The paradox of improving healthcare and unabated social violence

It was 20:00 in Ndwedwe, KwaZulu-Natal. A 74-year old gogo is nauseous. She collapses twice. In fact, she has been seriously ill since noon but as rural people often do, those around her relaxed, believing it would pass, although the gogo was clearly deteriorating.

Many people in such communities die due to general apathy about health emergencies. Often they say ‘uzoba right, mushayiseni ngomoya nim’phuzise amanzi’ (she will be alright, give her fresh air and water). Others would say ‘we can’t call the ambulance because even if it comes it would be too late and the person will be dead’. After all, emergency medical services (EMS) are a post-apartheid phenomenon in rural South Africa.

The emergency services were eventually called and arrived within 15 minutes – a significant milestone for this deep rural area in the north of Durban. I got there a few minutes later whilst gogo was being wheeled into the ambulance. The whole ordeal coincided with my quarterly visit to the land of my ancestors.

Two friendly young paramedics were attendance. They had stabilised the old lady and told her she was looking younger and healthier. She didn’t believe them but nodded in appeasement. They took her to Osindisweni District Hospital 22 KMs away. I followed with her grandchildren.

We arrived just before ten o’clock at Osindisweni, nestled in sugarcane plantations between Verulem, Inanda and Ndwedwe. Two nurses, senior and trainee doctors in attendance. Two general assistants and a porter are also doing rounds in the hallways .Few senior citizens on wheel chairs and moving beds curiously look on as we fiddle with paperwork.

The cleaning lady was polishing the floors so well you’ll swear kuza abakhwenyana – a tongue and cheek reference to unusually thorough cleaning that takes place on the eve of lobola negotiators visiting the would-be bride’s homestead.

Stretch-beds and wheelchairs are visibly tired and need urgent fixing at this hospital. The volume of the television in the corridor is at full blast with security guards enjoying the funky music ear-popping decibels. No ailing person can rest in this noise.

One of the senior sisters in attendance is visibly irate. It can’t be overload, ‘there is no overload at all tonight’ – the cleaner tells me. The sister could just be tired. It’s been a stressful year especially in the trauma unit.

The young Indian doctor ‘treating gogo is cool. He speaks isiZulu fluently, which excites her very much’, exclaims my young acquaintance. So is the young general assistant, pleasant health worker she is. They are interested in both medical history and symptoms of the new patient. They perform various tests. Like the young paramedics,they reassure her she’ll be fine. They put her on treatment to reduce blood pressure and dehydration. To my surprise, she gives them her medical records explaining chronic medication she is taking. She has internalised this protocol from her previous visitations to public health facilities.

Whatever the procedure and circumstance, I can’t believe these people are so lax when it comes to using gloves even as they handle medical equipment – especially the axillary nurse. What happened to the rules about infection control? She just free-styled throughout the procedures she performed, with bare hands.

We had been there for about 2 hours as treatment is administered in a paint-hungry room. Tired and reassured by the doctor that she would be fine, we waited patiently for her to be admitted or discharged. Meanwhile the mind wondered towards a conclusion that, all things being equal, healthcare is improving in rural South Africa.

I make so bold an assertion because few years ago my other relative died here at Osindisweni, under similar circumstances. Nobody cared. It was just routine. The ambulance never came. The neighbour brought her here. Because she did not make it, most people in her neighbourhood became cynical of EMS and public healthcare facilities, the only service available to them. But on this chilly Friday night we are treated humanely, so did other patients.

As we warmed the cold benches of Osindisweni, waiting for gogo to complete her treatment, a middle aged woman came rushing with a teenager who had a steak knife stuck on his skull. Doctors rushed to help. It was clearly a rare case this one: wondering how they’ll remove this steak knife from the skull.

The woman shed no tear as she waited for the doctors to update her on the teenager’s condition. She then decided to volunteer the story to us. Her son was stabbed by the uncle. There was some argument in the household and he became violent toward his nephew.

Suddenly her voice changed and she declared: “I am going to revenge. I am going to kill my mother.” Another bench warmer enquired: “why kill your mother because it’s your brother who did this?”

She exclaimed: “I’ll kill her because it is her son who did this. Why did she give birth to such a cruel person who did this to my son..? If I kill her, my brother will come to the funeral. Then I catch him because tonight I know he’ll run to Inanda squatter camps and we won’t find him…”

Nauseate by this we take leave of the benches to wait in the car. We are visibly shaken by this experience. I have seen people die in political violence. I’ve seen the worst car accidents. But not this: a butcher knife stuck in the skull of a helpless teenager!

Not even the national health insurance will resolve this. Neither can the police. Yes the doctors and nurses were hard at work. Our patient had stabilised. So were few other oldies there. But now this emergency!

Clearly the health system can’t cope with such levels of violence in our society. On such occasions, overstretched health workers have to leave their stations to try and intervene in such anomalous situations.

This is the South African story, of post-colonial Africa, where a library is built, burnt and a march held to demand another. And you think colonialism and apartheid was some sick joke that can be erased in two decades. We are just too accustomed to violence that it’s the natural response to family feuds and other disagreements, as witnessed in this case. Dire Socio-economic conditions drive the rage we see in our communities and determine the health outcomes. They rob people of agency; hence they die of curable diseases.

Additional staff and health facilities are stopping the flow of blood, but only a new psyche is needed to stop the bloodshed. A multiple wounded society like ours requires a lot of social re engineering and economic liberation. It also requires that the ruling party be given an opportunity to advance some of its most progressive interventions especially those desires to promote inclusion and social cohesion.

If what I saw that night did not shock me because I grew up experiencing and perpetuating violence, why would I expect the health workers to care when their lived experience is that of dealing with the aftermath of violence every evening and especially on weekends? What makes them superwomen engineered to be immune from trauma of witnessing violence? Mind you: some of these health workers are parents and partners to people who may not really appreciate what is going on at work. And yet they are still expected to perform as wives and husbands, nurses and doctors. Better still: how do we change our culture and cleanse it of violent behaviour, the notion that we must stage a war to end all wars?

In the 4 hours I spent at that hospital, there were 9 emergencies – 4 of them injuries, 1 girl child with allergic reaction and the rest were aged women needing rehydration and oxygen. How does the health system cope under these circumstances? How many more ambulances are needed to service all these avoidable emergencies?

Few years ago Stats SA reported that after each Soweto Derby, the number of unnatural deaths increase either due to stabbing at taverns or through road accidents mainly involving j-walking pedestrians. A month after reading that report I lost my cousin just after the Soweto Derby. He was hit by a bus jubilating Pirates’ win over Kaiser Chiefs. This week Stats SA released another study on mortality which showing that fewer South Africans are dying and most importantly, even fewer are dying of curable diseases. Although such things as homicide remain high especially among back males (like this young person who came to the hospital), fewer people are dying of AIDS and more TB cases are successfully managed today. All of these are signs of an advancing healthcare system consistent with the priorities of the mandating party.

This is the South African story, the story of change and continuity, the tale of hope, rage, alcohol, apathy and activism, life and death. Gogo lives. She collects her grant and chronic medication monthly. She feels very much affirmed by Mandela’s children (as she refers to the healthcare workers who treat monthly). The stabbing victim most likely died and so the cycle of social violence continues.

This is a mixed narrative of improving healthcare in a violent society, the latter negating advancements in the former. The story continues.

>> Ngcaweni is editor of Liberation Diaries: Reflections on 20 Years of Democracy (Jacana Media). He works in The Presidency and write in his personal capacity.