MAVERICK CITIZEN HEALTH

Eastern Cape’s Livingstone Hospital overwhelmed by Covid-19 cases — again

By Estelle Ellis 18 August 2021

A patient in the the Covid Patient Under Investigation Resus area in the emergency section at Livingstone Hospital, Gqeberha. (Photo: Shiraaz Mohamed)

For the third time since the start of the pandemic the largest designated Covid-19 hospital in the Eastern Cape, Livingstone Hospital, was forced to press the ‘bypass’ button and turn away almost all Covid-19 patients. Only those who were triaged as ‘Code Red’ and needed immediate lifesaving measures were stabilised.

Estelle Ellis

The critical and central emergency unit at Gqeberha’s Livingstone Hospital was this week overwhelmed by Covid-19 patients as cases in Nelson Mandela Bay spiked to more than 3,000. 

“It looked like a war zone,” a senior hospital source said.

It is understood that the nearby Dora Nginza Hospital had bed capacity, but refused to admit patients as it did not comply with the current “referral protocol”.

This time, however, unlike the previous two occasions when the hospital’s emergency unit, one of the biggest and busiest in the province, had to shut down because of patient overload, the closure was preceded by a warning from the frontline doctors to hospital management that they would not be able to admit many more patients.

The hospital’s management team was placed on special leave by the former superintendent-general of the department Dr Thobile Mbengashe, and neither the CEO nor the head of clinical governance have been replaced since.

Instead, a string of acting CEOs was appointed until September last year, when the hospital came close to collapse and a member of the department’s top management, Dr Mtandeki Xamlashe, was sent to avert disaster at the facility. In an interview this year, Xamlashe said the hospital was close to collapse.

In an internal memorandum dated 10 June, senior doctors at the hospital informed management that their staffing capacity was such that they would be able to accommodate only 25 patients. The hospital is the referral centre for the western part of the province and must also accommodate patients from the Karoo and smaller districts where specialist assistance is not available.

A Covid-19 treatment facility with bed capacity for 70 patients was created in the hospital “basement” in addition to beds in the hospital’s emergency unit, intensive care unit and wards for patients awaiting their test results.

The memorandum points out that critical staff shortages have led to a dangerous patient-to-staff ratio that has resulted in unsafe working conditions, medico-legal errors and substandard patient care. The memorandum also warned of the negative effect of continued Covid-19 waves on the mental and physical wellbeing of staff members.

It said that the capacity of the medical teams was such that only 25 patients could be accommodated in the Physician-On-Call section, where ill people are seen. This included 11 beds for Covid-19 patients and two high-care beds.

It was impossible to take more than this number of patients due to staff shortages, and the memo added that only four of the six medical wards would be operational, including the Covid-19 basement ward, and that another ward would be closed if the number of patients in the basement increased.

While the basement ward was designed for 70 patients, hospital management was informed that staffing constraints allow for only 40 patients who would be looked after by two doctors and an intern after hours.

All other high-care beds were shut down until more doctors and nurses are appointed. It is understood that the Department of Health was also informed that between four and six doctors would be needed to run the basement facility if they wanted to increase occupancy to 70. Doctors without Borders (MSF) is running the basement ward, but will leave at the end of August.

Hospital management received a request that the broken beds in the facility be fixed to make sure that other spaces could be used better and to prevent the emergency room from being overrun.

“This is an unfortunate side effect of working in a severely resource limiting environment,” the internal memorandum reads. This followed the presentation of a Covid-19 management plan by Darlene de Vos, the district health manager in Nelson Mandela Bay, saying health management there was largely unstaffed. It is understood that De Vos has already announced to key stakeholders in the metro that she will be leaving her job.

Despite these concerns being raised, not much appears to have been done.

This year, severe staff cuts, the termination of contract employment of doctors and nurses because of the dire financial situation that the department is in and a dispute with unions led to the closure of the Rev Dr Elizabeth Mamisa Chabula-Nxiweni Field Hospital, a state-of-the-art field hospital donated to the department by Volkswagen.

Promises were made that instead, an under-used TB hospital, Empilweni Hospital in Gqeberha, would be converted into a field hospital, but this seemed to have happened only on Wednesday.

Dr Rolene Wagner, the head of the Eastern Cape Department of Health, confirmed that Covid-19 patients were this week turned away from Livingstone Hospital. She said the Nelson Mandela Bay Metro was an epicentre of Covid-19 in the province.

“The public sector hospitals in [the metro] had increased capacity to be ready for the anticipated increase in numbers of a resurgence. This included opening the basement unit as well as the P-wards at Livingstone Hospital to create an effective additional 160 beds.

“Livingstone has to date accommodated those infected and ill with Covid-19, as well as those who are asymptomatic carriers, in these Covid wards, general wards and eight-bedded ICU facility. 

“The number of Covid-19 cases appears to have reached a peak with, in the last week, a 6% decrease in new cases in the district and an 11% decrease in active cases. The number of hospital admissions has also decreased by 8% compared to the preceding week. To date, the total number of beds available in both the public and private sector has been adequate overall, compared to the number of patients requiring hospitalisation.

“Notwithstanding, the department has noted that there has been an increasing number of patients in the metro presenting at Livingstone Hospital. This can be attributed to Covid-19 infections, but also due to the high number of trauma emergencies, especially at weekends, at this facility. 

