Clanwilliam Hospital
Tuesday dawned cold but clearing. No rain but still overcast. There is a tour group in the camp today so Ingrid led us all on a guided tour to Elephant Rock this morning, complete with her running commentary on the native plant life. It was a very interesting group of people, some from Sweden and some from Australia.
After our morning trek it was time to brave the showers. Lovely and warm while you are in them but rather “bracing” when you step out. A quick towel off and no time spared getting dressed and it was time to head off for my afternoon visit at the Clanwilliam Hospital.
By now the sun had begun to break through the cloud and was spilling over the valleys. I decided to take the back road to town which follows the rim of the valley that houses the Olifants River. The road had just been graded and the loose, red sandstone was on fire with the afternoon sun. The valley was spectacular and I was wishing that I had more time to stop and explore this fabulously scenic route. It would have to wait until another day.
As I rounded a curve just before dropping down into the valley and across the old bridge, a small troupe of baboons ran across the road in front to me. Mildly curious, they perched on the rocks at the side of the road and watched me watching them. Reluctantly I drove on as my agreed upon appointment time was drawing near.
Clanwilliam has a small, regional hospital with 48 beds. Up until three years ago it was a “private” hospital which meant that only people who had a health care plan could go there. These plans, from what I can gather, are similar to the HMO system used in the States except that anyone with a plan may go to any of the hospitals. Plans are available to varying degrees of coverage and people choose which plan they will purchase based on their need and siutation, and of course on affordability. Ah! Affordability. There’s the catch. The vast majority of black or coloured people cannot possibly begin to afford any kind of coverage so, for them there are the “State” hospitals.
Clanwilliam is a very small town, nestled in the mountains. Although they service a huge catchment area, it is mostly remote and therefore there are a lot of workers and not as many affluent people. Consequently, there came a point where the hospital was no longer able to operate as a private hospital as there just was not the population base of affluent people to support them. So, they became a state hospital, although they continue to operate a private wing.
There are 24 beds on each side.
The fee for staying on the “State” side is geared to income, starting at 20 Rand per night ($7) and up. This fee includes your bed, meals and all treatment. To stay on the “Private” side the cost is 518 Rand per night ($74) with your first night paid up front and you are billed after that. The Administrator assured me that there is equal quality of care on both sides; however, from my conversations with my friend Annatjie, I know this not to be true. Obviously, if it were true, what would be the sense in spending the money on the health care plan?
It was difficult to pursue this line of questioning as I did not want to offend these people who had so kindly offered to share their world with me. Through round about questions, I summize that the majority of patient care on the State side is given by nursing staff with physician consultation when necessary. I believe that it is primarily what we would call the “Residents” who care for these patients (medical students doing rotations in the hospital) and the treatment options available to these people are very minimal.
Patient care in the hospital is delivered by two G.P.’s in the village who do “Sessions” (we would call them Rounds) at the hospital each morning and book treatments/surgeries as necessary. These G.P.’s are the only medical staff available and continue as the primary physicians while their patients are in hospital.
As in our remote service areas, specialists from Cape Town visit once a week to hold Clinics: Orthopedics, Gynacology, Oncology, etc. Doctors bill either the insurance company or the patients directly as the case may be. Interestingly, nursing staff is paid a higher salary in the State hospitals than the private hospitals.
In this small, regional hospital, besides caring for ill patients they deliver babies (most deliveries being overseen by nurses unless there are complications) and basic surgeries such as Tonsils, Appendix and fixation of fractures. More major surgical cases would be referred and/or airlifted by helicopter to Cape Town.
After my meeting with the Administrator, one of the administrative staff gave me a tour of the hospital itself. A simple, one floor structure, the hospital was well maintained but, I suspect, far from the standards that our hospitals are held to. An aging building poses many housekeeping challenges. While the hospital appeared clean one doesn’t get the impression it is sterile by any stretch of the imagination. Treatment areas are small and confined with limited equipment. This was particularly evident in the Urgent Unit (Emergency Dept.) where I was struck by the minimal “at hand” equipment that we would see in our Emergencies. There was very basic equipment (oxygen, BP cuff and not much else) hardwired in the ER. While there is other portable equipment which can be accessed, one imagines precious time lost in truly critical situations.
There is a high percentage of trauma care at this hopsital. Most often from motor vehicle accidents, domestic violence and farm accidents. Priority is given to stabilization and transfer of patients as opposed to onsite treatment as opposed to on-site continuing care.
I was treated to an indepth tour of the Radiology Department by a very kind Radiologist. He was particularly proud to show me his brand new digital x-ray machine which allows radiographs to be viewed remotely by the Orthopedic surgeons in Cape Town. This is cutting edge equipment here which we in Canada have had for many years and take totally for granted.
It was a fascinating afternoon made incredibly interesting by the willingness of the staff to share their knowledge and experiences with me. I again was struck by the lack of barriers such as liability and confidentiality here. There was no restriction on where I was shown or into patient care areas. I got the grand tour. Absolutely great experience!
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Morag