In the Free State, access to health services can depend on who you know, as the tragic case of one woman illustrates.
There was a chance, a slim chance, but a chance nonetheless, that the patient, let’s call her Sarah, could have survived, had she received the extraordinary attention available in an intensive care unit (ICU).
But on Monday night this week Sarah, a surgical patient, died in an ordinary ward of the Dihlabeng district hospital in Bethlehem in the Free State because an ICU bed was not available.
A month ago she would have had a better chance; at the time, Dihlabeng had five ICU slots rather than three but, due to financial constraints plaguing the health sector in the entire province, doctors say the number was slashed to three.
Except that on Monday night Dihlabeng did, in fact, have a fourth, specially created ICU bed. But instead of Sarah, that bed was occupied by a man with a poorer prognosis, who, doctors were convinced, would not benefit from extraordinary care.
But political connections overruled clinical expertise: connections that were wielded to put the life of one person ahead of another.
Life and death
That ICU bed should not have existed. Having been brought into existence, it should not have been occupied by a man with virtually no chance of recovery, in terms of national public health policy guidelines on triage.
Had a bed been available, Sarah, who did stand a chance, should have occupied it. But the man in question was an ANC officer-bearer, and how he came to be there is a story of political interference in life and death.
The name of the politically connected patient is known to the Mail & Guardian, but because of patient confidentiality it cannot be published. Let’s call him Patient X.
Patient X, who suffers from a serious condition, was subject to the normal rules – and limitations – of the public health service until last Friday night.
Late that night, according to a doctor who requested anonymity for fear of being fired, the two highest-ranking health officials in the province walked unannounced into the Pekholong Hospital in Bethlehem where Patient X was initially receiving treatment and made their wishes known.
What the Free State health MEC, Benny Malakoane, and the head of the provincial health department, David Motau, wanted was for Patient X to be admitted to an ICU.
Pekholong, a district hospital, has no ICU, so the two officials ordered that he be transferred to Dihlabeng.
The late hour notwithstanding, Patient X arrived at Dihlabeng later that night. There the ICU consultant on duty assessed him and found that, in line with national clinical protocols, he did not qualify to be admitted as he was in the last stages of a chronic condition and highly unlikely to recover.
“No other ICU in the country would admit a patient like that, especially over other patients we could more likely save,” a senior doctor at Dihlabeng said.
Dihlabeng has only three ICU beds. According to University of Witwatersrand health economist Alex van den Heever, an ICU bed costs about R11 000 a day to run.
All three ICU beds at Dihlabeng were taken so Patient X was admitted to a secondary level medical ward in the hospital, even though patients with this prognosis are usually cared for at a primary level.
“But that was not good enough,” another doctor said. “The medical professionals on duty were in trouble for not sending him straight to ICU.”
Patients turned away
On Saturday morning, an instruction from Malakoane was delivered by deputy director general Teboho Moji to the clinical manager on duty: an ICU bed was to be opened “because the MEC had promised family members the patient would go to ICU”, the doctor said.
Two other critical patients, one with a mild heart attack and another a burns victim, had already been turned away from the ICU on Friday night due to space constraints.
On Wednesday this week, another two critical patients deserving of an ICU bed lay in medical wards while Patient X remained in ICU – with no improvement to his condition.
The only difference the M&G could discern between those denied access to ICU and Patient X is that Patient X had been a branch secretary of the ANC, among other positions in the party and, according to different sources, he knew Premier Ace Magashule well.
The M&G made extensive efforts to reach the Free State department of health this week but it had not responded to written questions by the time of going to print.
Who you know
In Bloemfontein, the Free State chairperson of the HIV advocacy group Treatment Action Campaign, Sello Mkhaliphi, was trying to make sense of the whole ordeal.
“It is clear that there are those who own the health system. Benny Malakoane is not managing the Free State health system, he’s owning it,” he said.
“For you to access services [in the Free State], it depends on who you know, who you are connected with and, above all, what power those people possess.
“As it is, Benny doesn’t care about the majority of poor black people who are utilising the public healthcare service. The health department system is run by black capitalists who care little about the rights of the patients. They care only about the minority that is attached to them, whether by friendship or by blood.”
But, unfortunately for Sarah, she didn’t have any of those connections. And for that she died.
(Names have been withheld to protect the identity of patients and their relatives.)