Abandon hope all ye who seek health care

October 20, 2006 - Today two South African newspapers ran stories describing mistreatment of patients by nurses. In "Nurses ill-treat and victimise HIV/Aids folk," published in The Herald, Nomahlubi Sonjica reports that some nurses at HIV/AIDS clinics shout at patients and disregard confidentiality. And in The Star's "Joburg Hospital: where nurses 'don't care,'" Shaun Smillie describes an abusive nurse who apparently rules an emergency department waiting room "through the use of threats and the muscle of two body guards." Both pieces make a limited effort to seek comment from responsible officials, and the Herald does include a comment that suggests nurses have difficult jobs. But both pieces could have done more to establish context for their reporting, especially the broad assertions in the headlines. Assuming the reports are accurate, why might nurses act this way? Could it relate to workplace conditions? Problems in training? What can be done? Though the reports do underline nurses' role as the first point of contact for many patients, they are clearly a troubling look at the care of the nurses they describe.

The Herald piece reports that patients and health workers say "some nurses" at HIV/AIDS clinics "are insensitive to patients and fail to keep their HIV-status confidential." In particular, the piece reports that nurses shout at the patients, blame them for their illnesses, and fail to protect confidentiality, segregating AIDS patients and loudly discussing their treatment in front of other patients. Some witnesses suggest that patients have, as a result of the abusive treatment, sought care elsewhere or foregone it altogether. One counselor reportedly says (in the piece's words) that people have "died because they feared being victimised in clinics."

At the end, the Herald piece makes some effort at providing context. An HIV/AIDS counselor stresses that some but "not all" of the nurses have poor "attitudes" toward HIV/AIDS patients. An apparent AIDS advocate says there should be an investigation into the clinics, though she also notes (in the piece's words) that "patients need[] to understand the pressure that nurses work[] under." And a health department spokesperson says that those "treated unprofessionally should report the incident to clinic supervisors," citing a toll-free telephone number.

The Star piece focuses on the experience of one patient, Lefa Motaung, at Johannesburg Hospital. Although a general practitioner had diagnosed a collapsed lung and provided a referral letter, Motaung reportedly waited many hours in a Casualty and Emergency Admissions waiting room to see a physician. During this time, Motaung's employer's husband called the Star in frustration. The waiting room appeared to be the domain of a "night male nurse" who told "irate relatives and the sick" that his name was "Ubaba Daddy." (Including the word "male" in this description suggests that men are somehow not normal nurses.) Ubaba Daddy "seemed to rule through the use of threats and the muscle of two body guards." He reportedly specialized in telling people that he "didn't care"--about how long patients had been waiting, that his decision to bar relatives and friends from the waiting room would mean the very ill would have no one by their side, or even that he was speaking with reporters from the Star . "He also told one person that he had been working as a nurse for 14 years, earned R6,000 a month and that he didn't care." Meanwhile, the "only apparent doctor on call also resorted to a couple of threats," saying that if patients did not do as they were told, she would "go sit in [her] room and do nothing." The note about the physician at least suggests that the problem is not confined to the nurses. In addition, the Star reporter did apparently seek comment from the hospital's "clinical director," who "said she was still investigating." The piece reports that the office of the provincial minister of health did not respond after being made aware of the allegations.

Clearly, both of these pieces are efforts to expose serious problems in care delivery to the relevant institutions and the public, and we commend the papers for running them. We wouldn't expect the articles to devote equal time to defenses the nurses involved or their advocates might offer. Still, both could have done more--the Star piece far more--to provide context that might give readers a better sense of the problems. Even if the nurses and their managers declined to comment, the piece could have sought comment from a nursing leader, who might have been able to offer some perspective on such issues. Why would nurses act this way? Do they face any particular problems that might contribute to these issues, like short-staffing, or inadequate pay, equipment, or training? What can be done, beyond simply encouraging people to make individual complaints? Both pieces do make clear that nurses are often the first point of contact for patients seeking care, and if that interaction is problematic, the consequences can be grave.

We hope that the Herald and the Star will make an effort in future pieces to give readers a sense of what underlies such troubling allegations.

See the October 20, 2006 article "Nurses ill-treat and victimise HIV/Aids folk" by Nomahlubi Sonjica in The Herald and the article "Joburg Hospital: where nurses 'don't care'" in The Star on IOL.