Drug shortages and a lack of ambulances emerged as some of the most pressing health system issues in Eastern Cape at a recent meeting of community-based organisations.

Drug shortages and a lack of ambulances emerged as some of the most pressing health system issues in Eastern Cape at a recent meeting of community-based organisations.

Organised by the Black Sash in partnership with the University of Cape Town's health economics unit and Health-e News Service, the provincial health workshops will travel to all provinces in South Africa, culminating in a report that will be shared with government once public consultations are held on the National Health Insurance (NHI) scheme.

Community-based organisations have been invited to participate in the provincial workshops and share their experiences of the health system and what they would like to include in any health system reform being debated as part of the NHI discussions.

In Eastern Cape participants spoke of tuberculosis drug shortages, long queues, a lack of accountability, a broken referral system, the poor treatment of patients by health workers, a weak primary healthcare system and the long distances patients have to travel to a health facility.

One participant spoke of diabetic patients travelling long distances to collect their supply of insulin, only to be told there was no stock. Another activist spoke of TB patients being forced to wait in long queues on empty stomachs, only to be told that there were no drugs.

A health worker shared the story of a patient with a serious medical condition who had been transferred to a central hospital four hours drive away, while a hospital under the jurisdiction of another province was much closer. The ambulance took very long to arrive and the patient died on the way to hospital.

"It's hard for me to see that patients are dying of conditions that can be treated if we had enough health workers in rural areas," she said.

An elderly community worker from the Port Elizabeth area related the story of a diabetic patient who had injured her toe, leading to her foot being amputated.

"She was never educated on the dangers such an injury poses to diabetic patients, and she didn't know how to care for the wound. A couple of weeks later they had to amputate her leg above the knee," she said.

The community worker went searching for the patient at the local hospital and was shocked at finding her with dirty bandages and no staff to attend to her.

"There was no water, no bedpan and not enough staff to change her dressings. Her wound was a gaping hole, it was terrible. They wanted to amputate the leg even further and I refused to allow them to do this," she said.

She managed to use her contacts to take the patient to a private clinic, where they nursed the wound back to health.

"Money gets everything right," she remarked wryly.

"Our patients don't see the point of going to the clinic if the treatment is sub-standard or absent," she added.

Participants also pointed out that the lack of ambulances for patient transport and trauma incidents was a major concern.

One man said they had to wait for two hours for an ambulance to arrive at an accident scene near Flagstaff.

Participants also debated the issues of financing the health system as well as the inequitable distribution of money and health care resources. They said hospitals, both private and public, were mostly found in urban areas, and that there was reduced access in areas where poorer households are situated, where the health needs were often much bigger. - Health-e News