“To accommodate the increased pressure at Livingstone Hospital, in this instance arising from the past weekend, the hospital is implementing a mix of interventions,” she said.

This would include the assessment of patients by the clinical team to identify those who can be discharged. Wagner said stable patients can now be referred to Empilweni Hospital.

“These transfers have commenced and will continue in the days ahead. At a time when there was pressure on the trauma unit, the hospital did indicate that they would attend to urgent and emergency cases as a priority.”

She said on Wednesday the demand had eased somewhat and this would continue as more stable patients are transferred out.

“We do want to apologise for any inconvenience this pressure on our system may have caused. Dora Nginza Hospital has been supporting other facilities in the region. The Orsmond Hospital is another public facility being made ready, in the unfortunate event the numbers requiring hospitalisation were to escalate in the region,” Wagner said.

Speaking on behalf of the Eastern Cape Health Crisis Action Coalition, Sibusisiwe Ndlela, an attorney at Section27, said: “The understaffing of doctors and nurses at hospitals in the Eastern Cape is a well known systemic issue that has led to widespread infringements of human rights in the province. It has come up a number of times when the Eastern Cape MEC for health has made presentations to the Parliamentary Portfolio Committee on Health over the past two years.

“It has also come up when doctors at healthcare facilities in the province address correspondence to the provincial Department of Health to plead for better working conditions in hospitals that include Dora Nginza and Livingstone Hospitals. It is a contributory factor in a number of medico-legal cases that have come before the courts.

Between Tuesday and Wednesday, 1,252 new cases of coronavirus infections were registered in the Eastern Cape. Of these cases, 46.6% were from Nelson Mandela Bay Metro and 15.4% from the Sarah Baartman District (which includes a number of seaside towns and large parts of the Karoo).

“The process for the appointment of medical personnel in Eastern Cape remains shrouded in secrecy, most notably, the criteria applied by the Provincial Cost Containment Unit to approve the appointment of medical personnel.

“The present issue of the understaffing of doctors and nurses in Livingstone Hospital, as a result of Covid-19, is one that the provincial Department of Health has long been warned about. 

“Recently, the Office of the Public Protector has made a finding that ‘the administration of health by the ECDoH at Livingstone Hospital does not accord with the obligations imposed by the Constitution and the law’. Acute staff shortages at the hospital was key amongst the systemic deficiencies that contributed towards the failure to meet the provincial government’s constitutional and statutory duties.

“In October 2020, recognising the chronic understaffing issues, and the potential impact of a second wave, which happened in December 2020, we requested access to the department’s plans to deal with C0vid-19 in terms of the Promotion of Access to Information Act 2 of 2000. This request for access was ignored and effectively refused; so too was the subsequent internal appeal we filed in respect of the refusal of access. Without access to these documents, we cannot even begin to critique the provincial health department’s plans [or] monitor their implementation.

“When we receive reports of the overwhelming conditions at Livingstone, as a result of Covid-19, our hearts go out to the frontline workers who place their lives at risk to provide care in the most trying of circumstances. We also cast our minds back to the consistent efforts, including participating in a march led by the Treatment Action Campaign in July 2020, we have tried to engage with the provincial health department in order to ameliorate the crisis.

“The closure of the Rev Dr Elizabeth Mamisa Chabula-Nxiweni Field Hospital in the Nelson Mandela Bay Metropolitan is also deeply regrettable, given that its purpose was to relieve the immediate or imminent burden placed on the Livingstone and Dora Nginza Hospitals. 

“The 2021 Eastern Cape Province’s Estimate of Provincial Revenue and Expenditure reflects that in the 2021/22 financial year an amount of about R640-million, which came from the province’s budget for payments in respect of capital assets, was reprioritised towards additional expenditure for field hospitals in response to the Covid-19 pandemic. However, the provincial health department has since indicated that these funds have been reallocated towards the renovation of older buildings in order to create bed space. Without doctors and nurses to care for Covid-19 patients the issue of bed space falls to the periphery, because irrespective of where patients are housed there simply wouldn’t be enough personnel to care for them.

“We call on the superintendent-general of the Eastern Cape Department of Health to act as a matter of urgency to appoint the additional medical personnel necessary to provide care to patients in a manner that vindicates the constitutional and statutory rights of persons in that province,” Ndlela said.

Previously when Livingstone Hospital declared that it was at breaking point, a visit from the minister of health followed. This was preceded by a few intensive days of cleaning up before the minister arrived, one or two strong rebukes, a few hearty words thanking the doctors and nurses and then nothing. On one occasion the minister was shown a bed with high-flow oxygen — but there was no oxygen.

In March last year on one such visit, the department declared that it was fast running out of money — mostly justifying why so few appointments of doctors and nurses have been made. This month the provincial Treasury said it had not been informed of this and as far as it was concerned the department still had money.

Between Tuesday and Wednesday, 1,252 new cases of coronavirus infections were registered in the Eastern Cape. Of these cases, 46.6% were from Nelson Mandela Bay Metro and 15.4% from the Sarah Baartman District (which includes a number of seaside towns and large parts of the Karoo).

Of the current 9,651 active cases in the province, 56.8% are in Nelson Mandela Bay (3,750) and 17.9% in Sarah Baartman District.

“Our frontline staff are very tired and can’t take much more,” a senior hospital source said. “They have reached a limit to what they can take.” DM/MC

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