A three-month-old baby is the latest victim of Mpumalanga’s crumbling health system. Nomashwa* died of an unspecified chest ailment on Wednesday night while being rushed 300km for a simple chest x-ray.
The three doctors who originally tried to save her at Barberton hospital were unable to diagnose her pneumonia-related ailment because Mpumalanga’s Department of Health had ignored five months of desperate pleas to appoint a radiographer at the hospital.
“We have the equipment and the budget for a radiographer, and have repeatedly written to the department since February begging it to fill the post,” said Barberton superintendent Dr Kobus Hugo. “But someone somewhere hasn’t put a signature on the authorisation, and so we have to refer patients all the way to Witbank.”
Rob Ferreira hospital in Nelspruit has radiographers and is only a 40-minute drive from Barberton, but would have been unable to treat Nomashwa because it is severely understaffed and has no paediatric specialists.
“It’s tragic. We could have sent her to Rob Ferreira, but they would simply have referred her back to us after the x-ray, adding an additional two hours to our response time,” said Hugo.
Barberton has 54 vacancies and is not the only hospital without key personnel such as radiographers. Other rural hospitals such as Lydenburg are also forced to drive patients hundreds of kilometres for basic tests.
The shortage of specialists has become so acute across the province that hospitals in Mpumalanga are forced to refer even routine cases to neighbouring Gauteng for treatment.
But, even then, bureaucrats are again endangering patient’s lives by failing to pay a R29,8-million bill to already overburdened hospitals in Pretoria and other Gauteng centres.
The province owes R9,8-million to Kalafong hospital alone, while Weskoppies psychiatric hospital estimates Mpumalanga’s debt at R20-million.
“We don’t charge for cases that require a high degree of specialisation or really special care, because we get conditional grants from central government for these services,” explains Gauteng’s Pretoria regional health manager, Dr Zola Njongwe.
“But we do invoice for treating cases that Mpumalanga should have been able to deal with itself.”
The bottlenecks, and their consequences, are not new.
Mpumalanga doctors told last year of how they were forced to operate on critically injured patients by torchlight and without much of the medicine or equipment they need.
Even basics such as sterile gloves, swabs, and intravenous drips were unavailable at major hospitals for months due to apparent financial mismanagement that saw Mpuma-langa default twice on its R48-million debt to 15 of South Africa’s largest pharmaceutical companies.
Rob Ferreira nurses were at one stage expected to keep intensive-care patients alive by manually pumping air into their lungs during the region’s regular power blackouts.
The hospital is equipped with ageing electronic ventilators and other critical care equipment, but has been unable to convince the provincial government to repair its emergency back-up generators for five months.
“It’s a labour of love. This area regularly suffers power cuts because of storms and flooding, but the faulty generator takes up to three hours to start. Even when it’s going at full tilt, it barely produces enough power to run the hospital’s lights, never mind the really important equipment,” said Dr Thys von Mollendorff, then hospital superintendent.
“Neither the public works nor health departments has money, so we make do with what we have. But some operations are too complicated to do by torchlight or using makeshift equipment.”
Von Mollendorff was later axed for his criticism of the department, and 11 other doctors at the hospital resigned in protest at repeated shortages and the politicisation of treatment for rape survivors and HIV/Aids.
Mpumalanga pharmaceutical director Amos Masongo attributed the medicine shortages last year to a “cash flow” crisis, but the province insisted it had remedied the problem.
Mpumalanga health spokesperson Dumisani Mlangeni was unable to comment on the crisis on Thursday, and would only say that specialised doctors were reluctant to work in rural areas.
He could not explain why the department had failed to replace vital but damaged equipment, including oxygen pumps, at key rural hospitals such as Shongwe.
Shongwe boasts a wide range of specialist doctors, who have not been able to operate on patients for weeks because makeshift repairs on their surgery oxygen machines keep rupturing.
As a result, patients are referred 80km to the smaller Barberton hospital, which in turn is often forced to refer patients a further 300km to Witbank for specialised treatment. — African Eye News Service
* Not her real name