Tuesday 26 November 2013

The Swan Song to the Month Long
by Ashley Brooks


I bloody finished it!

Well the four weeks of no hot food came to an end with a Buccsy Barefooted Bang! A massive Halloween party at Barefoot Cafe on Friday and a wonderful fish braai at Buccaneers Backpackers on Saturday, both of whom contributed so much to helping the cause. Thanks guys. Including the fundraisers and sponsorship we raised a massive R12, 000. That’s about £800 for you folks in the UK. And that’s definitely going to keep the feeding scheme at Chintsa East Primary running for a fair few months. Thanks to all those who donated and supported... well done to you all.
Not eating hot food was a pretty tough challenge for a slightly podgy ninety hmm kg Welshman with a taste for steak and chips, but hell I’m glad I did it. I have really come to realize how incredibly lucky I am. More than anything, doing the fast got me reading about food insecurity, wealth gaps and poverty within South Africa. What I found shocked and saddened me. Yet there is also cause for hope and celebration. Let’s take a look at the data!

Who is really hungry then?

The 2013 SANHANES-1[i] study found that over 50% of South Africans are food insecure. That is, around 26% are food insecure and a further 27% are currently hungry. These figures are based on the Global Hunger Index which incorporates energy intake, child morbidity and child undernourishment. Of all the provinces of South Africa, the Eastern Cape was the area worst affected by this depressing reality.

Hungry bellies make for wandering minds

A huge number of studies worldwide have shown that there is a direct link between learning and hunger. To name but a few; a study by the Centre for Research on the Wider Benefits of Learning in 2006[ii] showed that “Children with nutritional deficiencies are particularly susceptible to the
moment-to-moment metabolic changes that impact upon cognitive ability and performance of the brain”; A 2006 World Food Programme study concludes that at school age “…vitamin and mineral deficiencies may limit future capacity to learn … [h]unger also reduces opportunities to learn while in school by leading to low enrolment, attendance and retention (i.e. limited access) as well as to poor attention spans (i.e. inability to fully utilize the opportunity).” These results are repeated in study after study and should therefore guide our thinking in terms of how education can be of most benefit to a child. The lack of attention span of students was a result noticed on the ground by Mike and Jo Ford here in Chintsa and they subsequently started the feeding scheme in order to counter such negative results of food insecurity and hunger.



“So why are the kids of South Africa hungry?” I hear you ask

And so you should! In a country of enormous wealth, in fact, a country that has a GDP that makes up over one quarter of the GDP for the whole African continent, it shouldn’t be a question we ought to have to ask at all! South Africa is recognised by the World Bank as an ‘upper-middle income’ country[iii];  yet a the Human Development Indices of 2008 by the United Nations Development Programme[iv] found over 50% of South Africans live on less than $2 a day; and worse, over half of those live on less than $1.25 (the international standard for extreme poverty). These statistics go a long way to explaining the lack of nutritional food for the average mainstream student. I do not wish to simplify; there are many other determining factors including educational attainment of parents, place of abode, employment of household and sex[v], all of which are statistically significant contributing factors. But we can’t ignore the elephant in the room: poverty is at the heart of food insecurity.

So Filthy Rich, So Bloody Poor

Since 1994 and the end of the apartheid system South Africa’s GDP has risen dramatically, but the distribution of the generated wealth has been far from equal[vi]. South Africa is now one of the most unequal countries on the planet. And whether we like to face up to it or not, the colour of our skin is still a good indicator of whether we fall into the extreme poverty bracket or not. Despite all the rhetoric to the contrary, the average black household earns on average 16% of the average white household[vii]. The poor, rural schools with which we worked have 100% black populations whose catchment area are poor rural black communities. Again, living in a rural area being another significant factor in the chances of falling below the poverty line.


Shame upside down spells hope the right way up

Many of the papers I have been reading compared South Africa with other much poorer countries in a negative light, emphasising, for example, the high educational attainment levels of children from much poorer Latin American countries in comparison to South Africa. In fact, most papers I came across were less than complimentary about the education, poverty and inequality realities of Africa’s richest nation.

But then I realised, I had been reading the papers upside down and back to front. Such shocking statistics shouldn’t be read with a sorry heart. Indeed, they should be read as a reason for hope! If much poorer nations can achieve better results in educational, poverty and equity terms, then why on earth can’t South Africa.  Well, such an answer is far beyond the remit of this blog and way beyond my capabilities, but it has planted in me the seed of hope and a desire to research more about where things are going well.



