Access to quality public health services in South Africa is important, as people literally cannot live without life-saving health services. And when faced with inadequate or substandard services, they cannot live full lives. If someone has no, or inadequate access to health services when needed, she becomes weak and debilitated, and in such a state, her dignity eludes her. To ensure that the right to healthcare services really means something, government, in collaboration with civil society, and users of the health system, need to develop policies, plans and programmes, and budgets that are effective in addressing access to health care issues, and advancing the right to health in South Africa.

Sadly, the public healthcare system in the Free State has not been functioning in a way that can be considered acceptable. When people desperately seek medical care in the most vulnerable moments of their lives, they should be helped. They should not have to face frustration, indignity or avoidable suffering. Health workers should not be subjected to poor working conditions which inhibit their ability to provide the best possible care. This is what the Constitutionally-enshrined right to access healthcare services must mean for every person living or working in South Africa.

Today, we publish the findings and recommendations of the “People’s Commission of Inquiry into the Free State Healthcare System”. It was an honour for us to serve as commissioners, and to hear the brave testimonies of people who are dependent on the public healthcare system in the Free State. While we are the authors of the report, it is their story we must tell, and is to them that we have the greatest responsibility.

From the outset it was clear that the testimonies would be brutally honest, and place before us, and all who attended the hearings, traumatic stories that people or families would otherwise carry alone. For many of those who testified, recounting their stories involved re-living the trauma of loss and injury, the humiliation of being ill-treated, the indignity of not being afforded any answers, the injustice of having no recourse, and the hardship of having to make it through another day.

Though a number of common themes emerged, it is the specific details, and the specific individual suffering aired in the testimonies that touched us most deeply. For example, when she was four months pregnant, Malebabo Booi, a young woman from Brandfort, was told by her doctor that her baby had grown too large for her placenta. She was instructed to call an ambulance as soon as she felt any labour pains. On 22^nd June, at 2am, she called the ambulance, but it never came. “I gave birth at 6am and my placenta was in pieces, to an extent that some pieces were left inside,” Booi said.

Booi’s neighbours, who had assisted with the birth, called the police, who found that the ambulance drivers were sleeping. On arrival at the hospital later that day, the doctor removed the remaining placenta from her body. “My problem now is that I’m infertile,” she said in her testimony.

Yvonne Nchamo, of Harrismith, testified on the opening morning of the hearings. “I’m in pain each and every day of my life, including even now,” she said. The agony on her face was clear to see. At times she sat quietly crying, head down on the table.

Nchamo has struggled with a wound on her leg for 17 years, a result of diabetes. Often she has to buy her own pain medicines, bandages and gauzes on her R1400 disability grant. She describes occasions of being left unattended for as many as seven hours, after nurses have unwrapped her wound at the clinic. “We’re treated like dogs, and they don’t give you any attention when you require their help.”

Nchamo recounted a recent experience of being told to attend the clinic to fetch her medicines. However, when she arrived at the clinic she was told they had no painkillers. “I started crying, and asked them why they called me there if they knew that they had nothing?”

These are two of the many testimonies that we heard over the two days of the hearings. No single testimony is more important than any other. They stand as separate experiences that collectively reflect the consequences of a failed healthcare system in the province, a failure which is borne by people who have no other recourse, but to turn to the public healthcare system for help.

Apart from specific affected people we also heard testimonies from doctors and various civil society organisations. These testimonies strongly suggested that the problems in the system are widespread and systemic, and that we could have continued conducting the hearings for weeks or months, and not run out of heart-wrenching and disturbing testimonies. Incidentally, while we were busy writing this report, the South African Health Review reported that the Free State had lost 24% of its public sector doctors from 2014 to 2015.

The Free State Provincial Department of Health was invited to testify before us, and to present a different perspective, if they so wished. They unfortunately declined the offer. We consider it unfortunate for two reasons. First, we would no doubt have benefited from their perspectives. Second, and more importantly, though, by listening to the testimonies, they may have gained new insights into the kind of difficulties faced by people dependent on the services they are supposed to provide.

While we understand that the healthcare situation in the Free State has become highly politicised, we plead that, above all, the doors of dialogue are kept open. We want to ensure government of the commission’s commitment to cooperating rigorously with them, for the sake of the most vulnerable. Based on what happened at the hearings, we believe that the people, opposition parties and civil society as a collective want to, and will support committed government action to rebuild and turn around the provincial healthcare system to benefit those who need it most. But for government to show its commitment it must respond decisively to the urgent issues raised in our report. Responding decisively is to acknowledge people’s hurt and injury, and the continued suffering they must bear being dependent on the healthcare system in the Free State. It is, also, an acknowledgement that the situation must be turned around with a firm, time-bound action plan that provincial government must take the lead on.

We need strong political leadership that we can rally behind, to make such a turn-around a reality. For this reason we appeal to both the National Minister of Health, Dr Aaron Motsoaledi, and Deputy President Cyril Ramaphosa, who is also the Head of the South African National AIDS Council, to urgently and publically intervene to address the situation. Without such high-level political intervention, we fear our report may end up gathering dust, as had two previous reports into the Free State healthcare system; one by the Human Rights Commission, and one Department of Health report by the so-called Integrated Support Team.

Ultimately, the report of the People’s Commission of Inquiry is a public document. It is public testimony, which government must take seriously if it is serious about putting people first, and about turning around a failing system. There can be no doubt of the unacceptability of the situation in the province. The only question is how we as a society will respond to it. DM

Thembeka Gwagwa is a professional nurse. She was the General Secretary of the Democratic Nursing Organisation of South Africa (DENOSA) for 17 years. Bishop Paul Verryn is a Minister in the Methodist Church of Southern Africa. Thokozile Madonko is currently a Co-Director at the Alternative Information and Development Centre (AIDC). The three acted as independent commissioners for the People’s Commission of Inquiry into the Free State Healthcare System held in July 2015. The report of the commission was published on Tuesday 10^th November at an open dialogue in Bloemfontein. Copies of the report are available by emailing [email protected]

Photo of Bloemfontein by South African Tourism.