Gov­ern­ment needs to en­sure women have ad­e­quate health care

Weekend Argus (Saturday Edition) - - OPINION - WIL­MOT JAMES AND HEIN­RICH VOLMINK

OUR health sys­tem women.

Ev­ery year Par­lia­ment de­bates violence against women and chil­dren to ini­ti­ate what is known as a pe­riod of 16 days of ac­tivism. Ev­ery year we lis­ten to prom­ises, not to men­tion the se­quen­tial pon­tif­i­ca­tion of most MPs, about making a real and mean­ing­ful dif­fer­ence to the lives of women and chil­dren.

But what has been the prac­ti­cal ef­fect of gov­ern­ment mea­sures on our lives?

We say “our” be­cause as fa­thers to daugh­ters we have the great­est de­sire, like other fa­thers surely would, for them to be part of a world where women live safe, se­cure and pros­per­ous lives. Too of­ten the is­sue is framed as anti-male (Par­lia­ment’s web­site has it that men abuse chil­dren as if women don’t) and the pain of their sit­u­a­tion only un­der­stood by them­selves.

For all the talk, Par­lia­ment does not ex­er­cise its pow­ers of ex­ec­u­tive over­sight when it comes to the wel­fare of women.

is

fail­ing

We see women be­ing let down on a daily ba­sis – at po­lice sta­tions, in the courts and in our hos­pi­tals and clin­ics, with lit­tle pos­i­tive in­ter­ven­tion from those in charge. Of se­ri­ous con­cern, for ex­am­ple, is the fail­ure of the gov­ern­ment’s depart­ment of women to im­ple­ment its vi­sion of serv­ing women. Min­is­ter Susan Sha­bangu and her depart­ment have failed dis­mally to reach their tar­gets – not least fail­ing to in­ter­act with other de­part­ments and prov­inces – and to in­te­grate its well-in­tended but never im­ple­mented poli­cies.

In just one area, health, and we find nu­mer­ous ex­am­ples of how women are suf­fer­ing daily in our health sys­tem:

Kather­ine Childs wrote about Betty Mabuza of Welkom who went “back and forth to a clinic in the last few months of her preg­nancy. When she fi­nally got help in a hos­pi­tal, a doc­tor told her she had been car­ry­ing a dead child for more than a month”.

The Free State has some of the worst hos­pi­tals and clin­ics in the coun­try, so her ex­pe­ri­ence may not be atyp­i­cal. In­ad­e­quate ob­stet­rics care con­trib­utes sig­nif­i­cantly to our high ma­ter­nal death rate.

Ac­cord­ing to the World Health Or­gan­i­sa­tion, South Africa’s ma­ter­nal mor­tal­ity rates, (as mea­sured by preg­nant women who die per 100 000 live births), was 138 in 2015.

Brazil’s is 44, Rus­sia’s is 25, China’s is 22 and Is­rael’s is five.

Provin­cially, the Free State has the high­est ma­ter­nal deaths at 202 per 100 000 live births, and the Western Cape the low­est at 54.4.

In 2014, a to­tal of 140 moth­ers 18 years or younger died, of whom 37 were from Kwazulu-Na­tal, 28 from the East­ern Cape, 22 from Gaut­eng, 20 from Lim­popo, 14 from Mpumalanga, 13 from the Free State, four from North West and two from in the North­ern Cape. There were none in the Western Cape.

Our fig­ure of 138 is far higher than the 38 we set out to achieve with the Mil­len­nium De­vel­op­ment Goals (MDG).

Ac­cord­ing to the depart­ment of health’s Confidential Com­mit­tee of In­quiry into Ma­ter­nal Deaths, the three most im­por­tant causes are:

● HIV/Aids, which ac­counts for half the deaths. The depart­ment adopted a pol­icy stip­u­lat­ing all HIV- pos­i­tive preg­nant and breast­feed­ing women must be placed on life­long an­tiretro­vi­ral med­i­ca­tion for the preven­tion of mother-to-child trans­mis­sion re­gard­less of their CD4 counts. This would make a con­sider- able dif­fer­ence, but much de­pends on women’s ac­cess to clin­ics, and their per­sonal dili­gence in us­ing their med­i­ca­tion;

