By morning on Tuesday 14 March, striking healthcare workers and support staff in various parts of the country had returned to work, but there are reports that “back to work” does not necessarily mean the resumption of full duties in all cases. 

In facilities such as Motherwell Community Health Centre in Gqeberha, for example, one nurse said Nehawu workers returned to the workplace, but are not working. 

Following a Labour Appeal Court decision on Monday 13 March, Health Minister Dr Joe Phaahla, during a media briefing that evening, said the department has given essential health workers until Tuesday morning to report for work. Should they fail, he said “they will be making themselves liable to charges of misconduct”.

Phaahla’s ultimatum and the court decision comes as the protest action was set to enter a second week. Since health workers affiliated to Nehawu embarked on protest action on 6 March 2023, there have been various reports of violence, intimidation and vandalism at public health facilities.

Read more in Daily Maverick: “Health official ‘abducted’, doctor manhandled as interdict does little to quell violence”

Union members downed tools over deadlocked public sector wage negotiations. In a statement, the union announced that on 6 March its members would “embark on an industrial action as a result of collapsed wage negotiations, implementation of austerity measures, and the attack on collective bargaining by the government”. The union rejected the government’s 4.7% wage increase offer for the 2023/2024 financial year, and is demanding a 10% pay rise instead (Some of these numbers are disputed. See this Nehawu statement).

Phaahla during the media briefing said the legal advice he received following the court decision was that even if Nehawu chooses to appeal – in this case the next stop is the Constitutional Court, should they want to take the decision on review – the interdict applies and must be executed. 

Read more in Daily Maverick: “Doctors fear more loss of life as health workers strike set to intensify on Monday”

Things were quiet at Pelonomi Hospital in Bloemfontein on Tuesday 14 March. (Photo: Refilwe Mochoari/Spotlight)

Pelonomi Hospital in Bloemfontein

Meanwhile, at Pelonomi Hospital on Tuesday 14 March, things were seemingly back to normal. Admission staff were back at their posts and cleaners were in uniform, but there were still no security guards at the gate during Spotlight’s morning visit – only police monitoring the situation.

However, a day before the court ruling on Sunday 12 March, when Spotlight visited Pelonomi Hospital, there was no sign of the usual hustle and bustle of hawkers and vehicles filling the parking lot. Instead, there were no security officers at the hospital entrance, no staff to admit patients, and only a few nurses in the ICU. During the protests, some nurses had snuck in wearing casual clothes, pretending to be visitors.

Although there were no protestors at that time, the police were on standby.

Inside the hospital, the only section seemingly functioning at the time was the ICU, but nurses said they were also starting to fear for their safety. Some of them shared their concerns with provincial health spokesperson Mondli Mvambi, who accompanied Spotlight’s reporter on the visit.

We have become number-one targets

They told Mvambi that they are being threatened by protesters and asked how health authorities would guarantee their safety.

“We are here to work because we don’t want patients to suffer, but what do we do when the protestors force entry into this unit? We have become the number-one target because they even sent out messages [saying] that we think we are above all of them. So, what do I do when they come to the unit? Do I leave the patients who are on life support to die, or do I choose myself so that my children are not left without a mother? We don’t know what to do,” said one nurse.

‘We are not fighting against workers’

Mvambi said the department has been keeping a close eye on the situation.

“We are waiting for the Minister of Health, Dr Joe Phaahla, to tell us what to do. But as the province, we have put our contingency plans in place, such as requesting additional support. We have gone to the nurses on our database that are not employed by the department to come on board and assist.”

Mvambi said the department also reached out to NGOs for any form of support they can provide, and last week approached the court for an interdict against striking workers. 

“We are not fighting against workers. They have their own right to strike, but we also have the right to see life being attended to, which means that if people are on strike, let them strike and not be in the facility. Let those who are exercising their right to work and those that are exercising their right to access healthcare, do that,” he told Spotlight. 

