Sunday Times (Johannesburg) - May 21, 2009
Harriet Mclea, Sally Evans and Nkululeko Ncana

After being contacted by The Times late yesterday, Gauteng Premier Nomvula Mokonyane added the formula crisis to the agenda of a meeting to which she had summoned Johannesburg mayor Amos Masondo and his councillors.

The Times visited clinics in Soweto, run by either the province or the Johannesburg metro, and found that there was no formula available for HIV-positive mothers - even though the dispute over payment between the government and formula supplier Nestl was resolved last week.

A Johannesburg paediatrician, Neli Stoykova, explained that HIV-positive mothers could not breast-feed because to do so would risk transmitting the virus to their babies.

Paediatric nurse Debbie Hooper, who runs a baby clinic in the city, said infants fed maize meal were at risk of long-term health problems and brain damage because the porridge did not contain the nutrients essential for mental development.

"Babies need good nutrition to grow good brains and these babies are at risk of learning difficulties when they're older if they are malnourished," Hooper said.

Mokonyane said that, though the clinics that had no formula were run by the province, "they fall within the city and that is why I have summoned Mayor Masondo and councillors to a meeting about this issue ...

"Health is an essential service and there will be [an] intervention.

"I am aware of the problems in those clinics."

Mokonyane said she was also in discussions with the department of health.

"We need to move quickly on this matter so that we don't have hospitals running out of an essential product like milk formula."

At Chiawelo clinic, The Times spoke to a 28-year-old HIV-positive mother who was feeding her two-month-old son watered-down maize meal. She said she could not afford to buy formula.

"I can't breast-feed so he cries a lot," she said as she put a bottle of the watery porridge in his mouth.

The unemployed woman, who has lived alone with her baby since her husband died, was delighted to find out two weeks ago that her son is HIV-negative. She cannot risk breast-feeding him now and perhaps infecting him.

"The people at the clinic said there's no milk and maybe they will have [some] next month," she said. "I don't know why they are delaying the milk. It's too painful."

A 25-year-old mother said the formula shortage forced her to feed her two-month-old daughter five spoons of maize added to boiled water.

A 31-year-old mother from the Soweto suburb of Protea Glen said she had not been able to get formula for her seven-month-old daughter at her local clinic for more than a month.

She said she had to buy formula, which she diluted to make it last longer. Her baby is going hungry.

Hooper said two-month-old infants were "too young to be drinking watery pap".

"The babies will have nutritional deficiencies because they are not meant to go onto solids until at least four months, preferably six," she said.

In the absence of breast milk, formula was vital for babies' development, she said.

"Often, there is maternal ignorance coupled with huge financial problems."

The formula shortage began when Nestle stopped delivering it last month because the Gauteng health department had not paid the company for six months.

Last week, health department spokesman JP Louw said formula would be delivered to all clinics and hospitals by Friday.

But it wasn' t.

Nestle's Theo Mxakwe said deliveries to government clinics resumed on Thursday last week.

"The issue has been resolved amicably," Mxakwe said. "The Gauteng department of health honoured its obligation and we have resumed our deliveries."

The company would hold monthly meetings with the health department to ensure that the problem did not recur, Louw said.

He said he did not know why some Soweto clinics had not received formula but he suggested that there might be an internal distribution problem.

"It could be a question of [clinic staff] needing to collect their own supplies of formula from their district offices," he said, adding that he would investigate.

Last week, the supply of medicines to state hospitals in Johannesburg was disrupted when staff at the health department's central medical supplies depot had problems with a new computer system.

Louw said this might also be the reason for the delays in the delivery of formula.

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