Scathing report highlights maternal deaths

2011-08-08 22:37

Johannesburg - One woman waited 1.5 hours at the hospital, only to see a nurse who yelled that she was "lying about being in labour".

Three hours later, her baby was stillborn. Another woman gave birth on the street, steps away from a clinic that twice turned her away, saying her time had not come.

South Africa's maternal mortality rate has quadrupled while most African countries have improved theirs, according to a scathing report released on Monday by the New York-based Human Rights Watch.

The report says some of the increase - to more than 4 500 maternal deaths a year - could be the result of better reporting and a massive HIV/Aids rate that has 18% of South Africans infected, about 5.7 million people.

But the group says the health indicator also has worsened because of a lack of accountability, corruption and poor healthcare.

Don't complain

For example, at least three South African hospitals are being investigated for baby deaths including one where 29 babies died within a few weeks in January, apparently from a superbug.

The hospital had no gloves, disinfectant spray, soap or toilet paper.

Several other women recalled nurses telling them to "shut up" during labour, saying they had enjoyed the sex that made them pregnant so they should not complain about labor pains.

"All South Africa's good intentions, policies and strategies on paper won't save women's lives without strong accountability systems to make sure policies are carried out," Agnes Odhiambo, the chief researcher for the HRW project, told The Associated Press.

South Africa spends the most on health per citizen in sub-Saharan Africa at about R5 250 a year, and has infrastructure and expertise unrivaled on the continent.

Maternity care is free, abortion is legal, and there is a system of confidential inquiries to assess levels and causes of maternal deaths.

Almost 87% of women give birth in hospitals or clinics, though several women told HRW they were avoiding government facilities because of widespread stories of ill-treatment.

Yet between 1998 and 2007, the maternal mortality rate leapt from 150 to 625 deaths for each 100 000 live births. That means South Africa, sub-Saharan African's economic powerhouse, has no hope of meeting the UN millennium development goals that require 38 deaths per 100 000 births by 2015.

Health Minister Aaron Motsoaledi told reporters he agreed with some findings in the report and that officials are "painfully aware" of the problems.

But he added that he has been working for more than two years to lower maternal deaths.

Human Rights Watch interviewed 157 women, many nurses and community caregivers as well as health officials between August 2010 and April 2011.

Researchers visited 16 health facilities, all in Eastern Cape province, though the report emphasizes that officials acknowledge the problems are nationwide.

Baby stuck in trousers

The report quotes witnesses saying HIV-positive women are denied care or given it too late.

It quoted the mother of one such woman who went to a community health centre where the nurse said the baby was dead and called for an ambulance to take her to a hospital.

They did not treat the woman while she waited for an hour, bleeding. As she walked to the ambulance, the stillborn baby came out.

"The ambulance people did not assist her. She got into the ambulance with the baby stuck in her trousers and she was still bleeding. She stayed that way for many hours at Dora Nginza, with the dead baby, without help," the mother says in the report.

A week after delivering the stillborn baby, the daughter was still ill. A doctor ordered blood tests and X-rays and told a nurse she was in critical condition.

They waited six hours for a nurse who took her blood pressure and left. Shortly after, she died.

Like most victims, her mother did not complain.

Fit in a shoe box

The report does not identify interviewees by name, for fear of repercussions. But one victim, Ethiopian Ruta Araya, agreed to speak about the abuse she suffered when she was admitted to Dora Nginza Hospital in 2008, seven months' pregnant with high blood pressure.

She said nurses "swore at me and insulted me," telling her to go back to her own country - an attitude reflecting xenophobia in South Africa. A doctor who ordered a scan told her "he couldn't see anything, that I wasn't even pregnant".

She appealed to a doctor from Ghana: "I begged him, please, this doctor doesn't want to help me, they don't want to take the baby out, the baby's dying in my tummy."

The Ghanaian persuaded her doctor to operate. Fifteen days after her admission, Araya gave birth to a 1kg baby girl. Even in the operating room, the doctors joked that her baby would be so small they would put it in a shoe box.

