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SOUTH AFRICA: The quiet after the storm

[This report does not necessarily reflect the views of the United Nations]

QUEENSTOWN, 4 August (PLUSNEWS) - Calm has returned to the Frontier hospital in Queenstown, in South Africa's Eastern Cape province, after at least 40 people were injured when police opened fire with rubber bullets and teargas during protests against the slow rollout of anti-AIDS drugs.

The action last month sparked outrage across the globe, with UNAIDS condemning the attacks and the South African Police Service subsequently issuing a public apology for the assaults.

But beneath the hype surrounding the demonstrations - organised by AIDS lobby group, the Treatment Action Campaign (TAC) - there has been very little focus on the reasons for the demonstrations: the slow pace of the antiretroviral (ARV) rollout at the regional hospital, which has been exacerbated by the rural nature of the Eastern Cape province.

GETTING THE FIGURES RIGHT

On the 5th floor of the tallest building in provincial capital, Bisho, a spokesman for the Eastern Cape health department, Sizwe Kupelo, attributed the Queenstown protests to a communication breakdown, and a case of TAC getting inaccurate figures.

According to a TAC statement issued after the march, about 2,000 people in the district were in need of the life-prolonging medication, but fewer than 200 were receiving it; less than 10 people had been put on treatment this year.

Shaking her head in disbelief, provincial HIV/AIDS director Nomalanga Makwedini wondered, "Where did they get these numbers from? This is simply not true."

She pointed to a document with the latest figures, which indicated that about 278 people, including 71 are children, were receiving anti-AIDS drugs. From January to June this year, the hospital had placed an average of 27 patients per month on treatment.

A further four sites in the district, with an estimated 200,000 people, have been accredited and should begin gradually providing ARVs this month, she noted.

The Frontier hospital's CEO, Lebohang Mosia, was at pains to point out that the hospital was not only dealing with its five feeder clinics and a population of 200,000, "we are also helping other smaller rural hospitals in our district and, in actual fact, are servicing a population of up to 600,000 people. This is not reflected in all these statistics".

The province's status as a "labour supplier" of migrants to other provinces was another factor to consider, as many people were now returning from larger cities, sick and often on the point of dying.

TAC district organiser Mziwethu Faku and treatment literacy trainer Masizole Gonyela, however, remained sceptical about the figures and are frustrated by the difficulty of accessing such information. While commending the hospital for the progress made, they believed the slow pace of the rollout was still a problem.

"What's the point of us mobilising and encouraging people to get tested and get help, when they are going to wait nine months [for treatment] and die?" Gonyela asked.

THE BIGGER PICTURE

But the staff at the hospital's ARV clinic feel that with the little they have, this is the best they can do.

Matron Zepe, the clinic coordinator, has had to "borrow" three professional nurses, two doctors and three counsellors from the hospital, and shares a pharmacist who also runs the hospital dispensary.

The ARV clinic, squeezed into a few rooms at the end of the hospital building, is hard to find. On a Friday morning the patients slowly trickle in and stand in the corridors, chatting while they wait to collect their files. All are reluctant to be interviewed; the hospital has been in all the papers lately - their names might be mentioned.

Dr Jaxa, one of the clinic's two doctors, is keen to set the record straight. "I wish people could come here for a week and see the work we do ... instead of the quantity of people, I wish they could see the quality of service we provide."

Jaxa runs her own surgery in the area and works at the clinic part-time; she admitted that there was room for improvement. "We need space to work, more staff and better laboratory services."

The biggest challenge was people seeking treatment at a late stage. Shrugging her shoulders, Jaxa blamed this on the stigma and denial that still surrounds HIV/AIDS, despite the extensive dissemination of information and community mobilisation to encourage people to use condoms and be tested for HIV.

"People know now that ARVs are there; they know what the drugs can do, but they still wait 'till they are very sick," she remarked.

Provincial HIV/AIDS director Makwedini admitted that providing ARVs in the largely rural province was never going to be easy.

The Eastern Cape has been identified as the province with the greatest shortages of health professionals and facilities relative to demand, and is struggling to address the widening gap. An estimated 8.3 percent of the population is HIV-positive, according to government statistics.

A slew of job vacancies for the province's ARV programme have been advertised in regional and national newspapers, but few doctors and qualified nursing staff want to work in the rural Eastern Cape.

Makwedini pointed out that it was almost impossible to attract professionals with families to rural areas, where there were few schools for their children and no entertainment facilities.

"They [TAC] are telling us to get more staff as if it's the easiest thing in the world. Where do we get these people from?" she asked.

Nevertheless, with about 6,840 people on ARVs, the province has managed to meet its target of putting 2,700 patients on treatment by early 2005.

"Our target for March 2006 is 15,000 people, but I don't know how we are going to do this if we don't have the [medical] people we need," Makwedini added.

AFTER THE STORM

Two weeks after the protests, TAC treatment literacy trainer Nompumelelo Kweza told PlusNews, "I'm still coughing from the teargas", while Faku could still feel the pain of the rubber bullets that struck his leg.

Both are HIV-positive and had put their antiretroviral medication in their backpacks on the day of the protests. "We were prepared to maybe go to jail, but not for being beaten up with no warning," said a still shaken Faku.

Although the "storm" of protests and the violence that erupted at the hospital had been unpleasant for everyone, Jaxa noted that some good had come out of it: the media focus on the healthcare facility meant that "we are finally being heard; people can see what we're doing".

The provincial health department has resolved to set up a monthly forum meeting involving community-based organisations, to discuss the progress of the rollout and how NGOs could assist patients on treatment. TAC has also been granted access to ARV sites and feeder clinics in the district.

"I'm not sure if anything positive has come out of it yet," Gonyela said. "Yes, we are supposed to have meeting and, more importantly, we have access to information - but we'll have to watch this space. But we're not going to sleep - if anything, those bullets gave us more energy."

[ENDS]