan dood gaan as sy nie medisyne kry nie.” En hulle response was: “Wel,so wat?” {Afrikaans} [We had to fight with the hospital several times. The hospital secretary flatly refuses to see me. So we’ve been to the same hospital more than once and told them: “We have a problem. We have a crisis here. My wife will die if she doesn’t get medication.” Their response was: “Well, so what?”]

Alida Wagener (Healthcare worker): Sedert ek positief geraak het, het my empatie vlakke definitief gestuig. Die mense wat in kom met naald prikke, die personeel lede, dit is vir my baie tramaties. Ek wil letterlik saam met daai mense huil. Want dit is ’n geweldige ding wat met hulle gebeur .En dit maak my baie emosioneel en dit maak my baie ongelukkig. Jy gaan jou verkoming moet kry. Ek voel net mense moet naald prikke ernstig, in ’n baie ernstige lug sien as wat hulle dit sien. Ek weet van ander verpleeg personeel wat HIV positief is. Ek weet ook van ’n paarkies wat in die laaste twee jaar gesterf het daaraan. Die meisies wat HIV positief is wat werk in die hospitaal is so bang oor die stigma. Daar is nog ’n geweldige stigma. Ek het gesukkel om ’n werk te kry op die ou end dink ek hulle was bang as gevolg van my toestand gaan ek ’n hoë siekte profiel hê. Hulle is ook bang die gemeenskap vind uit en hulle se: “Moenie soen toe gaan nie. Daar is ’n suster wat HIV positief is.” Persoonlik voel ek moet mense meer openlik wees oor die feit dat hulle HIV positief is. Dit behoort nie meer ’n skande te wees nie. Dit behoort nie meer mense bang te maak nie. As ek, wat ’n verpleegster is ,as ek bloedruk gaan neem of vir hom ’n drup gaan in sit, en al daai dinge, het ek nie genoeg kontak met hom nie om vir hom AIDS te gee nie. Al kneus ek by hom gaan ek nie genoeg kontak met hom hê nie om vir hom AIDS te gee nie. {Afrikaans} [Since becoming positive, I’ve become more empathetic. Seeing staff members with needle prick injuries, it’s very traumatic. I literally want to cry with them. What’s happening to them is enormous and that makes me emotional and unhappy. You will need prophylaxis. I feel that people must take needle pricks more seriously. I know of other nursing staff who are HIV positive. I also know of a few who’ve died in the last two years. The HIV positive girls who work in the hospital are so scared of the stigma. There is still a lot of stigma. I struggled to find work. I think they were afraid that I’d have a high sick profile because of my condition. They also fear that the community would find out and say: “Don’t go there. There’s an HIV positive sister.” I feel people should be more open about being HIV positive. It need not be a shame. It need not frighten people. As a nurse, if I take someone’s blood pressure, or put them on a drip, I don’t have enough contact with them to give them AIDS. Even if I sneeze on them, I won’t have enough contact to give them AIDS.]

Support group

Jason Wessanaar: Alida referred to the fact that there is a number of nurses she knows that are HIV positive and we know that about 15% of nurses are infected now. Is the morale generally low amongst nurses in hospitals, and how is this affecting healthcare services?

Fazeela Feyers (HIV Programme Coordinator, HOSPERSA): Unfortunately, it’s been continuously reported that the stigma levels are still very high. You’d find that a healthcare worker is twice as shy to reveal her status to the point that when a nurse is actually needle-pricked, there’s all sorts of reasons as to why they refuse to actually go and test, because although it’s an injury and duty, she’s twice as scared to actually find her status out, and that reflects the fact that the stigma is still very high within the healthcare sector.

Anthony Fernandes: Why would the nurses be twice as scared?

Fazeela Feyers: The typical quote that came from one of the nurses was that: “My husband will never believe that I contracted HIV from the workplace”, so these are some of the real issues that healthcare workers who are largely women actually have to face.

Jason Wessenaar: A lot of stigma is there because people are misinformed or they are ignorant, they don’t have enough information. What is being done to educate nurses? What is HOSPERSA doing to bridge that gap?

Fazeela Feyers: I must say as HOSPERSA we’ve managed in the past four years to get somewhere and when I say we’ve gotten somewhere; we’ve got a pool of approximately thirty in a trade union that’s got seventy five thousand members, who we can now say are typically activists around HIV and AIDS in the workplaces, and we’ve tried to split those people within the provinces. Firstly, we’d like to base it on the research, also on the HSRC research. This study shows that only one third of nurses or healthcare workers were actually formerly trained clinically to deal with HIV and AIDS. And that was up until 2003.

Busisiwe Maqungo: The same thing goes for patients. If they know that the nurse is HIV positive they wouldn’t want to be attended by that nurse because there’s been stories like, nurses first prick themselves then put the same needle to the patient. You see those kinds of stories.

