They-used-to-wear-these-white-dresses…-Nurse-midwives- by akgame


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									‘They used to wear these white
dresses…’: Nurse midwives’
experiences with change in South
Africa’s health workforce

       Sarah C. Wilhelm
     MCH Research Festival
         June 7, 2006
   Grounded theory study
    exploring social & political
    changes in South Africa from
    the perspective of experienced
    Black African nurse midwives
       Struggle against & end of
        apartheid system of racial
       HIV/AIDS epidemic - prevalence
        now >20% nationally, almost 30%
        in study community
       “Brain drain” of health workers
        from the public sector - 27% of all
        health posts vacant in 2005
Study Aim
   Thesis examines themes that emerged
    from open-ended, semi-structured
    interviews related to:
       Participants‟ experiences with change in
        the public and private health sectors
       Factors contributing to health workers
        leaving the public sector
          Timeline of key
          contextual events
Social and                   Apartheid and
Political Context            Resistance            - Political
                                                   - Free elections
    Apartheid                        Soweto
                    ŅBan tu                                                     Court rules SA
    Regime                           Uprisings
                    EducationÓ                              Rise of HIV/AIDS    government must
    comes to
                    introduced                              epidemic            provide nevirapine

    1948            1961           1976 1980s 1992-1996                  1998    2002       2005

Implications for                                                                     Interviews
Nursing/Midwifery          Rapid growth in       Nurse           Free primary        conducted
                           number of Black       unionization    health care
                           African nurses        and strikes     introduced
   In-depth, open-ended interviews
       14 Black African nurse midwives
       Working in NGO-run PMTCT clinics in an urban
   Transcribed and cleaned
   Coded using atlas.ti qualitative analysis
   Grounded theory approach to analysis --
    allowed themes to emerge from the data
   Participants
     Age 45 to 71, average age 61

     All had some work experience in the public
     Over half had more than 25 years’ experience
      working in the public sector
     All except two were Coordinators of NGO’s
      PMTCT clinics, operating within 13
      government-run community health clinics
      Changing Status of Nurses
Nurses of today, they are not like us, with patience for their people. They just…
I don‟t know whether it‟s the generation or what. We used to like to take care
of a client… like if you are passing and you see the baby is sick, “Ma, you
must go to the doctor.” I don‟t think it happens with the nurses of today. They
are too sophisticated. So, it‟s the modern times…I‟m sure they don‟t take
nursing as a career, they chase money. They go for money, „I‟m working… So
what? It‟s fine.‟ We were working because we wanted to help our community.
We wouldn‟t just pass a person seeing as this person is very sick, because

this is inside you.
     Deteriorating health services
We are not getting things that we
used to get in the old government.
Unfortunately. Because I as a person   …there was never a shortage
believed where we now had a black      of medicines during
government, we were going to get       apartheid. They were getting
more things than what we got. But      treatment. Really and truly
really I must say we are not getting   speaking. I don‟t support it
as much as we used to get.             [apartheid]. I‟m not supporting
Everything was smooth. We had          it. I‟m just facing facts.
everything. We were working
        Public/private sector tensions
        and HIV/AIDS related care
Right now, we have sisters working in the maternity. But they are not all
PMTCT trained. You know? It was even called the “NGO thing”. And it is still
like that now, even if it is integrated into the program, it is a program now, by
the department of health. But they still wouldn‟t want to do it, as long as we
[the NGO] are still doing it, it‟s still hard for them. To, you know, come in and
ask and, they still, it‟s still our [the NGO] patients, you know? Yeah, it‟s still like

        Well, as I say, [the NGO] started the project and the Government was
        quite happy because, much that they wanted to do… they wanted
        extended hands I think. To say, ‘Okay, they’ve started. Then we join
        them.’ Now, I learn that they even joined in formula subsidies, and so on.
        That they are doing it, they’ve come in. But what is still being done is still
        [the NGO] is still taking charge, in the clinics of doing this project. I
        suppose they are grateful that there is staff which may not be theirs but
        is helping. Because with their problem of staff shortage…
      Health Workforce Shortage
In 2002, we actually lost a mother here who
was diagnosed positive. She came to the My problem now is that
clinic, maybe she was not well after delivery.…
                                              mainly… with all trends of
she died here in this clinic. She was taken from things, the technology,
this clinic. She came and then she spoke with main cry is still staff
Sister… the Sister said to wait there I’m     shortage. With all that is
coming. During that time she just faint and
                                              being done to try and improve
died. You won’t believe me. Maybe if the
Doctor was here, Doctor could have been services, shortage of staff is
called, I don’t know, I don’t know. What to say the crux of the matter.
about that. I’m saying, you know, if a clinic can
only be run by nurses?
   Staff shortages in the public sector
    critical issues in S. Africa today
   Experiences of these nurse midwives
    provide insights into motivations of
    nurses leaving the public sector
   Suggests complexity of the issue in
    post-apartheid, HIV/AIDS era South
Implications for Future
   Why have the ideals of post-apartheid South
    Africa not been achieved in the health sector?
   What can be done to keep experienced
    leaders in the health workforce, like
    participants in this study, in the public sector,
    which serves 85% of the population?
   What is the domestic impact of nurse
    migration from Africa to the U.S.?
   Thesis Committee                   Funding
        Michelle Bell, Chair              Puget Sound Partners for
        James Pfeiffer                     Global Health
        Lois Price Spratlen               US Department of Health and Human
                                            Services, Health Resources and
   At the UW                               Services Administration‟s Maternal
        Shira Rutman, MPH(!)               and Child Health Bureau (Title V,
                                            Social Security Act), grant #
        Amy Hagopian                       T76MC00011-21-00
        Andrew Levack                 My family
   In South Africa                        Martha & David Wilhelm,
        Zandile Myeni                      Christine Kolstad
        Avy Violari                       Fatsilah & Oopah
        G. Carter                         Jesse Hagopian
        The nurse midwives whose lives and stories made this
        study possible and whose inspiration keeps me going!
Questions? Comments?

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