In-depth: TB - the year that was

SOUTH AFRICA: Strike sends XDR-TB patients home

Photo: David Gough/IRIN
Many patients are having to fend for themselves
DURBAN, 3 September 2010 (PlusNews) - Striking public health workers in South Africa have virtually shut down King George V Hospital, a referral facility in the port city of Durban, KwaZulu-Natal Province, which specializes in caring for and isolating patients with multidrug-resistant (MDR) and extremely drug-resistant (XDR)-TB.

A senior doctor, who spoke on condition of anonymity, said only 32 adult patients and five children were left in the 192-bed hospital; the others had been sent home during the first few days of the strike, which started on 18 August.

"Some of these people were very sickly; we don't know whether they will make it back here. Some of them were told to come for their daily doses of medication and injections but most don't even bother, and there is no way of tracing them because of the strike," the doctor said. Even brief interruptions in treatment for both TB and HIV can lead to the development of further drug resistance.

"We only have a skeleton staff manning the hospital - we even had to let some people with XDR[-TB] go home," the doctor noted. "There is a great chance that they will infect their families and other community members." Dozens of patients due to start double therapy for MDR-TB and HIV will have to wait until the strike ends.

Bheki Mthiyane, 38, from rural Osindisweni, about 150 km north of Durban, has been at the hospital for the past two months receiving treatment for MDR-TB, but the last two weeks have been the most distressing.

"So far the strike has been nothing but hell to us," he said. "There are very few nurses who come and check us. I wish the strike was over because many of us remaining will die because there is no care."

''We had to let some people with XDR[-TB] go home. There is a great chance that they will infect their families and other community members''
Patients like Mthiyane will continue to suffer as wage negotiations appear to be deadlocked: the unions have rejected government's latest offer of a 7.5 percent wage increase and a R800 (US$110) housing allowance, and say they will go on striking until their demands for an 8.6 percent increase and a R1,000 ($138) housing allowance are met.

Mary Cele*, one of the few nurses at the hospital who did not join the strike, said the lives of non-striking workers were in danger. Last week, cars belonging to non-striking staff were vandalized, and they were also being threatened.

"There is no going back now, because the strikers know us and they have told us that we will reap what we sow. The sad part is to see patients suffering because the government and unions cannot agree," Cele said.

"The patients who remain at the hospital are really suffering - we can only do so much. We cannot cater for each and every patient; we only prioritize those who are very critical. Those who can walk and do things on their own are encouraged to do so."

Hospital spokesperson Thami Chizama said the hospital management had taken over many essential tasks since the start of the strike. "We are doing as much as we can but ... there are just not that many of us."

Local members of the National Education, Health and Allied Worker's Union (NEHAWU) have picketed the main gates of the hospital every day, throwing insults at non-striking nurses, but allowing patients through to collect their medication.

"We will kill all the rats who go behind our backs and work," said one striking nurse while her co-strikers cheered, closely watched by heavily armed security guards and members of the South African Police Service. "They are struggling just like us but they are selling us to the employer."

A NEHAWU shop steward at the hospital, Bongani Xulu, told IRIN/PlusNews that the strikers had closed down many hospital departments, including the intensive care unit, operating theatre, and many wards.

Read more
Survivor's guide for non-striking health workers
Strike jeopardizes HIV treatment
Turning the tide against drug-resistant TB
Prison-like hospitals for drug-resistant TB patients
"We know that people are sick and they need their medications, but we have no choice because the employer is willing to sacrifice the lives of the sick by not giving in to our demands [for] a living wage," he said.

Phineas Mthembu, an MDR-TB patient who had come to the hospital to fetch his medicine, said patients were divided on whether to support government or the striking workers. "We hear so many things; it would be better if these people just sort out their problems and leave us alone so that we can continue our treatment," he said.

At the hospital gates, three women negotiated with the striking workers to let them inside so they could bathe their sister, an XDR-TB patient. "We found her in a sorry state," one of the women said later. "We are not sure whether she will make it through if there is no one to take care of her here in hospital."

*Not her real name



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