Maverick Citizen


Desperate Livingstone Hospital doctors tell patients: Call President Ramaphosa – we can’t fix your broken bones

Desperate Livingstone Hospital doctors tell patients: Call President Ramaphosa – we can’t fix your broken bones
Orthopedic surgeons at Livingstone Hospital are unable to operate on patients with broken bones as they have no implants. (Photo: Donna van der Watt)

Instead of surgery, orthopaedic patients at Livingstone Hospital in Gqeberha, Eastern Cape, are being given a letter explaining that they cannot be helped because there are no metal implants available. The letter includes the number of the Presidential Hotline for patients to call.


Dear Patient,

You have been admitted to Livingstone Hospital because you require emergency/urgent treatment for an orthopaedic condition.

Unfortunately, the implants (metal devices used to fix broken/deformed bones) needed to best treat you are not currently available in the hospital. Depending on your injury and the delay the implant unavailability causes, you might not be able to be treated surgically and have a poor result/outcome. Your doctors have not been informed when implants will again be available nor given any alternative hospitals to transfer you to.

This is the text of a letter that is being given to orthopaedic patients who cannot be helped at Livingstone Hospital, one of three tertiary hospitals in the Eastern Cape and one of the largest and busiest casualty units in the province.

The hospital is estimated to serve about 2.5 million people, many of whom live in surrounding rural areas.

The letter lists three telephone numbers: one for the hospital’s complaint service, the other for the Eastern Cape Department of Health’s complaint line, and the third for the Presidential Hotline

Desperate patients with broken arms and legs are begging for help, but the doctors say there is nothing they can do. 

“The sad truth is that most of our patients think it is acceptable for them to wait,” a hospital source said. Patients also worry that complaining will jeopardise their chances to get surgery.

“Resources do not exist to treat trauma emergencies to a medico-legal standard,” clinicians warned in a letter written to the department’s managers in 2021. Yet the crisis continues.

Department actions

In a written answer to the Eastern Cape Legislature a month ago, Dr Rolene Wagner, the head of the Eastern Cape Department of Health, said the department was providing patients whose jobs depended on successful surgeries with sick notes and additional medical reports. 

“Additional support is provided by referral to the social worker and where applicable a referral for a temporary social grant is also facilitated.”

She said the procurement of implants and medical and surgical supplies, “supported by the approval of the relevant tenders and amended supply chain management regulations”, was underway. The hospital was also working with district hospitals to see which surgeries could be done there, she said.

The department, however, was unable to provide a timeframe for when the surgery backlog would be addressed. It indicated that it would “try their best” to do so in the 2023/2024 financial year. 

“Patients are not referred to other facilities, whether in or outside of the province, specifically for the backlog from Livingstone. Referrals would usually, on principle, be done for specialist care at the central hospitals or for specialist interventions not done in the facility.”

Failure of governance and oversight

Livingstone Hospital last had a permanent CEO in 2018 when a violent protest by four unions organised by Nehawu forced then CEO Thulane Madonsela and his management team out of the hospital.

Madonsela eventually resigned after being suspended by the former head of the department, Dr Thobile Mbengashe.

Madonsela and his management team were recently paid millions after the labour court ordered that they each be compensated with six months’ salaries and legal costs. The court confirmed an arbitration ruling that their suspension had been wrong.

In December 2022, Dr Mtandeki Xamlashe, the hospital’s then acting CEO, admitted to the health portfolio committee doing oversight at Livingstone Hospital that there was a shortage of orthopaedic implants and more than 100 trauma patients were on the waiting list. Xamlashe has since been promoted to top management in the provincial department.

In a report adopted by the Health Portfolio Committee in February, MPs wrote:

“The Acting CEO presented to the Committee and highlighted that the facility had been affected by Covid-19 and that there was a governance collapse. He further indicated that staff morale has been negatively affected by Covid-19. The Acting CEO noted that they had not received any support post-Covid-19. He indicated that the hospital faces severe staff shortages and that maintenance is very poor.”

The hospital currently has 400 unfunded beds. 

Failed legislature intervention

In June last year, the Eastern Cape Legislature passed a unanimous motion, brought by the Democratic Alliance’s Jane Cowley, that the suppliers of orthopaedic implants to state hospitals in the province must be paid. Yet payment did not happen.

Read more in Daily Maverick: EC legislature orders provincial health dept to pay for orthopaedic implants to avert ‘humanitarian crisis’

The shortage of orthopaedic implants was again raised in a letter written by a number of senior doctors in the metro. Health MEC Nomakhosazana Meth blamed Covid-19 and possible duplication of invoices. 

In August 2022, the department admitted that it owed the suppliers of orthopaedic implants R52-million.

Meth highlighted in her answer to the Eastern Cape Legislature that there had been “unprecedented demand” for trauma and mental health services in the Nelson Mandela Bay metro, which she said was also due to the increased population of the city. 

Meth indicated that the invoices would be paid by August 2022. This did not happen and, in November, replying to oral questions in the Legislature, Meth again said suppliers would be paid. 

Delivering his budget speech this month, Mlungisi Mvoko, the Eastern Cape MEC for Finance, said medico-legal claims were still draining provincial coffers, leaving the department with serious cash flow challenges.

He said a strategy to address this was being implemented: “The multi-pronged strategy’s main purpose is to steer provincial health services into becoming more comprehensive and balanced in responding to an individual patient, family, and community health needs.”

Mvoko said there had been a 96% reduction for in-year irregular expenditure to less than R3.4-million in 2022/23 from R104-million in 2021/22 due to improvements in systems and controls.

