It has been a very dark week in the Eastern Cape as all the unheeded warnings, the hidden agendas, patchy leadership and years of procrastination and misguided priorities all seemed to hit at once, creating a perfect storm and confirming what many knew and feared: when disaster comes to the Eastern Cape, it arrives at full strength.

It also forces us to ask what it will take for the national government to intervene in a province in crisis? Do they need people dying in the streets? Tick. A 1,000-bed hospital that is not used because staff weren’t appointed in time? Tick. A maternity hospital in crisis because staff are not arriving at work? Tick. R10-million in Covid-19 funding for scooters that, it turns out, will only be ready in three years? Tick.

What will it take?

Hospitals around the province are full. Both public and private hospitals are battling an increase in patients and a decrease in staff numbers as Covid-19 takes a deadly toll on overstretched health workers.

Accounts of beloved family members dying on stretchers without access to oxygen and ventilators are overwhelming social media. In some cases, people are dying while waiting for help.

Funeral homes and mortuaries have no more capacity.

This week was only the start of the “peak” predicted for the Eastern Cape – one of South Africa’s poorest and worst-run provinces.

The official unemployment rate, according to Stats SA’s latest quarterly labour force survey, is 40.5% with expanded unemployment, which includes those who have given up on looking for a job, at 48.9%. This is 10 percentage points above the national average – and the latest statistics were collated before the economic harm done by the lockdown. The rural expanded unemployment rate is currently 56%.

Rubbish piling up in the casualty unit in Livingstone Hospital during a hospital cleaner strike. (Photo supplied)

The South African Index of Multiple Deprivation, an index measuring multi-level poverty, ranks 63% of the province as “most deprived” with the provincial economy expected to contract by more than 5% due to the Covid-19 outbreak.

Municipalities across the province, meant to be at the frontline of water provision and local efforts to fight the pandemic, are bankrupt and in crisis. This week, the MEC for Co-operative Governance, Xolile Nqatha, admitted that he has asked the national Treasury to bail out 14 bankrupt municipalities:

• Walter Sisulu;
• Enoch Mgijima;
• Raymond Mhlaba;
• Dr Beyers Naude;
• Mhlontlo;
• Kou-Kamma;
• Makana;
• Great Kei;
• Amahlathi;
• Inxuba Yethemba;
• Ingquza Hill;
• Port St John’s;
• King Sabatha Dalindyebo and
• the Amathole District Municipality.

The Department of Health had a staggering R3-billion in unpaid bills at the end of the 2019/2020 financial year. It is facing medico-legal claims of close to R30-billion – R4-billion more than its entire annual budget for the current financial year.

At Dora Nginza Hospital, one of two centres for specialist maternal and paediatric care in the province, the past few years saw tremendous gains made in the fight against maternal and baby death rates. Specialists trained other homegrown specialists and young doctors pulled together to establish high-care units for moms and children. 

In two months of the pandemic, these gains are fast being reversed as maternity services are on the brink of collapsing as hospital cleaners and nurses refuse to work – according to them, in line with an agreement with the Department of Health over deep cleaning of working areas. Doctors were running the units, delivering babies, cleaning floors and theatres, and patients were left hungry as food delivery services had been interrupted.

But there were also no maternity panties and pads, just one undignified symptom of horrendous supply chain management and not something to be blamed solely on the Covid-19 pandemic. In sharp contrast, several department vehicles sport new branding. According to official documents supplied by the Office of the Premier, the Department of Health has been spending hundreds of thousands of rands on reflective jackets, loud-hailers, posters and sign-boards.

But the most glaring example of wastage though must be the R10-million spent on rickety scooters – a project launched with great fanfare while the biggest casualty unit in the province was shutting down because it had not been cleaned for days. The scooters are mentioned in procurement sheets as being for “Covid-19 tracing teams”.

The scooters make a mockery of a decade of campaigning by civil society organisations under the umbrella of the Eastern Cape Health Crisis Action Coalition for ambulances and effective emergency medical services in the Eastern Cape. Now the empty promises are there for all to see.

This was confirmed in a statement defending the programme by the national Department of Health. “They can be ridden by two community health workers to carry out the above functions: for example, Covid-19 screening in deep rural areas and general health screening and testing for other communicable diseases such as TB and HIV as well as non-communicable disease like diabetes and hypertension…” Minister of Health Zweli Mkhize’s spokesperson, Dr Lwazi Manzi wrote.

The only thing the representatives of the department all failed to mention was that the programme will only be rolled out over three years. But, this week, the department’s spokesperson Sizwe Kupelo confirmed that 150 people must still be recruited for the project and then trained, and then obtain their licences. “They have not been recruited as yet. We are taking the scooters to one of the villages in the coming week.”