Nurses refused to change her bandages from a Caesarean section unless she paid bribes, causing the wound to turn septic and painful.

"I'm 28 years old but I feel like a 50-year-old woman, I can't even pick up my own baby... I don't know when I will feel young again."

  • cliffarc - 2011-08-08 23:08

    - Yet more evidence of The Anc's total disregard for the very people who elected them. This country is really coming apart under this govt.

  • ProudofPink - 2011-08-08 23:25

    Viva ANC Viva! Just as good you keep your supporters dumb and uneducated because it's the only way you manage to remain in power. Thank AA and the ANC for this. It lies squarely on their doorstep.

      Yar - 2011-08-09 07:27

      @pink You are right as usual. It is right on the ANC's doorstep. Trouble is that the doorstep is such a mess.

  • jockvanwyk - 2011-08-08 23:52

    SA has a shocking record yet the hospitals and minister deny it.It is a disgrace.

  • OZNOB - 2011-08-09 00:05

    well as they say go big or go home and the anc has certainly taken that to heart with the medical field- with aids spiralling out of control , drug resistant tb etc . all i can say heaven help you if you end up in hospital because the anc will not

  • Komasa - 2011-08-09 06:03

    In state hospitals there is this stand off between doctors, nurses and pharmacists. They try and pass off their responsibilities onto each other and the main culprits are junior doctors doing their internship.

  • Vaughn - 2011-08-09 07:03

    South Africa has "infrastructure and expertise unrivaled on the continent". Then why do our children die? Mortality is almost 20 times that of the target. Why: because we hire people based on one single attribute (which is not a skill), namely being Previously Disadvantaged. This policy is killing (literally!) our country. Hire only on skill and provide quality service. You DON'T have the right to turn away pregnant women. You DON'T have the right to treat pregnant mothers and children with disrespect. This can be fixed.

      Yar - 2011-08-09 07:29

      Because SA has such a bad attitude to doing a decent days work.

  • tryanything - 2011-08-09 07:46

    Womens day today....Wonderful example we are setting

  • Zion - 2011-08-09 07:51

    6.25% maternal deaths. This is shocking to the utmost and a national disaster. Clearly an indication this country has reverted back way beyond a 3rd world country. What is also sickening is the treatment these mothers and pregnant women receive in our well documented and esteemed hospitals, nursing staff and doctors plus the braggadocios claim that our hospitals are well equipped and running smoothly. With history starting around 1994 there has been an obvious drop in standards and that tendency is exponential, again despite the loud-mouthing minister and cronies. The time has come to put the scalpel in and sever the disease that runs our hospitals.

  • Brigitte - 2011-08-09 08:01

    It all goes back to the poor state of education. If you had to pass Matric with at least 51% (not the current pathetic 30%)maybe these nurses would be better able to be trained properly. What happened to 3 year student nurse training schools at the teaching hospitals - it should be made law that if you don't qualify with 60% each year you are out - nursing is a vocation it is not just a job

      Letsfaceit - 2011-08-09 12:33

      Brigitte, it is not about education - it is about the INABILITY of management to MANAGE health workers. Many nurses are rude, lazy and arrogant - but if no-one does anything and the unions run to their protection, then we can forget anything but sliding downwards. There is no management, no accountability and no responsibility.

      jen - 2011-08-09 16:41

      Education plays a big part. Nobody with the mental capability to pass with 30%, can care for other people or work an environment with that much responsibility. I think it is actually and insult to tell kids that they only need 30% to pass and to tell black matriculants that they only need 70% to study medicine while their white counterparts need 90%. When I lived in Johannesburg my nanny lost her newborn granddaughter because the clinic was closed for the Sister's birthday party! I tried to make a case and spent a lot of money and time, we are still waiting.

