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Mtandeki Xamlashe: The doctor breathing new life into G...

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Mtandeki Xamlashe: The doctor breathing new life into Gqeberha’s ailing Livingstone Tertiary Hospital

the acting CEO of Gqeberha’s Livingstone Tertiary Hospital, Dr Mtandeki Xamlashe. (Photo: Deon Ferreira)

In a brutally honest interview, the acting CEO of Gqeberha’s Livingstone Tertiary Hospital, Dr Mtandeki Xamlashe, recounts how the hospital came close to collapse and closure during 2020 and is still surviving day to day.

Faced with linen crises, a collapsed facilities management, staff shortages and a highly unstable facility pushed close to collapse during the first Covid-19 wave, Dr Mtandeki Xamlashe, the acting CEO of Livingstone Hospital in Gqeberha (formerly Port Elizabeth), was sent “from head office” to revive the hospital.

There wasn’t much of a choice. The closure of Livingstone Hospital would have left large parts of the Nelson Mandela Bay (NMB) community and the Karoo and seaside communities around it unable to access medical services.

Amid the chaos, Xamlashe found hope. He saw resilience. He saw a dedicated line of clinicians and nurses bravely fighting to save lives.

But he admits that the facility was pushed close to the edge of disaster, adding that it will take about five years to recover.

Confronting his team of doctors was hard, he admitted, as facilities management at the hospital had collapsed when he arrived there in September last year.

“When we started talking to the doctors it was like we were here to hug a wounded lion. If you are careless when you hug it, it is going to be a problem.”

In July 2020, at the height of the first wave of coronavirus infections in Nelson Mandela Bay, desperate doctors fearing for their own health and safety and that of their patients temporarily closed the hospital’s casualty unit after it had not been cleaned for days because of labour disputes. Nurses had left the ward and doctors could not access medicine. Health and safety inspectors found a warehouse full of rotting linen that had not been washed for weeks. The linen shortage is ongoing. 

“Facilities management had collapsed. There were areas of serious incompetence in that space. This began to demoralise the clinicians. They did their utmost best under the circumstances,” Xamlashe said.

“That became my focus area. It is [still] really bad. It is going to take time to recover. We are still in the mitigation phase – asking, how do we survive day to day? Like the linen problem… how do we make sure that we survive the next day or the next week?

“You have a linen bank that can carry you for three months, but we can only show linen for three days. That is the very situation that we find ourselves in.

“As managers, we take turns to be on-site to make sure that things are carrying on, but we are finding ourselves in a very risky situation.

“I am from a small rural farming town that is notorious for stock theft. I am not sure if that is the reason I was sent here,” he laughed.

Xamlashe’s career in managing hospitals has taken him from Hammersmith Hospital in London to Belgrade to Mthatha Academic Hospital to Cecilia Makiwane Hospital in East London.

“Now I find myself in this dark corner of the province and I am hoping me and the team can put some light into it.”

In September last year he was seconded to the hospital as acting CEO. His permanent job is that of chief director of hospitals at the Eastern Cape Department of Health.

“We monitor the performance of our facilities from head office. [Around September] we realised that things were really collapsing at Livingstone Hospital. Not that we wanted things to be perfect, but things were really going down in a spiral. We decided that I should come here, and contribute with the local team, obviously – at least to keep it afloat, otherwise it almost had to close.

“I came to assist the team. We knew that we didn’t have top management in the facility – I had to come here myself and ensure that the hospital survives the Covid-19 attack.” 

In November 2018 the hospital’s entire management team, including its highly regarded CEO and clinical governance manager, were run out of the hospital by violent union protests.

“Even before Covid-19 there were challenges here,” Xamlashe said. “Covid-19 only made things worse. We realised that we really need to focus on recovery. Covid-19 just made it slow and difficult, but it had to happen for the people of Gqeberha.

“A lot of people have been acting. Different kinds of managers were deployed. Over time things had deteriorated a little bit.”

Xamlashe said a new nursing manager had been appointed and advertisements for the post of CEO had gone out.

“Hopefully, before the end of the month we will be able to appoint a new clinical governance manager.”

He said after he arrived at the facility in September he was struck by the number of strong people there.

We are even going to start working with the private sector. We have asked if we can use their laundry facilities at night as they are not using it. Believe you me, there is warmth to that proposal.  We must never be separated by business interests. We have a common goal, which is the health of the citizens of Gqeberha.

