Disrupted: The protest by civil servants at Chris Hani Baragwanath Academic Hospital resulted in health care being ‘chaotic’ . Photo: Fani Mahuntsi/Gallo Images
Strike-compromised doctors and nurses in several major hospitals in three provinces battled to care for patients on Tuesday as protesters blocked access to facilities, forcing the cancellation of surgeries and emergency treatment.
Worst hit were Chris Hani Baragwanath and Sebokeng hospitals in Gauteng and Grey’s Hospital in Pietermaritzburg, KwaZulu-Natal.
In the Eastern Cape, singing and chanting protestors gained access to Livingstone Hospital in Gqebera, marching between wards and disrupting doctors’ ward rounds.
The NU8 Clinic in the Nelson Mandela metro municipality was also disrupted, while the Dora Nginza Provincial Hospital in nearby Zwide contended with morning stay-aways and protests, creating protracted waiting times.
A “no work, no pay” rule was applied by the Eastern Cape health department.
The Gauteng protests led to a belated interim interdict being granted to the provincial health department on Tuesday afternoon, preventing unions and their members from obstructing health services.
It holds legal consequences for any union or its members “assaulting, threatening, intimidating and inciting violence against any healthcare staff members across all healthcare facilities, or destroying or damaging property”, and is valid until 1 March next year.
The interdict is particularly pertinent at Chris Hani Baragwanath Hospital, where a union memorandum gave management seven days to respond to pay demands. Half the nursing complement stayed away, posing patient care headaches for doctors.
By Tuesday afternoon, patient care at most hospitals in all three provinces had returned to a semblance of normality.
True cost still to come
Although there were no reports of deaths, aggravated ill health or major damage to property, doctors interviewed by Mail & Guardian said the true cost in care would only emerge once patients denied access to hospitals and those in intensive and high care were properly assessed and monitored.
At Greys Hospital, doctors, nurses, and incoming patients were stopped from entering the hospital by a raucous crowd, some carrying knobkierries, from about 7.30am, leaving the night staff trapped inside the building and forced to continue caring for patients on a make-shift basis.
Dr Nikki Allorto, the leading burn surgeon at Greys Hospital, said: “They physically barricaded the place and prevented any staff from getting in. It had a huge impact on service.
“Vital operations weren’t done and the tired doctors from the night shift had to stand in until 1pm when they allowed staff back in. It’s unbelievable.
“For surgery, there were two interns and two medical officers responsible for reviewing about 120 surgical patients, with no physical specialist support. When the specialists did get in, they had to clean up any potential disasters. There could be significant morbidity,” she warned.
Doctors shut out
Her colleague, trauma surgeon Dr Damian Clarke, said he and most of the hospital staff spent the morning window shopping and drinking coffee in the nearby Cascades Mall.
“On Monday there was a big meeting, singing and loudspeakers in the car park. I think the union decided to make an example of Greys on Tuesday. We had no prior input from management, so the lock-out surprised us. None of the support staff could get in.
“This could have serious consequences for urgent surgery. All elective surgery was cancelled on Tuesday morning. You know, if you have a patient on a ventilator or recovering from surgery, there can so easily be a problem,” he added.
Sebokeng Hospital operated with skeleton staff after doctors, nurses and administrative staff were prevented from entering the facility by protestors, a Gauteng health spokesman confirmed.
Professor Martin Smith, chief of surgery at Chris Hani Baragwanath Hospital, described in-hospital care as “chaotic”.
“Doctors had to step in and do all the observations, medications and dressings. Luckily, at least in my department, we had no adverse events. We discharged as many patients as we [clinically] could, which helped us cope.
“We had management sourcing and opening patient files and just enough nurses for at least one per ward, with a senior nurse overseeing them and us doing the work. We were in crisis mode, which is not that unusual. I’m not sure how the patients’ food got delivered but they eventually got it. By the afternoon things had settled down,” he said.
Smith said that by 7pm on Tuesday most nurses were back at work.
Blocked patients
“We had our normal on-call team take over [surgical] operations. We had two teams doing emergency ops during the day. There were some delays in the morning, but all the cases eventually got done. Being closed meant that no new cases came in so that took the pressure off, although I do worry about those patients. Helen Joseph and Charlotte Maxeke [Hospitals] were open, so hopefully they were taken there.”
Smith said staff members were told by the union to “get out” of the hospital, “so it becomes an issue of self-preservation”.
All elective operations were cancelled, “so we may be flooded [in the coming days]’’, he added.
He said he suspected the court interdict was “political posturing” but said it might serve some purpose in allowing patients to enter hospitals if the union again protested.
Dr Burger Terblanche, a general surgeon at Livingstone Hospital, said protesters moved through the hospital during ward rounds, making it difficult to hear one another.
“I didn’t notice any nurses among the group. They weren’t aggressive and it was mainly IT and other support staff. It was frustrating being unable to access patient files. Our ambulance drivers refused to transfer patients to other hospitals.”
He gave one example of a patient needing transfer to the cardiology department at the Port Elizabeth Provincial Hospital for an angiogram. “I’m not sure how urgent it was, but she was just lying there.”
Other hospitals surveyed at random showed a general theme of drop-in patients and staff arrivals delayed by an hour or two because of burning tyre barricades and protestors en route to work.
Nazreem Sonday, a long-serving physiotherapist at Khayelitsha Hospital, said, “Quite a few of us had to make detours. We told one another where the burning road barricades were. It’s not like we’re unused to this. We have contingency plans. We left early on Tuesday to avoid any action on the roads, but managed to see all our patients.”
Western Cape health department chief Dr Keith Cloete said the province was “minimally affected with no patient morbidity or mortality, major incidents or care compromised”.
He said that with the taxi strike overlapping the public servants strike, a “significant number” of nurses had trouble getting to work.
MECs speak out
Dr Pophi Ramathuba, health MEC for Limpopo, said her province “fortunately escaped the chaos” with only a few non-disruptive protests outside some hospitals.
“Even when we had strikes for water here previously, I told [unions] I won’t tolerate them stopping any patients coming through. You cannot disrupt casualty and theatre. In education you can disrupt classes and learners can rewrite, but you can’t interrupt doctors in theatre,” she said.
“It’s interesting — they’re not disrupting private hospitals where the people responsible for their problems go,” she said.
Spokespeople for the Eastern Cape and KwaZulu-Natal health departments said most facilities had little or no disruption to services.
KwaZulu-Natal health MEC Nomagugu Simelane appealed to the consciences “of those who participate in these gatherings to refrain from blocking access points to our health facilities”.
“Those who bear the brunt of these blockages are innocent healthcare users who may be sick and might even die. We’d like to remind all healthcare professionals that they’re classified as essential workers, which means they are prohibited from embarking on strike action. We appeal to organised labour to use all established channels to engage with us on any pertinent issue.”
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