“The provincial health department has reprioritised its budget and made available R544-million over the [medium term] towards maintenance and acquiring much-needed health machinery and equipment,” he said.

‘This is outrageous!’

Cowley, the DA’s spokesperson on the metro, said the operational budgets of all hospitals in the province were dramatically reduced in order for the Eastern Cape Department of Health to settle successful medico-legal claims against them.

She added that none of these steps had had any impact on the backlogs: “The situation is now so dire that the orthopaedic department at Livingstone has written to patients to advise that they simply

cannot assist them in any way. Further, the doctors have not been informed when implants will be available again, nor have they been given any alternative hospitals to refer patients to.

“This is outrageous! How can the situation at Livingstone be so dire if all the steps mentioned above have been taken? And why will the department not refer patients whose lives are in danger, even if this means referring them to another province?

“It is this callous disregard for patients that will perpetuate the scourge of medico-legal claims against the department. Furthermore, it will disincentivise even more doctors and specialists from working in the public sector, and doctor vacancies will continue to plague our hospitals.”

Steps to fix the problem

Department spokesperson Sizwe Kupelo said injuries due to trauma and violence were on the increase and the reasons for this needed to be addressed as societal issues.

“Our focus as health is to increase our surgical and orthopaedic capability by increasing the number of facilities that can do operations and also increasing the theatre time at our regional and tertiary and central hospital.”

He said this would include opening additional theatres and employing more staff, ensuring that infrastructure is up to standard and procuring machinery and equipment. He added that the province was also improving the anaesthetic services available at public hospitals.

“We have identified 10 peripheral hospitals that will focus on orthopaedic operations across the province to reduce the need at Livingstone and other tertiary facilities. At Livingstone, we have completed renovating two additional operating theatres. We are in the process of recruiting additional staff for the two theatres,” he said. DM/MC


Comments - Please in order to comment.

  • Jennifer D says:

    This is caused by inefficient ordering, management and corruption. The doctors that continue to try and deliver service in government hospitals deserve a medal. Given that the people appointed into positions of power all over the country are clearly unwilling to perform their particular responsibility, at what point do we take a stand up against it and why are ordinary South Africans so accepting of this? Everywhere one looks inefficiency and crime are evident – is there no inherent decency and pride in their work?

  • D'Esprit Dan says:

    Unbelievable. You’ve got a broken leg and they write you a sick note. Pure ANC, pure uselessness, pure corruption. Such a beautiful province, absolutely wrecked by a criminal syndicate called the ANC. Throw the lot of them in prison.

  • Francois Smith says:

    The people that are served, well not served at the hospital, received their expressed desire. They wanted no service by voting for a party that allowed R 3 trillion to disappear from the RSA economy and hence cannot provide the service.

  • Confucious Says says:

    But wait….. the NHI will be the panacea! t is difficult to fathom just how bad an incompetent this government is!

  • virginia crawford says:

    When is NEHAWU going to be held accountable for the destruction they cause?

  • Glyn Morgan says:

    This is caused by, among other things, BBBEE, AA and unions.

  • Hilary Morris says:

    Totally speechless!

  • Frank Fox says:

    I can understand the frustration of the orthopaedic surgeons but surgery is not the only way to set broken bones. Good outcomes were achieved with manipulation under anaesthetic and fixation in a cast. Patients should not be denied treatment because there are no implants available. I appreciate that the outcomes may not be as good in some cases and longer hospital stays might be necessary
    There is an element of political grandstanding in this.

    • John B says:

      Seeing as you seem to have the required medical expertise to sort this out, maybe you could volunteer to go show them how it should be done?

  • Steve Stevens says:

    I’m impressed! A very creative idea. Hopefully the patients read between the lines.

    • D'Esprit Dan says:

      I have absolutely no doubt that the ANC will respond quickly and efficiently to this situation, as they always do, and initiate a witch hunt for those who have exposed their incompetence and corruption. 2024 can’t come soon enough – and hopefully there is enough of a groundswell of antipathy towards the ANC to finally boot them into touch.

      • Dario Tanziani says:

        If what happened at Tembisa Hospital and to Babita Deokaran is anything to go by, then the term “witch hunt” is but a euphemism. And if we believe that the ANC will take defeat at the polls lying down in 2024, then we are all deluded fools.

  • Palesa Tyobeka says:

    What a painful read! Cannot fathom such incompetence and lack of empathy. May the Universe deal harshly with all those who are bringing services in this province to its knees.

  • Marius Marais says:

    The only way to start addressing this incompetence is at the voting station.

    • Gerrie Pretorius says:

      The anc will not relinquish power that easily. Take note of what happens in the Metros where coalitions have governed. The anc disrupts the councils and make sure there is chaos.

  • Paul Caiger says:

    This is why I left the government service 25 years ago ! Worked at a government hospital in 2013 – lasted 10 months and then resigned – almost had a complete breakdown. All my fellow colleagues suffered the same fate. DOH destroyed by ANC’s incompetence , corruption , cronyism , nepotism , ignorance , cadre deployment , entitlement and arrogance as well as by the trade unions.

  • Fernando Moreira says:

    Yet another reason to vote DA , but …..

  • Epsilon Indi says:

    It’s quite amazing just how rampant incompetence, embezzlement and corruption is in South Africa. It seems that everywhere a South African is in charge, that everywhere a South African has anything to do with money, there is a complete an utter box up.

  • David Crossley says:

    What a disgraceful situation and proof positive that if the ordinary people in the Eastern Cape don’t vote the useless ANC government out in 2024, then they only have themselves to blame. Catch 22 – no treatment = medico legal claims = equals no money for treatment. How on earth did we allow things to get this bad?!

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