      Maddy-CT - 2011-08-09 16:58

      @ Brigitte. I agree that nursing is a vocation. In my opinion anyone who wishes to enter a profession which involves the care of other human beings must be psychologically assessed beforehand to find out if they are suitable. For example, candidates who wish to study medicine, physiotherapy etc. at university level are assessed on factors other than just academic results. It should be the same for nurses, teachers etc. It also seems to me that this type of abuse is not found in the private hospitals, where in my personal experience the nurses are kind and efficient. I may be wrong but perhaps this situation has more to do with women entering a field of work due to limited other choices being available to them but for which they are inadequately qualified and not suited, dismal working conditions, overwork and poor salary. Nevertheless, it is a tragedy and there is no excuse.

  • Captainmorgan - 2011-08-09 08:13

    In SA these days , no matter what the PHUK UP there is always a task team to investigate & a report is produced telling everyone how bad things are. Nothing ever gets sorted out though , WHY ?? Because the only thing that is foremost in their minds is lining their own pockets.Self enrichment is the latest craze in SA !!!!!

  • Marc - 2011-08-09 08:19

    Well, this is interesting. A debate on infant mortality while the planets population soars past the 8 billion mark. If this is not evidence of the micro-brained obsession humankind has with itself I don't know what is. Miserable as this is for the mothers, it simply does not matter. All these details about bush doctors, bribes and competence – it’s spurious bunk. We can't even look after the people that are already alive and were sweating over this twaddle. I suggest if the concerned contributors and the writer here can’t work this all out with a moments real mental application and a pocket calculator, then we really are in a mess.

      BOFFINBOB - 2011-08-09 08:47

      Yes Marc. Less breeding = more feeding.

      Zion - 2011-08-09 10:27

      Well mark, cheers you have scoffed at the current views relating to infant mortality and maternal fatalities now what would your solution encompass? Please do not mention male and female condoms, abortions, shoot the mothers and poison the babies? I think you have a false perception of the world in that micro-brain of yours.

      Marc - 2011-08-09 12:06

      Well, Zion, you see: this is my point exactly. You have failed to apply your mind. Instead you leap to the "defensive mode" like a bull at a gate. How you wish to play your part in reducing the crushing volumes of humanity presently infesting this planet is up to you. What is certain, is that if you really care, you could actually help without resorting to the measures you have outlined. But worrying about how to put more people on planet, in line with this article, is not going to help. May I suggest you read up on a bit of economics, in particular, Malthus.

      Zion - 2011-08-09 15:03

      Marc,the topic and subject matter relates to Infant (new Born) and maternal mortality not methods of controlling the population in anyway whatsoever. Write and submit an article relating to global population control then we can discuss it together. On this particular subject we have mothers and children dying due to poor medical systems and that is what we, or at least myself, have to worry about. These 2 persons cannot just be wished away. I fully agree that planet earth is over populated and that needs urgent attention. I cannot look the other way when mothers and children die because of poor medical assistance.

  • John - 2011-08-09 08:29

    These numbers are wrong. An infection rate of 18% is 9 Million people -- not 5.7 Million. This is sloppy reporting.

  • dee654 - 2011-08-09 16:06

    As a medstudent, I've seen a few things. Being a nurse is equivalent to being a glorified maid - if it doesn't include changing a bed once a day, doing vitals twice a day and handing out medicatiion as they see fit, it's outside of a nurse's "scope". Nurses will refuse to sign a form as a witness because it is "out of their scope" Why do they employ nurses with a "diploma" when you could pay uneducated people half for the same thing? And yelling and swearing at a woman in labour? Pssh... I've seen nurses punching patients.

  • jen - 2011-08-09 16:45

    And the 89 newborns that recently died in a Eastern Cape hospital were not seen as a crisis by our health minister. They cannot even manage the most basic health service but want to implement an ambitious project like NHS.

  • khanyisolomonmanzini - 2011-09-23 16:09

    What legal recourse is there to make government sit up and listen. These are people not statistics.

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