Thanks for the energy M & J

First person experience of some of these realities has helped me gain far more understanding than any academic paper ever could. And we too, here in Chintsa, have cause for hope and celebration. The feeding scheme is working. The energy levels in the classrooms and computer laboratories where we run our Wild Coast Schools Programme are fantastic. And for that we have to thank Mike and Jo Ford, the founders of the Friends of Chintsa Feeding Scheme. It is making a real difference to children who would otherwise lack the nutritional food required to benefit from the education, however unsatisfactory, than they would otherwise could.  


Blundering my way through the bush

Ok, so this is all a bit disjointed and if you’re hoping that I will at last bring it all together in a simple, well formulated and inspirational conclusion then please stop reading now; I do hate to disappoint. However, I hope that I’ve given you some food for thought. Whoever you wish to blame for lack of nutritional food, the children themselves should be free from your accusations and deserving of your support. They require your help, whatever it is you can give, be it a few pennies, a huge fundraiser, a month long sponsored fast or simply a quick and relatively painless ‘like’ of our Friends of Chintsa Facebook page. I thank you all for your help and time, and proudly pass the baton on to our last Nuremburg volunteers, Kat and Jana who are currently going without the hot stuff back in Germany! Keep u the good work both. Love and (deliciously warm) peas.   



[i] The South African National Health and Nutrition Examination Survey, 2013, HSRC Press Ltd.
[ii] Sorhaindo S. and Feinstein L. ‘Wider Benefits of Learning Research Report No.18’ 2006. IOE London
[v] A. Narayan and S. Mahajan ‘The State of Opportunities in South Africa: Inequality among Children and in the Labour Market’ Poverty Reduction and Equity Department World Bank Vol. 2, No. 1 2013
[vi] Tonheim M. and Matose F. “South Africa: social mobility for a few?” Norwegian Centre for Peace Building, 2013 Report
[vii] 2012 Transformation Audit: The Youth Dividend, Chapter 4: Poverty and Inequality P.71 2012

Tuesday 5 November 2013

EC coalition meeting with Parliament 6 November - Pt. 8 Chintsa For Better Health Care


Dear East Coast Friends

Things are moving on both the small and the big level.

Starting big – tomorrow the Eastern Cape Health Crisis Coalition will be addressing the Parliament Portfolio Committee of Health. The Committee had already called our Health minister and Dr Mbengashe (the new HOD of Health in our province) to come and report following the Death and Dying publication that was released by Section 27 on the day of the March. At that meeting one of the committee members actually called for the MEC to be fired. It is a slim chance that we are actually going to get rid of the MEC but getting parliament involved will help strengthen the Coalition’s cause and hopefully motivate Dr Mbengashe to address our concerns. The coalition now has over 20 member organisations, with the Keiskammahoek Trust being the most recent one to join.

And on a local level. We had given our resolutions for health care access in ward 6 to our ward councillor, who presented our case to Mr Mali, who carries the Portfolio of Health for the Great Kei Municipality. He has given our report to Mr Lusasa, the Buffalo City subdistrict manager and Counsellor Billie, from the regional District Health Council. The most urgent issues around ward 6 – particularly mobile clinics, the health post handover and ambulance access will be on the agenda of the next District Council Meeting on the 22nd of November 2013 and Mr Mali will represent us at that meeting. I have sent a summary of our issues for their agenda to Counsellor Billie. They will be discussing the handover of health services from Buffalo City Metro to Amahlati and I am therefore very pleased that the issue of Ward 6, and particularly Chintsa, will be covered at that meeting. The slow, bureaucratic process has begun….




Remember to spread the word about how to get in contact with the ECHCAC and stay informed about our work:

Facebook: www.facebook.com/EChealthcrisis (please like the page!)
Website www.echealthcrisis.org (please sign the memorandum!)
Phone: Kwazi Mbatha: 0780599309 or Anele Yawa: 073 555 8849 

Madeleine Muller
RuDASA National Secretary
    
Rural Doctors Association of Southern Africa
Inspiring others to Rural Health
Tel: 0741028137

Catch up on all the health crisis stories in the posts below!