The scooters make a mockery of a decade of campaigning by civil society organisations under the umbrella of the Eastern Cape Health Crisis Action Coalition for ambulances and effective emergency medical services in the Eastern Cape. Now the empty promises are there for all to see.

In a province where fears have been raised that stunting, hunger and malnutrition are likely to make the impact of the pandemic much worse, diabetic clinics have been closed to save personal protective equipment (PPE). Staff who keep statistics to raise the alarm on malnutrition in children were kept at home for lockdown Level 4 and 5.

Doctors and nurses are forced to recycle PPE, despite claims from the department and even by the Minister of Health Mkhize, that there are eight weeks of PPE available. The hospitals are not receiving any.

Smaller hospitals like Humansdorp, Kirkwood, Willowmore and Middelburg all battle high rates of infections among health workers, some having to close their doors for days.

At the biggest casualty unit in the province and one of the Covid-19 designated hospitals, Livingstone Hospital, cleaning remains erratic at its best. In an agreement with the Department of Health, cases of theft made against 97 employees were dropped without money being deducted.

During June 2020, every single time questions were asked about cleaning not being done at Nelson Mandela Bay’s hospitals, spin doctors pulled out the same line and just recycled it depending on the hospital: A hundred general workers are being appointed “as we speak”. The advertisement was only published on 24 June 2020.

Clinics are closing as staff members fall ill and cleaning is not done fast enough.

The assistance of community leaders had to be called in to bring order to hundreds of panicky people in Kwazakhele, one of the Nelson Mandela Bay Metro’s hotspots, as a mobile testing centre with a single nurse and 50 testing kits could not handle the numbers. The district’s testing coordinator was allowed to take leave.

In March 2020, the Eastern Cape legislature’s portfolio committee visited the three big hospitals that would serve as the centre of the province’s Covid-19 response. At each, the same warning was sounded: We do not have enough staff.

Close to 1,000 nurses were subsequently appointed, but only after Mkhize had an angry meeting with high-ranking officials at Livingstone Hospital in Port Elizabeth. 

During June 2020, every single time questions were asked about cleaning not being done at Nelson Mandela Bay’s hospitals, spin doctors pulled out the same line and just recycled it depending on the hospital: A hundred general workers are being appointed “as we speak”. The advertisement was only published on 24 June 2020.

While Premier Oscar Mabuyane praised the speed with which a joint field hospital project between Volkswagen South Africa, the German government, Nelson Mandela University, Nelson Mandela Bay Business Chamber and the Nelson Mandela Bay Municipality began, the health department has only managed to contract five doctors to do 20-hour sessions each and recruit 40 nurses from other health facilities. Advertisements for jobs at the field hospital only went out on 26 June – seven weeks after the project was first initiated and on a day when there were no available ventilators and hospitals were full. 

If this facility becomes a white elephant due to the failures of the health department, it will be a crime against the people of the Eastern Cape.

How to save the province

Calls are growing for MEC of Health Sindiswa Gomba to be fired – but frankly, at this stage of the health emergency, the question must be raised if a new political head will help at all. The crises we are experiencing are not the making of Covid-19: It is the confluence of years of corruption, inefficiency, maladministration and cadre deployment at every level of provincial and local government. 

It was a collapse waiting to happen. It took a tiny, malicious virus to bring us to the brink.

Maverick Citizen calls for the setting up of a system of co-governance with civil society organisations that can make transparent, informed decisions that ensure the rapid deployment of resources to the right places at the right time.

The Eastern Cape needs a new dawn. It needs a deep cleansing of its government and a national plan to make that happen. The province needs a strong voice, the president’s, preferably, that says enough is enough – not one who waves happily while driving around a parking lot in a dodgy “medical scooter”.

But right now, the Eastern Cape faces a real humanitarian disaster that needs a fast and directed intervention. 

It needs more feet on the ground. It needs decisive and agile leadership. President Cyril Ramaphosa, his Cabinet and the health minister Zweli Mkhize need to give orders. Business for South Africa needs to mobilise resources and private capacity to supplement the public response. 

The Solidarity Fund needs to identify and mobilise resources to meet emergency humanitarian needs for food, water and shelter for vulnerable women and children. Volunteers must be mobilised to assist with administration and cleaning while health workers act to save lives. The only hope we have left is the province’s people. They have been lining up with donations of blankets, food and maternity pads at hospitals. There are those who are offering to clean hospitals at no cost, and those who are offering skills and talents. The danger, though, is that in the face of a rapidly unfolding humanitarian crisis, they will find the impenetrable walls of a blundering government too much to overcome.

That is why Maverick Citizen calls for the setting up of a system of co-governance with civil society organisations that can make transparent, informed decisions that ensure the rapid deployment of resources to the right places at the right time.

Unless we treat this crisis as an emergency requiring extraordinary measures, who else will stand up for the Eastern Cape as the province’s people fight for survival? DM/MC