South Africa

Limpopo public health’s chaos and hopelessness

By Mandy De Waal 15 August 2012

Ventilators aren’t working, labour beds are broken, there are shortages of essential medical materials and machinery is not being maintained. Limpopo’s hospitals are failing the electorate. For Elise Ngobeni, a much loved traditional healer from Basterspad, the disastrous Limpopo health system may have resulted in the loss of her life. By MANDY DE WAAL.

Elise Ngobeni was something of a legend in the small village of Basterspad. A traditional healer, people knew that if their kids had diarrhoea, Ngobeni was the woman who’d help them stop it before it became life threatening. In a small village surrounded by mountains, where the nearest clinic is over 40 kilometres away and the closest, reliable hospital an hour’s drive away, the traditional healer was revered and loved.

“My mother was a doctor (traditional healer). She helped all the people here. She helped the babies. If the babies had diarrhoea my mother helped. She helped babies to live, she helped people to live. She was very, very good. She did this for 15 years,” said Margaret Morjana.

But when Ngobeni needed medical help herself, she wasn’t as fortunate. “It was the Monday and my mother got up. Everything was alright. She stood up. She had breakfast. Then she screamed…. she said: ‘Help. Help. Help.’ Everyone ran and saw she was lame. She couldn’t even speak then. Her one arm and leg was lame.”

The 81-year-old was a sprightly woman who counselled local village people on medical issues and often travelled by taxi from Limpopo to visit her daughters in Tshwane, until she was felled by what appears to have been a stroke.

“When I arrived there in Basterspad, I found her lying on the ground. I phoned the ambulance twice when I was on my way to Basterspad, and they said that they will come back to me, but they didn’t come back to me. I reached the home and then I took my mother to hospital myself. I took me about 55 minutes to get home, but still the ambulance people didn’t call me back,” said John Tloubatla, Ngobeni’s son-in-law.

“We struggled to get her and put her inside the car. We struggled a lot because she was not moving. The first time when I called the ambulance they said I must rather just take her to the clinic, but the clinic is too far from Basterspad so I said I would rather take her to the hospital. The ambulance said they would get back to me, but up until today—the day I buried my mother—no-one has come back to me,” Tloubatla said.

Basterspad is a small, rural village located about 57 km from Mokopane, which used to be known as Potgietersrus. There’s no emergency medical support in the village, so locals must travel just over 40km to the nearest clinic, which doesn’t have the same kind of resources as a fully-fledged hospital. Alternatively, they can go the same distance to a George Masebe Hospital, which has an awful reputation, or take an hour to go to the hospital in Mokopane. Most villagers choose the latter.

“We are not professional medics, so we don’t know if we harmed my mother when we put her into the car and took her out again. We didn’t know what we were doing,” Tloubatla said.

At the Voortrekker Hospital in Mokopane, Ngobeni was seen by a doctor who told her family the woman had experienced a minor stroke, and then sent the patient up to the wards. “They said it was a minor stroke, but if you saw my mother you would see half of her body wasn’t even moving on her one side, and she couldn’t speak,” Tloubatla said. He couldn’t understand how that could be classified as a minor stroke.

Three weeks later, Ngobeni was discharged with some medication but no advice on how she should be cared for at home. Rehabilitation in stroke patients normally commences as soon as the person’s medical condition has been stabilised and continues after discharge. Stroke patients are at risk of having a further stroke, particularly after the first incident. Although Ngobeni was given medication, it wasn’t quite enough to see her through to the date of her next treatment, scheduled for some three weeks after her discharge.

“She was discharged but there was no difference. She was in the same state as she went into the hospital. She was supposed to go back on the 7th of August, but she died before she went back. She died the day before on the 6th of August,” said a still-distraught Tloubatla.

Ngobeni died days after her medicine had run out. “When she was discharged they gave her too little medicine. It got finished before the consulting day. The medicine was finished five days before she was supposed to be taken to the hospital,” Tloubatla added.

Such chaos and service delivery failures are a part of everyday life in the Limpopo health system. Surgical interventions have come to a standstill at the Pietersburg Hospital. The Polokwane Observer reported that none of the hospital’s theatres are working and patients—among them the terminally ill—are being turned away.

Cancer patients haven’t been treated at the Polokwane Provincial Hospital for four months and hundreds of emergency workers in the province were deregistered and fired after it was discovered they had bought fake qualifications.

And Ngobeni’s story is hardly an isolated case. In June, the country was shocked by the story from former Minister of Science and Technology Mosibudi Mangena who told how his 74-year-old brother died after failing to get a simple procedure.

Mashaole Mangena died after seven weeks of bungling at the Polokwane Hospital, when he required medical treatment for a bile duct blockage. In an open statement, Mangena—a former Azapo president—wrote how the Limpopo “health system betrayed us”.

Back in Basterspad, Tloubatla said he knew public health options are terribly fraught for people in the village. “The medical care here is not good. The way they are running things here (the public health care system in Limpopo) is not good.”