Thursday 24 October 2013

ECHCAC press statement: Request for meeting following non-response from MEC Sicelo Gqobana (Pt. 7 Chintsa For Better Health)



Report by Dr. Madeleine Muller:

       As you all remember we marched to the MEC offices on the 13th of September to hand over a memorandum to the MEC of Health. It was received by Dr Mbengashe, the SG and HOD of Health. In the memorandum we asked for a plan on fixing the Eastern Cape by 11 October.


The Coalition then met on the 14th of October, by which time we had no reply and I include the press statement below on the 15th expressing our disappointment. 


We were therefore very pleased when a reply was finally sent on Friday, the 18th of October. It does mention all the points in our memorandum but is unfortunately a fairly weak document with general promises with no timelines or specific plans of actions (e.g. they will fight corruption). We are currently interrogating this plan in detail and the coalition will respond to it.



What is amazing is that a first step of a conversation has opened up. The Health department is making commitments to improve care and we will continue to advocate for specific plans and timelines, which we will then monitor.



The most phenomenal experience for me out of these last 4 weeks are the many organisations that have joined the coalition and the amazing rise of civil society we have seen. Who know what might be possible!

 Remember to spread the word about how to get in contact with the ECHCAC and stay informed about our work:

Facebook: www.facebook.com/EChealthcrisis (please like the page!)
Website www.echealthcrisis.org (please sign the memorandum!)
Phone: Kwazi Mbatha: 0780599309 or Anele Yawa: 073 555 8849 



____________
EASTERN CAPE HEALTH CRISIS ACTION COALITION

15 October 2013

ECHCAC press statement: Request for a meeting with Premier, Provincial Government and the ANC following non-response from MEC Sicelo Gqobana

EAST LONDON - The Eastern Cape Health Crisis Action Coalition (ECHCAC) resolved at a meeting yesterday to immediately write to the ANC, the Eastern Cape standing committee on health and the Premier regarding Health MEC Sicelo Gqobana’s continued failure to respond to the memorandum we presented to his office on 13 September 2013.

We will request a meeting with these parties by the end of this month and will thereafter consider our options.

The health crisis in the Eastern Cape requires not only urgent action, but also the development of a recovery plan to make systemic changes to fix the healthcare system in the Eastern Cape, large parts of which are in a state of crisis and collapse.

The publication of a special investigative report by the Treatment Action Campaign and SECTION27, “Death and Dying in the Eastern Cape” did prompt a response by the national health minister. His response did not include a recovery plan, but did attempt to deal with some of the immediate crises identified in the report.

Whilst applauding the response of the Minister, in which he accepted that the Eastern Cape healthcare system is in a state of crisis, our members report that there been little real change on the ground. Unfortunately we have received a number of reports that other than at Holy Cross Hospital the promised equipment has not yet arrived at most of the institutions where the situation is equally desperate. Promised blood pressure machines, wheelchairs and other equipment has not reached many of the facilities. In fact, there are reports of a deepening crisis. We have also received some reports that health workers are less keen to report challenges following threats of victimization and the attention generated by the report.

ECHCAC’s demands were set in a memorandum accepted on behalf of the MEC by Thobile Mbengashe, the Head of Department for Health in the Eastern Cape, at a march in Bhisho on September 13.

However, a deadline to respond by October 11 has been ignored by the MEC and his officials.

We note media reports in which the MEC’s spokesperson Sizwe Kupelo is quoted as stating that the provincial department of health feels that Minister Motsoaledi's previous press conference qualifies as a plan and fills the conditions of the memorandum. Kupelo reportedly told a journalist that the national minister has already responded by tabling his plans to address the concerns raised.

Yesterday’s meeting was attended by a wide range of ECHCAC’s ever-growing organisational membership including the Treatment Action Campaign, Democratic Nursing Organisation of SA, Rural Rehab SA, Rural Health Advocacy Project, Keiskamma Trust, Democracy From Below, Budget and Expenditure Monitoring Forum, SECTION27, Public Service Accountability Monitor, Community Health Workers Chalumna, Black Sash, South African Medical Association, the Federation of Unions of SA, Rural Doctors’ Association of SA and the Methodist Church of South Africa.

