Swapna Prabhakaran
The KwaZulu-Natal Department of Health announced an “inadequate” health budget for 1998/99 this week, sparking an outcry from hospital staff who predict it will have dire consequences for health services.
Drastic cutbacks in services and staff have already been implemented at some provincial hospitals in preparation for the budget, which is R621-million short of the expected expenditure for the year. Several vital health-care services will either be completely suspended, or run at partial capacity.
In his budget speech, MEC for Health Dr Zweli Mkhize said while cuts are unavoidable, they have been planned to have “the lowest possible impact on the population as a whole”.
He did admit, however, that some of the measures “will have negative medical, or even life-threatening consequences”. One of these is that no government ambulance services will be available to patients in KwaZulu-Natal between midnight and 6am.
This measure, which the department labels as “cutting down on ambulance response time by 30%”, may be a blanket measure, regardless of how ill the patient is. Alternatively, ambulances may respond selectively, attending to only the most dire emergencies during those hours.
Earlier in the month Mkhize warned that the balancing act of budgeting health meant making some tough choices. “The truth is, there is very little fat to trim in KwaZulu- Natal and any cuts go straight into flesh and bone,” he said.
And now those cuts are beginning to bleed. Some hospitals have been forced to close down specialised wards – two wards have already been closed at Addington hospital in Durban, and the closure of nine other wards seems likely – while smaller hospitals have to close down entire sections.
King Edward VIII hospital has to cut down 50% of all non-emergency operations, while Wentworth hospital faces a 50% cutback on cardiac surgery procedures.
St Mary’s hospital in Marianhill has already cut back on a large number of patients’ beds and is considering closing the doors of its casualty ward after hours and on weekends -patients who become ill on a Saturday night will have to find another hospital, or wait until Monday morning.
In a statement jointly released by doctors and nurses at some of the province’s biggest hospitals, one angry doctor warned of the dreadful consequences of the cutbacks.
“The scenario we face is that on any night in Durban, about 500 ill and dying people will be desperately trying to get into a hospital, any hospital. Hospital gates will be closed, with little tent cities of desperate, sick people waiting outside, praying for hospital beds,” the doctor said.
Mkhize denied the need for such pessimism. “What we have to do above all else is focus on the R4,7-billion we have got, and not only on the R621-million that we do not have,” he said in his budget speech.
Over the past few weeks, the Department of Health has drawn up a list of some of the money-saving devices planned for the near future. Much of it is administrative detail – increasing efficiency, cutting out waste of resources, shortening the length of stay at hospitals.
But also on the list are some items marked as “negative medical implications”. These include: “reduce treatment to terminal cases”; “closure of 9 000 out of 28 000 beds [available at hospitals]”; and “cut highest levels of surgery”.
One particularly carefully worded item – “introduce stricter protocols” – effectively means victims of strokes, heart attacks and other major debilitating diseases may be refused beds in hospitals if they don’t meet the strict criteria of entrance.
Doctors predict these are most likely to affect “the weakest in our communities – the elderly, children, pregnant women and their unborn babies, and those with chronic diseases and Aids”.
The sad irony is that the cuts come at a time when the province’s health-care service is experiencing a boom.
More people than ever before have had access to health care and child mortality rates have dropped by nearly half.
Much of this is thanks to the province’s network of clinics, and the department has committed itself to improving this network of services and staff. However, clinics are not able to replace all the services hospitals provide.
The superintendent of St Mary’s hospital, Dr Douglas Ross, says the state-subsidised hospitals are among the worst hit by the cuts.
He says large-scale retrenchments seem inevitable at his hospital – its subsidy has been cut by R10-million and it seems likely this will mean the hospital will scale down to become a community health centre.
“It’s terrible, shocking, almost ridiculous,” Ross said this week. “I’m faced with the position of retrenching doctors at a time when the government is importing Cuban doctors.”