PROPOSED REPORT THAT WILL BE PRESENTED TO THE PORTFOLIO COMMITTEE ON HEALTH

VENUE: Committee Room U227 2nd Floor, Old Assembly Wing Parliament, Cape Town

DATE: 08 June 2000

I am professional nurse Kenneth Lucky Khoza, a trained MVA Midwife who is presently working for the Department of Health at Shongwe Hospital. Shongwe Hospital is situated in the Nkomazi region which is in Mpumalanga. Shongwe is a 350 bedded hospital and about 10kms to the Swaziland Border. Nkomazi region has also another hospital - Tonga hospital which is a 250 bedded hospital. Tonga does not provide TOP. Nkomazi is a rural area with about 42 villages in it. There is about 22 clinics in this region of which 3 are 24 hours. Farms also form part of the Nkomazi region of which they are quite a nnmber although I am not sure of the number. Most of the people in this region are illiterate although I am not sure of the percentage. Mode of transport is mostly buses and taxis.

The Top service was started in March 1997 by the Cuban doctor Maria Hernandez. She worked with different people during the procedure. Most women that she did termination on, were the below 12 weeks. She did not like doing the D 12 weeks. She continued to work alone until I joined her in June 1999, after I went for the MVA training for Midwives in May 1999. She was initially resistant to work with me and did not understand my role, she later accepted that, and we worked harmoniously. In September 1999 (end of the month) Dr Maria left for Rob Ferreira Hospital which is about 100kms away from Shongwe Hospital. I started working on my own, doing the precounselling, MVA and post counsellling. The social worker who used to come to do the precounselling had already stopped coming even before Dr Maria left. Mondays are for counselling and assessments, Tuesdays the clients come to sleep over in the hospital and get the misoprostol tablets. Wednesdays MVA is done. Presently there are no follow ups being done. Most of the clients that I met after TOP, have reported to be having no problems however this does not mean that they don't need to be followed up. What about those that I do not meet after TOP?

The number of Top clients from 1997 - 2000 is as follows:

Most of the women who seek Top are multiparous women e.g. for the year 1999, 141 multiparas were done and 35 were primiparas.

The number of women who come with abortion other than Top, exceeds 200 per annum. In this 200, others are spontaneous and others are induced.

The number of women who come to deliver exceeds 4000 per annum. In this 4000, there are women who were declined Top for some other reasons including the D 12 weeks.
The reason why I am quoting the statistics is because I want to indicate that the Top service is not accessible to most women of the Nkomazi region.

REASONS/offered by women who seek Top /that contribute to the women falling pregnant

· Illiteracy and lack of knowledge e.g. usage of Quinine tablets as a contraceptive.
· Unavailability ofF/P (Family Plarnnng) centres especially in the farms.
· Failure to comply with the contraceptive method.
· Alleged contraceptive failure.
· Traditional beliefs e.g. Tying of a rope that has been traditionally worked up, around the waist.
· Lack of knowledge about the legislation - C.T.O.P

PROBLEMS ENCOUNTERED IN TOP DELIVERANCE
· The service is not yet decentralised to the primary health facilities - not accessible If I am sick or on leave, clients must wait until I come back.
· There is only one trained MVA Midwife for the vast Nkomazi Region.
· There is no proper place to refer the D 12 weeks. I suspect they go out and seek other methods to abort hence the increased number of abortions.
· Top clients being labelled as ‘Lucky's clients.'
· The rigidity re: doing of Top's on Wednesdays only - they cannot be done on any other day due to the sharing of instruments with the main theatre.
· Shortage of staff hence I don't have a permanent person to work with.
· Nursing management only know that the Top service is available but how it is run, they seem not to care about that - none of the managers has bothered to come to the clinic and see how it operates. I would say they don't care, they only come when statistic is needed to compile reports.

SUGGESTIONS ON TOP SERVICE/S
· Decentralisation of the service to the PHC facilities. The 24 hour clinics can be identified so that consultation takes place locally. Specific days for consultation can be set-this could also include Tonga hospital where presently there is no Top Service.
· Educating the women about the CTOP Act this can be done in a form of going out to the women e.g. getting prominent women leaders to help with the compaign this must be an ongoing process.
· Visits to the farms and schools to empower women about their reproductive rights.
· Getting more willing, self motivated, dedicated and effective midwives to be trained for MVA.
· Nursing managers must view the service as a need to the needy and a right to the poor because the rich can afford to go private. More staff must be allocated to participate in the service.
· Women should not be encouraged to do Top but they must be encouraged to use contraceptives, but if a woman is pregnant and seeks Top, she must be allowed to have it. With this statement, I want to point out that Family Planning must be strengthened and the compaign/education about HIV/AIDS must be more stronger because those that seek Top, were obviously not using any barriers like condoms.

Comments on Positive aspect from the Province.
The provincial co-ordinator and the head of the mother and child Dr Pat Godi have been very supportive to the MVA midwives. In the year 2000 we had a provincial meeting with all the Mpumalanga MVA trained
midwives where problems encountered in the work situation were higlighted. Another meeting will be held somewhere in August


Thanks for the support.