ECHCAC is inspired by the continuously increasing unity amongst a broad spectrum of civil society and call upon religious leaders, social movements, NGOs, healthcare professionals and members of civil society to join our campaign to work with the government to fix the healthcare system in the Eastern Cape. The purpose and principles of this campaign were agreed and are set out in a separate document.

We are particularly encouraged by the increased flow of information from healthcare professionals working in the Eastern Cape and the groundswell of support for ECHCAC at the community level. We encourage healthcare professionals and users of the system to speak out to assist us in our effort to ensure that the people of the Eastern Cape have access to quality healthcare as is promised by the Constitution.



ECHCAC will now urgently write to and request meetings prior to the end of October with:
* The Premier of the Eastern Cape Mrs Noxolo Kieviet;
* The Standing Committee on Health in the Eastern Cape;
* The Eastern Cape leadership of the African National Congress.

ECHCAC also condemns any intimidation or victimisation of healthcare professionals who speak out and call upon the MEC for the Health and the National Minister of Health to make clear public statements to this effect.

Unless the above meetings lead to agreement that there is a need for a comprehensive recovery plan, combined with actions to fix life threatening problems, ECHCAC will organise further demonstrations, mobilisation and protest within the Eastern Cape and throughout the country.

If we do not begin to see urgent action and a movement towards systemic change in the Eastern Cape public healthcare system it was resolved to explore the option of taking legal action. In the run up to the 2014 Elections, we call upon the Eastern Cape government to take seriously people’s demands for their constitutional right to have access to healthcare met.

_____________


The ECHCAC is a coalition of organisations and individuals primarily from the Eastern Cape dedicated to fixing the healthcare system and ensuring the realisation of the constitutional right to health in the Province, and includes:


Visit the ECHCAC website  and sign the memorandum at: http://echealthcrisis.org/

Contact: 
Kwazi Mbatha: 078 059 9309 / ECHealthCrisis@rhap.org.za 

Anele Yawa: 073 555 8849

Sunday 6 October 2013

Eastern Cape Health Crisis Action Coalition Update: Volume 1, 4 October 2013 (Pt. 6 Chintsa For Better Health Care)

This is the first in a series of updates from the Eastern Cape  Health Crisis Action Coalition (ECHCAC), a Coalition of organisations and individuals dedicated to fixing the healthcare system and ensuring that the constitutional right to health is fulfilled in the Eastern Cape. Please contact us through the means provided below to get involved.

Email: echealthcrisis@rhap.org.za Web: www.echealthcrisis.org
Facebook: www.facebook.com/EChealthcrisis
Phone: Kwazi Mbatha: 078 059 9309 or Anele Yawa: 073 555 8849


CONTENTS:

INTRODUCTION
Part 1: OR TAMBO HEALTH DISTRICT
Part 2: HOLY CROSS HOSPITAL, FLAGSTAFF
Part 3: THE EASTERN CAPE IN GENERAL

_______________________-

INTRODUCTION

On 19 September 2013, the Minister of Health, Dr Aaron Motsoaledi, held a press conference in response    to pressure from the Eastern Cape Health Crisis Action Coalition (ECHCAC) and the release of   a report on the Eastern Cape health system. He made several commitments to fix the health system in the  Eastern Cape. This document summarises his commitments and is part of the ECHCAC’s effort to  monitor implementation of them. We encourage people to contact us to report evidence of implementation or its absence. It is up to communities, patients using  the health system, and civil society to ensure that government delivers on its commitments. Report evidence of:
• New equipment
• Improved  access to medication and supplies
• Improvements to infrastructure
• New appointments
• Other evidence of implementation

This document also points out some of the gaps in the commitments  made and highlights the need for further attention from the MEC for Health in the Eastern  Cape, Sicelo Gqobana, and the Minister.

Report problems not addressed through the Minister’s commitments including:
• Human resources problems, in particular in relation to recruitment and retention of health care providers in rural and remote areas
• Problems outside of  the OR Tambo District
• Facilities in particular need
• Medicine and medical supplies availability             
__________________________


1. OR TAMBO HEALTH DISTRICT

The Minister acknowledged that there are deep problems in the OR Tambo District; in particular he noted:    the state of buildings, electricity supply, water supply and overall space availability is lacking in health facilities. This is what he reported:

1. Eight clinics need to be demolished and rebuilt from scratch. Five will be built in this financial year with contractors on site by January 2014 and the contract period will be eight months. We are liaising with the Department to identify which clinics these are.