“Health is an essential service, and that is what must happen. That is what the interdict serves to do. If the interdict is undermined, we are calling on the police to come in and act on those that are undermining it.”

The Free State Department of Health approached the court on 8 March for an interdict against the striking workers. 

A volunteer from the Red Cross Society takes out rubbish, while cleaners strike at Pelonomi Hospital in Bloemfontein. (Photo: Refilwe Mochoari/Spotlight)

Non-stop stretches of 27 hours

In the casualty unit at Pelonomi Hospital, Dr Janekke Nordier said instead of her usual seven-to-seven shift, she had at times been working non-stop for stretches of 27 hours at a time, due to the protest action.

“If the government stepped in earlier, we would not have been in this situation. But we cannot let patients die because that is our first priority as doctors. Nordier said she knows of some patients who have died at home, where they had to be taken care of by families, and who should have been in hospital. Due to the strike, however, the hospital could only take in limited and critically ill patients. “We are now transporting patients between here and Universitas Academic Hospital just to get the basic X-rays such as CT scans for our patients, which is delaying treatment. And we have to wait five days for one patient to get an X-ray,” she said.

“Unfortunately, basic services are not being done on patients. They are getting septic. They are not getting their pain medication and they are not getting their antibiotics. I will continue to do my utmost best for the patients because no one has physically come to harm me, but the hospital does not run on doctors alone. We really do miss our support staff – from nurses to cleaners.”

Read more in Daily Maverick: “Massive hospital disruptions across SA as health workers continue strike”

Heeding the call

Meanwhile, one of the NGOs that heeded the department’s call for support is the South African Red Cross Society. 

The Society’s provincial manager, Claudia Mangwegape, said they have so far deployed their community health workers (CHW) and general volunteers to help keep Pelonomi Hospital running. They deployed 10 volunteers, but are considering sending more should the crisis continue. 

“Our CHWs assist in the maternity, trauma, and the paediatrics and gynae ward because that is where the need is. They help with the feeding of patients, bathing of patients, and help with taking patients from one ward to another,” she said. “Our volunteers also ensure that the hospital is clean, as we have seen trash and vomit all over the floors.”

Family members of patients also told Spotlight they had to jump in and help. 

Mpho Leshoro said she had been taking care of her husband who, after a car accident, was admitted to the casualty unit on Monday. She wanted to ensure that he was taken care of despite the strike.

“I have been here since Monday. I have even started helping the volunteers clean the ward and bathing patients. I am here for my husband but I feel sorry for patients, so I have decided to also help the patients. The volunteers and doctors are really trying their best to ensure that the hospital is working, even during this difficult time,” she said. 

Healthcare users waiting on medicine at Motherwell Clinic in Gqeberha, on Tuesday 14 March. (Photo: Luvuyo Mehlwana/Spotlight)

Motherwell and KwaZakhele in Gqeberha

By Tuesday 14 March, clinics in the Nelson Mandela Bay District were open, but offered limited services, with some only offering immunisation to children and distributing medication. Since Monday last week, the normally busy Motherwell Community Health Centre (CHC) has been closed. On Monday 13 March, except for a nurse who was handing medication over the fence in the morning, the CHC was empty. Patients who came for services other than medication collection were turned away. While workers gathered inside the CHC parking lot, there was still high police visibility. Since the beginning of the strike, there have been no workers or patients inside the CHC.

One nurse at Motherwell CHC said, “We are in a minority union, and Nehawu staff reported for duty but are not working. And we will not work until we receive a clear path forward from their leaders. This means that we cannot open the clinic as we fear for our safety. In spite of the fact that we are busy distributing medication, we cannot allow patients inside the facility for their and our safety.”

Last Friday 10 March, police were stationed outside the Motherwell CHC when Spotlight visited. Desperate patients were sitting in front of the gate with little hope of getting help, since the clinic could only take the most critically ill patients. 

