Maverick Citizen

Maverick Citizen Eastern Cape

Eastern Cape Health MEC said ambulances were sent to Nelson Mandela Bay — but no sign of them yet

File photo: 28 July 2020: MEC Sindiswa Gomba with Minister Zweli Mkhize at Livingstone Hospital. (Photo: Mike Holmes)

After heated questions in Parliament last week, the Eastern Cape MEC for Health, Sindiswa Gomba, assured MPs that the ambulance fleet in Nelson Mandela Bay, which has been hit hard by Covid-19, had already been boosted by 10 more vehicles. At the time, doctors were complaining that there was a single ambulance in Nelson Mandela Bay for Covid-19 patients and only one in Uitenhage. However, a week later, there has been no sign of the emergency vehicles, only the promises that they will arrive.

A week after Eastern Cape MEC for Health Sindiswa Gomba told a joint sitting in Parliament that 10 ambulances “have been moved to the Nelson Mandela Bay metro” to increase the emergency fleet and bolster the metro’s response to the Covid-19 pandemic, not a single one of the promised vehicles have arrived at the Emergency Medical Services (EMS) base yet.

A few hours before an oversight visit by Minister of Health Zweli Mkhize last week to the metro’s state hospitals, Gomba told the joint sitting of the Portfolio Committee for Health and the select committee on Health and Social Services: “Nelson Mandela Bay [around Port Elizabeth] initially had 40 [ambulances], but we moved 10 from OR Tambo [around Mthatha] to add on to Nelson Mandela. Therefore Nelson Mandela has got 50 ambulances.”

According to three sources in the health department, the 10 ambulances had not arrived at the Nelson Mandela Bay EMS base at Dora Nginza Hospital. The Eastern Cape Department of Health also confirmed earlier in July 2020 that there were currently only two ambulances for Covid-19 patients on the road: One servicing Nelson Mandela Bay and one in Uitenhage. Two patient transfer vehicles were also operational and 12 ambulances were on the road for other cases.

The metro currently has 19,350 positive Covid-19 cases and 15,903 recoveries with 578 deaths. According to statistics released by Eastern Cape Premier Oscar Mabuyane on Tuesday, 28 July, Nelson Mandela Bay metro had the highest fatality rate in the province with 3% of patients dying.

Sources in the health department confirmed that apart from two double-cab vans, no other vehicles have arrived at the EMS base in the metro and the department’s communication director, Siyanda Manana said some of the ambulances will likely arrive on Wednesday, 29 July 2020.

“The MEC did not lie in Parliament. She took an oath and understands the implications of lying in Parliament.”

He said that at the time that she appeared before the joint sitting of the two committees, the “administrative processes of the transfer of the vehicles” had been completed.

“The other assets that are in the ambulances also had to be transferred. The first five ambulances will arrive in the metro tomorrow, the other five will follow suit and on Friday, all will be delivered. There are also five other ambulances that did not have stretchers and they will be provided with stretchers to add to the operational ambulances in the metro,” he said.

Gomba’s answer was a specific response to concerns raised over the pivotal plan that ambulances would play in a plan to provide an efficient response to the peak of Covid-19 cases in the provinces expected during August 2020.

Repeated calls were made for the department to be placed under administration, but Mkhize last week said this was not going to happen at the moment. He sent a team of experts of the province earlier in July 2020 to assess and strengthen the health department’s response to the outbreak. In a report, the support team stated that EMS and patient transport services “require intervention to ensure continued function”.

Following hearings in 2015, the South African Human Rights Commission issued a report in 2016 finding that there was a dire shortage of ambulances in the Eastern Cape and Nelson Mandela Bay.

In a document seen by Maverick Citizen setting out the needs of Livingstone Hospital ahead of Mkhize’s visit, the current emergency medical services situation was explained as follows: “Only one dedicated Covid-19 ambulance is available. Shortage of drivers and paramedics to assist with transfers. Patients left in the community, inter-hospital transfers delayed by days, leaving patients requiring oxygen stranded. Nelson Mandela University has offered students to support, but requires a paramedic support. Additional drivers/paramedics and patient transport urgently needed to allow appropriate triage systems to work with additional dedicated Covid-19-related transport.”

A similar report on Dora Nginza Hospital, the regional hospital based in Nelson Mandela Bay, read as follows: “Transport of medical patients in between hospitals has largely been halted. It takes 12 hours to 24 hours to get a patient to the Intensive Care Unit. We are unable to transfer any patients to TB hospitals, isolation facilities or the field hospital. This has meant our in-patient hospital numbers are ballooning. We need a dedicated EMS service for Dora Nginza Hospital.”

