South African Hospitals ‘Overwhelmed’ by AIDS Patients

Hospitals in KwaZulu-Natal province, South Africa, are "overwhelmed" by an influx of AIDS patients, which has some hospitals operating above maximum bed capacity, and the problem may only get worse as the number of infected South Africans is expected to climb from 4.7 million to seven million by the end of the decade, Reuters reports. A South African Medical Journal survey of hospitals in the nation's "most AIDS-ravaged province" found hospitals in some areas devote 80% of their beds to HIV-positive patients (Swindells, Reuters, 6/7). And in some rural areas, hospitals are operating at 120% over capacity. Dr. Paul Kocheleff, clinic chief at the Grey's and Edendale Hospital HIV/AIDS clinic, said that based on HIV's six-year incubation period, the "tide of sick people" represents the 1994-1995 HIV prevalence figure of 15%-20%. Currently, 36% of those in the province are estimated to be infected, Smith said, adding "[Y]ou don't need much imagination to picture the hospitals in another six or seven years -- the exponential increase will be huge." Admissions for HIV-positive patients at King Edward Hospital "jumped" from 39% in 1997 to 53% in 1998. Dr. Sean Drysdale, principal medical officer at Hlabisa District Hospital, said "[N]obody seems to be planning for the AIDS epidemic which hasn't hit us yet. In five years time this place will collapse -- it's crumbling as we speak. It's a catastrophe waiting to happen."

A 'Downward Spiral'
If the numbers of HIV-positive patients continue to increase, the level of care for inpatients will "continu[e] to spiral downwards," the study states. Dr. Jim Muller, acting head of medicine for Edendale, Grey's and Northdale Hospitals said, "[P]eople are dying prematurely because we are so stretched. Medical patients who don't have HIV/AIDS are being severely compromised because we have to discharge them prematurely -- everybody is being compromised -- the system just can't cope." The survey found that HIV/AIDS patients are being rerouted to other wards, elective surgeries "fall by the wayside" and patients are receiving "inappropriately skilled" nursing care because the demand is so great. Doctors also face the "ethical nightmare" of determining "who lives and who dies." Muller said that the doctors "assess each case on its merits" and if it appears that they are going to "pull the plug" on a patient, they try to ensure that it is a "consensus decision." The survey found that "[n]early all" physicians complained about a "lack of clear provincial and national protocols to guide them through the new ethical minefield." Kocheleff said, "If we can draw a distinction between those near death and those for whom quality of life and life expectancy can be improved, we can make headway with a more holistic approach." However, those guidelines do not appear forthcoming, though the health department has pledged to increase staffing levels. Ronnie Green-Thompson, the provinces director-general of health, said that "purveying an attitude of doom and gloom and scare tactics won't help the guys on the ground" but added that if he was "dealing with patients every day I'd be seeing it the same way" (Bateman, South African Medical Journal, 5/2001).