Let’s get real here. Although manifestos in recent elections have portrayed a united approach toward improving and advancing health care access and services in South Africa, who are we really taking into the picture? Who and what medical conditions are seen as important and who is being benched to the sideline? In a country where a significant percentage of people live disabled lives, the need to prioritise access to health care for disabled individuals is pivotal and yet so far from transformation.
The predominant problem is that poverty, a large portion of the time directly overlaps with disability and rurality. These circumstances trap citizens in a vicious cycle of navigating their disadvantaged lifestyle in a terrain made even more difficult by their condition. 56% of our population live in poverty of which 2014 governmental statistics reported 7.5% are disabled. The inability to be treated correctly, checked up on, offered support by medical professionals and health care workers, and prevalently, the lack of access to special equipment and prosthetics can result in infection, incredibly poor quality of life, and in some cases, death.
You’d think we as a country would be taking it more seriously by now right? Well, according to a study conducted from 2014 to 2016 by the Office of Health Standards Compliance, 40% of the health clinics and hospitals under observation in South Africa failed to meet the elemental requirements. Beyond these concerning findings, these statistics show that the experiences disabled individuals across the country encounter differ vastly from one another and highly depend on the type of medical care received and socio-economic status they are situated in. The problem is that there’s no one size fits all - each unique individual is provided a unique experience based on what lifestyle they’re born into. To understand the bigger picture of why such a poor quality of life exists for disabled people of the country, we’ll have to take a closer look at the multiple linking sectors of the healthcare system and the domino effect that they have on one another.
According to the South African Healthcare Review (SAHR) report of 2014/2015, individuals with disabilities are under prioritized in various facets of the public healthcare system due to government concentration on medical conditions and diseases seen as more pressing— such as HIV. In addition to this mentality surrounding disability, a fair percentage of public health care workers are not adequately skilled regarding the necessary knowledge or referral skills, nor are a notable percentage of the workers able to communicate with disabled individuals properly.
These factors are exacerbated in rural settings, where most patients make use of public health centers and hospitals. Due to the demand for health care, waiting times are prolonged and additionally, the cost of transport to these regions remains a huge financial burden.
Many scholars point out that location also plays a significant role in access to health care within rural regions. Disabled individuals living in rural impoverished communities have proposed that uneven roads, hilly topography, and lengthy distances to clinics prevent them from seeking medical help, which increases the likelihood of self-medication. Without adequate medical guidance and treatment, these individuals risk destroying their quality of life.
This almost probes us to question what our doctors are doing and why public health care centers are severely understaffed? It’s easier to have someone or a collective group to blame, but our country’s position is far too complex to create binaries that pinpoint the bad guys and champion the good guys. Currently, 84% of our population seek public health care, a sector in which only 30% of the country’s doctors work. This statistic isn’t tricky to decode. The private health care sector, in which the remaining 70% of doctors practice, devotes itself to the wealthier of patients within the country - a strikingly obvious minority.
Better staff management, medical stock and supply, access to prosthetics, treatment of patients, and in-depth knowledge of disability treatment are just a few of the many advantages that disabled individuals attending private health care centers will receive. One might be tempted to point fingers at public hospitals which are often poorly stocked with minimal medication and assistive devices. Service delivery however, depends very much on governmental health care expenditure and is an entirely different debate on its own but remains a prevalent issue with regards to supplying hospitals with essential products needed to aid disabled individuals.
So what’s the deal with assistive devices? Let me elaborate on this vague term I keep throwing around. Medication is one thing, prosthetics is another - and a costly ‘’other’’ by financial standards across the board. Although disability extends and covers a range of both emotional and physical conditions, amputees face a particularly heavy blow to the wallet, regardless of which limb they lose. While this may be feasible under private care or medical aid for a middle-aged business executive residing in Constantia, Cape Town, the access to suitable prosthetics for a young single mother raising her children in Langa would be quite the contrary.
We conducted an interview with Frikkie Harmse, part of the admin team at the Paul Steyn Foundation (a non-profit organisation based in Cape Town) to delve into the complexities of prosthetic care and access for disadvantaged South Africans. Harmse proposes that the cheaper options for a prosthetic limb can range in value but tend to average out at about R60 000 per piece which seems unfathomable for those living below or above the poverty line. This cost covers the initial payout for the limb but further maintenance costs of prosthetic upgrades are case-specific and overall they aren’t bound to make the bank too happy.
An interview conducted by SAB with Michael Stevens, operations manager at Jumping Kids (also a non-profit organisation) revealed that for those paralysed from the waist down, wheelchairs designed for case-specific individuals also cap off at around R60 000. Having this in mind, it’s safe to say that the government paints a pretty picture with the notion of disability grants. These grants are supposed to cover the expenses disabled individuals will endure during their lives. The reality is that most of the time these grants are tremendously difficult to acquire and neglect to compensate for a substantial amount fit to cover the expenses of equipment or assistive devices needed. The incapacity to access all the medical needs required as a disabled individual stunts that person from seeking work opportunities. This makes way for fast financial regression and increased vulnerability to health risks never mind the emotional pain and psychological trauma for which they’re not sufficiently receiving any means to cope with.
So where do rehab and emotional wellbeing fit in? Continuous rehabilitation plays a significant role in accepting disability and body image, boosting self-confidence, and developing the desire to become active in daily life. Rehabilitation occurs in stages and needs to be case-specific as no individual is the same. A study completed in the Western Cape suggests that all information about patients needs to be collected and analysed so that medical practitioners can carry out treatment and rehabilitation procedures sufficiently. Only after these two steps, should the individuals receive rehabilitation. This rehabilitation process is supposed to involve community professionals trained to guide patients through their new adaptation skills they’ll need going forward in life. Currently, there is a huge gap between these rehab stages, particularly involving physiotherapy and vocational training.
With the National Health Insurance plan underway, the seed for effective medical and emotional treatment of disabled individuals has been planted in society. This process however, needs to be cooperative and unite forces between the government, health care centers, and citizens of the country. Practically speaking, transformation in: knowledge about disability treatment, adequate rehabilitation strategies, health risk prevention techniques, and an effective system for staffing and material resource standards is imperative. However, beyond the practicality, what’s evident is that the emphasis is on the treatment of disability in society. If we as citizens fail to acknowledge the importance of access to equal services, activities, and general participation in the public sphere for disabled individuals - we’re denying these people a basic human right. In order to even remotely achieve some sort of social justice, we need to re-figure the systems in place, but moreover, we need to reshape our understanding of disability within the daily South African context as a whole.
On the brighter side, there are some incredible organisations putting in a phenomenal effort to help disabled individuals in our country. Check out these links for more info on the work these organisations do and how you can get involved:
**All photo credits: Unsplash
If you have a particular cause you’d like to contribute toward or take a closer look at, simply browse through this List of National Disability Organisations: