Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
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Mail & Guardian (Johannesburg)- February 11, 2002
Justin Arenstein
"Nothing is proven yet. We're sticking to our policy of only providing nevirapine at two rural pilot clinics in the province and will not extend the service anywhere else until we get orders to do otherwise or until the trials are completed in December," said provincial health department spokesperson Dumisani Mlangeni.
"I can say, however, that we are finding it difficult to run the trials. Our rural people are simply not used to having to register for medication, undergo counselling and come in repeatedly for treatments. We're having a very slow uptake in the trials."
Provincial statistics indicate that only 407 women have registered for treatment at Shongwe hospital in Mpumalanga's HIV/Aids epicentre of Nkomazi, while 641 women have registered at Evander hospital on the Highveld.
This is despite Mpumalanga's status as South Africa's second-worst HIV/Aids hotspot, with an estimated 20 people dying every day in Nkomazi alone.
Mlangeni believes that additional transport costs for patients have influenced the number of women registering. He refuses to comment on whether Mpumalanga's documented antagonism towards anti-retroviral campaigners has changed.
"That's a tricky question and not one that I can answer alone. We'll just have to wait for our trials to run their full course," he said.
Manana's persecution of everyone from rural hospice volunteers to veteran hospital superintendents who support the use of anti-retroviral drugs has earned her a reputation as Mpumalanga's own Nurse Ratched.
Like the dictatorial character in Ken Keasey's book One Flew Over The Cuckoo's Nest, Manana is accused of ignoring the plight of patients in favour of rigid adherence to bureaucratic dogma.
Terrified hospital staff, who watched as Manana systematically axed veteran doctors for giving anti-retroviral drugs to rape survivors, only dare refer to her as the "Big Nurse" in whispers.
Her track record as a highly qualified homeland nurse during the 1980s smoothed her way into provincial politics, securing her a backbench seat in Mpumalanga's legislature on the ANC ticket in 1994.
Never high profile, Manana quietly chaired the legislature's standing committee on health until she was appointed ANC caucus chairperson and then ANC whip.
Her skills as a no-nonsense enforcer won her a seat in Premier Ndaweni Mahlangu's hardline cabinet in 1999, and have helped her implement often unpopular edicts.
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