There is a sense that we are in the last few months of having a workable specialist health service for the western part of the Eastern Cape, although  the pessimists among us believe we have already passed that point.

It was the human faeces on the floor that led me down the road of despair.

It’s possible that Nelson Mandela Bay has some of the toughest and most resilient state doctors in the country. So when they say the situation cannot continue, we should sit up and listen.

If Covid had not cruelly taken Dr Lungile Pepeta, the former dean of Nelson Mandela University’s medical school, I have no doubt he would be in front, leading protests and speaking out. His message would be clear: People deserve better than this.

In an interview last year, the acting CEO for Livingstone Hospital said they had come close to shutting down the facility in 2020 as almost all support services had either collapsed or were being withheld.

In the past two months, I have watched the Eastern Cape health department suck the life out of their doctors month after month, expecting them to perform miracles during the pandemic and sending them, stressed and exhausted, back to the front lines — back to work in a collapsed system.

Human faeces

The managers at one facility could not even persuade cleaners to remove a pile of human faeces in the middle of the floor. So it just lay there. For days.

In previous interviews, the national department of health said there was little that could be done as the provinces had the power to fix things.

So where are Health MEC Nomakhosazana Meth and Premier Oscar Mabuyane when doctors have to work around faeces on the floor in a hospital ward?

Where are they when families struggle to carry their sick relatives up and down the hospital stairs because the power has failed and no one can see when it will be fixed?

Where are they when a patient who needed routine emergency surgery is admitted to the ICU with brain damage because there was no functioning operating theatre available?

Where are they when babies die in their numbers? When mothers die in ICU because of delayed treatment?

Where are they when people lose limbs because they could not be operated on as the department has not paid its bills?

Where are they when cancer patients must wait months for treatment?

Where are they when a doctor must keep a patient alive using a generator?

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 Excuses

The Eastern Cape Department of Health will be quick to tell you that the fault is that of the attorneys and the staggering R37-billion owed in medico-legal claims.

In a recent judgment, though, Judge Jannie Eksteen told the department in no uncertain terms that they needed to start budgeting for these claims. He said their refusal to budget for claims was a breach of the Public Finance Management Act. The Auditor-General had a similar assessment.

That aside, you don’t need R40-billion to clean up faeces, empty bins and order a batch of first-line antibiotics.

It’s likely that this series of stories will spark a witch hunt in the department to find out who is talking to the media about this appalling state of affairs. Then there will be the inevitable spin from the likes of the charming communications manager, Siyanda Manana. The latest mantra is, “We are working very hard to fix things, but you know… the lawyers.”

Forget the excuses. Start with getting the faeces picked up, the bins cleaned and linen laundered.

High-profile visits

I imagine we will at some point see high-profile visits from Health Minister Dr Joe Phaahla and perhaps his deputy. Maybe even the superintendent-general, accompanied by Meth, and since there is politics involved… Mabuyane too.

When former health minister Zweli Mkhize came around, staff proudly showed off the oxygen system — which wasn’t even connected.

On the positive side, state hospitals are generally warned of impending visits from politicians and are preceded by a cleaning spree. That might be the only way someone is going to clean up the faeces.

People deserve better than this. DM/MC

(Photo: iStock)

‘We speak up for our patients’

What follows is a letter from a doctor who works in the public sector in Nelson Mandela Bay, describing the conditions clinicians face daily.

In less than a year, from the end of 2021, the following senior specialists have resigned/are in the process of resigning from Livingstone (LTH) and Port Elizabeth Provincial Hospitals (PEPH).

The head of Cardiothoracic Surgery.
The head of Emergency Medicine.
The only two urologists.
The only two neurologists.
The only orthopaedic spinal surgeon.
The only surgeon with a hepatobiliary fellowship (specialising in liver and gallbladder surgery).

In addition, a highly regarded cardiologist, who started doing sessional work at PEHP, resigned.

Several others have indicated that they will be leaving in due course.

This mass exodus is unprecedented and we have experienced nothing like this before. These senior specialists, and the remaining specialists, have demonstrated exceptional resilience over the years. When colleagues who never intended to leave the public service start leaving one by one, one can assume that conditions of work have become unbearable.

Like one of the surgeons said: “I am too young to sit at home in the afternoon because of reduced theatre time. I am not using my skills here. And I cannot face the patients who need surgery any longer.” Another specialist said: “I cannot go on being on call every second weekend.”

The list for emergency orthopaedic procedures is around 100 cases long. Planned orthopaedic surgery for hip and knee replacements is more or less a thing of the past. How will local trainee specialists learn how to perform these procedures? Imagine the suffering of patients who have been on the waiting list for years. There is no point to even add further names to a waiting list.

Up until the end of 2017, the senior specialists have seen, and engineered, the slow improvement in services and registrar training. Then at the end of 2017, most of the senior management were suspended by the then superintendent-general. It is now 2022 and to our knowledge nothing justifying dismissal has been found against these individuals. However, all but two resigned as time went by since they were left sitting at home for years. Even now, the Livingstone Tertiary Hospital still has an acting CEO, HR manager and facilities manager.

In addition to these problems, the last HOD of Internal Medicine resigned prior to the Covid-19 pandemic and he has not been replaced up until now. The Department of Internal Medicine, which was the admitting department for 90% of Covid patients including all who had respiratory failure, was allowed to go through the whole pandemic without appointing a replacement HOD.

This is despite the fact that suitable candidates had applied during this time. Even after the acting HOD contracted Covid-19; was ventilated in ICU and had to take time off work, no permanent HOD was appointed. This person came straight back to battle through the next Covid wave in the vain hope that the DOH [Department of Health] would take step up and appoint a HOD. Needless to say, it is now 18 months later and there is still no HOD.

This same department has a dearth of registered specialist physicians and appropriate subspecialists, and is therefore ill-equipped to support the new Nelson Mandela University with the training of medical students. Interviews were held months ago, but no one was appointed. We are not aware of plans to remedy this situation.

In general, this tertiary service, which was built up over time by a group of resilient specialists, is crumbling in front of their eyes. There are fewer theatre slates and ICU beds (due to nursing staff shortages) than before Covid. Open posts, including important non-clinical ones, mostly take months to fill, and some are merely left vacant. Specialist posts are a nightmare to fill, even if there are suitable applicants. Apparently, all posts must all now be advertised, but these take months and months to get published and when they are, the successful candidates are sometimes never contacted to start, presumably because of budgetary restraints. 

A major problem is that there appears to be a perception that appointing one or two specialists per subspeciality constitutes a full “service” in that subspeciality. This then enables managers to tick the speciality on the National Treasury Services Grant (NTSG) list which attracts funding. Unfortunately, this is simply not sustainable because no one can be on call that frequently, carry the clinical load whilst providing trainee specialists AND pre graduate medical students with lectures and bedside teaching. Most tertiary hospitals in the other provinces would have a full complement of at least four specialists per subspeciality. These disillusioned specialists then end up leaving and patients are left without the necessary care.

The effects on patient services, outreach and teaching have been disastrous. In view of all of this, we fear for the implementation of the National Health Insurance locally and the new local medical school to which we had all been looking forward.

Ideally, the patients should speak out, but our experience is that our patients in general seem to lack the agency to do so. Or maybe they fear that they will be dropped from some long waiting list? Either way, when we speak out it is not for us. It is for them. DM/MC