The young doctor sweats in the barren parking lot of Zithulele Hospital, in Oliver Tambo District in South Africa’s Eastern Cape province. But it’s not just a searing midday sun that’s responsible for the rivulets of perspiration running down his cheeks.
Dr. Thembinkosi Motlhabane is waiting anxiously for an ambulance to rush one of his critically ill HIV-infected patients to a bigger medical facility in Mthatha, a city more than 60 miles away. The doctor’s worried that the man’s body is collapsing.
Zithulele, an isolated rural hospital in one of the poorest parts of South Africa, doesn’t have an intensive care unit to provide the patient with the urgent attention he needs to stay alive. It doesn’t even have an ambulance.
“You are faced with someone who is dying, and you know that if he’s transported somewhere with better facilities, he’ll be saved,” said Motlhabane. “But the ambulance has to come all the way from Mthatha. If it’s still busy with another hospital then you have to wait…sometimes 12 hours. Sometimes it doesn’t even come.”
His colleague, Dr. Liz Gatley, said it often takes days for an ambulance to collect seriously ill patients. “Then, when the ambulance comes, it rarely has paramedics, because there’s a huge shortage of paramedics here,” she said.
Because of circumstances like these, people whose lives should have been saved sometimes die, acknowledged Ben Gaunt, the hospital’s head doctor.
Yet Zithulele isn’t one of South Africa’s typically dilapidated and severely under-funded public health facilities. It was recently almost completely refurbished. It has a full staff complement. Its health workers are leaders in the field of rural medicine.
But it’s also plagued by some of the same crises that have led international healthcare monitoring groups to consistently rate South Africa’s public health sector among the worst in the world. This, despite the fact that the government gives more than 100 billion rand ($13.3 billion) every year to state health – one of the biggest expenditures on such services in the developing world.
“It’s the poor who live far from the cities who are dying. The wealthier people can afford good private healthcare,” said Ncedisa Paul, a local community health worker.
Eighty percent of South Africa’s population of about 50 million people depends on public healthcare.
Gatley, provincial winner of South Africa’s Rural Doctor of the Year 2011 award, said the crisis is particularly evident in countryside regions like Oliver Tambo District.
“(Our) patients struggle to access care, so they often only get to us when they are very, very sick,” she pointed out. “I know it sounds like a silly thing to say but when doctors who come from other parts of the country come here, they comment to us on how sick our patients really are.”
Laura Grobicki is a South African physiotherapist who recently returned to her home country to work in rural health after working in Australia for several years. “What shocked me when I came back was the high rate of HIV. Most of the patients I see are infected. Most of my colleagues in Australia have never seen a patient with HIV,” she said.
Grobicki attributed the “sad state” of public healthcare in South Africa largely to HIV. “That’s putting a huge drain on our system, because of the total number of patients and how sick they are,” she said.
South Africa has more HIV-infected people than any other country – an estimated 5.5 million people. The state is providing life-saving antiretroviral (ARV) treatment to more than a million of them. But many more aren’t getting the medicine they need to boost their weak immune systems. So they’re becoming extremely ill with infectious diseases.
“This, together with all the resources needed to roll out ARVs, is a massive burden for any country, let alone a developing country, to bear,” said Gaunt.
Tuberculosis rates are also “through the roof” in rural South Africa, said Gatley, especially because the disease is fueled by HIV. People with weaker immune systems are much more susceptible to TB.
According to the World Health Organization, South Africa accounts for about 24 percent of global HIV/TB cases. Studies show that six out of every 10 people with TB in the country are also infected with HIV.
Thembeka Gaushe, a senior nurse in Zithulele Hospital’s TB section, said overcrowding is a major driver of the sickness in South Africa’s rural regions.
“People in these areas are very poor and so they are forced to all live together in a single hut. TB is an airborne disease, so it spreads very easily in crowded conditions,” she explained.