Nurses in Swaziland are taking industrial action to push for better pay and to protest what they say are life-threatening conditions in public hospitals and clinics.
Although the nurses called off a strike after two days last month for fear of being dismissed like other public sector workers, they continue to press home their demands through other forms of protest.
Shortages of essential medicines and supplies at public hospitals and clinics have become routine while erratic water supplies at rural health facilities sometimes forces nurses to fetch water from nearby rivers in order to wash their patients, according to Amos Ndlangamandla, an intern at Mliba Clinic, in the Manzini Region.
Even Swaziland's main referral hospital, the Mbabane Government Hospital in the capital, has been without water for the past week.
According to the Swaziland Water Board, a faulty water-delivery system is to blame. With no water to wash film prints, patients in need of x-rays are being turned away. Toilets, kitchens, the hospital laundry and surgical preparation areas have also been inoperative, while equipment in need of sterilization is being sent to Pigg's Peak Government Hospital 90 minutes north of Mbabane.
After the Education Department fired over 100 teachers who had refused to return to work after five weeks, about half of the country’s nursing workforce went on strike for just two days, amid fears that the government could take similar action against them.
"If a school closes down temporarily, the students suffer, but they can make up lost class time later. If hospitals and clinics close down because all the nurses have been fired by government for going on strike, people die," said Cynthia Khumalo, a nurse in the central Manzini region.
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"We have to be careful how we proceed," agreed an official with the Swaziland Democratic Nurses Union (SWADNU), who declined to be named. "It would be ironic if our protest against hospital conditions that are compromising lives led to people's deaths."
Like the teachers, SWADNU is seeking a 4.5 percent salary increase for nurses, well below the current inflation rate of 9 percent. Prime Minister Sibusiso Dlamini has responded that government cannot afford to increase salaries before 2015.
"If government cannot find funds to provide basic services to hospitals and clinics, many people will die," said the SWADNU official, who said that nurses were not prepared to wait another three years for a salary increase and would likely strike again.
In the meantime, SWADNU estimates that about a quarter of the country’s public sector nurses are finding other ways to protest. At the government hospital in the eastern provincial capital Siteki, nurses are reportedly on a go-slow, while nurses at the Mbabane Government Hospital have stopped working during the lunch hour, normally a busy time.
"We are using this down time to educate the patients and their relatives. They ask why we are not working at times and we tell them that the clinic is not properly working at all times, and if we do not press for change it will get worse,” explained a head nurse at a clinic in Manzini Region, adding that no patient was neglected and that emergency services are not disrupted. “They understand and this way we can earn the public’s respect and understanding.”
Swaziland has suffered a net loss of nurses over the past decade.
Lured by better salaries and working conditions, many nurses graduating from the government-run teaching academy in Mbabane accept jobs in neighbouring South Africa or further afield. Some of those who remain feel their role has, by necessity, evolved to include agitating for better health care.
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"Government should make sure the hospitals are safe and well-supplied. When government does not, we have to make a noise about the absence of rubber gloves or proper sanitation," said Thembi Mtembu, a nurse in Manzini.
"People ask us why we are not working. We tell them that if we do not make a statement, their loved ones in this hospital can die because of the conditions here... we have no water, no face masks, no drugs, just because of negligence, I believe," said a nurse at the Mbabane Government Hospital, who asked not to be named.
As the decline of Swaziland's public health sector continues, Swazis are increasingly turning to traditional healers for health care.
"I see more people coming to me for treatment because they are not served at the clinics. They go a long way and pay bus fare to go to a hospital and they are told there are no drugs," said Manqoba Fakudze, a traditional healer in the eastern Lubombo region. "Many Swazis go to an ‘inyanga’ [traditional doctor] first, before going to a clinic, but it has been many years since Swazis only used traditional healers."