[43] Nurse Ndjala admitted during cross-examination that she read the
plaintiff’s antenatal care record and when she saw the inscription “BTL” and
another inscription where there is reference to “Family plan: BTL” she assumed
that the plaintiff wanted to be sterilised and that plaintiff had already been
counselled. She admitted that the instruction given to her by the doctor on 9
December 2007 was to prepare the patient for a caesarean section only. She
testified that because of her assumption that the plaintiff had already been
counselled she did not consider it necessary to counsel her again. She testified
that she needed to obtain confirmation from the plaintiff that she would still
want to have a sterilisation. She denied that she compelled or coerced the
plaintiff into having a sterilisation. It was put to her that the plaintiff’s evidence
was that she was told that she would have to have a sterilisation because she
was HIV positive, to which nurse Ndjala responded that she has never heard of
a person being sterilised because she is HIV positive. 23
[44] Celest de Klerk a general practitioner qualified at the medical school of the
University of Cape Town in the year 2003. She worked as a medical officer in
the Katutura Anti-Retroviral Clinic from 2004 until the year 2009. On 26
October 2007 she saw a female patient, the second plaintiff. She testified that
she made notes, inter alia, one on the outer cover of the antenatal care record
card where there is an inscription “BTL”. She describes that a description
“Family plan – BTL” indicated that the plaintiff “opted” for a sterilisation as a
method of family planning after the birth of her child. She testified that she
would have discussed family planning in general in layman’s terms and would
have referred to different options including sterilisation. If the patient opted for
sterilisation she would have made the inscription as it appears on the
antenatal care record of the plaintiff. She wrote “BTL” on the cover of the
antenatal care record to draw the attention of personnel at the antenatal care
clinic because the two clinics are different and there for different purposes. She
testified that she made it clear that the plaintiff would still have time to go
home and consider the chosen option.
[45] It was put to Dr de Klerk during cross-examination that the inscription
may be interpreted differently by another health official as meaning that it is
something which was merely raised with the patient or recommended to her
and would not necessarily be read as an accepted option. Dr de Klerk, after
much debate, conceded that an indication regarding family planning would not
necessarily be considered as final consent by the patient. She also
acknowledged and accepted the fact that the patient may have opted at the
time for sterilisation as a family planning method cannot be relied on for
purposes of claiming that she had given her informed consent to the
sterilisation procedure.
[46] Dr de Klerk testified that she gave the patient information about family
planning, and that issues like how the procedure for bilateral tubal ligation is