Rotting limbs and the reuse of discarded medical items are some of the scenarios recounted to the Mail & Guardian during a tour of public hospitals in Limpopo last month.
The radiology departments of some hospitals are not functioning, which means doctors cannot perform orthopaedic surgery. In some cases, the shortage of necessities results in hospital employees dipping into their own pockets to replenish supplies.
In December the provincial health department was one of five placed under administration in Limpopo because of poor governance and financial mismanagement. In an attempt to turn things around, the national government deployed a task team to probe the provincial department and get them back on their feet (see “Plan to stem the bleeding”).
The M&G visited five public hospitals in the province and was shocked by the situation.
Situated just outside Tzaneen, Letaba Hospital was one of the worst. Its radiology department has not been functional since June 22. Principal radiation control officer Khulekani Manqele warned Letaba staff on May 22 that their X-ray equipment did not comply with the licensing conditions of the radiation control board.
“Our records reveal that there is gross noncompliance with the licence conditions in your hospital. No annual quality control tests were performed in the past 24 months. Failure to comply will result in the sealing of the X-ray units and cancellation of the licence,” wrote Manqele in a letter the M&G has seen.
Letaba’s entire radiation unit was officially shut down a month later and sources from the hospital said there had been no communication from the province about what would be done to get the unit running again. In the meantime, employees from the radiography department have been paid to do nothing. When the M&G went to the hospital, the radiology department was deserted.
An employee said none of the radiology machines worked and no orthopaedic surgeries were taking place. A staff member showed the M&G a large X-ray machine worth more than R1-million that was reportedly a gift from the Chinese government a few years ago.
“It broke down because it was not being serviced, just like all the others. When you ask why machines are not being serviced, you are told it costs too much money. But why have this equipment if you don’t service it? Of course it will break down,” the employee said.
Letaba’s failure to service its equipment from mid-2010 to mid-2012 may also have resulted in patients being exposed to excessive radiation, according to a doctor at the hospital.
The radiology department at Mokopane Hospital almost suffered the same fate as Letaba’s. Staff said the radiation control board nearly shut them down on June 22 after finding their equipment was not up to standard. Because Mokopane is a referral hospital, it managed to negotiate with the board to continue functioning. But staff fear being shut down in the weeks to come because the hospital has yet to address the issue.
At the time of the M&G site visit it had just one operational X-ray machine, which tended to give faulty readings. An employee said one mediocre machine for a referral hospital was not enough and staff faced major backlogs.
The hospital also had no portable X-ray machine and patients connected to life-support machines in the intensive care unit had to be unplugged and taken to the X-ray machine.
“This puts patients’ lives at risk. The situation is just difficult. If you get a fracture here it’s not advisable to go to a public hospital,” the hospital employee said.
The hospital also faced a shortage of gloves, tissue paper and soap.
In March, Mokopane did not have food for its patients. They were fed after donations came pouring in following a plea made on local radio station Thobela FM.
In May, the hospital was supposed to get a C-arm X-ray machine, which is smaller and more adjustable than traditional machines. Only half of the parts were delivered and the hospital was promised that the remaining parts would be delivered in the days to come. Three months later, it is still waiting.
Staff accused the hospital’s procurement department of being tight-fisted when it came to releasing funds for the servicing of equipment.
“You have to fight to get machines serviced. It’s as if you are chowing money with the people who fix machines, but we need them to be maintained so we can do our jobs properly,” an employee said.
Following the M&G’s official queries, staff reported that last Tuesday a functional portable X-ray machine and a C-arm machine had been delivered.
When the M&G arrived at Lebowa-kgomo Hospital four weeks ago, its radiology unit had not been operational for five weeks.
Hospital insiders said the machine repair technicians would not come to fix the machines because the hospital had not settled invoices since 2009.
Said a doctor: “If someone needs a solution and comes here I tell them: ‘I think your arm is broken, go get an X-ray somewhere else.’ You can come here with a broken arm and it gets rotten here and ends up being cut off. That’s why I try to avoid admitting people, because we can’t even treat them as basic necessities are in short supply.”
Patients in need of care were often sent away and staff said there were severe shortages of supplies such as antiseptic soap and bandages. A nurse and a doctor said they often bought basic necessities from their own pockets and that there were not enough incubators for premature babies. For the eight babies there at the time, only three incubators were available. Of particular concern to them was the “high infection rate”.
One employee said she was so desperate that she sometimes went to a private hospital and took items out of its bins. She took them home and washed and sterilised them as best as she could before bringing them to the hospital for use. “If I’m found out I’ll lose my job,” she said.
Less than two weeks after the M&G made official inquiries, staff reported that the radiology unit was up and running again.
No surgeries were being done at Polokwane Hospital, because it was discovered that oxygen supplies had been contaminated.
The length of the queue of mostly elderly people suggested that the radiology department was struggling to cope with the number of patients requiring X-rays. Just outside, at least eight X-ray machines were standing idle in the corridor.
It has the largest neonatal unit of all the public hospitals in Limpopo and premature babies are often referred there if other hospitals cannot cope. But staff at Mankweng Hospital said they were battling to accept referrals because incubators were not working owing to a tubing shortage.
It was not the first time that there had been problems with the incubators. An employee recalled how staff recently had to wrap babies in plastic owing to a shortage of blankets.
At the time of going to print, the chief executives of all five hospitals had not responded to questions sent to them weeks ago.
Radiation control board deputy director Susan Nel referred the M&G to Fidel Hadebe, the national health department’s communication director, but no response has been received.
Provincial health department spokesperson Snenhlanhla Gumede said it had dealt with mechanical problems at the Lebowakgomo, Polokwane, Mankweng and Mokopane hospitals.
She said Letaba’s radiology department would be functional soon and patients would be taken to nearby hospitals in the meantime.
She urged hospitals to report issues to the department timeously so that they could be addressed.
Plan to stem the bleeding
National health department spokesperson Joe Maila said that when the Limpopo department was placed under administration last December, “a diagnosis had to be done in order to understand the underlying causes that may have led to poor financial management”.
The diagnosis report found that there were poor procurement systems in place.
“In essence, a tender system and procurement process gone wrong replaced the healthcare system … which resulted in irregular expenditure,” said Maila.
He said the team found that some service providers were not meeting the required standards.
Hardest hit were the maintenance and supply of medical equipment and the procurement of pharmaceutical supplies, said Maila, areas in which tender processes had not been not followed.
Another area of concern was the hiring of excess administrative staff “at the expense of health professionals at district and facility level. This practice also resulted in the appointment of [the] wrong people in posts and lead to the shortage of health professionals at the coalface,” said Maila.
He said poor management had resulted in poor monitoring and ineffective supervision in terms of service delivery.
Maila said suspected fraudulent and corrupt transactions as well as cases of irregular expenditure had been handed over to law enforcement agencies, the results of which have yet to be finalised. In the meantime, the department had developed a supply chain management policy in consultation with the provincial treasury, he said.
“Measures were put in place to manage cash flow, prioritise payments for critical and essential services and stop the bleeding. The result was no overexpenditure at year end, which had initially been projected at R450-million.”
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The M&G Centre for Investigative Journalism (amaBhungane) produced this story. All views are ours. See www.amabhungane.co.za for our stories, activities and funding sources.