Unimaginable Pain of Labour

‘Absolutely heartbreaking’ was how patients, at the Rahima Moosa Mother and Child Hospital in Johannesburg, have described the treatment nurses allegedly gave to a woman who went into premature labour and lost her baby. 

In August 2015, media reports quoted patients who watched in horror as a woman in labour screamed in pain and cried for help but was ignored and even insulted by the staff, eventually forced to give birth without any help.

A witness claimed the nurses called the woman stupid before shouting at her and telling her to stop crying. 

They then allegedly ordered her to go and wash herself, just moments after the baby died. 

The witnesses and other patients tried to get nurses to help the woman, but with no luck. 

“The baby was kicking and moving and she started going crazy and screaming, ‘sister please help me, my child is still alive’”.

A witness said that the baby was born alive but died while they fought with the nurses to get them to assist. She’s shocked by the nurses’ behaviour: 

“We were traumatised, I even started crying. She tried cleaning the baby’s nose even [saying], ‘please baby please, oh please help me, baby please…’”

Unsurprisingly the online comments were forthright:

“The bad ones seem to think they have the 'power' to treat people badly.”

“Who is supervising the nurses at government hospitals?”

“… and of course naturally women are screaming in pain during labor.during this time the nurses would shout at the women, "SHUT UP, YOU MAKING A NOISE" and to my disgust i was asked not to scream during labor.”

“Heartbreaking. A friend also ended up giving birth on her own in a state hospital in Bloemfontein while the nurse told her to be quiet because she was trying to sleep. How do you watch someone suffer and not do anything!”

On Wednesday, 17 November 2015, another instance hit the media. Another woman at Rahima Moosa gave birth to a still-born baby, was shouted at by nurses and had to lie on sheets so dirty that she went home to collect her own sheets.

Section 27 of the Constitution provides that everyone has the right to have access to ­health care services, including reproductive health care and that no one may be refused emergency medical treatment.

Incidents such as that at Rahima Moosa are reported not infrequently and allegations of callousness by nurses are distressingly repeated.

In a statement of 22 September 2014 on Politcsweb Jack Bloom MPL, DA Gauteng Shadow MEC for Health, reported liability claims against the Gauteng Department of Health as at 31 March 2014.

The claims stood at R8.943 billion, up from R4.75 billion the previous year, according to the Department’s Annual Report tabled in the legislature.

Most of the claims are medico-legal arising from alleged negligence in hospitals. These have more than doubled from R3.025 billion as at 1 April 2013 to R6.566 billion as at 31 March 2014.

According to Bloom, the rising tide of negligence claims reflects poor conditions in our hospitals. In August 2014 there were two large pay-outs for medical negligence: R6.1 million paid for brain damage to Lethabo Matlawa when he was born at the Chris Hani Baragwanath Hospital, and R11.1 million paid to a baby boy who was brain damaged at the George Mukhari Hospital

“Mothers should be able to have confidence that their babies will be delivered safely in hospitals.”

It is impossible to comprehend this negligence, callousness and brutality. A paper produced by CERSA - Women’s Health unit of the Medical Research Council researched and written by Rachel Jewkes, Naeemah Abrahams and Zodumo Mvo entitled WHY DO NURSES ABUSE PATIENTS? REFLECTIONS FROM SOUTH AFRICAN OBSTETRIC SERVICES published in 1998.

The study looked at the situation of two primary midwife units in the Western Cape: one in an urban, African township and the other in a historically predominantly Coloured area. Patients were only referred from these units to tertiary or secondary hospitals if they were at risk or developed complications.

Neither environment was squalid and the workloads were not excessive. But, as we know, such violence and neglect is not found particularly in rural or township environments. The media frequently reports incidents in major urban, tertiary hospitals.

According to the study, many of the patients reported clinical neglect, and verbal and physical abuse from nursing staff which was at times reactive, and at others ritualised in nature. Their findings appear to confirm the views expressed in the online comments about the abuse of power and mismanagement.

Although patients explained nurses' treatment in terms of a few 'rotten apples in the barrel', analysis revealed a complex interplay of concerns including organisational issues, professional insecurities, perceived need to assert “control'' over the environment and sanctioning the use of coercive and punitive measures to do so, and an underpinning ideology of patient inferiority.

The findings suggest that the nurses continuously struggled to assert their professional and middle class identity, and in the process used violence against patients as a means of creating social distance and maintaining fantasies of identity and power.

The deployment of violence became commonplace because of the lack of local accountability of services, and lack of action by managers and higher levels of the profession against nurses who abuse patients.

The authors state that such behaviour became “normal'' in nursing practice because of a lack of powerful competing ideologies of patient care and nursing ethics.

The study found that most patients expected to be on the receiving end of abuse at some point. It was a classic interplay of power relations between the nurses in charge and the patients dependent on the services. Abuse could occur for reasons of changing dangerous behaviour by patients, some were punitive and some were ritualised.

Abuse was verbal and physical, and there was considerable contempt shown for teenagers and prostitutes. Neglect was cited as the most dispiriting aspect of their treatment.

The abrogation of the Constitutional rights cannot be remedied through throwing more money at the problem. It can be mitigated without spending an extra cent: it requires one thing in particular. All others can follow.

Management. That’s it. Those responsible for staff (in any environment) are obliged to ensure that they perform their functions efficiently, professionally (where appropriate), with due competence, and with the client’s (patient’s) needs and dignity met.

The standards of nurses’ work environments are tough, but not tougher than some and less tough than others. The same applies to their conditions of employment. What differs is the power they wield over very vulnerable people who are in little or no position to challenge them or complain. This power even rests in the hands of staff with relatively low status.

The fundamental way to counteract this abuse of power is for management to ensure that it doesn’t take place and if it does, to take appropriate disciplinary action which will often include dismissal. Behaviour can be trained and taught, attitudes can’t. Attitudes are individual beliefs and if they cannot or will not change, then those holding them must be excluded from the environment.

The supreme irony of this incident is that when the MEC for Health Gauteng, Qedani Mahlangu addressed the media on this issue, she adopted the same hectoring and accusatory tone that her errant nurses indulge in.

Although she has undertaken to take action against the 3 responsible nurses, she questioned why women, complaining about misconduct by nurses at the Rahima Moosa mother and child hospital, run to the media. She said they should go to her office instead.

Since the complaint under discussion, a number of women have come forward with similar complaints. Mahlangu said that patients must not “piggy back” on one woman’s experience. They should have alerted authorities directly when they were treated badly by nurses.

“If people want us to deal genuinely with their concerns, I am more than available 24/7 to deal with those issues but we must cooperate and work with one another. You cannot piggy back on someone’s issues because ‘mine were not dealt with last year; mine were not dealt with the other year’”.

That’s what we like to see – a lack of empathy and contrition from the management of this country towards the people it serves.

Sara Gon is a Policy Fellow at the IRR, a think tank that promotes economic and political liberty. Follow the IRR on Twitter @IRR_SouthAfrica.