The department of health in the Eastern Cape was at loggerheads with its landlord because it hadn’t paid rent on the building that housed the Lusikisiki community clinic for some time. No problem. Find some ground. Pitch a couple of tents. Rent a trailer and there’s your medical centre. Too bad it hasn’t got the optional extras – vanities like water, sanitation or electricity. MANDY DE WAAL investigates.
For the people of Lusikisiki, a rural hamlet near Port St Johns in the Eastern Cape, accessing medical services at the local clinic has become a trial, health risk and an assault on their human dignity. They used to have a medical centre that saw about 8,000 people from the OR Tambo district each month, a clinic that was housed in a safe, secure building in the town of Lusikisiki. But after provincial government lagged on rent payments, a decision was made by the EC department of health to move the facility.
Now the clinic is ‘housed’ in two makeshift tents and a mobile home, the combination of which acts as a pharmacy, diagnosis area, treatment room and waiting area. This makeshift mobile clinic has no running water, no electricity, no satisfactory sanitation facilities and no proper entrance. This means locals have to brave the elements to get essential medical services, while diagnosis and treatments are done in the open in front of other patients. Pharmaceutical products are being kept under unsuitable conditions, while routine procedures that require electricity – like pap smears – can’t be done properly, if at all.
“The (Eastern Cape) department of health should have planned properly for the needs of the patients and workers at the site before they moved the clinic,” Zukile Madikizela, a district mobiliser for the Treatment Action Campaign (TAC) told Daily Maverick during a telephonic interview from Lusikisiki. “Initially the department said that they would provide three mobile homes for the new clinic, but there’s only one and it is very, very small.”
“There are procedures done by the clinic that can’t be accessed now because there is no electricity. The clinic should cater for people with TB, HIV, non-communicable diseases like diabetes and should offer immunisations. But vaccines are supposed to be kept in a fridge. The driveway is not level, which makes it impossible for the ambulance to get in, and there is a very steep hill with mud steps which leads to a pit latrine. Already health workers have been injured trying to access that toilet – what about elderly people or pregnant women who might need the toilet?” Madikizela asked.
“When we arrived on the scene, there wasn’t even water. How can a clinic operate without even water? People still go there because they have no other alternative. There is no other clinic for this catchment area. We have petitioned the department of health on these issues, but the response from the MEC, Sicelo Gqobana, is ridiculous. He says that he will not account to any NGOs (non-government organisations), but only to his Exco (executive committee) and his superiors,” the activist health worker said.
“We met with delegates of the department of health and they said when women get pap smears the health workers must just use an ordinary torch. They said that the women should lie facing the window with their legs up so the health workers can use the natural light to do a pap smear. But what about the dignity of these women? And what about the people walking past the window of the mobile camper when this is done?” Madikizela asked in an exasperated tone.
“We are not complaining about the new location of the clinic. It is very accessible, but there are no basic amenities and the plans for setting up this clinic haven’t been well prepared or executed,” the TAC district mobiliser said.
Section27, the public interest law centre that has been helping TAC and the people of Lusikisiki to rectify the situation, told Daily Maverick that the lack of amenities at the clinic puts patients and health workers there at risk. “Moving the clinic isn’t the problem, it is the lack of basic services and the amenities at the new facility which are so poor. The tents and mobile structure means there is no privacy, services are limited and it is a very poor environment for nurses and users of the healthcare system,” Sasha Stevenson, an attorney with Section27, told Daily Maverick. The makeshift clinic had three tents, but now only has two. One of the tents blew away after strong gusts of wind a couple of days ago.
“The lack of facilities increases the risk of something going wrong at that site, where medicines are being stored in mobile facilities in the heat, which isn’t optional. Other medicines which require refrigeration are being kept away from the site and transported daily in cooler boxes.
“There is so little privacy. People are being treated out in the open, and in front of each other. And there is only one toilet situated up a very steep hill. We hear that already one nurse slipped en route to this pit toilet and broke her arm,” the Section27 attorney added.
The great tragedy of this story is that the sudden relocation was effected after what appears to be an altercation between the provincial government and their landlords. The old clinic was housed in a building owned by Teba Development, an NGO focused on improving the lives of people in rural communities that have provided labour to the mining industry over many decades.
Tension between Teba Development and the provincial department of health erupted when the provincial government department was errant in paying rent. “We had issues with the department of health over a long period of time which related to the non-payment of the rent. We learnt to deal with that … We had rented the building to them for five years because we’re sensitive that the clinic is important to the public at Lusikisiki,” Teba Development’s Chris Hatting told Daily Maverick.
“We’d rented the building to them for five years, and at the beginning of 2012 the department asked us to get a SARS tax clearance certificate. We weren’t able to produce this document overnight, with a company these things can take a little time.” Hatting says that the document was given to the provincial health department, and that the payment of the rent deteriorated from then onwards.
“We told the department we’d like the rent, and despite the outstanding fees which ran to as much as 12 month’s rent, we still offered to renew the rental lease. We understood as a company the importance of that clinic, because whenever we went there we saw how many people were going in and out the doors. As a company that assists people in marginalised communities we’d never evict them,” Hatting said.
But the spokesman for the provincial health department, Sizwe Kupelo, said that they were forced out the building. “The department had to move from TEBA building due to TEBA not meeting procurement requirements. They had their rental payment delayed for three months because they did not have a tax clearance and could not have payments done due to that and when they eventually got the tax document they started putting pressure for the department to pay and even threatened to close down the service which happened for over an hour in one day.”
By way of response, Hatting replied: “Look. We don’t want to get into any unpleasantness with government; we have a good relationship with government, but we won’t accept our good name being rubbished. They are not telling the truth in this instance.”
Regardless, people are still being exposed to risk at the new make-shift clinic. What does Kupelo have to say about that? “A temporal structure and a tent have been erected as a temporary measure. The department is awaiting delivery of another prefabricated structure which will enable itself to run a full-fledged service. Currently some critical services are referred to gate way (sic) clinic which is less than 5 kms from the new site. In the next few weeks the new structure would have been delivered,” Kupelo claims.
If you’ve been to Lusikisiki, you’ll appreciate that there are no hotly contested taxi routes and that the area is mountainous. A five-kilometre walk could take about an hour or an hour and a half, depending on your fitness, whether you’re heavily pregnant, elderly or have HIV or TB. If, that is, you’re fit enough to make the trip – clearly not everyone in Lusikisiki has access to a vehicle.
Kupelo blamed the current problems on “procurement procedures” and stated that the health department officials who attended the meeting with TAC never made any derogatory statements concerning women and pap smears. He said the TAC and Section27’s allegations about the clinic were “full of distortions”.
Arguments aside, both the TAC and Section27 took photographs which Daily Maverick has received, so you can see for yourself what’s going on. Let’s hope that once the facts are out in the open about the disaster-waiting-to-happen which is Lusikisiki’s new make-shift clinic, the mobile medical mess will be hastily attended to – regardless of the reasons. DM