Toilets Of Despair: Dirty, broken Toilets at Clinics Speak of Systemic Neglect
- November 19, 2024
- Health
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Read Time: 8 minutes For World Toilet Day, our community journalists, Molefi Sompane, Montsho Motlale and Sandile Mbili visited 31 primary health facilities and spoke to 313 patients across the Free State, Limpopo and KwaZulu Natal, assessing the state of sanitation. We’ve chosen to use pictures which won’t make readers queasy. This story was made possible with funding from OpenUp and Africa Data Hub. The visual and data graphics featured were created by the OpenUp team. Seven clinics in Limpopo had some sort of pit latrine. Broken bathrooms were experienced much more in KZN and Limpopo than in the Free State. Male Female Age Inside Has Access Usable Has toilet paper Has soap FS Outside No Access Unusable No toilet paper No soap LP Both KZN Dirty toilet Dirty seat Dirty wall Under 20 minutes 21-50 51-70 Size of facility 71-100 Over 20 minutes 100+ Feel unsafe Female Feel Safe Male Age Feel safe Feel unsafe FS LP Less likely to return KZN What we did To better understand the state of sanitation in our primary healthcare system, we asked our network of community journalists to tell us what the bathrooms are like in their local clinics. We also also asked them to interview people who had recently used the clinics. They visited 31 clinicsin 3 provinces– Free State, Limpopoand Kwazulu-Natal And interviewed313 recent usersof those clinics. Interviewees were evenly split between age and gender. Many clinics in Limpopo and KZN rely on outdoor facilities. But while all the clinics we visited in the Free State had bathrooms inside the clinics, they were also the least accessible to patients with a disability. 75.4% of people we spoke to said that at some point, the toilets had been out of order when then visited the clinic. Even when patients could visit the bathroom, however, both male and female toilets were unlikely to be stocked with basics such as toilet paper or soap. Unsurprising, then, that our CJs found the state of the toilets to be very unhygienic, with urine or feacal matter on the seats in 13 clinics, including nine in Limpopo. In addition to the basic state of hygiene, in some larger facilities our reporters witnessed people queuing for up to an hour to use the bathroom. No wonder then that so many people told us that they didn’t feel safe using the toilets. This included more than half of all women interviewed. Surprisingly, two thirds of 18-25-year-olds said they didn’t feel safe, compared to around 40% of those aged 26-40 or older than 60. Apart from the obvious implications to health, and our expectations of germ control in a medical centre, 84 patients we spoke to told us that the state of the bathrooms put them off visiting again. The implications of this – people avoiding primary health care facilities – are severe. And all for the sake of a usable bathroom. Across South Africa, accessing healthcare at primary health facilities is often an act of indignity—from long queues and overburdened staff, to the simple act of using a restroom. Clean bathrooms in many clinics are a rarity, not the standard. And they’re not just poorly maintained, but actively hazardous. For patients, using the toilet can be a dehumanising experience. “These toilets have flush water but they are dirty and the floors are always wet. They are infectious because there is no toilet paper, soap, sanitiser and hand washing basin. If have a choice I will not come to Zone 3 Clinic again.”-Rami*, 24, Limpopo Rami* is among 313 patients who shared their stories with our community journalists in Limpopo, KwaZulu-Natal, and the Free State as part of a survey of 31 primary health facilities to assess sanitation conditions. The evidence is not just anecdotal. The findings reveal a picture of neglect. Most toilets in the facilities visited don’t work, lack basic supplies like soap and toilet paper, and fail to provide adequate handwashing stations. An issue of dignity and human rights I was very disappointed when I went to the reception at Halley Stott Clinic to ask for toilet paper since there was none in the men’s bathroom. I was told that there was no toilet paper. One lady who was a patient felt pity for me and went and got some from the ladies toilet. After finishing my business I needed to wash my hands with soap but it was not provided.-Mandla, 34, KZN This lack of hygiene isn’t just inconvenient—it’s a harsh reminder of systemic neglect. “A lack of adequate sanitation affects patients’ rights to equitable care and access, rights that are enshrined in the Constitution”, says Morongwa Ntini, a researcher at the Treatment Action Campaign (TAC). Our findings align with TAC’s clinic monitoring programme, Ritshidze. In a national report assessing 471 facilities and over 25 000 patients, 53% rated the toilet facilities as ‘bad’. “The data is alarming, and we can see a lot needs to be done”, says Ntini. Safe toilets for all by 2030 is one of the targets of Sustainable Development Goal 6, but ‘attention is given to other factors like medicine stockouts and staff shortages’, says Ntini. “A hygienic environment deserves attention.” “Sanitation is an issue of dignity”, says Nina Benjamin, a programme manager at the Labour Research Service (LRS), who facilitated a pilot social action project at the Meadowlands Clinic in Soweto. “We’ve gotten so used to this type of service, nobody is questioning it any longer. The assumption is that people shouldn’t expect any better.” A public health failure “My worry about these toilets of Moletjie Clinic is that there is no single piece of hygiene. It is unsafe using these toilets because you know you are a target of infectious diseases. For starters never enter a toilet here if you do not have your own toilet paper for there is none here.”-Lamson*, 68 , Limpopo Of the bathrooms visited by our community journalists, 78% were unclean, with 40% showing visible faecal matter or urine on the toilet
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