TAC Electronic Newsletter

Sunday 18 September 2005

Is Government underestimating deaths in Delmas typhoid and diarrhoea outbreak?

· Evidence uncovered of far more than the three official typhoid deaths in Delmas typhoid and diarrhoea outbreak

· Allegations that outbreak started in June

· Community members are unhappy with the response to the outbreak

· Too little water is being supplied to a school in Delmas and children from the school are getting ill

· No account is being taken of the special needs of people with HIV who are much more susceptible to illness and death in a diarrhoea outbreak

It has been alleged to TAC by multiple sources that government is substantially underestimating the number of deaths in the current outbreak of diarrhoea and typhoid in Delmas, a small town of about 50,000 people in Mpumalanga Province. An investigation by TAC has found evidence to support this allegation.

As of the evening of Friday 17 September 2005, the official number of deaths in Delmas ascribed to the current typhoid outbreak was three. Our investigation has found evidence supporting the allegation that more people have died. We present this evidence here, as well as other allegations made by members of the Delmas community about government's failure to respond to the current outbreak. We also report on some good work that is being done in Delmas to control the outbreak.

TAC trainee journalist Sydney Masinga, Mpumalanga provincial co-ordinator Msanyana Skhosana and TAC volunteer Augustus Dludlu visited Delmas on Wednesday 14 September. Masinga filed a report after receiving allegations from staff members at Delmas's Bernice Samuel Hospital that government is underestimating deaths and not responding adequately to the outbreak. He returned to Delmas on Friday 16 September and collected evidence to substantiate the allegation of unreported deaths.

Unreported Deaths and Community Dissatisfaction in Delmas

By Sydney Masinga

The Mpumalanga Health Department claimed on Friday that there have been three typhoid deaths in Delmas and 483 cases of typhoid. Symptoms of the disease are also being reported to have been first noticed in August. [Source: online Mail & Guardian, SABC news]

The number of deaths caused by the outbreak of typhoid and diarrhoea are contradicted by reports I have received by staff members at Delmas Hospital, claims by the Delmas community and my own investigations.

Two staff members at Delmas Hospital have separately reported to me that the diarrhoea outbreak started in June and that the number of deaths has been greater than reported. It has been alleged by the staff members that the official figures do not include deaths at Delmas Hospital or people who have died at home. A staff member involved in processing deaths at the hospital, says that more than 20 people have died at Delmas Hospital alone, as a consequence of the outbreak.

I spent Friday afternoon locating families of people who contracted diarrhoea and died. I located six in just a short space of time. I personally saw three death certificates stating typhoid as the cause of death and this was still when the official death toll was two. The other three families presented plausible accounts that their lost ones had died as a consequence of the current diarrhoea outbreak.

I also spoke to community members who said that Delmas usually has about ten funerals a week, but last week Saturday there were 21. On Saturday I spoke to a local clergyman, Pastor Budha, who as part of his job presides over funerals. He has witnessed an increasing number of these and has complained to the local newspaper that government is underestimating the number of deaths.

We also interviewed counsellors and nurses at Delmas Hospital about HIV and the typhoid outbreak. They did not have knowledge of specific cases of HIV coupled with typhoid but were concerned that the outbreak would hit HIV-positive people harder because of their compromised immune systems. The counsellors said they test about 30 people per week for HIV and about 20 test positive. (Antiretroviral treatment is not yet available in Delmas. The hospital is being considered for accreditation and one doctor estimated that implementation would begin in January or February 2006.)

We spoke to a woman from the local home-based care forum. She said that since the beginning of the outbreak in June, many more of their HIV-positive patients had died than usual.

A community meeting on Saturday morning estimated that the number of deaths due to the typhoid and diarrhoea outbreak was 49.

The CEO of Delmas Hospital denied the allegation of unreported deaths. He would not confirm any deaths at Delmas Hospital. He also claimed that the outbreak was under control and getting better. He claimed there were no new cases coming in. All of this was contradicted by another staff member who claimed the outbreak was getting worse and more cases were being admitted all the time. I located the family of a 33-year old woman who died on Thursday 15 September at Delmas Hospital. Her death certificate states typhoid as the cause. The CEO denied knowledge of this death.

Her death does not appear to be part of the official death toll, because the third official death reported on Friday was “a 46-year-old woman [who] died in Kwamhlanga hospital” [Gabashane quoted in Mail & Guardian]. I did not meet the family of this person, but yet I saw three death certificates of other families confirming typhoid as the cause of death. This is evidence that there are confirmed typhoid deaths that are going unreported.

Here are details of the deaths of five other people whose families I met:

A 15-year old girl died in Witbank Hospital. She was buried last Saturday. Initially she was sent to Delmas Hospital. She was put on a drip, recovered, but became ill again. She was then sent to Witbank Hospital where she died. Her death certificate says she died of respiratory collapse. The family is convinced her death was related to the current diarrhoea outbreak.

