Aaron Nicodemus
Most government hospitals are bustling, noisy places. The wail of infants punctuates the low murmur of waiting-room voices. Patients are wheeled on squeaky trolleys from room to room. Machines beep.
The hallways of rural Derdepoort Community hospital on the North-West province/ Botswana border, though, are eerily quiet. This modern and superbly equipped hospital, with storerooms filled with drugs and supplies, will be closed in three weeks’ time. The bewildered community of 22 000 that it has served for 40 years will now have to make do with nine tiny understaffed and under-equipped government clinics and hospitals located more than twice the distance from their homes.
This week, the local village chiefs decided to file a court interdict against the closure, in the hope that some government official might explain the decision. They suspect the government is planning to privatise the hospital, catering to the needs of the rich.
When asked about privatising the hospital, the provincial district manager, Jarhard Henning, said the building and its assets “may not be disposed without the full involvement and consent of the villagers in the area”.
However, when the Mail & Guardian presented him with documents including a plan to lease the facility to Botswana for use as a private facility, he said: “Those plans have fallen by the wayside because of international legal implications. After the idea of leasing it was discarded, the decision was made to close the hospital.”
Asked whether the hospital could be ceded to the nearby Madikwe Game Reserve as a private facility, Henning replied: “If it is to be sold to the game reserve, so be it,” adding that “it would still be considered a government facility, as the game reserve is a government parastatal”.
This week uniformed nurses were quietly packing supplies and documents into boxes, trying to look busy in a hospital that has not had any patients for a month. New and modern equipment – including a ventilator and a portable X-ray machine – stand at attention in dark rooms. Six surgical tables and four intravenous drip stands are still swathed in their original wrapping. There are two laboratories, new laundry facilities and a fully functioning kitchen. One of the most striking aspects of Derdepoort is that everything works, even the public phone outside.
Nurses tell stories of unbelievable waste. Thousands of rands worth of medicine have expired sitting on storage shelves, and the staff say they destroyed 100 boxes worth of expired painkillers, antibiotics and vitamins last month. More expired boxes of medicine wait for disposal.
Meanwhile, less than 100km away, the medicine shelves of Pitsedisulejang village’s government clinic – one of the province’s medical facilities meant to replace Derdepoort – are almost bare.
Derdepoort’s head matron, Phillipine Sentle, said the closing is a “terrible waste”, adding that the provincial government refused all requests to redistribute medicine. Government officials rammed through the decision without consulting hospital staff or even visiting the facility, she said, just like the apartheid government before it. “It’s even worse than that.”
Henning tells a different story. He says the hospital was running at a R5-million annual deficit with only 14% occupancy. Where most government hospitals consider spending R200 per patient per day a reasonable cost, Derdepoort was spending R1 970 per patient, and most of the hospital’s patients were from Botswana. Regarding the issue of waste, Henning said hospital employees have threatened provincial workers coming to redistribute equipment and supplies.
The news that Derdepoort will be closed has hit the community hard. Built in 1949, Derdepoort’s construction and funding was a combined effort between local villagers and the Dutch Reformed Church. A separate tuberculosis wing was built in 1961 in response to conditions among villagers at the time, bringing the facility to its peak capacity of 150 beds. The hospital fell under the control of the Bophuthatswana government in 1977, and the land and building were transferred to the Bantustan regime without the consent or knowledge of local village chiefs. It has been in government hands ever since.
“This hospital was built by our fathers and forefathers,” said Silas Modisane (68), a chief in Pitsedisulejang village. “The community is strongly against the closing of that hospital.”
The North-West provincial government has been slowly closing Derdepoort for several years. In 1996, there were more than 23 000 admissions. In 1998, the government decreed that no more patients from Botswana could be admitted, and admissions dropped. In April, the hospital’s two Cuban doctors were redeployed and staff were ordered to refer patients to Lehurutshe and Zeerust hospitals, both more than 150km away. Admissions dropped to about 150 per month. On December 3, the government decreed no more patients could be accepted at Derdepoort and announced the closing date of December 31.
The closing of the hospital will affect villagers in practical ways. Chief Mogalenyana Matlepeng of the Molatedi village said: “This imports a hardship to the community, especially to the poorest of them. They will now have to travel more than 100km to seek help. Where are they going to get the money from?”
The provincial government had promised to build a centrally located community health centre, but Henning says those plans have been scrapped. Instead, six existing government clinics in the villages will be expanded into health centres.
An examination of the current state of these clinics reveals how steep the drop- off in medical care will be. The clinic in Pitsedisulejang village is supposed to provide 24-hour service, but the nurse on duty explained what that means. “I live here for seven days in a row, 24 hours a day, by myself,” she said. “I have no security, no sterile packs, no gowns, no transport, no telephones, no two-way radios.” There is no food for patients other than what nurses bring on their shifts. The medicine shelves are nearly empty and there is no doctor.
At the Dikome clinic in Sesobe village, Polena Maphunye is a nursing assistant in charge. Her superior is on maternity leave for the next month, and no one else is authorised to dispense drugs to patients. The clinic’s ambulance driver is also on leave. There is no telephone or two-way radio. Despite being built in 1991, the clinic’s walls are filled with cracks large enough to fit two fingers.
In winter, the clinics are warmed with paraffin heaters. There is little paraffin to be had. Should it come as any surprise that Derdepoort has boxes and boxes of paraffin in storage?
In her office, surrounded by now- meaningless employee attendance charts and ambulance routes, Sentle said it is the poorest of the community who will suffer under the new plan. “I worry about what will happen.”
Just outside her office door, in the hallway, there are jars of formaldehyde with poisonous snakes inside. The snakes, collected by a doctor, are coiled up and displaying their fangs, ready to strike.
To workers from the nearby Madikwe Game Lodge, snakebites are a constant threat. Closing the hospital will put their lives at risk, they say. But with or without the hospital, a game reserve tour guide revealed his method of treating snakebites in the bush. Tightly tie pieces of string on either side of the bite, he said, and then use a cut tennis ball to suck the poison out of the wound. By the time they get to the hospital, they’re usually fine,” he said.