“The strike has also been challenging for those on chronic medication,” said Nokwanda Mazomba, 66, from Motherwell. My brother is diabetic and I normally collect insulin from NU8 Clinic. But the clinic is closed, so I’m not sure if the CHC will help me without a referral letter. I am concerned that if he does not get insulin, he may become very ill. Because of these circumstances, I have no choice but to ask a person who has a similar illness to share insulin, even though I understand that his doctor prescribed him insulin based on his illness. This can be dangerous, yet not having insulin could have far-reaching consequences,” she said.

“This is the third day I’m visiting the dentist, but no one is attending to me,” said Mthuthuzeli Njolingana, 70, from Motherwell, who was also among patients waiting outside. “The nurses say they only take emergency cases and my situation is not an emergency. I’m in pain. I can’t sleep with this toothache, and today I can’t return home without being helped because I don’t sleep. I have nowhere else to go because I can’t afford to go to a private doctor.” 

Elsewhere at KwaZakhele Community Health Centre, a 46-year-old TB and HIV patient told Spotlight, “Government failure to provide or arrange contingency plans to allow us to continue with treatment could have dire consequences. After I relocated from Mthatha to Gqeberha, I failed to adhere to my HIV treatment, and had TB diagnosed on 24 February. During my visit to the clinic for medication, they requested my referral letter, which I did not have. My blood sample was taken as soon as they discovered I had TB, so I could begin therapy immediately. 

“As of Monday, 6 March, my results were supposed to arrive, and I was supposed to start treatment. But the clinic pharmacies that are supposed to refill my prescription are closed because of a strike,” she said.

Charlotte Maxeke and Helen Joseph Hospitals in Johannesburg

The Gauteng Health Department released a statement on Tuesday 14 March, stating that preliminary reports show that most Gauteng public health facilities were operating as expected. “The department has called on all its workers to return to work with immediate effect. We are monitoring the situation on the ground to ensure that services are fully restored. We will be implementing the ‘no work, no pay’ principle, together with instituting disciplinary measures where necessary, in cases where the court directive is not heeded,” Gauteng MEC for Health and Wellness Nomantu Nkomo-Ralehoko said in the statement.

 On Friday 10 March, when Spotlight visited Charlotte Maxeke Johannesburg Academic Hospital and Helen Joseph Hospital, it seemed almost like business as usual.

At Charlotte Maxeke, a single police nyala was parked near Gate 6, which is the entrance to the administration blocks where the hospital CEO’s offices are also located. Immediately outside the security gates were a group of about eight people dressed in Nehawu T-shirts. Most of the group was clustered under a tree and sitting on the kerb. 

Visible damage on the campus included some burnt-out debris left in the middle of the road on the main access route into the hospital. It had not been cleaned up by Friday morning. 

The main doors to the hospital were open on Friday, and patients and visitors were going about their usual routines with no additional security checks required to access the reception area of the Parktown hospital.

Small business vendors that usually trade near the main security gate on the hospital campus were also open for business, and minibus taxi drivers that park along this drag of the campus were washing vehicles or waiting for their next passenger loads to fill up – as if it were just another Friday morning. 

At Helen Joseph Hospital, protesters had burnt razor wire and tyres at the entrance of the hospital on Friday 10 March, but had dispersed by mid-morning. 

The hospital remained open and was accessible to patients and visitors. When approached about the situation, a security guard shrugged and said, “They [the protestors] are gone now; maybe they’ll be back on Monday,” and pointed to a tangle of burnt razor wire and a melted tyre that strikers had set alight earlier in the morning. The pile of rubbish had been moved to a central island outside the hospital to allow for vehicles to pass. 

Vowed to continue protest action

Striking workers have vowed to continue with their protest action this week [13 March] but provincial governments, including Gauteng, interdicted workers by 8 March, making the strike illegal, and leading to a visible return to calm by Friday 10 March. 

Responding to a request for support from the national health department, the South African National Defence Force (SANDF) also last week deployed military health practitioners to hard-hit hospitals, including Thelle Mogoerane Hospital on the East Rand in Gauteng.

