Ceres Hospital is under mounting pressure to improve service delivery. Dissatisfaction among residents of Witzenberg Municipality comes after months of poor patient care, long waiting times and language barriers at the facility.

The hospital is 140km from Cape Town. It operates in conjunction with eight clinics and several mobile clinics to provide healthcare services to more than 143,000 mostly rural people, according to Handri Liebenberg, acting director for the Western Cape Department of Health and Wellness in the Cape Winelands District.

Some patients wait for days to be treated at Ceres Hospital, according to Naomi Betana, a community activist with the Witzenberg Justice Coalition (WJC). The coalition deals with community issues in Witzenberg Municipality, including farm evictions, land claims and water rights. More recently, the coalition has focused its efforts on improving healthcare.

“The problem that we currently have at Ceres Hospital is that our people will go to the hospital in the morning and they will sit for two to three days before they are helped,” said Katinka Koopman, a community activist based in Ceres. “This is really unacceptable. There are people who lost family members who waited too long.”

The long waits endured by patients are partly due to a shortage of doctors and other medical staff, as well as limited bed capacity.

“There are not enough doctors, there is not enough staff. It’s like today… I was sitting there for three hours waiting for a physiotherapist. There’s only one physiotherapist, and there were 29 people in the queue,” said Betana.

Noami Betana from the Witzenberg Justice Coalition says the coalition has been working to highlight the problems at the Ceres Hospital. These efforts include an occupation of the local clinic and then meeting with the MEC to find a solution to the crisis. (Photo: Brenton Geach)

Language barriers within the facility further hinder patient care.

Mieta Jacobs, a resident of Ceres who worked at the hospital as a nurse, said because the region is predominantly Afrikaans-speaking, many people are unable to communicate effectively in English. Witzenberg Municipality is 81% Afrikaans-speaking, according to census data.

“How can you communicate with your doctor… how can your doctor communicate with you if the doctor does not understand you and you also do not understand the doctor?” she asked. “Many of [the doctors at Ceres Hospital] don’t even try [to speak Afrikaans].”

Jacobs pointed to another issue at the hospital: a lack of privacy.

“There is apparently no money for curtains. If I must give you a full body wash, everyone can see. If I must do a private thing, the other patients will watch. If the doctors come to have a chat, the other patients can hear everything.”

While the issues at Ceres Hospital are long-standing, it was an incident in December 2021 that pushed the WJC to escalate its efforts to have the problems addressed, according to Betana. On 17 December, the coalition was told that a taxi transporting 17 migrant workers had been involved in an accident.

“[The workers] came to the hospital at four o’clock in the morning. At four o’clock that afternoon, no one had assisted them yet,” said Betana.

When Betana got hold of the head of Ceres Hospital, Dr Elton Titus, he informed her that they had to wait as the hospital was full. The injured workers left the facility without treatment.

In the aftermath of the taxi incident, the WJC asked Western Cape MEC for Health, Dr Nomafrench Mbombo, about the service delivery issues at Ceres Hospital. Mbombo met the coalition in February, assuring them that there was an implementation plan in place to fix the hospital and that an additional 10 beds would be made available.

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Betana said that while the coalition was grateful for the provision of more beds, it did not solve the serious shortage of staff at the hospital.

“We said, thank you for the beds, but with a bed, surely a nurse needs to come along? And with a bed surely there should be a physiotherapist or a doctor? It’s no use if they give us beds and the hospital gets painted, but there are no people who can help,” said Betana.

There are three vacancies at Ceres Hospital – two medical officer positions and one family physician position, according to Liebenberg. She acknowledged that healthcare services in the Witzenberg area had been under increased pressure, resulting in “negative patient experiences”.

“Filling posts in rural areas is a challenge. Appropriately qualified candidates are not always available locally. Secondly, successful applicants do not always have a local language as their first language. Our human resources team is aware of the urgent need for recruitment and selection to fill vacancies,” said Liebenberg.

Liebenberg emphasised that the department was aware of the need to improve service delivery and was working towards this. However, accounts shared with Daily Maverick by those who have recently sought care at the hospital suggest that little has changed.

Patient experiences

When Daily Maverick visited Ceres Hospital in April, the surrounding streets were quiet. On the field opposite the facility were two cars, their drivers waiting for relatives who were seeking medical assistance. Taxis came and went at sporadic intervals, dropping off people in front of the hospital gates.