● Hy­per­ten­sion in preg­nancy: Hy­per­ten­sion in preg­nancy ac­counts for about 15 per­cent of ma­ter­nal deaths. Se­vere hy­per­ten­sion in preg­nancy is a se­ri­ous con­di­tion that can re­sult in a range of com­pli­ca­tions for both mother and the un­born baby. Pre-eclamp­sia is hy­per­ten­sion in preg­nancy with or­gan dam­age, com­monly to the kid­neys (which causes an in­creased amount of pro­tein in the urine). Eclamp­sia, a con­di­tion char­ac­terised by fits (seizures), greatly in­creases the chance of death in preg­nancy; and

● Pre-birth and post-birth haem­or­rhage (bleed­ing) is also a ma­jor cause of ma­ter­nal mor­tal­ity, caus­ing about 16 per­cent of th­ese deaths. Ob­stet­ric haem­or­rhage is one of the lead­ing causes of pre­ventable ma­ter­nal death, with con­tribut­ing fac­tors be­ing a lack of ad­e­quately trained health care staff – and am­bu­lances ar­riv­ing too late, or of­ten not at all, to take pa­tients to hos­pi­tal.

The gov­ern­ment can­not dic­tate the life­style habits of in­di­vid­u­als. But it is re­spon­si­ble for the qual­ity and staffing lev­els of ob­ste­tri­cians at pub­lic hos­pi­tals and the ad­e­quacy of emer­gency ser­vices.

Firstly, there is a need to ad­dress the short­age of mid­wives and ob­ste­tri­cians, es­pe­cially in pub­lic health es­tab­lish­ments.

Greater num­bers of grad­u­ates from nurs­ing col­leges and med­i­cal schools are ur­gently needed. The use of in­no­va­tive train­ing ap­proaches should be ex­plored, such as offering spe­cial­ist ob­stet­ric train­ing posts in ru­ral ar­eas, sup­ported by satel­lite teach­ing units and telemedicine.

Se­condly, South Africa has a na­tional 112 emer­gency num­ber, but it is sup­ported only by cel­lu­lar net­works and there­fore has lim­ited reach. Nu­mer­ous meet­ings be­tween the de­part­ments of health and com­mu­ni­ca­tions since 2001 and a trial 112 Western Cape cen­tre have de­liv­ered noth­ing. It is not rocket science. It is a trav­esty that there is no sin­gle num­ber like the US’s 911 via which an am­bu­lance, fire bri­gade or the po­lice can be reached.

The cost (in 2012) for set­ting up a sin­gle num­ber emer­gency ser­vice was R24 mil­lion in cap­i­tal and R124m in re­cur­rent costs, not a huge sum of money given the com­pelling im­por­tance of the ser­vice.

Thirdly, emer­gency re­sponse times vary greatly. The norm for pri­or­ity calls in­volv­ing the crit­i­cally ill or in­jured pa­tients is 40 min­utes in ru­ral ar­eas and 15 in ur­ban. But in Kwazulu-Na­tal three of 19 dis­tricts meet the norm 50 per­cent to 75 per­cent of the time, and only one dis­trict 75 per­cent to 100 per­cent of the time.

In the East­ern Cape six of 14 dis­tricts met it 50 per­cent to 75 per­cent and none 75 per­cent to 100 per­cent. In Mpumalanga all five dis­tricts met the norm 0 per­cent to 25 per­cent of the time, the worst in the coun­try. By con­trast, five of the 12 Western Cape dis­tricts meet the norm 50 per­cent to 75 per­cent and seven dis­tricts 75 per­cent to 100 per­cent of the time.

There are cur­rently 234 ob­stet­rics am­bu­lances in the coun­try. There is a need for more am­bu­lances in th­ese prov­inces – but the re­sources are not there to buy them.

A fail­ure to ad­dress the most ba­sic of health needs can lead to the most vi­o­lent suf­fer­ing of women. The gov­ern­ment should take heed.

‘We see women be­ing

● Dr James, MP and Dr Volmink MP are DA spokesman and deputy spokesman on health, re­spec­tively.

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