COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

Themes
Hospice
All three of the Paarl deaths which were AIDS-related died in the local hospice or had been
admitted to a hospice during the time of their illness. Hospice was not mentioned in either of
the other sites, although one mother in Rietvlei was described as having been admitted to a ‘TB
hospital’ in a distant town. In most cases the families were left to care for the women. The
burden placed on families by the lack of a hospice and home-based care is a major concern.
One family member alluded to this:
“…she was not properly fed, on the day of her death, she was lying on the floor…at her house
she was left alone, her children and partner were not there. She could have lived longer with
proper care. Many people I know who are HIV positive are still alive and looking well”.
Blaming the Hospital for Death
In five of the deaths the family members blamed the hospital/health staff for the woman's death.
Sometimes this was direct, for example one mother blamed the death of her daughter on a
‘injection’ she got postpartum after which she became disoriented:
“…unfortunately, the injection knocked her off and she did not wake up
thereafter, until she was confirmed dead”.
One family blamed the hospital for a delay in the diagnosis and treatment of TB in the woman
who died. They stated that the diagnosis of TB was made at another hospital far away but not
at the local hospital where she was a regular patient. In another case the boyfriend blamed the
hospital for allowing the woman to spend two days in labour when she had had two previous
caesarean sections:
“The boyfriend is aggrieved that she died due to negligence from (hospital) doctors and nurses.
He feels that she should not have been allowed to deliver vaginally, because they (health staff)
knew that her previous delivery was caesarean section”.
The hospitals were blamed for both a poor quality of care and a lack of communication with the
family as noted in the next section.
Poor Communication
In the majority of cases very little, if any, information about the woman's illness and cause of
death were given by health care providers to the family. Eleven of the families stated: ‘Nothing’
when they were asked what information they got from the health providers. This is concerning
as in many cases the family was caring for the women at home after discharge or in-between
hospital admissions. Lack of information and understanding led some families to blame the
hospital. This leads to mistrust in the community and a lack of confidence in the health care
system, which may result in delays in seeking care in the future. While the patient’s right to
privacy is a concern, especially in the case of HIV, many of the women were disoriented and
could not care for themselves. Frank discussion of the woman's condition, prognosis, and care
needed with her family would have been appropriate. Guidelines to assist health care
providers in this regard may be needed.
Disclosure
Disclosure of HIV status by women who were known HIV-positive to their family members was
seen in five of 11 cases (45%). All three of the Paarl patients disclosed, while two of the six
Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 26