Phaahla, during his site visit to Charlotte Maxeke Hospital on Thursday 9 March, said that the province is looking into possible legal action against Nehawu, following what he said was the deaths of four people “directly attributed” to the strike action. 

By Thursday, the Gauteng Department of Health confirmed that there were total shutdowns at Kopanong, Sebokeng, Thelle Mogoerane, and Bheki Mlangeni hospitals “where patients were left unattended as striking workers went inside wards ordering staff out of facilities”. The department also noted disruptions at Chris Hani Baragwanath Hospital. 

Khayelitsha and Michael Mapongwana Community Health Centres in Cape Town

According to Mark van den Heever, provincial health spokesperson in the Western Cape, they received no reports of disruption at public health facilities, or any staff participating in protest action on Tuesday 14 March. 

During the protests of the previous week, however, services at Khayelitsha District Hospital and Michael Mapongwana Community Health Centre, among others, were disrupted by striking workers. Bar a handful of Nehawu members striking on Friday 10 March, it was business as usual at the hospital when Spotlight visited. Law enforcement officers were still on guard as protesting workers sang and danced outside the hospital building.

In an update, Health and Wellness MEC Nomafrench Mbombo said that although there was no structural damage, the strike resulted in the transfer of 45 critical patients to other facilities such as Helderberg, Tygerberg, Mitchell’s Plain, and Karl Bremer hospitals. The strike also resulted in shortages of healthcare workers as they were allegedly barred from entering the facilities.

One resident, Christolene Marthinus, on Friday 10 March, took her husband Neal to the eye clinic at the Khayelitsha Hospital. She told Spotlight that they were happy they were attended to. “We were transferred from Macassar Hospital to the eye clinic in Khayelitsha. The service was good despite the strike. The nurses were really trying their best, so we were not that affected,” she said.

Following a Labour Appeal Court judgement on Monday 13 March, Health Minister Dr Joe Phaahla said the department had given essential health workers until Tuesday morning to report for work. (Photo: Refilwe Mochoari/Spotlight)

Expecting 10% pay increase

But some Nehawu members said they will not back down until they get what they want. One Nehawu member, Bongani Pondoyi, stressed that they expect a 10% increase as public servants, and they will not stop until their demands are met.

“When we – the social engineers of this country – ask for an increase, there is no money at all. But there are other portfolios, ministr[ies] that don’t make sense at all. Now they recently appointed the minister of electricity and there is a portfolio of women, youth and persons with disabilities. Why, when we already have the Ministry of Social Development? They have money for other things, but not us. [It] just shows that there is money, but they don’t want to increase our salaries,” he said.

Nehawu on Sunday 12 March announced that they will intensify the strike on Monday. But after the court judgment posted a notice on their website stating that “all workers must comply with the order and the limitations on the strike in health services”. 

Nehawu has by and large denied responsibility for the incidents of violence, intimidation and compromised patient care which, reporting by Spotlight, Daily Maverick, and others, suggests is widespread.
“Yes, there have been a few incidents, and some are very unfortunate. But to say Nehawu has embarked on a programme to intimidate and cause disruption and violence in the sector – we dispute that,” the union’s spokesperson Lwazi Nkolozi told 702 Radio. 

Following interdicts secured by various provincial health departments, Nehawu last week, in a statement, called on its members “to adhere to the framework of these interdicts through engaging institutional (hospital) managements to ensure access to the service”.

“Indeed, our strike is directed to the employer not to our communities,” the statement read.

This, while Cosatu in a statement, urged workers to “unite and wage a peaceful strike”. Nehawu is a Cosatu-affiliated union. “Public service unions should ensure that they avoid violence and intimidation, but campaign for the active participation of the broadest sections of workers and communities in the fight to defend collective bargaining. A successful strike should be based on persuasion and not coercion,” said the statement. 

*Reporting by Refilwe Mochoari, Luvuyo Mehlwana, Ufrieda Ho, Tiyese Jeranji and Alicestine October.

*This article was published by Spotlight – health journalism in the public interest.