Maverick Citizen

HOSPITAL ON THE EDGE, PART ONE

Eastern Cape Health Department transfers CEO and senior doctor in continuing Zithulele conflict

Eastern Cape Health Department transfers CEO and senior doctor in continuing Zithulele conflict
Protesters assemble outside Zithulele Hospital in the Eastern Cape. A protest leader emphasised, ‘Our main focus is not Dr Ben Gaunt and Mrs Nolubabalo Fatyela fighting. We care about patient care. We care about our people getting the services they need to get. We care about the hospital.’ (Photo: Supplied by Zithulele Hospital Protest Committee)

In Zithulele, a rural Eastern Cape community where the collective fight against HIV/Aids was being won, the application of strict departmental policy has led to protests, fear and uncertainty as doctors and the community claim that it was harming patients and negatively affecting medical care.

The Eastern Cape Department of Health has said that it is ordering the precautionary transfer of both the CEO of Zithhulele Hospital, Nolubabalo Fatyela, whose arrival prompted a series of decisions alleged to be catastrophic for patient care, and longtime clinical manager Dr Ben Gaunt, who pushed back. 

This was being done, said the department’s superintendent-general Rolene Wagner, so officials could consult with all relevant stakeholders on the issues raised at the hospital to find long-term sustainable solutions.

eastern cape health zithulele graphic

A similar strategy was followed by the department when violent protests rocked the high-security psychiatric hospital, Fort England Hospital, in 2018, but this backfired when the Labour Appeal Court ordered the reinstatement of Dr Roger Walsh. The decision to remove Walsh led to all doctors leaving the hospital. Contingency plans had to be implemented.

At Zithulele, the fight against HIV/Aids specifically cannot be lost.

Zithulele Hospital sadly on the brink – time to put the ‘public’ back into public health

Providing feedback on her meeting on the Zithulele crisis, MEC for Health Nomakhosazana Meth has framed the issue as one of a potential conflict of interest as hospital clinical manager Gaunt also serves on the board of the Jabulani Rural Health Foundation, an NGO that works closely with the doctors at the hospital and has provided many support services.

She didn’t mention community unhappiness about patients who are no longer able to access their ARVs at the hospital as they used to.

But that is all the department will say at this stage about the conflict at a hospital that has become known as a centre of excellence in a province where the public healthcare system is beset by problems.

A request by Maverick Citizen for an interview with Fatyela to answer allegations, including one that she threatened community members by saying she was a sangoma, was answered by department spokesperson Yonela Dekeda, who said it was a personal matter.

eastern cape zithulele

Zithulele near Mqanduli in the Eastern Cape. (Photo: Hoseya Jubase)

A new investigation into the instability at the hospital will likely be finalised by next week. 

Dekeda said the CEO took action that she deemed appropriate for the non-disclosure of financial interest by Gaunt, who was a director of the Jabulani Rural Health Foundation. 

“The suspension of the NGO is a matter that the Department is addressing with the CEO directly.

“The decentralisation of services to primary healthcare clinics is a policy that is not inappropriate when trying to bring services closer to where people live and work. In the process, we do want to establish that there is continuity of care and so handover and involvement of the clinical care team at the hospital and the primary care clinics is essential. The department will ensure that this takes place in the best interests of our patients. 

“Steps are being taken to ensure service continuity and stability at Zithulele Hospital. When appropriate, this will be shared with interested stakeholders,” Dekeda said.  

“The MEC has promoted transparency and fairness. The investigation assisted with highlighting key issues, some of which require further action. 

Eastern Cape Health Department transfers CEO and senior doctor in continuing Zithulele Hospital conflict

Until all the issues have been resolved and all stakeholders consulted, the department will then be in a better position to communicate the final outcomes as the process unfolds,” she said.

Deep rift with community

But the conflict has caused a very deep rift with the Zithulele community, exacerbated by protesters being seriously hurt during a protest outside the hospital.

Doctors are uneasy with a decision by Fatyela to screen patients for entrance to the hospital, without taking measurements such as blood pressure, and to turn many away from the hospital to get their ARVs at clinics.

Protest organisers, who are opposing policy-driven changes at the hospital,  told Maverick Citizen that dozens were badly bruised by rubber bullets and three people were severely injured. Siyamcela Mkhontwana sustained serious burns on his hands after police forced him to move a burning log and pushed him into a flaming tyre. Aphiwe Mbabane was shot in the eye with a rubber bullet, causing internal damage. He is worried he may lose his vision. A rubber bullet caused severe injury to Akhona Somgidi’s head. They have opened a misconduct complaint against the police. 

Dr Suretha Cilliers, who worked at Zithulele for 10 years before resigning in July 2022, explained that turning people away from the hospital violated a core value that doctors had decided on, of putting patients above policy.

But after Fatyela arrived at Zithulele as the new CEO, the clinical team became worried about a series of decisions she had made. 

eastern cape zithulele hospital

Zithulele Hospital near Mqanduli in the Eastern Cape. (Photo: Hoseya Jubase)

Two doctors said the decisions amounted to management interfering in clinical decisions and that they prioritised policy over patients. 