A man exiting the hospital, Jakobus Lord, told Daily Maverick that he had visited the facility due to problems with his kidneys. The 38-year-old had arrived in his wheelchair from the Koue Bokkeveld region of Ceres (about 40km away) at 9pm the previous evening. At 11am the next day, he was only just leaving the hospital.

“Many people got helped before me,” said Lord.

Jakobus Lord (38) from Koue Bokkeveld in the Witzenberg municipality said the services at the Ceres Hospital needed to be improved. He had waited for more than 12 hours for attention to a kidney problem. (Photo: Brenton Geach)

There is a need for better staff at the hospital, according to Lord, as well as staff who speak Afrikaans. He described the service at the facility as bad, adding that he generally preferred to go to Worcester Hospital, about 50km away.

Curtis Brummer, who was visiting his father, told Daily Maverick that his dad had been admitted the previous afternoon, but had to wait 10 hours before being taken for observation. He then waited another two hours in the casualty section before being seen again and kept overnight.

“[The staff at the hospital] didn’t give him oxygen despite having a letter from a doctor,” he said.

Melony Jordaan, a resident of Ceres, was dissatisfied with the care she received at Ceres Hospital when she visited in early April.

“I had an accident at work. I didn’t know what was happening. I asked my aunt who is a staff nurse at the hospital and she said it looked like I had a miscarriage,” said Jordaan.

After arriving at the hospital just before 8pm*, Jordaan waited until 2am the following day to be sent for observation. At 9am, she saw a doctor for the first time.

“I feel very unhappy about the service [the doctor] gave me. I don’t have a problem with the staff or the people that were there. It is just the doctors’ service,” said Jordaan.

Jordaan said the doctor failed to communicate with her effectively. When he did speak to her, she struggled to understand his accented English.

“He speaks English, but I couldn’t hear what he was saying. Most of the time he was on his phone, and if I asked him something, then he spoke that strange kind of English… I understand English, but he didn’t speak loud and clear [so] that I could understand him,” she said.

Nothing has changed [at Ceres Hospital]. Everything is still exactly the same. They dream up the most beautiful plans. So beautiful. Really beautiful. But nothing gets done.

The doctor told Jordaan that he would bring her medication, but this had still not happened by the time her aunt arrived an hour later.

“My aunt wanted to speak to him to ask what was wrong, but he was just busy on his phone. She went to speak to another doctor to get the medication. He just gave me a packet of blue pills.

“It was like I was there, but [for the doctor] I wasn’t there… he was on his phone the whole time. It was like he wanted nothing to do with me. He just told me if I am still bleeding by Friday, I must come back. If that is the type of service you are getting, who will go back?” said Jordaan.

Improving healthcare

Liebenberg said the Western Cape Department of Health and Wellness has noted the concerns around long waiting times at healthcare facilities in the Witzenberg region. She said this was partly due to the triaging process at facilities, which has those with the most urgent need receiving care first.

“Ceres Hospital has a very high bed occupancy rate (95%), with most patients admitted due to complex medical conditions. The high influx of patients in the Emergency Centre, especially over weekends, and due to mental health and alcohol-related conditions, as well as limitations in terms of the current infrastructure, results in a bottleneck of patients,” said Liebenberg.

“To ensure a proper flow of patients through the facility and a better experience for patients, we are relooking at improving the patient journey through the hospital and how space is currently being used, so that more operational beds can be made available.”

Measures that the department will implement at Ceres Hospital to improve services include:

• Infrastructure upgrades and additions, including the addition of a four-bed psychiatric unit;
• A monitoring system to alert the department when response times in the Emergency Centre are lagging;
• Strengthening of the triage system.

“To improve the overall healthcare service in the Witzenberg region, the department recently acquired another building in Ceres that will be used as a clinic,” said Liebenberg.

Despite the department’s assurances that the situation at Ceres Hospital would improve, the Witzenberg community has little trust in the hospital or the broader health system, according to Jacobs.

“Nothing has changed [at Ceres Hospital]. Everything is still exactly the same. They dream up the most beautiful plans. So beautiful. Really beautiful. But nothing gets done,” she said.

Betana echoed this scepticism, saying that since December 2021, “there was not a single moment where we could have proudly said that things are busy improving – it’s just getting worse”.

Daily Maverick asked hospital chief Titus for comment on the dire situation at his facility but he referred us to the provincial health department. DM/MC

* This article was updated to correct a factual error at 8.14am on 5 May 2022.