After the release of the report by Professor Malegapuru Makgoba, the Health Ombudsperson, of the findings and recommendations of his investigation into allegations concerning quality of care at Rahima Moosa Hospital, Dr Tim De Maayer received numerous requests to comment from the media. He declined most of them. 

However, after careful consideration, consultation  with colleagues and because his Open Letter is acknowledged in the Ombud’s report (see pp 37-38), he has prepared the response below. He believes this is necessary for the public record and to close the circle on his original decision to speak out about conditions at his hospital. As the Ombud’s report notes:

“Dr T De Maayer said he would remain in the public service. He indicated that he is often invited to work in the private sector but felt it would take away from his full-time job. He said he chose not to go to the private sector and hopes never to go to the private sector. He confirmed that he would stay in South Africa.”

We therefore publish it in the interests of the constitutional rights of everyone to have access to healthcare services and information and bona fide comment that advances that right. – Mark Heywood, Editor, Maverick Citizen

Read more in Daily Maverick: It is criminal what is happening to patients, says Rahima Moosa whistle-blower Tim de Maayer

Read the Ombud’s report here. 

I welcome the release of the report into allegations at Rahima Moosa Mother & Child Hospital (RMMCH), released on 14 March 2023.

The findings of the report are accurate, and its recommendations, if brought to fruition, will bring the hospital some necessary relief. 

Nevertheless, the Ombud was not tasked with investigating the rot in Gauteng’s hospitals in general. RMMCH is far from unique in its failure to uphold the constitutional rights of South Africans. A report in any of the other Gauteng hospitals will likely reveal similar dysfunction.

The motivation behind my original letter was to highlight the plight of our patients, who are still receiving second-rate care because of the dire circumstances public hospitals function in. 

Read more in Daily Maverick: A wake-up call for Health Department heads: Children are dying because of horrendous state of our public hospitals 

After the public outcry many delegations from the likes of GDoH and NDoH came to see how to help. Despite these many meetings and plans, very little has changed on the ground.

On the positive side, we are not receiving regular load shedding, and the sewerage situation mentioned in the report appears to be improved. Gift of the Givers sank a second borehole, and there is a better relationship between hospital management and staff at all levels. Current management has shown itself to care about patients, and not just public image.

But most other problems persist; nothing has been done to address the crumbling infrastructure, stock-outs of essential items continue, the CT scanner which passed its sell-by date a long time ago is broken again, we still are not reclassified as a tertiary hospital, overcrowding is a daily reality. 

Most importantly, patients are still suffering as they were before. To hear that R200-million was returned to the fiscus by GDoH last year as they had failed to spend it, is not only a slap in the face for public-sector patients, but also typifies the incompetence and poor management in the health sector. 

Imagine, the hospital with probably the second-busiest maternity unit in the country has not had a head of obstetrics for close to two years!

Staff morale is low. It is difficult to motivate yourself to come to work every day to face the challenge and try to do your best for patients knowing you are fighting a losing battle. For example, as a paediatric gastroenterologist I’m still forced to treat inflammatory bowel disease patients with substandard treatment, while better drugs have been in existence for more than 20 years! 

The Rahima Moosa Mother & Child Hospital in Johannesburg. (Photo: Denvor de Wee)

When specialists and subspecialists are not able to apply their trade effectively, frustration sets in quickly. Cynicism and depression ensue. These are key components of the burnout so many of us are experiencing.

A particular low point in the report is its findings against the nurse who had incorrectly mixed patient cleaning solution. While the error in her actions is irrefutable, the obvious question is why a busy hospital performing many Caesarean sections in one day, is allowed to run out of cleaning solutions in the first place? Making a plan with the limited resources available to us, even if we know we are not providing the best treatment, is a daily occurrence. Healthcare workers of all levels are doing as much good as possible with what we have. And if we were not to do so, many more would die.

In the wake of the report, I was asked to respond by the press. But the fear of reprisals for whistle-blowers remains stifling. The consequences of the punitive action against those speaking out in healthcare led to many South African healthcare workers joining the “I am” movement last year, speaking up against continued victimisation. Despite the initial acknowledgement and meeting, as a healthcare worker, I am still just as scared to speak out.

The report’s recommendations do suggest clear timelines though, and we hope these will be monitored and compliance checked. DM/MC

Dr Tim De Maayer has asked us to convey that this will be his only public statement on the issue and that he will not be giving any further media interviews or comments. He thanks the media for the support they have shown, and continue to show, highlighting the challenges in the health system that face patients and healthcare workers.