The Department of Pediatrics at Dora Nginza Hospital also raised the issue in their report saying that children are spending up to a week longer in hospital than they have to. “Due to interruption of ambulance service, patients from the district spend up to a week in hospital awaiting transport back. This places even more strain of limited bed numbers.” Dora Nginza Hospital is the specialist centre for pediatric services for the western part of the province.

Following hearings in 2015, the South African Human Rights Commission issued a report in 2016 finding that there was a dire shortage of ambulances in the Eastern Cape and Nelson Mandela Bay.

At the time, the metro had 10% of the required emergency vehicles with only 12 ambulances rostered and 40 being operational.

In their report, the human rights commissioners wrote: “Despite having identified a number of issues in the Commission’s 2007 Health Report, including challenges relating to the provision of emergency medical services and the adequacy of transportation systems on the ability of persons to access healthcare services, particularly the poor and those residing in rural areas, there appears to be a significant lack of progress in addressing these issues. This report has illustrated a number of challenges faced by the Eastern Cape Department of Health which has contributed to its failure to adequately fulfil the right that no person may be denied access to emergency medical services and access to healthcare services in general, which failure further contributes to the perpetuation of a number of other social problems.

According to the national department of health requirements, the metro is supposed to have 115 operational ambulances.

“The importance of immediate or timely medical assistance in an emergency situation is indisputable in the recognition that a denial or delay of treatment may potentially have a profound and devastating effect on the health and resultant quality of life of persons… The problems stemming from the already under-resourced fleet size are further compounded by an equally under-resourced staff profile, a shortage of highly qualified EMS personnel, low numbers of ambulances that are currently operational and a majority of the current fleet unable to navigate the difficult terrain to respond to emergencies in large parts of the province…

“While the immediate and long-term implications on a person’s health are easily recognised, the in-depth investigation into the lack of access to emergency medical and patient transport services has demonstrated the perverse and incessant impact on the economic stability of families and on the eventual eradication of poverty, and inequality. The high costs involved in obtaining private transportation services place an incredible financial burden on families, often with devastating effects. Daily necessities such as food, clothing and education are sacrificed, while the reliance on already unaffordable loans at high interest rates drive families deeper into poverty.”

By 2018, despite a number of recommendations by the commission that the situation must be attended to, the situation in Nelson Mandela Bay remained largely unchanged. According to an answer provided by the former health MEC, Helen Sauls-August, to the Eastern Cape Legislature in 2018, there were 43 ambulances in the metro, of which 35 were operational.

According to the national department of health requirements, the metro is supposed to have 115 operational ambulances.

Thoko Mtsolongo from the Eastern Cape Health Crisis Action Coalition, a group of NGOs and public interest organisations in the province’s health sector, said that based on Stats SA data, the population of Nelson Mandela Bay is approximately 1.1 million.

“According to the National Standards as set out in the National Data Indicator Set released by the National Department of Health, the required number of ambulances is one ambulance for every 10,000 persons in the province. This means that there should be at least 115 ambulances serving the metro. MEC Gomba confirmed in a health portfolio committee meeting that Nelson Mandela Bay has just 40 ambulances and that 10 more would be moved from OR Tambo to bring the number to 50. This is still woefully inadequate.

“The long-standing crisis in emergency medical services in the Eastern Cape is, now more than ever, a matter of immediate urgency with severe consequences for the rights, health and lives of millions of people. In addition, it is even more crucial now that there is a functioning EMS system as some facilities are closing down and inter-facility transport is urgently needed. The fact that the additional ambulances the MEC promised have not yet been delivered is shamefully demonstrative of the health department’s historical lack of ability to plan adequately to meet the health needs of the population it serves,” she said.

The DA’s spokesperson for health, Jane Cowley, said: “These ambulances have yet to arrive in Nelson Mandela Bay a full week later. The MEC spoke of the matter as a fait accompli, however, this transfer has not yet taken place. She would be well advised to avoid making statements that could see her perjuring herself in a parliamentary sitting.”

According to a presentation compiled by the Covid-19 project management unit, appointed by Mabuyane, head of the unit Sibongile Zungu explained that it was imperative that there is accelerated recruitment of clinical, support and EMS services. She also advised that EMS students should be drawn in to help. DM/MC

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