“There was some resilience here. The hospital was on the edge when it was hit by the first wave. But a lot of people came forward and formed a defence; they stood up and they saved lives and saved the situation. That crisis brought out some stars in the system.” 

Xamlashe said they needed support from strong management.

“They could only go so far,” he said.

“I do not have a silver bullet for each and every problem, but we have started to forge partnerships with the Department of Public Works on maintenance; with Correctional Services, they come in to help. 

“We are even going to start working with the private sector. We have asked if we can use their laundry facilities at night as they are not using it. Believe me, there is a warmth to that proposal.  We must never be separated by business interests. We have a common goal, which is the health of the citizens of Gqeberha.

“It may well be a good thing going forward that we found new friends, new relationships during Covid-19. We are talking to the university, only to find that they are so keen to help.”

He said the linen shortage in the hospitals’ wards had become a very sensitive issue.

“It is an infection-control issue. It is a dignity issue. You come from home and you see these torn sheets. It is an image issue for the institution. That is how seriously we are taking it. We have sleepless nights making plans that the little we can do is happening.”

He said the management of the laundry problem was far below par.

“We do not use local skills for maintenance. Our laundry is managed by a company in Cape Town. That does not sit well with me. We know it is going to break down. It will take two weeks for people to come down. That will disrupt the service. Linen has to do with the continuity of care. 

“Unfortunately, I think we have always looked down on certain sectors in the hospital. Our focus has been too much on doctors and nurses. But the blind-spot areas are catching up with us. One of them is this linen service.

“We built that facility on imported machines. The skills to maintain these are scarce in the country. The machines have come to the end of their life. They are 16 years old. I find it very awkward [that we have] engineers in Gqeberha who maintain ships and look after airlines. Now you tell me they can’t repair a laundry machine. It does not sit comfortably with me.

“I will sit in a coffee shop, and an engineering company will approach to ask who maintains the laundry. I will probably lie to them. Just to save face for that moment. It goes against the objectives of the government, to support local businesses, to tell them it is someone in Cape Town.

“There are things that sometimes go wrong. In recovery, we must not repeat those mistakes. They should have started planning for a replacement machine before it collapsed completely. That is where leadership comes in.”

Xamlashe said sorting out the linen crisis was a high priority.

“If you sort linen a lot of different things will also come right. But ultimately people depend on what happens at facilities management.”

He said the laundry machine constantly breaks down.

“We asked that they bite the bullet and keep repairing so it can keep going for the next six months. But we know it is going to break again in two days’ time. It is what you get there. We can no longer depend on the machine. It has let us down.” 

The hospital’s laundry is now taken by truck to Queenstown (a 700km round trip), where the department operates a big laundry.

“If the laundry comes back from there it gives us a three-week supply. It augments the little output we get from this laundry. Our situation is unpredictable. We can have another third wave. Suddenly the demand shoots up and we find ourselves in the situation that we are.

“I am prepared to pay top dollar for a solution that will give us clean linen on patients’ beds. Someone must pay and it cannot be the patients and the doctors.”

Last week doctors were struggling to get patients admitted while hospital staff scrambled for clean linen to cover beds. One doctor reported that a child was wrapped in a curtain.

“I investigated the curtain story,” Xamlashe said. “I was upset. I asked the nurse, why did you use the curtain? But I was touched when I heard. She said, ‘I was about to go off duty.’ The child received medication that made them feel cold. She didn’t want to leave the child shivering. But the linen had not been delivered yet. She took a clean curtain to give this little child extra warmth. Nurses do things to get around. 

“The doctor was upset. I was touched by the intention. Nurses use everything at their disposal. Here some use cable ties to stop the drip stand from sagging. They do what they can.

“I discuss it with them. I said, do anything to make sure your patient is comfortable. Do anything to save a life. Nothing must stop you.

“I agree that we don’t have enough linen. Our linen reserve must be 60 days. Now it is three weeks. The linen goes directly from the machine to the bed. Those are depleted.”

He said they can buy linen in bulk, but without an operational laundry, the linen is left to rot and must then be destroyed.

“You can buy R9-million of linen, but it won’t be there in four months if the machine does not work.

“We are procuring volumes of linen. If you keep it unwashed for 48 hours you can’t wash it any more. It either rots or has a stain that doesn’t allow you to use it. Your laundry plant must work well before you invest.” 

Xamlashe said now that their plans to manage the situation were taking shape the hospital would buy new linen.

“This was a painful way to learn. It is something that should never happen in any hospital in the country.” 

