The culture of neglect of workplace health and safety
impacts not only on the healthcare workers, but also contributes to a declining
quality of health care that they are able to provide to the communities they
serve. The findings of this collaborative participatory research project were
published in: Who Cares For Health Care Workers?: The State of Occupational
Health and Safety in Municipal Health Clinics in South Africa, Municipal
Services Project, Occasional Papers No. 8, January 2005.
The research, carried out by a collective of SAMWU members and conducted at 38
municipal clinics over an 18-month period, reveal a culture of reactivity and
minimal legal compliance. OH&S is all too often reduced to the processing of
compensation claims. No proactive or preventive procedures are in place for
identifying hazards, evaluating risks, preventing workplace injury and illness,
and maintaining a safe workplace. An inadequate supply and use of personal protective equipment, negligent waste disposal methods, overcrowding, bad ventilation, staff shortages and high
patient loads, inadequate health and safety awareness amongst clinic staff, an
absence of effective protocols and a culture of stigma around HIV/AIDS all
increase the health and safety risks facing healthcare workers. Many clinics did
not even have such basic supplies as soap.
Because their work involves coming into contact with people carrying infectious
diseases, health workers are routinely exposed to dangerous pathogens, such as
viruses, bacteria and parasites. Working with sharp instruments, such as
needles, presents and an additional hazard to health workers. Furthermore, the
critical shortage of staff, coupled with ever-growing queues of patients -
especially those affected by the HIV epidemic is taking its toll on the
health and safety of healthcare workers. While nurses consider a nurse/patient ratio of 1:35 to be the norm, clinics had ratios ranging from 1:40 to 1:90. Overworked staff face the trauma and stress of
increasing numbers of HIV/AIDS patients a challenge which puts the resources
of the clinics and the clinic staff under added strain. Stress and burnout also
make healthcare workers more prone to infection and accidental injuries, such as
preventable needle stick injuries resulting from fatigue or the rush to see
patients. The pressure to provide care to all patients regardless of the
circumstances creates a high workload for health workers and can result in
mistakes being made with regard to patient care.
Staff shortages also often force clinic workers to work outside their job
descriptions often without appropriate training or remuneration. The
research found cases of nurses working as pharmacists, nurses working as senior
sisters without being paid an extra allowance, nurses expected to counsel
patients who come for HIV tests without receiving any counseling training, and
even a clinic administrative clerk having to transport medical waste and
suffering a needle stick injury in the process. Probably the most tragic story
of staff shortage came from the Freedom Square clinic near Bloemfontein, where
patients are required to clean the clinic before they are attended to because
there is no cleaning staff at the facility. While 83% of the clinics surveyed said that they have a protocol in place in the event of a health worker being exposed to HIV in the workplace, the efforts of
the employer with regard to preventive HIV measures are haphazard and
inconsistent. Some OH&S initiatives have been taken but many remain on
paper. HIV/AIDS workplace policies are often centralized in municipalities, very
general and not directed at the specific conditions and needs of different
departments or clinics. Staff are also often not familiar with the contents of
these policies.
The SAMWU/IHRG/MSP research project emphasized that any challenge to the
negligent and reactive culture of OH&S in the municipal health clinics (and
in the public health sector more generally) must come from the organized
activity of health workers. While employers have obligations towards their
employees, and while workers OH&S rights are written in law, these will only
be enforced and effective if workers and their trade unions build a proactive
and preventive culture of health and safety in the workplace.
With regard to HIV the research findings indicate that only once healthcare workers develop the
confidence to establish and enforce adequate protection against occupational
exposure to HIV, can they overcome the fear and stigma associated with the
disease and provide leadership to their patients in building a culture of
prevention. Public health sector trade unions have a vital role to play in
developing this leadership.
(Source: Pambazuka News, April 12, 2005)
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