Fix our healthcare system so that we may live!

Participants in a workshop on constitutional rights discuss their right to healthcare services in the Eastern Cape. Photo by Mluleki Marongo.

Tim Hodgson and Mluleki Marongo

4 June 2014

Access to the Constitution and constitutional education in isiXhosa is not an an added extra—it is a constitutional right, argue Tim Hodgson and Mluleki Marongo.

In March, the Stop Stockouts Project and SECTION27 held human rights awareness workshops focussed on the right to health in the Eastern Cape.

We conducted workshops in East London, Hamburg, Nqileni Village and Lusikisiki on healthcare rights and tools for realising them, as part of the work of Eastern Cape Health Crisis Action Coalition (ECHCAC) and its efforts to empower community members to claim the right to health.

Though many gains have been made, particularly in recent years, drug stock outs and shortages continue to plague healthcare facilties countrywide. The healthcare system remains deeply inequitable. It is often experienced by poor black South Africans as if it were still designed and implemented by apartheid architects. This is exacerbated by the lack of interest shown by the private healthcare sector in its moral and constitutional obligations as providers of a fundamental human right.

The problems in the health system are particularly pronounced in the Eastern Cape. Though the National Health Act commits to ending the apartheid in our healthcare system by “uniting the various elements of the national health system”, the vast majority of poor, black people living in the Eastern Cape suffer the indignity of daily violations of their right to healthcare services. As the Coalition’s Death and Dying Report and its work in the province indicates, the healthcare system in the Eastern Cape requires an urgent and comprehensive overhaul.

One example of the depth of the problem is emergency medical treatment. People in the rural Eastern Cape grow angry at the mere mention of ambulance services. Many report waiting up to eight hours before an ambulance arrives. Often, an ambulance never arrives or indicates that it cannot travel to a remote rural location. Stories of people dying while waiting for ambulances, or because there is no medically trained person assisting the driver of the ambulance, are common.

Phumzile, a participant in the workshop in Nqileni Village, said he had never seen an ambulance in his community. Dave Martin, a community member in Nqileni Village in the Xhora Mouth area, has laid a complaint with the Eastern Cape Human Rights Commission in a desperate attempt to rectify this situation. A backpacker’s lodge in the area has provided a bakkie as the community’s only “ambulance” for nearly ten years.

Reports in other areas indicate that people are pushed long distances to healthcare facilities in wheelbarrows.

The Eastern Cape Department of Health acknowledges that 600 ambulances are needed in the province for the fulfilment of the right to emergency medical treatment. But “the provincial ambulance fleet currently stands at 300 with ambulances undergoing conversion such that by the end of the financial year the fleet will be around 400 (68%).”

Each and every missing ambulance exacerbates emergencies and contributes to preventable deaths. Each and every ambulance that is missing is a violation of the right to healthcare services.

To add insult to injury, the Constitution, which demands the immediate remedying of this situation – and has done so for nearly 20 years since its enactment – is hidden from the people of the Eastern Cape. It is hidden in the pockets of a handful of progressive lawyers, the dusty drawers of public servants and policy makers and most alarmingly in the language of the privileged and the educated: English. This is a language that most people in the Eastern Cape do not speak or understand with anything approaching the confidence of fluency.

Many, particularly in rural areas, do not speak English at all.

But since at least October 2013, constitutions in isiXhosa have been completely unavailable. When they are printed, they are not made available in clinics, schools, post offices and other accessible public buildings and are rather ineffectively distributed on an ad hoc basis upon request and at specific workshops run by provincial departments of Justice and Constitutional Development.

Armed with one purchased copy of Bill of Rights For All – the Bill of Rights in all eleven languages published by Juta – and with a colleague fluent in isiXhosa we began our workshops.

This was all the particpants’ first meaningful, understandable encounter with the Constitution. A woman in Hamburg stopped Mluleki after his first sentence. Glowing, she said “can you just say that again—it was so beautiful”. He had read, in isiXhosa, a right directly out of the Constitution. It was the first time she had heard it.

Encouraged by this experience, we got participants in Nqileni to read the text of the Constitution themselves. The first woman to read caught herself half way into her first sentence. She paused and looked up at the 20 or so community health workers, a sub-headman in the host village Nqileni, pre-school teachers and community members. Smiling, she said “I like this one very much! Listen.”, and read in isiXhosa the right to equality.

We were distraught to have to turn down request for copies of the Constitution at these workshops and explain that copies in isiXhosa simply weren’t available despite our best efforts and a growing campaign to ensure that the government print and distribute them.

With this foundation, participants explored in detail the content of their right to access to healthcare services in the Eastern Cape.

People living in the Eastern Cape need a language of power with which to face the Eastern Cape Department of Health. This language of power is found in the Constitution and most particularly its Bill of Rights.

Access to constitutions and constitutional education in isiXhosa is not an added extra—it is a constitutional right. It allows people to imagine the realisation of constitutional rights in their words and feelings.

The message from the people of the people of the Eastern Cape is clear:

Ezempilo Zililungelo! Lungisa Isebe Lezempilo Sizophila!*

*Healthcare is a right! Fix our healthcare system so that we may live!

Hodgson is a researcher at SECTION27 and works in the area of constitutional literacy. He tweets on @TimFish42. Mluleki Marongo is a Students for Law and Social Justice Fellow at SECTION27 and hails from the Eastern Cape.