2. Bambisana and Zithulele hospitals need to be entirely rebuilt. Contractors will be on site in May  2014 and June 2014 respectively and the duration of the work will be 36 months (3 years). The appointmentof service providers will be finalized by December 2013 (Bambisana) and January 2014 (Zithulele).

3. St Barnabas Hospital’s psychiatric wing will undergo major refurbishment.

4. 30 clinics do not have enough space in terms of the number of patients they are treating. We are liaising with the Department to identify which clinics these are.

5. There are varying problems of water and electricity in clinics.

6. There is an urgent need for additional space for doctors’ consulting rooms, patient waiting rooms and  toilets. To address this, the national Department of Health will erect park homes with a 20 year lifespan that  have been designed for the environment – they are cheaper than building, are cooler thereby reducing the  need for air conditioning. Four have been erected with the balance completed by early next year. We are  liaising with the Department to identify how many of these there will be and where. They should:
a. Be  connected to water – municipal or a borehole.
b. Have electricity, whether by connection to an electricity  grid or by a generator.
c. Be connected to the sewerage system or a septic tank. Please report if  you know  of these units and if they have all of these features.

7. Two nursing colleges, Butterworth and Madzine-­‐Ka-­‐Zulu will be refurbished with the contractor on site   by October 2013 and completion by March 2014. Please report if the contractors are seen on site.

8. All hospitals in the District will receive the equipment listed as being provided to Holy Cross Hospital below.

9. The costing of the OR Tambo infrastructure work is a priority and will be completed by the end of this year.

________________________________

2. HOLY CROSS HOSPITAL, FLAGSTAFF

A ministerial task team visited Holy Cross Hospital and interviewed five nurses and midwives and inspected  the maternity wards. This is what they found:
-­‐ Most nurses have been working at the hospital for over 10 years
-­‐ In maternity there were eight advanced midwives (one working as an area manager), nine midwives, five  enrolled nurses and three enrolled nursing assistants.
-­‐ There was no basic equipment for use for patient care
-­‐ There was no blood pressure machine supplied by the Province (nurses contributed from their own  pockets and brought a BP machine)
-­‐ No fetal heart monitors (three midwives had their own feto scopes)
-­‐ Few thermometers
-­‐ No glucometer
-­‐ No baby warmers on the resuscitators with babies being resuscitated in cold rooms
-­‐ A lot of linen, green towels, gowns and sheets were used to cover chairs in the ward
-­‐ Most nurses interviewed said they tried their best, but there was no team work
-­‐ All admitted that there were some practices by some colleagues that may contribute to sub-­‐optimal care
-­‐ They are aware of some instances where charting of vital evidence, medicines and the patrogram are  recorded even though not executed
-­‐ Most deliveries (births) have records done after delivery
-­‐ All nurses interviewed agreed that staff attitude towards patients, relatives and among themselves is not acceptable
-­‐ Nurses feel there is generally no leadership and no guidance
-­‐ everyone does as they like
-­‐ There are nurses who are dedicated, but are discouraged by the actions of others
-­‐ The facility lacks quality leadership and management
-­‐ Holy Cross was part of the Hospital Revitalisation Programme and R105-­‐million was spent on  refurbishing it and completed by January 2012
-­‐ There is no record of meetings, in-­‐service education, meetings to discuss mortality rate
-­‐ Nurses and midwives were not made aware of crucial policies, guidelines and targets.
-­‐ Folders that could be purchased for R3 000 were purchased for R30 000.

This is what the Minister has committed to:
-­‐ The Hospital CEO will be suspended with immediate effect pending a full investigation into her role in  respect of serious dereliction of duty, mismanagement and harm to patient care;
-­‐ The Nursing Services Manager will be suspended with immediate effect pending a full investigation into  her role in respect of serious  dereliction of duty, mismanagement and harm to patient care;
-­‐ Progressive disciplinary measures will be instituted against the Hospital Administrator;
-­‐ The CEO and Nursing Services Manager will be reported to the SA Nursing Council for breach of  professional ethics;
-­‐ An urgent forensic audit will be done into the purchase of the hospital files;
-­‐ A massive amount of equipment has been purchased by the national health department including:
o 20 Baumanometers
o 10 Neonatal Ambubags
o 10 Paediatric Ambubags
o 10 Adult Ambubags
o 10 Pulse Oxymeters
o 2 Electric POP Saw
o 8 Infusion Pumps
o 5 patient body warmers
o 2 Vacuum extractors
o 5 000 disposable thermometers
o 10 suction machines
o 5 glucometers
o 10 Foetoscopes
o 5 ENT sets
o Laryngoscopes
o Gloves
o syringes and needles.