Anthony Fernandes: How do HIV positive nurses protect themselves from being blamed that they are the cause of infection? Is there kind of protection for people in the workspace so say that they can’t be blamed be pointed a finger or that they are high risk for the work that they do because you must addmite the work the nurse do is very close and touch to a patient?

Fazeela Feyers: It’s a difficult one, but education is the key to all of it.

Vuyani Jacobs: What would trade unions’ working programmes look like?

Fazeela Feyers: There isn’t any support systems in place in the workplace. There should be employee assistance programmes, and it’s our duty, therefore, if government is not making the kind of inroads it should be, and I’m clearly saying that within the public health system that is not happening, it’s about education, education, education. And all that we are trying to do is to accelerate that level of education, as best as we can.

Jason Wessenaar: Would you say that the provision of post exposure prophylaxis has helped for nurses to go for VCT, and for some nurses to disclose their status?

Fazeela Feyers: The availability of the PEP obviously is also based on the fact that you’ve gotta test yourself first. And that’s where the biggest problem lies, where you find half of them don’t want to take that test.

Vuyani Jacobs: There’s been a lot that has happen. We have seen nurses resigning. My best friend was a nurse, she resigned after testing positive, because she was mishandled in the profession, and she became one of the leading activists on AIDS in South Africa. And what I can say now is that there’s been a lot of change now among healthcare workers in SA, based on the access of community mobilisation towards education. Second thing is the access to post exposure prophylaxis, because I think with the government, it’s one of the most progressive part to give healthcare workers post exposure prophylaxis, whilst at the same time it was refusing to give it to rape survivors.

Jason Wessenaar: We will talk more about the impact of HIV and AIDS on health workers and the health services after this break.

Jason Wessenaar: Mohe reya le amohela hape mona hoSiyayinqoba Support Group. {Sesotho} [Welcome back to the Siyayinqoba Beat It support group.] Uhlelo lwakho loku phila kancono ne HIV. {IsiZulu} [The programme for anyone affected and infected by HIV.] We went to visit GF Jooste Hospital, which serves Mannenberg, Heideveld, Nyanga, Gugulethu, and Khayelitsha in Cape Town. The hospital used to have a bad reputation among PWHAs, as a result of low morale among healthcare workers. We spoke to Giovanni Perez the hospital manager and Sister Nomalungelo Konza about how they turned the situation around.

Turning a hospital around for the better

GF Jooste Hospital

Giovanni Perez (Manager, GF Jooste Hospital): We have had to implement fairly stringent security measures in order to reduce criminal activity on the premises of GFJ. And we’ve introduced perimeter fencing, we’ve introduced full-time security guards. At any one there are six security guards monitoring this area that I’m standing infront of. As a result, certainly for myself, coming into my own hospital, it feels a little bit like a prison. GFJ used to have, and possibly still has the reputation of being the hospital of death. And that’s because the nature of the hospital in the past, originally it was planned as a hospice for patients with terminal diseases. And everybody that came to Jooste did in fact die. And that was in the 1970s and the 1980s. In 1996 the nature of the hospital changed to being a trauma and emergency hospital, but the reputation in the community persisted. Within the medical wards we’ve got a mortality rate of ten to fifteen percent, and a large percentage of those are directly related to terminal AIDS Stage 3 or Stage 4, the opportunistic infections. The mortality rate in the non-HIV population, is very much smaller than five percent, so the hospital of death is still, but not to the same extent. The numbers seen in our hospital has stayed relatively stable over the last six to seven years. However, the nature of the disease profile has changed fairly dramatically from being a hospital focusing on trauma and violence, to being a hospital focusing largely on medical emergencies caused by HIV/AIDS and tuberculosis. As a result in the change of the profile of the disease, the resources that one has to allocate have increased. It’s far more labour and time intensive to treat a patient suffering from a chronic, possibly terminal disease, to suturing somebody who was stabbed in a gang fight.

Nurse Nomalungelo Konza: The first pressure that we’ve got is the shortage of staff. The people are sick. So now we are encountering problems, because there’s more people that needs attention, and here we are maybe one sister in the ward and you must do the lot of work, so we are really under pressure. Stress level is too high.

Giovanni Perez: I think that the efforts of the staff to deal with this burden of disease should be acknowledged by the Department of Health, and I think that there’s a big problem of staff burnout in this kind of climate. Just the mental and physical resources that one has to allocate in treating patients in large volumes suffering from very severe illnesses cannot be underestimated. It’s a major challenge to keep the staff motivated and focused on the task of treating every patient with dignity and compassion. We at this hospital were extremely lucky in being at the forefront of antiretrovirals. We implemented the ARV Programme before it became government policy to do that, and as a result we’re a little bit further down the road than a lot of other clinics that are starting now, that are rolling out now. We’ve got the benefit of a few years of experience in the field. We’ve got approximately two hundred patients on antiretrovirals treated on an outpatient basis, but in the main we try to discharge them to the antiretroviral clinics which are now in existence in Khayelitsha, Mitchell’s Plain, Gugulethu, and in a few other sites. The availability of antiretroviral dosages has improved staff morale to a large extent I think it’s improved the feeling of hopelessness the staff had before the advent of ARVs. In the past, one had to virtually give the patient and send them home. Now we can actually offer something that really changes their quality of life in a positive way.