A 29-year old woman died at home on Tuesday. She will be buried Saturday 17 September. She received treatment at hospital twice, but was sent home where she died. The family says she had diarrhea and is convinced she died of typhoid.

A 10-year old boy died in hospital and was buried last Sunday. The death certificate confirms typhoid.

A 28-year-old woman died at home. She went to Delmas Hospital last Tuesday, was treated and released. But she needed to return to hospital on Thursday. According to the family, they were told the hospital was closed. She died at home. She had diarrhea and a headache before her death.

An 84-year-old died two weeks ago in Witbank Hospital. The death certificate confirms typhoid fever.

GOVERNMENT RESPONSE

If this is what I came across in one afternoon, the allegations from multiple sources of underestimated deaths are at least plausible. My colleague Nokhwezi Hoboyi therefore asked the Mpumalanga Provincial Health Department for comment. She also tried unsuccessfully to get comment from the National Department of Health.

Hoboyi spoke to the Mpumalanga health spokesperson, Mpho Gabashane. He denied that they were underestimating the number of deaths. He denied knowledge of deaths at Delmas Hospital. He claimed only two people had died, both at Witbank Hospital (this was shortly before the department confirmed the third official typhoid death). Gabashane said that he did not understand why we were making this a serious issue because the department was looking at it.

I also spoke to a member of the Mpumalanga Department of Health and asked her about the under-reporting of deaths. She explained that the issue had now "become political" and they did not want to "create alarm". She felt they would soon have the outbreak under control.

Msanyana Skhosana and a delegation from TAC were due to meet the mayor of Nkangala district, which includes Delmas, on Friday to discuss the outbreak. But the mayor had to cancel because of an urgent matter.

COMMUNITY DISSATISFACTION

Members of the community are not only dissatisfied that government is underestimating deaths. They are also dissatisfied with the response to the outbreak. I was informed that a large protest took place in Delmas on Thursday to highlight the poor response to the outbreak. The exact sequence of events that led to violence is unclear. But at some point police used rubber bullets and one woman was shot in the shoulder and had to be hospitalised. She has since been released.

A staff member at the hospital claimed that patients were not being given sufficient medication. He claimed they are put on drips. They recover and are then sent home. But they often come back a couple of days later in worse condition. I do not have sufficient medical knowledge to confirm the allegation that insufficient medication is given to patients.

Tents have been established next to Delmas Hospital to handle the overflow during the outbreak. We interviewed a number of patients in the tents who complained they were too cold and that they were often ignored.

We also interviewed seven school children who were being treated in the tents. They attend Sizuzile Primary school and complained about the inadequate water supply being received at the school. We went to the school and confirmed that Rand Water supplies the school with 32 x 20 litres per day. Either the supply is irregular, poorly timed or inadequate, because when we went to the school, there was no water and the children had no choice but to drink tap water, which is possibly a source of contamination.

It was also brought to our attention that residents of Delmas town were supplied with bottled water, but residents in the township were supplied with tanks of water.

GOOD WORK

Despite the misery of the typhoid and diarrhoea outbreak, there is much good work being done in Delmas to contain it. Government has sent more personnel to the area to deal with the outbreak. There is also a sense of urgency among health-care workers who are clearly trying their best under difficult circumstances.

We met Sister Lillian Cingo, the manager of the Phelophepha train, which is a mobile clinic. They arrived in Delmas during the outbreak and are trying to help wherever they can. They need more assistance though. Sister Cingo says that they are trying to help but the number of cases is out of hand and preventing new cases must be a priority.

The South African Red Cross is also donating bottled water and personnel to Delmas Hospital.

But much more is needed. A clean and adequate water supply is necessary for the entire town. Government must make sure that sufficient doctors, nurses and medicines are made available at Delmas Hospital and the town's two clinics. The tents must be heated or alternative premises must be found to deal with the overflow of patients. The possibility of an outbreak of diseases other than typhoid needs to be considered. Most importantly, complete honesty is needed about the extent of the outbreak.

A regular supply of clean water to the school and community will stop outbreaks of typhoid and diarrhea. This is government policy and it must act with urgency to deliver.

Achieving all of the above requires genuine partnership and decision-making with the local community.

We urge the media to send journalists to Delmas to investigate the outbreak in depth. I have not released the names of most of my sources and the families of the dead in this report, but I am willing to assist accredited journalists who guarantee confidentiality and come to Delmas.

Contact: Sydney Masinga - 082 679 4721

FACTS ABOUT DELMAS

Population size: Approx. 55,000

Number of hospitals: One – Bernice Samuel Hospital (referred to as Delmas Hospital in the above report). Bernice Hospital had 11 doctors, but one resigned a few months ago and one has been sent to Witbank, so there are currently nine.

Number of clinics: Two, one in the main town and one in the township. An ambulance and minibus transport people from the clinic to the hospital, a distance of about 4 kilometres.

[END OF NEWSLETTER]