This equipment should have been delivered to the hospital by now. The same  equipment is to be provided to  the other 12 District Hospitals, 2 Regional Hospitals and 3 Specialist Hospitals in the OR Tambo District.

Please report evidence of this equipment! If there is other equipment that is urgently required, or if the equipment delivered is not required, please report this.

___________________________

3. THE EASTERN CAPE IN GENERAL

The Minister’s commitments relate mostly to the OR Tambo District. In the other districts, the national       Department is working with the Province on implementing 287 projects covering new additions, upgrade,     renovation and maintenance work in 132 facilities. A total of 159 of these projects are in the construction   phase while the rest are being developed. They cover 106 primary health care facilities, eight nursing colleges  and hospitals. A total of R1.045-­‐billion is budgeted for this work up to the end of the financial     year. We are liaising with the Department to obtain more specific information. In addition, the Minister also   committed to:

Equipment
According to the Minister they have information revealing that as of August 2013 the province had a backlog  of 2 581 wheelchairs and other “assistive” devices such as hearing aids (703), prosthesis (707) and  cochlear implants (2). These will cost R15.3-­‐million and will be purchased by the national health     department and dispatched in “the next coming weeks”. Please report evidence of this equipment.

Ambulances
Most of the Eastern Cape has a shortage of ambulances and poor roads in the OR Tambo makes matters  even worse. 100 ambulances  have been ordered. The minster said the province has agreed to send 26 to  OR Tambo as soon as the conversions are completed. No deadline was given. Please report evidence of  these new ambulances.

Drug supply
The national Deputy Director of General Hospital Services and Human Resources has been tasked to ensure  implementation of a “Development Accord” intended to ensure a reliable supply of medication and  equipment to facilities. The provincial department identified 16 hospitals that would benefit from this  Development Accord. Committees will be established in regard to various aspects of the plan.

No deadline was given for the implementation of the Accord in the Eastern Cape, but the Minster said the    DDG would follow up and committees would be formed by the end of September. We will liaise further with the Department on details. Please report evidence of implementation.

In regard to stockouts generally, also report to the Stop Stockouts Project at: Tel: 084 855 STOP Fax: 011 728 1251 Email: report@stockouts.org

Procurement reform
Earlier this year the Minster of Finance established the Office of the Chief Procurement Officer. A       Procurement Transformation Initiative (PTI) has been established to develop procurement operations end to  end. In agreement with the Minister of Finance, this PTI will be urgently implemented in the Eastern Cape.     The Minister said he envisaged that the teams would be dispatched “very soon” to start with the implementation process. A memorandum of understanding has been signed between the Chief Procurement Officer in National Treasury and the Director General of the Department of Health to facilitate the procurement reform in among others the Eastern Cape.

Management 
A new Head ofDepartment has been appointed. The Eastern Cape now has a Chief Financial Officer and a  permanent Deputy Director General for Human Resources. The Minister has spoken to the new HOD to  prioritise the appointment in the directorate of Pharmaceutical Services. The Minister reported that the       Province has delayed the appointment of hospital CEOs. However, advertisements for a number of new CEO positions in a number of hospitals are being placed in the media.

Please report evidence of these appointments.

Contact ECHCAC via Facebook, our website www.echealthcrisis.org,
Kwazi Mbatha: 0780599309 or Anele Yawa: 073 555 8849, echealthcrisis@rhap.org.za

Remember to always also report stockouts and shortages of medication to the Stop Stockouts Project at: Tel:  084 855 STOP Fax: 011 728 1251
Email: report@stockouts.org

Email:  echealthcrisis@rhap.org.za Web: www.echealthcrisis.org 
Facebook: www.facebook.com/EChealthcrisis
Phone: Kwazi Mbatha: 078 059 9309 or Anele Yawa: 073 555 8849