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South African Health Care Might be Rationed

A Paramedic from the Kwazulu-Natal Emergencies Medical Rescue Services (EMR) inspects one of the 150 new Ambulances stationed at Durban's Wentworth Hospital, South Africa, 28 Feb 2010

A Paramedic from the Kwazulu-Natal Emergencies Medical Rescue Services (EMR) inspects one of the 150 new Ambulances stationed at Durban's Wentworth Hospital, South Africa, 28 Feb 2010

South Africa continues to be in a health care crisis. Doctors and nurses are leaving the country. Equipment, supplies and hospitals are inadequate. And, there are charges that the health care system is rife with fraud and mismanagement.

This woman, who does not want to be identified by name, has tuberculosis. Every day she comes to this clinic to get her medication.

"I lost two brothers because of the TB," she said. "That is why I want to take the treatment for TB and finish this course.

She is one of the lucky ones. The Eastern Cape is poor. Unemployment is high and disease is rampant. HIV, tuberculosis and other infectious diseases are all at pandemic proportions. But the health care system is in chaos.

Daygan Eager is a researcher for the Public Service Accountability Monitor.

"There isn't capacity there to deliver even the most basic services," said Eager. "You're talking about rehydration packs for people with diarrhea. Diarrhea is a major killer in South Africa."

In South Africa, each province has its own health care department. Here in the Eastern Cape, this department has a long documented history of mismanagement and fraud. Siva Pillay is the head of the department.

"We did investigations. We found huge fraud. I don't want to lie to you. There's more than $200 million rand [$27million] of fraud and things like that," noted Pillay.

The biggest problem, though, is the increase in tuberculosis. Most of the patients here with TB are also HIV positive. Doctors, like Pillay, believe the increase in TB is because of the HIV epidemic.

"Our biggest pandemic today is the HIV pandemic, with the TB component which is complicating the issues," added Pillay.

Yet, reports say people often go untreated for both HIV and TB because the department does not have the capacity to handle them. So this volunteer, who goes by the name Toyota, tries to deal with the HIV part of it by counseling women to be tested for HIV. She is HIV positive, herself. She got the disease when she fell in love with a man who was HIV positive.

"He helped me by lending me money to go to school," said Toyota. "But, at the same time he hurt me, because he didn't tell me he was HIV positive."

The man died. Today, she is on anti-retroviral drugs. She says many women will not go in for testing, because being HIV positive carries a certain stigma.

"Meaning you are like a prostitute, you got it from selling your body. So that's why people don't want to come out," added Toyota.

It is estimated that tens of thousands of people are walking around, untreated for HIV/AIDS. And, that has just worsened the TB problem. TB can be life threatening, if it is not treated. For those that can find the treatment, it is long. Six months of pills taken daily. But a volunteer named Duda says a lot of people stop taking their medication too early.

"They [are] feeling strong. They are gaining weight. Now they stay at home. They think they are cured," Duda explained.

But they are often not cured. The TB comes back and sometimes in more dangerous forms. Again, researcher Daygan Eager.

"You talk about high level services like HIV and TB. Very often the services are not there for people who need the services desperately," added Eager.

Health department head Pillay says he just does not have the money to improve the services.

"You have a budget that is insufficient to provide the necessary treatment to provide health care," he noted.

And Pillay says, if the number of ill continue to increase, he will have to consider denying treatment to some people, so he can give it to others - even for critical conditions like HIV. In effect, he will be rationing the care.

"We like to believe that there is none, because health care is a very emotional issue, but everywhere there is rationing of care. And, rationing of care is a reality we will have to face," added Pillay.

The United States, one of several countries providing aid to help African nations combat HIV/AIDS, has given more than one billion dollars, so far, to South Africa. And it has pledged another $500 million, in the next two years. Yet treatment is not reaching thousands of people, either because they do not want it or because South Africa's strained health care services cannot deliver it.