Rob Ferreira Hospital, Nelspruit
Savera Mohangi, acting CEO of the embattled Rob Ferreira Hospital in Nelspruit, refused to speak to the M&G unless provincial department of health spokesperson Mpho Gabashane was present. Her reticence is understandable, given that a spate of resigÂnations in the past three months has further crippled this already incapacitated tertiary hospital, rated one of the five worst in the country by local newspaper The Lowvelder.
Numerous radiographers, dieticians, social workers and medical technologists have left or are in the process of doing so, citing intolerable working conditions and unfulfilled promises.
“Many feel that there’s no place for upward mobility,” says Mohangi. “They feel the organogram does not cater for them and they are looking for better posts in other provinces. This is supposed to be a tertiary hospital, but there are services we can’t give because we don’t have the expertise.”
The roots of the staff exodus can be traced back to 2001, when morale took a battering after superintendent Dr Thys von Mollendorf was fired by erstwhile provincial health minister Sibongile Manana for allowing the Greater Nelspruit Rape Intervention Project (Grip) — an NGO that provided free counselling, health care and antiretrovirals to rape survivors — to operate from the hospital. In 2003, the Public Service Health Sectoral Bargaining Council found Von Mollendorf, who was widely respected at the hospital, not guilty on insubordination charges, but the trickle of departing staff had already become a flood.
One of the major complaints heard in the dilapidated corridors is about unpaid overtime, which is draining already low morale. Rob Ferreira recently became a referral hospital, admitting patients from seven smaller hospitals in the surrounding Gert Sibande district. The increased number of patients has put added pressure on the staff, especially the nurses. “This is [the] orthopaedic [unit], right,” says one nurse, checking the blood pressure of a patient with a broken leg, “but now they are mixed up with TB patients and surgical patients. You have to leave your patient and go to the next. There’s too much to do. We’re too busy bathing and feeding HIV-positive patients and not administering medicines.”
Jobs are made harder by equipment shortages, she adds. “There are only one or two ECG machines in this hospital. You have to run around this whole place looking for one — and it’s a waste of time.”
Her two colleagues, who are filling in patient forms, lament the lack of training at the hospital. “There is a new neuro-ward that has been opened, but the equipment for that is not ready yet. We want to know what is wanted by the doctors, but we need to be trained for that.”
Dr Shaun Labeodan, a young neuroÂsurgeon, walks with me to the intensive care unit to check on a 12year-old who has just had a brain tumour removed. As we walk and talk he points out overflowing dustbins and litter-strewn roofs. “It’s a small hospital and should be easy to run,” he says. “When I need things to operate with, they should be here.” The difficulties are getting people motivated, getting them overtime pay and retaining skilled staff such as anaesthetists.
“The staff here are not bad. They work hard for no extra pay, but there are not enough senior people. Many people see this as a temporary place. It needs to work on its retention strategy.”
According to Matron Thuli Khoza, the hospital has, for several years, been operating at less than 50% of its optimal staff quota. Last year, she says, it was working at 42% of capacity.
But the hospital is not a uniform blanket of chaos. Dorothy Mahlangu, the sister in charge of what she carefully calls the mental healthcare unit, proudly gave me a tour of the recently established, 60-bed unit. Her patients are referred to as “users” of the facility, she says, in an effort to destigmatise their condition.
They too are short-staffed and Mahlangu says they need a risk allowance, as they work with volatile patients. “If they get aggressive, no one can contain them except nurses. We have to convince them and then sedate them.”
It becomes clear why a nurse refers to the area as a “danger zone” when Mahlangu shows me the male wing of the ward. Half-demolished walls and broken door panes look incongruous against the clean floors and crisp linen.
“If this was a private hospital, they would have attended to this immediately,” says Mahlangu. “But they are still consulting, and it’s a long procedure.”
Provincial health department spokesperson Mpho Gabashane says: “The head office is responsible for approving payment of overtime, but more often than not the delays are caused by facilities that submit late. To address this situation, all managers are expected to submit requests for overtime, which are then signed before it is actually worked. We have acknowledged that there are challenges that need addressing, such as staff shortages, and our commitment in addressing them cannot be questioned.”