Med-e-news 10 February 2012
10 February 2012Health service on brink of collapse (IOL)
Gauteng’s public health service has run out of life-saving drugs and its laboratory services are on the brink of collapse.
This week, concerned doctors met with senior officials from the national and provincial health departments demanding concrete steps to address the two pressing issues, an end to critical staff shortages and the rationalisation of hospital budgets.
The medical professionals, including senior academics, specialists and professors working at three academic hospitals, sent a desperate letter on Monday to the health and finance ministers, the Gauteng premier and health MEC and the head of the provincial health department, inviting them to an urgent meeting on Tuesday.
“We trust you understand the urgency. Each day that goes by, patients are put at risk,” they wrote.
It is understood that an undertaking at the meeting was given by senior national and provincial officials, including Health Minister Dr Aaron Motsoaledi, to work around the clock to restore the drug supply and laboratory services by the end of the week.
Gauteng premier spokesman Simon Zwane said the province was committed to clearing all its health-related debts by the end of June.
Professor Ashraf Coovadia, a paediatrician specialist at Rahima Moosa Mother and Child Hospital, said drug shortages had grown chronic towards the middle of last year. “Before that, we had good alternatives when we ran out of one drug. Now we are finding the ‘stockouts’ of essential drugs to be more protracted, and directly linked to the non-payment of suppliers.”
He said the final straw for him was when he was told last week that the pharmacy had run out of a first-line drug to treat bacterial meningitis, a potentially fatal condition.
Coovadia said the latest pharmacy list at the hospital showed there were no first-line drugs to treat seizures, diabetes and high levels of potassium – all life threatening conditions.
“As far as the National Health Laboratory Services (NHLS) is concerned,I can’t even get a simple urine test done to determine if a baby has an infection.”
Treatment Action Campaign chairwoman Nonkosi Khumalo said they were aware of widespread “stockouts” of antiretroviral drugs in Gauteng, with some patients being overdosed on available drugs and under-dosed on scarce supplies, especially tenofovir and lamivudine. “This is a sure recipe for drug resistance.”
Other patients with HIV have been waiting since last year for TB results. “Our information is that these patients have been duped into believing their specimens had been lost, while they had not been sent away in the first place,” said Khumalo.
She said several clinics and hospitals had no gloves or bottles to collect TB sputum. Some of the hospitals and clinics she listed include Kaalfontein, Ebony Park, Edenvale, Lenasia, Vosloorus, Kempton Park and Alexandra.
It has also been revealed that the NHLS has been unable to provide courier services since Monday, meaning specimens from clinics and hospitals could not be transported to laboratories.
Non-payment to laboratories could also mean services being available at the four central hospitals only in the next fortnight. In-house laboratories have already been closed at Kopanong, Yusuf Dadoo, Germiston, Rahima Moosa, Edenvale, South Rand and Pretoria West hospitals. Several other laboratories will operate only between 8am and 7pm.
NHLS CEO Dr Sagie Pillay said he could not continue to run services on promises, and that Gauteng owed the NHLS R697 million by the end of last year.
A junior doctor, who spoke on condition of anonymity for fear of losing his job, said the academic hospitals, including Helen Joseph, were running out of food, linen and drugs daily. “It is heartbreaking. A few weeks ago, against great odds, we saved a guy who had a blood clot and a heart functioning at 10 percent. Once we pulled him through, he lay naked on a bed for a week. There was no linen.”
In another incident, they had to “play God” when two young patients had to be ventilated. “The only two available machines had been out of order for months, but we fiddled with them and got one going. We had to choose who to save. It’s not right,” he said.
MEC: Go to clinics first(Sapa)
People needing medical treatment were urged on Thursday to visit their local clinics before going to big hospitals.
"People want to be treated here believing it's the best treatment while they could have gone to the clinic," Gauteng health MEC Ntombi Mekgwe said at Chris Hani Baragwanath hospital, south of Johannesburg.
She was briefing reporters about problems at the hospital, such as staff shortages reportedly causing unnecessary infant deaths.
"Yes we acknowledge the fact that we have a shortage of nurses," said Mekgwe.
Critical positions would be filled first, she said. The hospital had 20 theatre-trained nurses and had called in an extra five nurses from the military service.
Mekgwe said the hospital needed six nurses per shift. Currently there were only five nurses per shift.
The hospital's chief executive Johanna More said most people who came to the hospital were "self-referred".
"Here, you will find people that have never been to a clinic... when they come here, we then have to put aside the booked patient and attend to the emergency."
She said between 65 and 70 babies were being delivered daily. Clinics were not delivering as many.
As a tertiary institution, the hospital was meant to deal with high-risk cases only. More said if the hospital had to deal only with cases referred by clinics, the nurses would not be under so much pressure.
Health minister excited about year ahead (Bua News)
Health Minister Aaron Motsoaledi has echoed President Jacob Zuma's call to accelerate the prevention of HIV and Aids, saying that stronger emphasis will be placed on combating the disease.
Delivering the State of the Nation Address, the President said that while the country was doing well with regards to treatment and the prevention of mother-to-child transmission, general prevention efforts must also be accelerated.
During World Aids Day on 1 December 2011, Zuma launched the new National Strategic Plan (NSP) for HIV and Aids 2012 - 2016, which promised to do much more to tackle TB and issues of violence against women.
The NSP proposes to deal with HIV, sexually transmitted infections and tuberculosis by adopting a holistic approach which includes preventative and therapeutic measures.
The country also adopted the 'three zeros' agreed to at the United Nations high level meeting in New York this June as a vision for the next 20 years. In addition, a fourth zero has been added, which aims to eliminate HIV transmission from mother to child.
The four zeros are: zero new HIV and TB infection; zero new infections due to mother-to-child transmission; zero preventable deaths associated with HIV and TB, and zero discrimination associated with HIV and TB.
"We want to move even stronger to combat the disease of HIV and Aids," said Motsoaledi, speaking to BuaNews after Zuma's address.
Zuma also touched on the need to reduce the impact of non-communicable diseases such as diabetes, heart disease and hypertension.
"Non-communicable diseases are also becoming a very big problem. And I'm very happy because the President announced officially what I had been struggling to tell the population, that they need to live healthy lifestyles.
"We can't just go for treatment, we need to stop diseases from happening and this year we are going to be passing lots of regulations and laws around alcohol and tobacco advertising, among others. We are going to go all out to make sure that we reduce the harm caused by these diseases," he said.
Critical social infrastructure projects have also been identified, including projects aimed at laying the basis for the National Health Insurance system such as the refurbishment of hospitals and nurses' homes.
Motsoaledi said this would be extraordinarily important for a country that will start universal coverage via National Health Insurance.