Lee T, Buch E, Peden C
Department of Community Health, University of the Witwatersrand, Johannesburg.
S Afr Med J. 1991 Aug 3;80(3):146-9.
A study comprising in-depth interviews of sisters in all 15 rural clinics in the Mhala district of Gazankulu showed them to experience major problems with support systems: radiophone communication was unreliable (and even absent in 3 clinics); transport was inadequate; the cold chain was not well maintained and essential drugs and equipment were absent (only 1 clinic had all the equipment to manage a neonatal resuscitation adequately). There were also serious deficiencies in facilities, lack of running water and electricity posing the most serious problems (resulting in deliveries and suturing of episiotomies by candlelight). Other pressing problems include inadequate waiting space and patient privacy. Staffing at the clinics fell well below what is required, yet the commitment of staff was often inspiring. The state of the clinics must be seen within the constraints of 'homeland' policy and the unequal distribution of the country's health care resources. Despite these limitations the clinic service can be improved. Recommendations are made for this, concentrating on improving support structures rather than on the more costly improvement of facilities.
一项对加赞库卢省姆哈拉地区所有15家乡村诊所的姐妹进行深入访谈的研究表明，她们在支持系统方面遇到了重大问题：无线电话通信不可靠（3家诊所甚至没有）；交通不便；冷链维护不善，基本药品和设备短缺（只有1家诊所具备充分管理新生儿复苏的所有设备）。设施也存在严重缺陷，缺水和停电问题最为严重（导致分娩和会阴切开缝合手术只能在烛光下进行）。其他紧迫问题包括候诊空间不足和患者隐私问题。诊所的人员配备远低于所需水平，然而工作人员的奉献精神常常令人鼓舞。诊所的状况必须在“家园”政策的限制以及该国医疗资源分配不均的背景下来看待。尽管存在这些限制，诊所服务仍可得到改善。为此提出了一些建议，重点是改善支持结构，而不是对成本更高的设施进行改善。
