When Zithulele Hospital’s new CEO, Nolubabalo Fatyela, arrived in September 2021 — wielding the Eastern Cape Department of Health rulebook — her management style and decisions caused a considerable amount of conflict as she made it clear that she intended to run the hospital according to the letter of the law.

While there is nothing inherently wrong with such an approach, it appeared that effective consultations with the clinical team and the community have fallen by the wayside.

The clinical team — mostly doctors and allied health workers such as physiotherapists — had previously conducted patient care on a values-based system, the first commandment of which is one that is fairly unique to the public health system: Turn nobody away.

Collateral damage — declining care, victimisation and protests at Zithulele Hospital

Essentially, the CEO says that patients won’t be admitted unless they present a referral letter from a clinic. Unless, of course, it’s an emergency case. It wasn’t always that way. Before Fatyela’s arrival, patients could simply arrive at the hospital and request treatment. 

The clinical staff believe that if a patient has gone to the trouble of getting to the hospital, they ought to be helped. And even more so if they have a chronic condition such as HIV, which can be managed with the right drugs.

The voices that are not being heard in all of this are those of the Zithulele community — people for whom easy access to this small state hospital had saved time and money.

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

While it might be easy to ignore the problems of a small state hospital in a deep rural area, Zithulele shows that we need fundamental change to fix primary healthcare in this country.

Most state hospitals in the Eastern Cape are in shocking condition. And healthcare in this province has been a disaster for decades.

Failing infrastructure, a lack of access to medical supplies and union-controlled health workers who think nothing of going on strike and shutting down a clinic have only worsened the situation.

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There are countless horror stories of people with serious ailments not being triaged correctly and sent home with a mild painkiller.

In the case of Zithulele Hospital, the Eastern Cape Department of Health seems deaf to the strongest of indications that, while a proper referral system between primary and tertiary levels of the health system is necessary, it only works if primary healthcare works.

Zithulele shows that what is needed in facilities like these is not the enforcement of rigid rules, but instead more flexibility and pragmatism and an investment in strengthening the quality of primary healthcare. It’s the staff at the coalface of care, rather than the administrators, who generally know what is in the best interests of their patients. 

We already know that the Bhisho bureaucracy is so bloated that millions of rands in salaries that could go to clinical personnel are spent on hundreds of managers, assistant managers and myriad other titled officials who seem to think they are vital to a system that is barely limping along.

This is true of most of the provincial health departments.

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

Let the communities have a say. After all, they’re the ones being treated. Hospital boards and clinic committees have been ignored or feel compelled to take the side of the Bhisho bureaucrats, probably out of fear that funding will be withdrawn. 

Let’s not forget that this is a province where, instead of using clinic committees, the Department of Health sidelined some of the strongest community leaders during the lockdown in March and April, refusing to provide them with permits to do their advocacy work.

Communities know the solutions to their most pressing problems — primary healthcare is just one. Our hope is that the people of Zithulele will get the attention of the bureaucrats.

An investigation commissioned by the provincial health department into claims being made by both sides in this messy saga is likely to be completed this week.

But even though it’s a relatively complex matter, the fact remains that the people of Zithulele have still not been heard. DM/MC