From the front line

I have already made reference in a previous posting to the problems that Zithulele and other hospitals experience when they refer patients to Mthatha hospital, and the knock on effects that the strike at Mthatha is having.

What I should also have mentioned is that probably the most significant effect is being felt on access to the supplies that are needed to run Zithulele as a hospital. All of our pharmaceutical supplies and sterile materials, intravenous fluids, needles, intravenous lines, urine bags – in fact everything I take for granted every day in the NHS – come from the depot at Mthatha. Since September 11th there has not been a proper delivery from there. Initially they were stocktaking and now the strike has meant that there are two managers trying, and failing, to keep up with orders. Our pharmacist has been over there in person three times and been allowed to bring back minimal quantities of drugs.

There is a morning meeting of some sort here every day; a journal club or a morbidity and mortality meeting and sometimes just updates such as on Monday morning after the weekend’s events. Since I arrived at the beginning of October it has been a feature of these to have listed what drugs are out of stock, and (sometimes quicker) what is left that we can prescribe for a particular condition. I joked a few weeks back that it was like being in a war zone, or Berlin at the time of the airlift, with the daily update of what munitions and food had made it through and what the strategy was for keeping the war effort going in the face of severe shortages.

Unfortunately the joke has worn thin. Day by day the number of medicines unavailable or worryingly low has grown. Aspirin was out for a while and is now back, coinciding with paracetamol running out. Neither of these is a huge inconvenience in a rural practice compared to treatments for the many immediate life threatening diseases. The state of far more important supplies is now however critical. In the next few days or weeks the end of the line is in sight for many vital drugs. There is enough 50% dextrose to treat three patients whose blood sugar drops dangerously low, and enough magnesium sulphate to treat 1.5 (yes, 1.5) women with eclampsia. Ciprofloxacin (basic antibiotic), Flammazine ointment (first line for the many burns we see), as well as the first choice suture for closing a uterus at Caesarean section are just three of the 19 basic items that are completely out of stock. For only three of the 11 standard antibiotics is there enough left to treat more than 10 patients. For some there is literally one course remaining.

I think I was not alone in imagining that this was a relatively short term problem. Strikes which endanger human lives should never happen anyway and the very gravity of it would have triggered adverse publicity and prompt (and panicky) political action in most democracies. The occasional delivery fostered hope. I was expecting to write, under this title, an amusing tract about how we made it through, in the form of a wartime spoof, Dad’s Army style. No way.

There is no decrease in demand for healthcare either. Last weekend there were almost as many patients waiting in outpatients for admission (and being treated there) as there were beds in the hospital. That won’t change much, but the suboptimal (bordering in some areas now on sub basic) care we are able to give reduces the successful discharge rate and means the availability of beds declines except where people vacate them in the way we least want.

The Mthatha depot at its best is not great. They have a habit of sending us supplies a few weeks before their expiry date. They presumably reserve the newest for themselves. Using a drug at or after its official expiry date is a gamble; a gamble with a person’s life.

Here in Zithulele, an extraordinarily resilient, positive and motivated staff is having their best efforts stymied. It gives the appearance that other people don’t think what they are trying to do is worth bothering about; certainly compared to important things like performance related pay. There is great leadership here and fantastic spirit and optimism. It is a potential tragedy of huge proportions when the wilful and selfish action of others raises the risk of eroding that.

The dazzling irony of the current position is of course that all the supplies that are needed are already sitting at Mthatha. If they didn’t exist people would just hunker down and do what they could with a philosophical resignation but with the knowledge that it was out of everyone’s control. This scenario is like the parched man who can’t quite reach the glass of water. Or rather the stupid, self-centred and thoughtless person holding it just out of reach. This situation could be remedied in a couple of days with a couple of large trucks.

South African people did not vote for this. This is not what the electorate in this remarkable country expects or deserves. No one believed that a utopian society would emerge miraculously overnight after apartheid fell. But people should not to have to put up with a supine, impotent administration turning a blind eye to the inconvenient truth of poor folk dying for lack of access to something that they have a right to, because it is locked up in a depot a few miles away.

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