A nurses' strike has shut down most of Swaziland's health care system, drawing attention to financial and technical shortcomings, and the problems besetting the nursing profession.
"While we continue our strike action, doctors and orderlies will have to take care of patients," said the president of the Swaziland Nurses Association, Masitsela Mhlanga, at a press conference on Thursday.
Nurses are striking over the government's inability to pay salaries on time, back pay and salary increases.
Dr. John Kunene, principal secretary of the Ministry of Health, said the nurse's strike action over pay was premature, as the ministry had promised to settle salaries by the end of February. "We are still in February," he told the press.
The lack of remuneration, at a time when AIDS has burdened nurses with more than they feel they can handle, has caused a shortage - hospitals and clinics are short-handed, leading to compromised health care for patients and stressful working conditions that have led to a rise in medical problems among nurses.
There are also other issues. "It's all about respect, or the lack of it, for nurses," said Nurse Belinda Ndwandwe.
A humanitarian organization studying Swaziland's medical system found that the lack of respect was caused by the legal status of women as minors. "In Swazi culture, women are the caregivers. A nation’s health care system is one of its most important services, but because caregiving is associated with women in Swaziland, the system suffers because women are legal and cultural minors. The welfare of all Swazis, particularly the ill and orphans, who require special attention, is compromised, and national progress is retarded because of outdated attitudes toward women," the organisation said.
Nurse Thandie Nhlengetfwa noted that Swazi nurses are leaving for better-paying jobs in neighbouring South Africa.
"Nurses are quitting - not because they are not dedicated, but because we feel we are not appreciated. We are not given the salary increases - 97% of nurses are women, and I guess the authorities feel that this is women's work and it isn't important. We don't have supplies at the hospital: a baby comes, it's bleeding - there are no gloves for protection against HIV. You can't let the baby bleed, you must take her, and treat her. All the nurses are demoralised," she said.
The director of a children's welfare NGO told IRIN: "More people are sick today in Swaziland than at any time in history - hospitals are overflowing. What do we do? We send patients home. Home-based care sounds nice, but it is difficult - infectious diseases are infectious - and without training the caregivers fall ill. The pressures on the extended family became so great the family couldn't cope - too many children, too much poverty. There is a need for professional caregivers, and this puts more pressure on hospitals, nurses and the social welfare system. The system is in danger of breaking."
Some general practitioners in private practice see the nurses' strike as a wake-up call for a national health care system gone awry. "There needs to be more commitment to better health care from the very top," said an Mbabane physician who asked not to be identified.
A new state-of-the-art medical facility for the exclusive use of King Mswati and the royal family is being built in Lobamba, 20 km east of Mbabane, the Swazi press reported.
Health workers recall one of government's principal goals a decade ago: "Health care for all by 2000".
AIDS made that goal impossible. But nurses' union officials said government seemed completely paralysed and unable to find solutions. Nurses and doctors bear the brunt of the AIDS crisis as they try to cope with an expanded patient load and a simultaneous deterioration in health facilities.
Raleigh Fitkin Memorial Hospital, the main health facility at Manzini, Swaziland's most populous urban centre, was taken over this year by government after mismanagement had compromised patient care. "The hospital was founded by Nazarene Church missionaries and was the first facility to treat Swazis. Its deterioration was sad, and symbolized the troubled medical facilities we find in Swaziland," a staff nurse said.
Both the nation's daily newspapers were critical of the strike, portraying it as a monetary issue exploited by uncaring nurses. The nurses' complaints were not published, and the Swazi Observer claimed the Mbabane Government Hospital had become a "hospital of death" when the strike began Tuesday, saying: "Three patients reportedly died while nurses watched television."
A representative of the nurses' union denied that any patient deaths could be attributed to the strike action. "Mbabane government hospital has been a 'hospital of death' for years, due to underfunding, stolen equipment, no security, no medicines, insufficient number of beds, and a uncaring health ministry."
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions