If there is one place that symbolises the dysfunction of public health, it is the Eastern Cape. Already crippled by staff shortages, it continues to haemorrhage nurses and doctors, who are driven away by the working conditions. It is a cruel and seemingly unending conundrum. Add to this the Aids epidemic and the recipe is one for near total breakdown.
Perhaps this is why the Eastern Cape hospitals were the most difficult to gain access to. The provincial health department refused to let us speak to management, claiming we were pushing an agenda.
This famous old hospital is one of three in the East London hospital complex. It sprawls, servicing a population of three million. Six in 10 doctor’s posts are vacant at the 1 724-bed hospital, and 56 doctors resigned last year.
Four in 10 specialist positions are vacant, so the already thin group of specialists must rotate through the three hospitals. If you get to see them, you’re lucky. We sought and received permission to visit Cecelia Makiwane, but when we arrived the permission was cancelled and we were booted out.
Perhaps this is because they are facing a massive negligence suit after four babies died during a power cut. It was a fundamental abrogation of duty; hospitals must have generators.
Yet, Minister of Health Manto Tshabalala-Msimang denied culpability, though Premier Nosimo Balindlela told the mother of one baby a different story. ”The premier said that the hospital generators are quite old. She said she would help the family with all kinds of expenses, including the baby’s burial,” said 25-year-old Siphokazi Citashe, adding that all the families received was R5 000.
We tried to speak to nurses on the record, but an atmosphere of fear pervades the nursing staff. ”If they know I talked to you, I can kiss my job goodbye. Not that I care so much, because no one cares about us. But you know, I need this job,” said a nurse, whose comment was a common one, revealing low morale.
The nurse’s home was filthy and many windows were broken. At the hospital’s burns unit, which I visited, the stench was unbearable and there was no air conditioning.
A lone nurse was in the ward to care for the 30 patients who need specialised attention as they are highly susceptible to infection.
It is a similar story of neglect and haemorrhage. Since 2003, 348 nurses and 68 doctors have quit.
About 2,5-million people rely on the Mthatha hospital, yet one in three doctor’s posts is vacant. There is a chronic shortage of pharmacists, so the desperately needed anti-retroviral treatment programme has stalled. Earlier this year, we witnessed people dying, as only 10 Aids patients per month were admitted to the programme.
When we told provincial health minister Bevan Goqwana about our story, he insisted that staff work overtime. He has since been fired and now the hospital’s Dr Anele Mani says it has returned to running at a snail’s pace.
As was the case at most of the hospitals we visited, waiting areas have become zones of pain and evidence of overload. People in trauma lay on stretchers and benches, drips attached to their arms as they waited for an elusive bed. Dustbins were overflowing and toilets were filthy.
This tertiary hospital was meant to take pressure off Mthatha but it has been unable to attract staff so it is largely a white elephant.
Dr Ogo Chukwu Anizoba is from Nigeria and works near the Sipetu district hospital. It is a picture of decrepitude and not what he expected in sunny South Africa. ”I never really imagined I would find what I saw at Sipetu,” he says.
There is only one doctor and not a single ambulance for a population of about 200 000.
The back-jarring dirt road to Sipetu can only be reached by bakkie as minibus taxis refuse to use the road.
The operating theatre has not been working for more than a year, so not even run-of-the-mill Caesarian sections can be done.
The anti-retroviral programme has not been rolled out because there is no one to dispense the drugs. Volunteers dispense medication as no pharmacists want to work at the 147-bed rural hospital.
Public Service Accountability Monitor researcher Thokozile Madonko says alarm bells have been ringing at all levels throughout the Eastern Cape public health sector since 1996.
”At the heart of the department’s problems has been its consistent failure to undertake rigorous strategic planning exercises, which has resulted in it being unable to properly manage its finances,” says Madonko.
”This has led to the department routinely incurring significant over-and under-spending, which severely hampers effective service delivery.”