Bruce Wilson, who fell through a roof and broke his femur has spoken about the nightmare 19 days he languished in a state hospital awaiting emergency surgery.
A Northern KwaZulu-Natal man who fell through a roof and broke his femur has spoken about the nightmare 19 days he languished in a state hospital awaiting emergency surgery.
Bruce Wilson’s story highlights the plight of thousands of patients in the country who depend on the services of ill-equipped state hospitals, a crisis a leading health expert partly blames on political appointments and “substantial corruption” in the public health sector.
It also calls into question the viability of the government’s proposed National Health Insurance (NHI), which aims to provide universal coverage for all citizens, but which critics say is unworkable and will further undermine healthcare in South Africa.
Wilson, 54, was initially admitted to Hlabisa Hospital after waiting four hours for an ambulance following the accident on 4 October.
“When we got there he needed to have an X-ray — the radiographer was rude to a point where I had to help my husband on the bed, and they were manhandling him like there was no broken bone,” his wife Karina said.
Because of the severity of the fracture, the couple had anticipated he would not have to wait too long for surgery.
“But he was told he needs to wait until 7 October to be transferred to Ngwelezana Hospital where the operation would be done,” Karina said.
Wilson could not be transported privately to Ngwelezana because he would lose his place in the surgery queue.
“We were then told that there is a shortage of ambulances and they are not sure if an ambulance will be able to take him to Ngwelezana Hospital. By then we knew how dangerous it would be to even try to transport him ourselves as we could rupture his main artery in his leg; he needed an ambulance and professionals,” Karina said.
The couple hired a private ambulance after the state ambulance refused to transport Wilson because he would “take up too much space” as he needed to lie down. When they arrived at Ngwelezana, there was no bed for him.
They eventually “found” a bed. “A few hours later he phoned and said no one knows when he will be operated on,” Karina said, adding that a broken femur should be repaired in the first 24 to 48 hours of the break.
“This calls for change within the public healthcare system, the shortcomings of the system are horrific,” said Karina.
Wilson described a crowded and under-resourced rural hospital where windows remain shut to keep the heat out on hot days, linen was dirty and some patients had been in hospital for more than two weeks in the same clothing.
“A patient was released and the bed was soaked in urine. At this stage, supper was served. The room was designed for five beds, not seven, so the bed next to me was 1.2 metres away, stinking,” he said.
Wilson said nursing staff were “very frustrated” and some had “lost their zest to be helpful”, although others were “angels”.
When he was moved to another ward he was “scared, bewildered and in a lot of pain” but a sister tended to him and “I felt cared for, for the first time in a week”, Wilson said.
He had no idea when he would be operated on because new patients, mostly children and older people, were pushed to the front of the queue.
After the Mail & Guardian sent questions to the KwaZulu-Natal department of health about the state of emergency services and why Wilson had waited so long for surgery, he got news that his operation would be on 22 October — 19 days after his accident.
KwaZulu-Natal health spokesperson Ntokozo Maphisa said it was “important to state that planned patient transport is available and there are standing protocols for the transfer of patients between different facilities. It is not clear why this particular patient allegedly could not be transported.
“Ngwelezana Hospital serves a large catchment area, including not only King Cetshwayo, Umkhanyakude, greater Zululand, and other surrounding areas. The hospital’s orthopaedic department usually operates at full capacity.
“Despite these challenges, we remain committed to providing patients, including the patient in question in this matter with the care that they need, as soon as possible.”
Wilson was discharged on 25 October but said this week he has no idea how the operation went.
“No X-rays were taken after the operation. The recovery will be longer due to not getting surgery in the first 24 to 48 hours; the muscles lost all capability,” he said. “All this has an impact financially.
He was discharged with crutches because the hospital did not have a walker.
“The physiotherapist was there quickly, but no exercises were given to me to do at home so I am trying to figure it out on my own until the end of January 2025 when I have my first appointment with the physiotherapist,” he said.
The health department did not respond to questions regarding the apparent shortage of ambulances, medical staff, operating theatres and equipment in KwaZulu-Natal.
Commenting on resources in the province, as well as Gauteng, the Eastern Cape and the Western Cape, University of Witwatersrand health economist Alex van den Heever said there is no continuously updated public database of health facilities, emergency vehicles and health professionals in the country.
“As a consequence, no systematic analysis of provincial services is possible,” he said.
Asked how equipped provincial health services are ahead of the implementation of the NHI, Van den Heever said information on the public and private health systems does exist and should be publicly available but it is not.
“The performance decline in all but the Western Cape has resulted from leadership appointments unrelated to the mandate or mission of provincial health services,” he said. “The political appointments into provincial health administrations has resulted in substantial levels of corruption, which is reflected in the irregular expenditure levels.
“It is likely that the levels of corruption exceed what can be tracked as irregular expenditure. There is no evidence that this tendency will change in the near future as there is apparently no political will to address it.”
Van den Heever said there is also no financial appraisal of the NHI nor any indication of target levels of service provision.
“The NHI also has no clear implementation pathway. Importantly, emergency transport services are not a national competency and cannot fall under the NHI. As things stand, there is no national plan or framework to address critical care services in South Africa,” he said.
He added that the NHI fund can only be financed by general taxes.
“The idea that new taxes can be raised for NHI is questionable and unlikely to occur. Most South African households would never be able to contribute to the NHI fund, which is why all funding has to take the form of general taxes … this is how the public health system is financed.”