After bringing the largest casualty unit in the province to its knees over the past two weeks, hospital cleaners, porters and laundry workers returned to their jobs on Monday 15 June as the Department of Health agreed to pay unrestricted overtime until severe staff shortages at Livingstone Hospital were addressed.

The superintendent-general of the Eastern Cape health department, Dr Thobile Mbengashe, said on Monday they were trying to bring stability to the hospital which serves as one of three Covid-19 facilities in the province, and that senior personnel would be sent from Bisho to address the issues. 

“It is not only the cleaning that was a problem. There is also a severe backlog of orders for supplies that we have to deal with,” he said.

During meetings to gauge the preparedness of the Eastern Cape to deal with Covid-19, the department was warned by doctors coordinating the response that severe staff shortages would seriously hamper the hospital’s ability to respond. Nelson Mandela Bay has been identified as one of the hotspots for coronavirus infections in the country and currently has 2,935 confirmed cases of the virus. There are 1,468 recovered patients in the metro and 79 deaths. The Eastern Cape currently has 10,027 confirmed cases of the virus.

Livingstone Hospital’s permanent management team was suspended 18 months ago after a strike by Nehawu members, and since then the facility has had seven acting CEOs.

Mbengashe said the go-slow by general assistants was triggered by a misunderstanding over overtime. “We are not allowed to pay more than 30% of a staff member’s salary in overtime. But we realised that there are severe staff shortages so we had no choice. Those workers refused to go even one extra mile for us,” he said.

An attendance register sent as part of a memorandum to the hospital’s acting CEO, Dr Khanyisa Makhamba, showed that since 28 May the hospital’s busy casualty unit did not once have a full staff complement, and on the majority of days not a single general assistant would arrive for work on the night shift. On several days during this period, up to nine workers per shift were reported as being absent.

Livingstone Hospital’s permanent management team was suspended 18 months ago after a strike by Nehawu members, and since then the facility has had seven acting CEOs.

On 12 June workers started protesting outside the hospital and no cleaning was done at the facility. This led to the night shift nurses refusing to work because the casualty unit was dangerously dirty.

On the same day, Minister of Health, Dr Zweli Mkhize, visited the province. But neither Mkhize nor Health MEC Sindiswa Gomba visited the facility to do oversight since the strike started. Instead, as the crisis grew, they were in East London launching a controversial R10-million project to provide ambulance motorcycles to health workers.  Both the minister and the MEC took rides in the new vehicles. Gomba’s spokesperson, Judy Ngoloyi referred all questions to Mbengashe. Mkhize’s spokesperson, Lwazi Manyi, did not answer any questions. 

On Friday evening, doctors sent out an emergency call for help after they found themselves unable to assist a patient who suffered severe blood loss after being shot in the chest. 

Apart from the accident and emergency unit having blood on the floor and hazardous levels of waste, including blood-soaked bandages, piling up, discarded PPE and other medical waste materials were also piled up in the passages. Nursing services stopped as a result of unsafe working conditions and doctors were unable to access certain essential drugs as a result.

Doctors who tried to move boxes overflowing with medical waste to make room to work placed themselves at risk as bloodied bandages, discarded drip bags, needles and used PPE littered the floor of the casualty unit.

A private company was called in to clean up on Saturday but striking workers returned to the unit to threaten them. Another emergency call was sent out: “The private cleaning company left the premises due to intimidation from other staff on duty. The public order police were contacted to restore law and order. Not sure if the private company will staff.”

A memorandum revealed the extensive impact the strike has had on the facility. “There are no general assistants on duty to perform these duties,” the document reads. This included the removal of medical waste, including hazardous medical waste, the collection and distribution of food and the removal of soiled linen.

As an interim measure, the hospital had to outsource the hospital’s laundry and cleaning services. Workers, however, arrived at the hospital in their numbers to intimidate the private cleaning company’s personnel while they were cleaning the casualty unit.

The protest comes as the appointment of a hundred general assistants at Eastern Cape hospitals, promised in April when President Cyril Ramaphosa visited the facility, is yet to be finalised.

“They are being recruited as we speak,” Mbengashe said. “We are giving them one-year contracts.”

“We should have made provision for overtime until then,” he said.

“I really regret what happened at Livingstone Hospital. That is not how we wanted to manage our hospital,” he said. 

Nomawethu Sweetness Stokwe, Nehawu’s general secretary for the Nelson Mandela Bay region, said there remains a dire shortage of staff at the facility. “They have been working overtime. There are supposed to be 30 staff members – 23 to work in the day and seven at night – but many people have left the services of the hospital and were not replaced.” 

“The hospital is clean now. There has been some improvement but this is temporary. We need the department of health to address the staff shortages,” she said. “They keep on telling us: there are another hundred people coming but they are not here. The battle against Covid-19 is now in the hospitals.”

At the time of the strike, there were 11 people on duty during the day and two or three on duty at night.

She said the only way to manage this was to provide overtime work for staff members. “Then the managers said no more overtime. That is why we did what we did.”

“Our issues were only addressed on Friday. We said to the management: you need to commit. Government promised them a raise at the end of April. That is not happening. Their morale is very low. Now you say you won’t approve overtime. We said we can’t be expected to work.”

She said after an agreement was reached, workers were called back at the weekend. 

“The hospital is clean now. There has been some improvement but this is temporary. We need the department of health to address the staff shortages,” she said. “They keep on telling us: there are another hundred people coming but they are not here. The battle against Covid-19 is now in the hospitals.”

Stokwe said the union also donated PPE to the hospital. More than 60 health workers, including a number of nurses, have tested positive for coronavirus.

“This action was justified. As much as we understand the risk it caused, we will not be exploited,” she said. 

The coordinator for the Eastern Cape Health Crisis Action Coalition, Thoko Mtsolongo, said patients who visit the hospital deserved a facility that was in a clean condition to protect their health.

“There must be a balance between the concern of the hospital staff and the treatment of patients. At all times the department should be ensuring that patient rights are not affected, but now during the Covid-19 pandemic the disruption of health services is terribly concerning,” she said. 

“Protest action has been an ongoing concern in the Eastern Cape. For a long time civil society has tried to request that an agreement be entered into between the department of health and the unions that will allow for workers to have the right to strike, but will also keep a minimum level of services going for the sake of the patients.

“It is now more crucial than ever that the department ensures that the hospital is capacitated to provide critical care,” she said. MC