Anso Thom, Kerry Cullinan & Khopotso Bodibe
The elderly woman, her thinning grey hair swept into a tiny ponytail, kicks her feet under the blue hospital blanket and lets out a long moan. She rocks her head from side to side and wails quietly, before turning onto her side.
The nurses stoically continue the morning briefing, a ritual that happens just after 7am every day at the medical ward of GJ Jooste Hospital in Cape Town.
Shortly after 7.30am, two nursing assistants are no longer able to ignore the womans distress and wander over and start straightening the bed linen.
Move your body up, a large nurse with flashy gold spectacles orders.
Just before eight, the patient keels over the side of the bed and crumples to the floor, her arms outstretched. A young woman in an adjoining bed shrieks and places her hand over her mouth.
Within seconds, two doctors rush over and pick her up by her arms and legs. A nurse rips the pink curtains shut around the bed. A few nursing assistants peer through a gap as three doctors try to resuscitate the woman.
No, shes dead, a staff nurse tells her colleague and wanders off.
One of the doctors runs to an adjoining ward to fetch a defibrillator machine. The bed springs squeak as a tall doctor rocks up and down, applying pressure to the womans lifeless chest. Another doctor pumps a bag attached to the patients mouth.
A professional nurse, a few steps away hardly glances at the commotion, stoically chewing gum while restocking the drug trolley.
At 8.05am the commotion comes to an abrupt end and the patient in bed 23 is declared dead, another addition to South Africas Aids statistics.
By 8.30am her body is washed, taped up in plastic and taken to the morgue. The only remaining sign that she was ever there is a see-through plastic bag containing a box of Corn Flakes, a pair of dainty black moccasins and a brown blanket.
Despite governments introduction of antiretroviral drugs in 2004 to contain HIV in those already infected, thousands of people are still dying of AIDS-related illnesses, and hospitals from Cape Town to Mussina are struggling to deal with the increased load.
Last year, an estimated 320 000 people died of AIDS-related illnesses in South Africa.
Half-a-million people are estimated to be sick enough to need antiretroviral (ARV) drugs but slightly less than half this number is getting ARVs.
The impact of AIDS can be seen on the countrys mortality figures, with a 79% increase in all deaths over the past seven years (1997 to 2004) and a 161% increase in people aged 20 to 49, according to Statistics SA. More people aged between 30 and 34 are dying than in any other age group (58 000 in 2004, in comparison to almost 19 000 seven years before).
The antiretroviral rollout is not yet at a level where it has significantly altered HIV-related admissions and fatalities at hospitals,says Professor Helen Schneider of Wits Universitys Centre for Health Policy.
In addition, say hospital doctors, people with HIV are only seeking help when they are already very sick and it is difficult to treat them.
We are overwhelmed by medical patients. We used to admit between 10 and 15 medical patients on a daily basis. Now that number has gone up to 40 to 50 patients per day. And most of these patients have HIV-related complications, says Dr George Abraham, acting senior clinical manager of Natalspruit Hospital.
The day before Health-e visited Natalspruit, seven people had died in the 734-bed hospital of AIDS-related illnesses.
Up to 60% of all patients in paediatric and adult medical wards countrywide have HIV-related conditions, according to researchers.
But hospitals in areas with high HIV rates are taking even more strain:
* 90% of children and 80% of adult medical patients at Stanger Hospital on KwaZulu-Natals north coast are HIV positive, and 30% of male medical patients die.
* Three-quarters of the male patients and 70% of female patients who died in the medical ward of Mseleni Hospital in far northern KZN over the past three months suffered from AIDS-related illnesses.
* About three-quarters of the patients in the 135 medical beds at Durbans Addington Hospital have HIV-related illnesses.
* Two-thirds of patients tested for HIV at Rustenburg Provincial Hospital in the heart of North Wests mining area, were positive.
* Between three and four women die every day in GF Joostes medical ward in Mitchells Plain while almost 50 000 medical patients, mostly HIV-positive, were seen in the hospitals casualty ward last year, almost 20 000 more than in 2003.
It does overwhelm us because really, the AIDS patients are sick, explains Nombulelo Mabhija, sister in charge of Natalspruits 38-bed male medical ward.
They need to be cared for all the time. They are totally dependent upon us because most of them can hardly walk. They can hardly feed themselves. They can hardly wash themselves, so we have to wash them.
The Hospice Palliative Care Association (HPCA) last year took care of 35 000 HIV positive people a mere 12% of those who died.
We talk about thousands of AIDS-related deaths, but what about the suffering that led up to those deaths? No one talks about that, says Dr Liz Gwyther, chairperson of HPCA.
When a person is dying, their physical and medical needs actually increase because of the increased pain management needed.
A wide range of organisations, including the Treatment Action Campaign and the HIV Clinicians Society, have criticised government for not providing ARV treatment at a faster pace.
Meanwhile, UCT Economics Professor Nicoli Nattrass says that a shortage of health staff is a severe problem constraining ARV provision.
Unless public sector recruitment can keep pace, human resources will constrain the rollout. Addressing the human resources crisis in the public health sector thus ought to be an important priority for the Health Minister, says Natrass.
AIDS Statistics for 2005
* An estimated 5.3 million South Africans are HIV positive -- 18.78% of the population.
* There are 3.12 million HIV positive women, 2.9 million positive men and 235 000 children under the age of 14 HIV infection among females aged 15-24 is eight times higher than males of the same age.
* 30.2% of women giving birth in public health facilities in 2005 were HIV positive.
* Worst affected provinces: KwaZulu-Natal, Mpumalanga and Gauteng.
* By 2004, there were an estimated 2.2million orphans.
* The rate of new HIV infections is starting to stabilize among 15-19 year-olds.
* Adult mortality has increased by 79 % between 1997-2004.
* Worst affected age groups: children U5 and adults aged 25-44.
* 42% of deaths of children under 5 are estimated to be AIDS related.
* 60% of hospital deaths in 2005 are estimated to be AIDS-related.
* AIDS is the leading cause of maternal deaths (women who die during or shortly after giving birth).