Livingstone cannot solve all the health problems in NMB. We are just the tertiary hospital. [Tertiary hospitals are where specialist services are provided and students are trained]. We treat people at the last mile. The focus must be on screening and prevention.

Xamlashe said that he was part of the “club” of CEOs, municipal managers and department heads that constantly complains about being underfunded.

“We never have enough money.  As leaders, we have to focus on efficiencies.”

The operational budget for Livingstone Hospital is R1.4-billion. 

“Livingstone cannot solve all the health problems in NMB. We are just the tertiary hospital. [Tertiary hospitals are where specialist services are provided and students are trained]. We treat people at the last mile. The focus must be on screening and prevention.”

He said instead of giving Livingstone Hospital more money, it was important to invest in primary healthcare.

“It is not possible for our doctors and nurses to see everyone being bussed from other districts. 

“We are making staff shortages worse by inviting the whole world. The doctors and the nurses feel all the strain as much as infrastructure. It has an effect on everyone, including the cleaners and the porters if an outpatients’ clinic has 800 people instead of 400. We are just making it worse.”

He said they had taken a decision to decentralise specialist services and to send specialists to district hospitals to do simple consultations.

Xamlashe said Livingstone Tertiary Hospital is running a 1,000-bed facility, but was funded for only 600 beds.

“We run at a deficit of 400 beds – but these patients should not be treated at Livingstone Hospital.” 

Nelson Mandela Bay metro only has one district hospital, in Uitenhage, where less complicated cases can be treated. The OR Tambo district in the former Transkei has 15 district hospitals.

“Around 40% of the patients we treat should be treated in a district hospital, but we are compelled to treat them here because they have nowhere else to go.”

He said they are planning, over the next three years, to turn one of Nelson Mandela Bay’s tuberculosis hospitals, Empilweni Hospital, into a 255-bed district hospital.

“That will reduce the surplus at Livingstone. We hope that in the next three years we will be able to reduce Livingstone Hospital’s load to 600 patients. Only then our budget will start making sense.

“We are not going to change this overnight. But we are living with the pain.”

He said the hospital was carrying the load of two other district hospitals.

“When specialists have to see 150 patients a day they are no longer specialists. They are general practitioners.

“The clinicians are getting frustrated. They are asking themselves, is this how I must operate until I retire? They say, no, I must go to another place.” 

Xamlashe said there were 60 specialists at the hospital. 

“The picture is not good, but it is not that bad, but it is made worse by this. My focus is on reducing [non-complicated cases.]

“Otherwise, no matter how many more specialists I get, I will just have a bigger frustrated army.”

Patients at the hospital were left without the services of a neurosurgeon after the doctor who ran the service by himself for a few years left last year.

“We are employing two neurosurgeons now. The doctor was overloaded. He was all by himself on call every day.

“My aim is that specialists should see around 30 patients a day. We must get the environment better [so] that the few who come here will stay longer.”

He said he has instructed the hospital’s Human Resources Department to focus on retaining specialist staff.

But two brutal waves of the Covid-19 pandemic have taken their toll.

“Our staff got affected in many ways. They got ill. Some passed on. Some got psychologically affected. Some lost their friends, their colleagues, their relatives. We saw a number of resignations. They saw death at a massive scale that they could not stand. 

“When you talked about a second wave or a third wave they did not want to be witness to that. Others of course did say, we cannot work in a place like this. In some areas, the system couldn’t retain our doctors.

“We need to get our systems right. Get the environment conducive. Professionalise it. Collaborate with partners, universities and communities. This mission will take five years.

“We must get our house in order first. Linen must be washed. The hospital must be clean.” 

Xamlashe said instability caused by labour unrest was a big issue when he arrived at the hospital.

“It is one of the reasons we are here. I think we have come a long way. Without stability, it is difficult to sit and plan all the things we are talking about. It was our first goal. I said, let’s talk to each other. We have improved the engagement rate to 80%. It was a big problem. Nobody was talking to anybody. 

“And the leadership vacuum was making things worse. There was nobody to coordinate stakeholders. We can tick that as an achievement. We have achieved stability. There are constructive engagements. All of us are talking together [about] how to deal with the laundry crisis. It is a rich engagement, also with hospital board members.”

He joked that he was keen to get back to his job so that he can play more golf. “But the people here have asked me to stay until more managers have been appointed.”

“Our recovery is going to take us to a much better place than where we were before Covid-19. It is becoming an interesting journey. I am getting addicted to it, but I still want to go home,” he said. DM/MC 

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