Early in the Covid-19 pandemic, Dr Angela Hartwig was the only doctor at Adelaide Provincial Hospital, which offers 60 beds to a catchment area of 13,000 people in the sheep-farming town of Adelaide in the rural Eastern Cape. When Hartwig started at the hospital in March 2020, she was seven months’ pregnant with her third child.

Pregnancy notwithstanding, she continued treating patients – even after testing positive for the virus in May 2020 and being admitted to a Covid-19 ward herself – until two weeks before giving birth.

A stressful start

“We moved to Adelaide two weeks before lockdown,” says Hartwig. “It was a very, very stressful time for our hospital and for me personally. We were swamped with Covid cases. We had a staff outbreak of Covid too, so there was a shortage of nurses. We had several nurses die from Covid… They were constantly phoning to get people from other shifts to come [and] cover… There were people driving every second day to fetch oxygen cylinders in Queenstown, so we wouldn’t run out. It’s about a six-hour round trip. So, just trying to stay on top of all of that, there was a lot going on.”

In February 2020, SABC News reported strikes at Adelaide Hospital as staff downed tools in support of then hospital CEO Dr Mandla Makangala. At the time, Makangala was being investigated for misconduct.

Rural hospitals in the Eastern Cape, including Adelaide Hospital, struggled with limited resources during lockdown. (Photo: Joyrene Kramer / Spotlight)

“There was no strike action when I arrived,” says Hartwig. “Dr Makangala was being investigated, but the week before I arrived he was seconded to Fort Beaufort Hospital to work under supervision, pending the investigation.”

The 37-year-old doctor is speaking to Spotlight from her home in Adelaide, which she shares with her husband, who works in the NGO sector, and their three children (seven, four and two years old). As our interview begins, a beaming toddler’s face pops up on the Zoom screen.

Indeed, Hartwig continued working during her maternity leave in hard lockdown, visiting the hospital on most days, sending voice notes to staff and attending Zoom meetings, often with her newborn son in her arms.

Hartwig says that for the first month of the pandemic she was the only doctor on duty at the hospital. After that, a second doctor joined, and later in 2020 a third.

It took Spotlight more than a year to secure this interview with Hartwig, who has almost no internet presence. She does not even have a LinkedIn profile.

This may attest to her character: an individual too immersed in daily life to court attention online.

Hartwig won the South African Rural Doctor of the Year award in 2020, awarded by the Rural Doctors Association of Southern Africa (RuDASA), and was named one of the Mail & Guardian’s Top 200 young South Africans in 2020, for which she was nominated by RuDASA.

Meet South African Rural Doctor of the year for 2020, Dr Angela Hartwig from Adelaide Hospital (EC). Dr Hartwig was also honored as MG 2020 top 200 young South Africans. When she moved to the hospital, she was the only doctor. Later, the hospital was the Hotspot for Covid-19. pic.twitter.com/HzPCkpSd1n

— Ndiviwe Mphothulo (@Nmphothulo) October 26, 2020

Making a difference

Speaking to Hartwig, a recurring theme is “making a difference”.

“I’ve been exposed to rural health for many years; since I was a student I [have been] interested in it,” she says. “And so I’ve watched a lot of other people go through challenges at rural hospitals. There are things you really don’t have control over, and you’ve just got to do the best you can with the resources that you have, whatever those resources might be.

“[W]e are there for the patients, people who would otherwise have nowhere to go. And if we can offer them a decent service, then we [have] accomplished what we set out to do.”

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Asked to recall a moment when she knew she was making a difference, Hartwig recounts the time she helped to deliver triplets at Adelaide Hospital. “I was at the hospital when suddenly there was a call to come to maternity for an emergency,” she says. “There had been a lady who was pregnant with triplets, and she was already in labour, and we didn’t have time to transfer her to a referral hospital. And so, between the midwives and me, we delivered those triplets. And later we managed to send them to a referral hospital – Frere Hospital [in East London]. And they survived, and last month the triplets turned two years old. It was great teamwork… It was the first time triplets have ever been born at our hospital and it was in the middle of Covid.”

Thrown in the deep end

Home-schooled in Westville near Durban, Hartwig studied medicine at the University of Pretoria. She completed her community service at Church of Scotland Hospital in Tugela Ferry, KwaZulu-Natal, in 2012, where she worked in the paediatric ward.

Dr Angela Hartwig says that for the first month of the pandemic she was the only doctor on duty at Adelaide Hospital. (Photo: Supplied)

Subsequently, she also worked as a general practitioner in Greytown in KwaZulu-Natal, and volunteered as a doctor in Malawi.

Where did her interest in paediatrics start?

“It was really during that year of community service,” says Hartwig. “I actually didn’t think I was very good at paediatrics. It scared me a little. With babies and small children, everything is so different [from] adult medicine. But I was just put in the deep end, being given a ward to take care of. And I just learnt as I went along. And I’m really passionate about public health and there’s a lot that can be done in the field to improve child health. And if you improve health for a child, you can really make a difference to their whole life.”

She explains: “There are lots of problems with alcohol abuse in our area. And so we have a lot of parents who are alcoholics. And the big problem was the substance abuse treatment unit at Fort England Psychiatric Hospital in [Makhanda] – we refer patients to them – closing for the duration of Covid. So we had nowhere to refer substance users. Although this year it opened up again.

“At our hospital we treat withdrawal but we can’t do rehabilitation.

“Also, many parents live on farms, and they have to send their kids to town to go to school. And then the kids are all living with some or other caregiver, but often there isn’t a lot of supervision.”

She adds that, from this year, Adelaide Hospital has a social worker available to children and families once a week.

Although the Eastern Cape is widely lamented for its inadequate public health services – and unreliable figures pertaining to Covid – Hartwig says the provincial health department supported their hospital during the pandemic.

“I think, at that stage, everyone was so thinly stretched. There were problems everywhere,” she says. “I think it would have been difficult to have received more support than we already did. I mean, we were given contract workers… And there were some efforts made to track the amount of oxygen being used. And [the health department] sent people to come to do repairs to the hospital. Our paediatric ward at that stage had been in a prefab building. And so they actually just built a whole new paediatric ward… We also had oxygen put into a lot of different wards for Covid patients. But yes, there were so many fires that needed to be put out all at once. I really don’t know how it could have been done any better.”

She credits non-profit organisation Gift of the Givers for delivering food parcels around the community and to the hospital’s own kitchen.

Go rural

Hartwig closes with a message that may have been her driving motivation for doing the interview in the first place: “I would just really like to encourage anyone thinking about working in a rural area to do it. It really is such a worthwhile opportunity. I want to encourage anyone interested in coming to work in Adelaide. We are always looking for people. Anyone can make a difference.”

Her plans for the future? Hartwig smiles. “At the moment I’m very happy where I am. I’ll spend some more time here, then see how things go.” DM168

This article is part of Spotlight’s 2022 Women in Health series.

This story first appeared in our weekly Daily Maverick 168 newspaper, which is available countrywide for R25.