[Ip-health] AP -- Lack of doctors and nurses killing AIDS patients, says MSF Lack of doctors and nurses killing AIDS patients, says MSF

The Associated Press
Thursday, May 24, 2007

CAPE TOWN, South Africa. Lack of medical staff is emerging as one of the
biggest obstacles to providing patients with anti-AIDS drugs, condemning
untold numbers of Africans to an unnecessary death, says a new report.

As Africa slowly gets to grips with providing anti-AIDS drugs â increasing
the number of people on treatment from 100,000 in 2003 to 1.3 million in
2006 â the dire shortage of doctors and nurses is now jeopardizing more
widespread provision of the lifesaving therapy, according to a report
Thursday by Medecins Sans Frontiers. 'The international community says it
wants to achieve universal access, and in Khayelitsha we were coming
close, but at a certain point things started to collapse,' said Eric
Goemaere, who heads MSF â also known as Doctors Without Borders â in a
sprawling Cape Town suburb. 'We are absolutely saturated, we have come
back to waiting lists, and it feels again like we are losing the battle,'
he said.

Southern Africa is hardest hit by the AIDS epidemic, accounting for the
vast majority of the 40 million infections and the daily death toll of
8,000. Despite the advances of providing treatment taken for granted in
rich countries, more than 70 percent of the Africans in need of treatment
are still waiting. On an average day, around 200 AIDS patients flock to
see Mpumelelo Mantangana and her closely knit medical team at a clinic in
an impoverished part of town. Many others languish at home, not for lack
of drugs but rather lack of health workers to administer them. At the
clinic started by MSF in Khayelitsha â where about 30 percent of adults
have the AIDS virus â nearly 6,000 people are currently receiving
anti-retroviral therapy. But the number of new people starting treatment
each month dropped from 270 last May to 100 in December â mainly because
of lack of health workers. Mantangana, a nurse at the clinic, says her
workload has soared as other nursing staff have left for greener pastures
in the private sector or abroad. She understands them â the work is
exhausting and the pay is peanuts.

'I work purely because of passion for what we are doing. People come in
and they are very sick and we see them get better. That is the only thing
which gives us strength,' she said in an interview at the clinic, gazing
at the long lines of people waiting patiently on wooden benches on the
concrete floor. South Africa has 393 nurses and 74 doctors per 100,000
people, but a high percentage work in the private sector and shortages are
especially acute in rural areas. This compares to 247 doctors and 901
nurses per 100,000 people in the United States. In tiny Lesotho, which is
also ravaged by AIDS, there are just 5 doctors and 63 nurses per 100,000.
In Malawi, it is 2 doctors and 56 nurses and in Mozambique 3 doctors and
20 nurses.

The MSF report, which focussed on the four southern African countries,
made grim reading. It said that in the Thyolo district of Malawi, a single
medical assistant can see up to 200 patients per day. In Mavalane district
in Mozambique, many patients died during the two month wait to start
treatment because of the lack of doctors and nurses. In one of Lesotho's
main hospitals, more than half the professional nursing posts were vacant.
The report said that countries would only be able to cope with the crisis
by 'task-shifting' â allowing nurses to do work assigned to doctors,
medical assistants to do the work of nurses and using more community
workers. Malawi is already doing this and a new AIDS plan recently adopted
in South Africa also decentralizes treatment and care away from hospitals
and gives community a much bigger role. Lesotho also has nurse-based
treatment â but there simply aren't enough nurses.

The report also pointed the finger of blame at donor governments, who were
willing to pay for antiretroviral drugs and new clinics but not contribute
toward staff salaries to operate them. For instance, it said the US
Millennium Challenge Account had committed an unprecedented $US 140
million to improve physical infrastructure at health facilities. But no
plans had been made to recruit the estimated 600 additional health care
workers needed to staff the facilities. 'People living with HIV/AIDS do
not only need drugs and clinics, they need trained, motivated health care
workers to diagnose, monitor, and treat them,' the report said.

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