Discrimination, xenophobia and disregard of patients’ rights found in North West health system

Damning discrimination, xenophobia and a total disregard of patients’ constitutional rights were highlighted at the North West Ritshidze “State of Health” report back meeting held at the end of June.

Foreign nationals — documented and undocumented — as well as transgender people were among those who retold personal stories at the meeting. They told of their hurt, frustration and anger because of mistreatment at their clinics at the hands of nurses, even cleaning staff and security guards. They are seen as somehow different, inferior or as community outsiders by some nurses.

It’s another black mark for the province’s clinics that for years already have been in a state of crisis. The province’s health department remains under administration.

Poorly functioning clinics are at the heart of why people stop taking their ARV treatment and why the UNAIDS’ 95-95-95 target that initiative that aims for 95% of people living with HIV know their HIV status; 95% of people who know their status to be on treatment; and 95% of people on treatment to have suppressed viral loads remains still an unrealised goal.

This emerging problem of deepening discrimination adds to the healthcare crisis gripping the province. Ritshidze’s latest report found that 56 facilities suffered stockouts of key medicines. A total of 895 medicines were not available at these clinics in May 2021.

At the report back meeting held in Mahikeng, community members were also told that organisations representing people living with HIV had in the past months met with government and global funders in a hope to address this problem by closing staff vacancies gaps, particularly around a lack of pharmacists and pharmacy assistants at clinics.

Severe understaffing has made the management of huge patient loads that much more of a challenge. Of 14 regularly monitored sites, a full 100% of Facility Managers said in the last quarter that they had understaffing issues at their facilities. And it’s patients who bear the brunt. One woman whose recorded personal story was shown at the meeting, said that her initial three-months supply in June last year soon became a one-month supply and then she was told to buy her own medicines when the clinic ran out. But she’s unemployed and doesn’t have the money.

“Sometimes I want to stop taking my pills because you go to the clinic, you stand the whole day and then you go home with nothing,” she said.

Ritshidze’s Community Monitors have heard repeated stories complaining about long queues, long waiting times and bad attitudes of nurses and clinic staff. It’s a vicious cycle that impacts on the quality of care and drives up the unacceptable behaviour like discriminatory and bullying practices targeting foreign nationals, transgender people, others from the LGBTQIA+ community and sex workers.

Patients who spoke at the Mahikeng also pointed out that nurses who do have jobs at facilities routinely slack off and are neglecting their professional duties.

One woman told the meeting: “Even when they take blood from me, they never give me my results.”

She added: “Is it possible that nurses start work at 9am and then they go for tea break at 10am? And when they leave they all go together to the tearoom while we patients wait. And then it’s their time for lunch so they go.

“Our files also go missing, every time we are told they can’t find our files and they won’t help you if you don’t have a file”.

For a trans woman who addressed the gathering she said not only has been difficult to access hormone treatment in the province, meaning she has to travel to Gauteng to get these services, but the real challenge is having to deal with insensitive nurses who have no respect for patients’ privacy or dignity.  

“I have to explain what transgender is — explain myself and my sexuality, it’s exhausting. I sometimes hide that I’m a transgender because I can get away with it because I look like a woman,” she said, adding that many others would not have the same luxury.

She said in the past nurses have made her something of a show, a spectacle. “One time when I asked for lubricants the nurse asked me why I need it and I had to say it’s for one, two three and then she called other nurses to come and listen like this is something new,” she said of being treated with no respect for her confidentiality.

Many of the patients who spoke and were recorded for the report back presentation ask for their identities to be protected. They say it’s because they’re fearful of being victimised – “they can even inject you, can kill, we are scared for our lives” one person said. It’s highlights a breakdown of trust for public healthcare at many clinics in the province.  

Speaking in Portuguese, a woman at the meeting said she wanted to speak out on behalf her sister who is living with HIV and on treatment for diabetes. She said that her sister’s legs became swollen some weeks back and it caused her to be hospitalised. When she arrived at the hospital she was horrified to find her sister had been tied with ropes to the bed.

“Because I couldn’t speak the language I couldn’t even complain, I just untied the ropes and took my sister home,” she said, her voice breaking from the emotional burden.

She returned to the clinics for the regular collection and check-ups for her sister. But she said nursing staff didn’t even want to give her sister a proper consultation.

“They just give you the medicine and say ‘go’; they didn’t want to touch her, or help and even now the swelling has not gone down. My sister is not getting better and all I get is shouting that I’m not taking good care of my sister,” the woman said.

Another Angolan national who spoke out said they those who are not South Africa are “being treated unequal”. She said that nurses speak about patients’ behind their backs, shout at them and treat them rudely.

“They will call us  “kwere kwere” — we are Africans we have come here with our government, they don’t have to call us this; we are facing challenges, really we are,” she said.

The North West “State of Health” report sets out the data and findings from the clinics and it also includes recommendations that are focused on locally appropriate interventions that address on-the-ground realities that many patients face.

However, these findings need to be acted on, said Anele Yawa, General Secretary of the Treatment Action Campaign (TAC), who chaired the meeting. TAC is one of the Ritshidze partners.  

Yawa slammed the provincial health department for “not coming to the party”. At the North West meeting, officials from the North West Department of Health joined the meeting online but were then unavailable to give any significant or comprehensive response about plans of action or implementation strategies or timeframes.

Two officials who spoke only said they noted comments and recommendations and would look into it and pass on Ritshidze’s report.

It’s the kind of lukewarm interaction that Yawa said is no longer acceptable. “We want to see leadership in a province that is still under administration. It must come from the Deputy President who is the Chairperson of the South African National AIDS Council (SANAC), through to the Premier, the MECs and HODs,” he said.  

Yawa also reiterated that the rights of all patients are enshrined in the Constitution regardless of the passport they hold, or their sexual orientation.

“From Cape to Cairo we are Africans, we will fight against these evils of discrimination and if the authorities will not fight for you, we will fight and even take this to the courts. We are with you, nobody must be left out,” he said.

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“Ritshidze” — meaning “Saving Our Lives” in TshiVenda — has been developed by people living with HIV and activists to hold the South African government and aid agencies accountable to improve overall HIV and TB service delivery.

Partner organisations include the Treatment Action Campaign (TAC), the National Association of People Living with HIV (NAPWA), Positive Action Campaign, Positive Women’s Network (PWN) and the South African Network of Religious Leaders Living with and affected by HIV/AIDS (SANERELA+)—in alliance with Health Global Access Project (Health GAP), the Foundation for AIDS Research (amfAR), and Georgetown University’s O’Neill Institute for National and Global Health Law.

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