James Rampaodi’s skin is peeling off his face and his hair is breaking. He is too ill to walk on his own and relatives have to carry him each time he visits the hospital. Sitting on a wooden bench in a filthy room at Tshilidzini Hospital in Thohoyandou, he leans forward to rest his head against his mother’s back. He coughs incessantly.
“He has got TB and no one is willing to help us here,” says Rampaodi’s mother, Maria. It is 4.30pm and Rampaodi is number 166 in the queue. He has been here since 6am. “On Friday we were here … they said we must come back on Monday because there were no doctors. We are here today, no one is helping my son. I’m afraid he is going to die. This can’t be right,” she says as she wipes the sweat off her face. She is also concerned that if they leave late there will be no public transport available to take them back to their village of Shayandima, 15km away. “I don’t know how we are going to get back home because it will be too late by the time we get to see the doctor.”
Like Rampaodi, Sara Matondzi has been queuing for more than six hours to see the doctor. “People have been here since 5am. They are not attended to. I have not seen anyone coming to them. They are just seated there, they don’t know where to go. That man there has been here since this morning. No one is taking care of him. This hospital is falling apart. Sometimes people sleep on the bench, others on the floor because doctors are not here,” says Matondzi.
Like many public hospitals, Tshilidzini is experiencing an acute shortage of nurses and doctors. The hospital is used as a referral facility for six districts in the Vembe region of Limpopo province. Patients, including those who are seriously ill, are often sent back home because of the shortage of doctors, nurses and necessary equipment.
When the Mail & Guardian visited the hospital there was only one nurse opening files for the more than 300 people queuing in the outpatients section. According to AP Mphaphuli, the hospital’s CE, there are more than 200 vacant posts at Tshilidzini, including 52 for doctors, 89 for nurses, 50 for specialists and 18 for registrars. Mphaphuli blames the provincial department of health for the high vacancy rate.
“The function for advertising is not decentralised. We advertise centrally and the province is taking too long to advertise,” says Mphaphuli. “Most doctors leave the hospital after two or three years. Most of the doctors who are here now are juniors. People move because they want to specialise — not everybody is prepared to stay in a rural area like this for long.”
Another key problem affecting the ability of health professionals to do their jobs is the shortage of equipment and vital infrastructure. On our visit to the hospital we found that there were no ventilators for newborn babies, only one functioning X-ray machine and the washing machine for linen and uniforms was broken. Of the hospital’s 498 beds, about 50% were occupied by patients with Aids.
A doctor who preferred to remain anonymous told the M&G: “HIV and TB are the biggest problems we are facing. We can’t take care of patients who need permanent care.”
Space is also at a premium and management has been forced to convert a number of ward duty rooms, bathrooms and even kitchens into mini wards to cope with the overcrowding. The hospital has a budget of R131million, of which 68% is spent on salaries, but Mphaphuli says they need more than R150million to deal with infrastructure problems.
Phuti Seloba, spokesperson for the provincial department of health, says the department is developing a revitalisation programme to address issues of infrastructure, equipment and management capacity, and will spend R160million on the programme this year. The department’s long-term vision, he said, was to build a fully fledged regional hospital with modern technology in Thohoyandou.
A state of emergency
Almost one-third of health posts across the country are vacant and some hospitals are operating with less than half the staff they need.
Nursing is “in crisis”, according to an investigation commissioned last year by the department of public service and administration. Conducted by Karl von Holdt and Mike Murphy of Cosatu think tank Naledi, the investigation describes public hospitals as “highly stressed institutions due to staff shortages, unmanageable workloads and management failures”.
Hospitals in rural areas and former black townships find it especially difficult to attract and retain staff — and this is where they are needed most.