Support Group

Vuyani Jacobs: Jooste was one of the problematic hospitals in the Western Cape, where if doctors say: “You must go to Jooste”, they practically cried. But now the situation changed. People never wanted to go to Jooste before the rollout of the ARVs. But when it happened, everyone wanted to go there, and it changed even the attitude of the healthcare workers because now they are very nice.

Lihle Dlamini: I can relate to what, what is that guy’s name Giovanni, I can relate to what doctor Giovanni was saying because I’m taking my medication through McCord Hospital and you found out when you go there you find out that they are short staffed. In such a way that they have asked some of the volunteers some of the support group members to volunteer their services at the hospital then it is very hectic some days, some people have to be started on treatment and they have to be told about ARV’s before they go on treatment, then you find out you go to hospital in the morning you have to wait because all the doctors are not there, they are in the board room telling people about the ARV’s that they are going to be put on roll-out and so forth and the you have to wait fro long hours.

Jason Wessenaar: So what you’re saying Lihle is that the introduction of the rollout has caused more stress on the healthcare workers, and that there is a need for more healthcare workers.

Jason Wessenaar: There’s no training or comfort and what kind of comfort zone do nurses have for themselves? If they get bombarded with every single day with people coming with HIV. There must be a huge fear aspect to their own worries, like: “I’m probably gonna be on the other side of this pretty soon, and get tested positive as well.” I’m just wondering is literacy about HIV and AIDS just as important on the agenda as emotional support, understanding for this disease?

Fazeela Feyers: You’ve touched the heart of the actual problem. But in the healthcare sector, the press exposure to HIV and also unnecessarily to AIDS, has created within the mind of the healthcare worker, a situation of despondence. And it’s sad to hear that the healthcare workers would actually tell you: “Go home and die”, but many of them have gone through the situation themselves of not having the medication to go. That was the message which we received for so long: there wasn’t any ARVs, there wasn’t any treatment provision, and therefore the insensitive manner of saying it to a patient in that way also reflects upon something else and that’s the fact that there are no measures in place to deal with this despondence.

Jason Wessenaar: We are going to the break we will be right back.

Jason Wessenaar: Mohe reya ho amuhela ho Siyayinqoba Support Group. [Welcome back to the Siyayinqoba Beat It support group.] Uhlelo lwakho loku phila kancono ne HIV. {IsiZulu} [The programme for anyone affected and infected by HIV.] Today we are talking about the impact of HIV in the health system. What do you say is the role of other people living with HIV as towards healthcare workers who are living with HIV?

Fazeela Feyers: I think we have dual role towards each other, because we should be respecting each other as human beings. Burn-out often presents in a way that you’re absolutely insensitive. That’s the second point, that government needs to put in place a system to address the burn-out levels as a result of occupational stress that’s resulting from the understaffing, that’s resulting from the range of illnesses that are being seen too, and also under-resourced; for example, given the panado to the cancer patient for pain. And also, underpaid, undervalued, totally undervalued in terms of the fact, which is another gender bias, that it’s a field of work that is predominantly female. And that’s been researched internationally, that female fields of work generally are pitched and valued at lower levels.

Vuyani Jacobs: My experiences with healthcare workers have always been mixed. I’ve felt quite a lot of beauty and warmth with healthcare workers, trying to make out the system that has failed them. For instance, in TB clinics where you really find good people who are really working very hard to make sure people understand the issues, and they go through this whole process. If I just look around and see, if they have HIV they are more vulnerable to catch the TB from me and the other person, but they’ve got this compassion that they work into, but the system always fails them. And the other thing I’ve actually noticed, when the healthcare workers grasp the issues and how to react when they understand how they can effectively work with it, they become the champions of the programme itself.

Fazeela Feyers: Yes Vuyani, I would agree with that, and I thank you also for feeling some of the beauty, because there are thousands of healthcare workers out there. It’s not only HIV, but they also seeing to cancer, they seeing to dread diseases which bring a tremendous amount of grief to them. And at the end of the day, they’re human; mothers, sisters, they’re coming out of the community. They only mirror what the community is about.

Jason Wessenaar: Thank you Fazeela, the support group and you viewers at home. Things to remember are:

1. Healthcare workers have a right to PEP after a needle prick injury.
2. HIV positive healthcare workers are entitled to the same rights at work as any other person, and may not be discriminated against.
3. ARVs at clinics has helped boost the morale of healthcare workers.

We hope that you have enjoyed the show and are feeling the Siyayinqoba Spirit that together we can Beat It. If you have any questions or comments please contact us on the numbers on the screen right now. Join us again next week on the Siyayinqoba Beat It support group. Till then, stay healthy and stay positive. Goodbye.

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