The Eastern Cape Department of Health requires patients to visit a clinic first and then, only if they receive a referral letter, may they visit a hospital. 

But at Zithulele, doctors tried to see everyone who arrived, especially as patients often had to pay hundreds of rands in transport costs to get there. 

Fatyela put a stop to this, saying it contravened policy. She introduced a new system where people were screened at the hospital gate. 

‘Human rights abuse’

An anonymous doctor said that without a basic assessment of whether the patient required emergency care, “to refer some people back is against policy and is a human rights abuse.” 

Doctors also raised their concern that following the referral system might mean that patients did not access medical care in time.

‘At all costs’ — the human and health impacts of the implosion of Zithulele Hospital

Another Zithulele doctor was deeply concerned that, “trust by the community in the hospital has deteriorated significantly. We’ve worked hard at building it over years, it takes a long time to get a community to trust you.”

Two members of the clinical team believe that Fatyela is concerned only about reported statistics, like wait times in the outpatient department, rather than the accessibility of patient-centred care. 

In May 2019, Zithulele attended to 3,091 outpatients. As patients began to be turned away, by May 2022, this plummeted to 1,033, according to official hospital statistics. 

In February and March 2020 it is understood that Fatyela brought in another NGO to speed up further referrals to clinics.


Visit Daily Maverick’s home page for more news, analysis and investigations


Clinics in the rural Eastern Cape are not well-functioning, a report issued last year by Ritshidize, a project by organisations representing people living with HIV has shown. 

Zithulele ward councillor Phumelele Methu said that the issues around ARV access were the same challenges faced by any hospital.

“Even the issue of ARVs they are complaining about, it is not only Zithulele Hospital, but it happens in all hospitals. The CEO is simply complying with the Department of Health’s orders.”

Doctors at Zithulele, however, said that being pragmatic is part of what led to the hospital’s excellence. Dr Cilliers said, “You can try to work at a district hospital where they follow 100% of all the rules and regulations and it’s not contextual, and it falls apart. But in a setting like this, you get people that are saying, “Listen, there’s a problem. We are never ever going to be able to fix it. Let’s see what we can do to at least make it function to an extent.”

‘Victimisation’

Most doctors, protest organisers, patients and a nurse spoke to Maverick Citizen only under the condition of anonymity. They said that this was necessary because of victimisation by the CEO, intimidation by local leaders and stories of threats from unknown cell numbers that have circulated in the community since tensions in the hospital escalated. 

At least one person involved in the protests and meetings against the declining services at the hospital said she had received death threats.

Zithulele chief, Nkosi Gcinuvuyo Dudumayo, urged those who were claiming they were being chased away to come forward so that the problem could be solved. He said those who claimed they received death threats never came forward to him to raise those issues.

Hospital board chairperson Thembile Nyalivani said when the new CEO arrived in September 2021, the board had already been appointed.

eastern cape health zithulele

On 21 July, about 270 protesters gathered outside the gates of Zithulele Hospital in the rural Eastern Cape to deliver a petition out of concern for the declining patient care, demanding that hospital CEO Nolubabalo Fatyela leave. (Photo: Supplied by Zithulele Hospital Protest Committee)

Nyalivani said the CEO arrived at Zithulele Hospital, found that the policy was not followed by the hospital and she emphasized the importance of the policy. That was where the problem began between the clinical manager and the new CEO.

Nyalivani said he had been part of the previous board and since the arrival of the new CEO he had seen a lot of improvement in Zithulele Hospital.

“As the people who have been in this hospital like me, we are seeing a big positive difference. It was hectic before, people were just doing what they liked. We saw that happening for a long time, but there was nothing we could do about it because our own responsibility was to deal with patients.”

“When the CEO arrived a lot of things improved, now everyone entering the hospital is signing papers, but before staff were doing whatever they want, there was no control, the CEO arrived in this Zithulele Hospital to maintain the policy.”

Nyalivani said what they were seeing was that people were used by the clinical manager, who was also the director of Jabulani NGO.

Rudasa concern

The Rural Doctors’ Association, Rudasa, has expressed serious concern over the situation at Zithulele Hospital and called for increased accountability from the health department.

In a statement issued earlier this week, the organisation said the hospital had always been a model of care and “indeed a beacon of hope”.

“We recognise that changes in management necessitate a season of change and transition within organisations. However, we note with dismay how this particular situation has been allowed to escalate into open conflict between new management and staff, to the point that it has affected the care that clinicians are able to provide to their patients. This has created an unstable environment where many healthcare workers have been thrown into uncertainty regarding their futures at the hospital, risking a disastrous exodus of staff.

“Rural health services remain fragile throughout South Africa and everything should be done to support frontline healthcare workers in fulfilling their roles to care for the communities they serve rather than undermine their best efforts,” their statement reads. DM/MC

For more on the Zithulele Crisis, read the EditorialPart Two and Part Three.

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