She’ll never forget the day it happened. A couple were there to see her, she was told, and she went out to meet them.
When she saw the pair she presumed the young woman had come for a check-up – she’d had an abortion a few days earlier and Brenda Bamuza had performed the procedure.
Her patient’s partner seemed upset, she recalls, and when she asked him what was wrong he spat out, “Sister, you killed my child!”
Those were the last words she heard before the man attacked her, beating her so badly she spent nine months in hospital.
Yet nothing could put Brenda (now 44) off her job – not the threat of violence or the abuse she often gets, even from people in the nursing profession.
Brenda works at the Marie Stopes Centre in Gandhi Square in Johannesburg as a termination of pregnancy nurse, assisting young women who have chosen to have abortions. She believes in what she does, she says, because “I’m saving lives”.
The violence to which Brenda was subjected and the verbal and emotional abuse many termination of pregnancy nurses experience isn’t unusual, Daphne Tlhabela, 54, says.
Daphne is the assistant director for women’s, youth and adolescent health in the Gauteng health department.
She worked as a nurse and midwife before she joined the department, and has brought to light the stigmatisation and emotional trauma abortion nurses in Gauteng health facilities experience daily. It forms part of her master’s degree thesis, which looks at the psychological effects of the nurses’ jobs.
Her research found that nurses “suffer verbal abuse for the work that they do, with members of the community often referring to them as murderers and baby killers”.
Daphne, who completed her master’s at the University of Pretoria, was herself on the receiving end of a verbal assault when a colleague told her, “Wena angeke uye ezulweni ngoba uyenza ama abortion (You will never go to heaven because you conduct abortions).”
There are only 57 such nurses in the public health sector in Gauteng and they work under tremendous stress, Daphne says.
“It’s not that we didn’t train more nurses than the 57 we have, but they left because of the conditions they work under. The nurses who are left are passionate about what they do.”
Brenda, a single mom of three, says she hasn’t kept count of how many abortions she’s performed since she began working as a termination of pregnancy nurse in 2007.
Before that she was a gynaecological nurse and she chose to switch specialties because she wanted to help women in need, something she still fervently believes in despite the brutal assault that nearly cost her life.
She’s a devout Christian and despite her religion’s teachings on termination of pregnancy, she’s adamant she’ll support any woman who makes the decision to abort her pregnancy.
“From the Christian point of view you will always get criticism about what you do,” she says.
“When I was assaulted in 2010, some friends and family members saw it as punishment from God for the work I do. But I refused to let that change me. I respect every woman’s choice and their rights.”
A major motivation in her work is backyard abortions, which she says cause huge problems for nurses. She and her colleagues often treat patients who come to them after a botched abortion and are in need of serious medical attention.
“Sometimes we get lucky and we can still assist them, but there are others we can’t help because we are a clinic and they need to be admitted to hospital,” Brenda explains.
She knows what she does is vitally important. “There is a reason for this law [the Choice on Termination of Pregnancy Amendment Act No 1 of 2008, which allows legal abortions in South Africa],” she says. “It’s saving lives.”
A 2013 research survey found that almost half of all abortions performed in South Africa were done illegally, despite abortion being legal here for years.
Brenda says the link between abortion-related deaths and poverty is also a motivating factor in her work, along with her belief in women’s rights to make their own choices about their bodies.
An abortion nurse in Gauteng can see up to 40 patients daily, Daphne says. These nurses also struggle with difficult working conditions – understaffed clinics, equipment shortages and a lack of managerial leadership and counselling.
Daphne, who worked as a midwife at Chris Hani Baragwanath Hospital for 18 years and has performed 10 abortions herself, says nurses are often “overwhelmed and find it difficult to cope with everything that goes on”.
With no counselling sessions available to nurses they have to find their own ways to deal with the pressure of their jobs, often breaking down at home, Daphne says.
Daphne recalls one shift when a nurse treating a patient who had been to a backstreet abortionist was left traumatised after she had to deliver a stillborn baby.
“People who are not trained to terminate pregnancies will give a woman tablets and tell them when they start bleeding they must go to hospital. That becomes a problem for trained nurses because a lot of the time patients will seek help when it’s too late because they’ve bled too much,” Daphne says.
Despite having to deal with life and death daily, there’s no money for counselling sessions for abortion nurses at government health facilities, she says. However, Marie Stopes offers counselling for nurses to help them deal with the pressures of the job.
It’s not hard to see why nurses would switch to other fields given the pressure they work under, but for the 57 nurses in the Gauteng health department the rights of the women they treat are of paramount importance to them.
“It’s something they believe in,” Daphne says of the nurses who work in the 28 clinics and hospitals she’s responsible for.
“We don’t just take any nurse to do abortions – they volunteer for the role. Anyone who wants to come for this specific training must have a passion for why we do this – regardless of their beliefs.”
As a Christian herself, she believes in a woman’s right to terminate a pregnancy. “I’m passionate about women’s health because we are saving women from dying in the streets.”
In a bid to help the 57 nurses Daphne has presented Gauteng health MEC Gwen Ramokgopa with the findings of her thesis.
“I want the Gauteng government to know what is happening in clinics and I hope they can use my recommendations, which include offering incentives for nurses and conducting debriefing sessions.”
Daphne has also suggested the department increase the number of facilities that offer second-trimester abortions, as currently only one hospital does this.
Public health facilities can only perform termination of pregnancy up to 12 weeks (the end of the first trimester).
The system needs to change, she says – and until it does, people like Brenda will be there to help where they can.