While reading a multitude of reports and memorandums generated by the Eastern Cape health department, a single thought comes to mind. What is it that comes after a failed state?

In Gqeberha, public hospitals have become a place befitting a quote from the Italian poet and writer Dante Alighieri’s Inferno: “Abandon All Hope, Ye Who Enter Here.”

Our hospitals have become the place from which hope flees. When people need it most.

Since Maverick Citizen’s last editorial on the topic, addressing the then Minister of Health Zweli Mkhize, things have in fact deteriorated even further in the province that markets itself as the home of legends.

Mmamoloko Kubayi-Ngubane took over Mkhize’s duties this month when he was placed on special leave until the Special Investigating Unit probe into irregularities around the controversial Digital Vibes contract have been finalised.

Up to now, Mkhize and his director-general, Dr Sandile Buthelezi, had resisted answering whether they will put the Eastern Cape health department under administration – no matter how many times we have asked. But perhaps this is because the answer is an uncomfortable one. The province’s bureaucrats have proven themselves resilient enough to bounce back to their old ways, no matter how many administration orders are thrown their way.

While Premier Oscar Mabuyane has assured the province that he believes its medical services are “better off” now than in the two previous waves of Covid-19, which hit the Eastern Cape hard, a senior doctor summarised the situation: This ship is no longer sinking. It has sunk. But it must be good politics to keep everyone’s spirits high.”

A string of desperate memorandums creates a horrifying picture of the current state of the department: 

1. In 2020 the baby death rate increased from 15 per 1,000 births to 20 and it is probably still climbing as the unit has been hit by an outbreak of hospital-acquired infections due to severe overcrowding;
2. For public-sector Covid-19 patients in Nelson Mandela Bay and the Sarah Baartman District, covering large parts of the Karoo, there are a maximum of four ICU beds available, no high care and no overtime for doctors who must look after an overflow ward. If contracts are not renewed by the end of June this ward too will be without doctors;
3. Department of health spokesperson Sizwe Kupelo said a report on the reasons for the high death rate in the province due to Covid-19 during the first two waves “has not been presented yet”. But, according to the department’s own epidemiological records, Buffalo City metro has the highest mortality rate at 293.6/100,000, followed by the Nelson Mandela metro at 273.5/100,000 and the Chris Hani district at 209.1/100,000. Compared with the World Health Organization’s Covid-19 data, these rates are among the highest in the world and significantly higher than those of Italy (175/100,000), the US (166/100,000), Spain (157/100,000) and Brazil (142/100,000);
4. A state-of-the-art field hospital has been closed. Not “mothballed”, as the department describes those facilities that are temporarily closed due to staff shortages. Completely closed. “We are waiting for them to fetch their equipment,” a security guard says. Instead, staff who worked at the field hospital – which was run by a CEO who was paid more than R1-million a year and was assisted by a CEO from one of the TB hospitals – have been moved to the latter CEO’s hospital where it appears some form of field hospital or isolation facility is being set up. However, nobody is answering questions about it;
5. The clinic looking after children with HIV was closed for a while earlier in the month because doctors had not been paid;
6. Young cancer patients could not receive chemotherapy because procurement did not order the specialised food they needed; and
7. The patient registration system is being shut down because nobody paid the bills.

Yet, the Cost Containment Committee, a body that senior National Health Department officials did not even know existed, gets away with not making any appointments as hospitals fold under pressure. Up to now the Health Department has refused to answer questions about the way they work. MEC Nomakhosazana Meth said on Monday she “has not met with them” yet.

On Monday, another acting superintendent sent from the premier’s office, who has been an acting superintendent at the department, replaced another acting superintendent who was first appointed to head up the Covid-19 response and then became acting superintendent after the permanent superintendent resigned to head up the Covid-19 response in the premier’s office. Perhaps given the current leadership issue, and while it did not appear possible at first, it is not surprising that the Eastern Cape department of health has managed to sink deeper into chaos and debt since the last visit by a “concerned” Mkhize.

A bailout seems off the cards despite a rare admission of exactly how deep the trouble is that they find themselves in. Let’s not forget that these are the people who showed Mkhize a whole state-of-the-art Covid-19 ward even though none of the beds were connected to oxygen. By its calculations the Eastern Cape department will start running out of operational funds by July. The department had already used 16% of its budget before the financial year started and still owes R4-billion to unpaid service providers. In one of his last speeches in Parliament before going on “special leave”, Mkhize complained about the serial underfunding of his department – including the provinces.

Hope has left the building.

But for thousands of patients the crippled system remains all they have.

Will communities rise up now and demand accountability for public funds? Almost all of the systems have been set up in a way to minimise and exclude those who use the hospitals. Hospital boards appear to have been sidelined. Clinic committee members are threatened not to speak out about problems. During hard lockdown a deliberate decision by a previous health MEC kept community leaders without permits to move around, preventing them from consulting those who were in the most trouble.

Perhaps this will be a moment when civil societies, communities, religious leaders and businesses join hands and say: No more. The time has come to demand real justice for the babies who died – not adverse findings and strict admonishments. Demand safe maternal units with enough staff, not just a small band of honourable people who refuse to give up. Demand beds, doctors and nurses for those who are ill and dying. 

Perhaps after decades of hobbling along, critically wounded, the Eastern Cape health department, relying on the resilience of its doctors and nurses, can finally become a new model for what public health should look like.

Perhaps the chance is now as the mighty Bhisho bureaucrats are in a weakened state. Perhaps now is the time to invite hope to return. 

Nobody else is coming for the Eastern Cape. The province will have to save itself. DM/MC