No one goes to George Masebe Hospital, at 40km away the closest to Basterspad “The staff at George Masebe Hospital, eish… they are not right,” he said.

At Ngobeni’s funeral, everyone agreed: George Masebe Hospital is a no go area.

“People here all know you mustn’t go to George Masebe.”

“You don’t get better at George Masebe Hospital.”

The DA’s Shadow minister of health, Patricia Kopane, said it is not just the George Masebe Hospital that is a disaster zone. “The situation in Limpopo is very disturbing, and I can see that the whole health system there is on the verge of collapse,” Kopane said to Daily Maverick on the phone from Cape Town. A couple of weeks ago, Kopane toured Limpopo hospitals to establish first-hand how bad the situation is in the province.

“Some of the hospital managers in Limpopo don’t even have the capacity or the management skills to run the hospitals they are in charge of,” she said. “To run a hospital you need some kind of a medical background. The decisions you take can affect the lives of people.”

Kopane reminds Daily Maverick about the non-payment of the national laboratory. “Limpopo is one of the provinces where they failed to pay the National Laboratory Service. In a hospital, things like laboratories are the starting point for any doctor to make a diagnosis. If management decides that they are not going to pay the laboratory, that already shows they don’t know what they are doing.”

The way Kopane tells it, the big problem with Limpopo is the lack of accountability and an inability to manage finances. The shadow minister of health details a litany of problems she evidenced during her tour of hospitals in Limpopo included broken down X-ray machines and ICU ventilators that had not been maintained.

“Companies have been employed, the tenders have gone out, but these people are not coming to maintain the machines as required by the tender agreement between the province and them. The problem isn’t about money, because South Africa is spending about 8.5% of our GDP on health. Other developing countries spend about 5%, which is what required by the World Health Authority. This shows that money is not a problem. The people running the department of health are what are causing the problem.”

Kopane said when she was in Mokopane the kitchens in the hospital were in a terrible state. “I opened the fridge and the food was ‘vrot’ right in the fridge. In a hospital diet is prepared according to the diagnosis of patients. When I asked for the diet sheets there was nothing like that. There were only loaves of bread and milk—that’s all what the patient can eat,” she said.

The real horror of the hospital’s mismanagement emerged when Kopane made her way to the labour ward. “They didn’t even have suturing material. In other words, women who were delivering for the first time were being given an episiotomy (an incision of the posterior vaginal wall and perineum) and they are not being sutured because the suturing material isn’t there. This means you destroy the future of that woman,” Kopane said with some stress in her voice.

The nurses and sisters in the labour ward had no disinfectant, she added, there were no screens for privacy and most of the delivery beds were broken.

A spokesperson for Limpopo’s MEC of health, Norman Mabasa, told Daily Maverick the situation around Ngobeni’s death was not reported directly and as such they had no insight on the issue. “We are unable to assist until we get media reports. We will follow up to see who is responsible, we will investigate and disciplinary action will be taken if necessary.”

The spokesperson said that the X-ray equipment that was faulty at Lebowgang Hospital had been restored. “We are not aware of the lack of sutures in the Mokopane hospital’s labour department,” she said in between giggles. “We are also not aware of the other issues raised by we will be following them up and will give feedback on where we are,” she said, attempting to make light of the situation with inappropriate titters, perhaps intended to make her more charming or endearing, producing entirely the opposite effect.

The massive frustration is the gravitas of the problems. People are dying and their lives are being impaired because of the issues at hand.

“The underlying problem is that there is no accountability,” said Kopane. “No one is being held properly accountable for any poor service delivery or failed outcomes. People continue to do things as they are doing them. People know that they can get away with murder and nothing will happen to them. The ANC is running away with this because they know our people don’t know their rights.

“Presently, Limpopo health is under administration. It is under the National Department of Health, who must make sure this is sorted out, but they are merely playing politics with the lives of people. People are dying. So in other words the very same government that people have voted into power is killing our people.”

Kopane is currently lobbying the Human Rights Commission for intervention with the Limpopo public service health crisis. Hopefully strong words will galvanise some action. Unfortunately for Ngobeni, any action will be too late.

So, how did the Daily Maverick learn about Elise Ngobeni’s fate? It is rather simple: her daughter, Sophia Ngobeni is employed by this reporter.

Instead of the usual ending, dear reader, spare a thought for the thousands of other victims of the system that’s fallen apart. Thousands of people who suffer in silence and vanish from the face of this planet much earlier than they should. Because they have no money. Because they know nobody in media. And because the culture of incompetence and cronyism have destroyed the public health system of this country. DM

Read more:

  • Limpopo hospitals in a sick condition in Sowetan;
  • Limpopo Health’s finance chief ‘facing suspension’ on IOL;
  • Disfigured Limpopo boy succumbs in Sowetan;
  • Limpopo ambulance staff deregistered, fired on IOL;
  • No joy for Limpopo cancer patients at the SABC.

Photo: Elise Ngobeni’s funeral (Mandy de Waal/Daily Maverick)


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