Amid concerns about the security and safety of health workers at public health facilities in the Eastern Cape, the Democratic Nursing Union of South Africa (Denosa) says it is considering legal action against the provincial health department for neglecting health workers and what it calls the department’s “total disregard for the Occupational Health and Safety Act (OHSA)”.

According to the union, many nurses are working in dangerous conditions.

Assaults, robberies and vandalism

This follows a series of security incidents at public health facilities in the province.

In January, electricity cables were reportedly stolen at Cecilia Makiwane Hospital in East London, causing disruption of services and plunging the hospital into darkness. Patients at the outpatient department and all Caesarean sections were diverted to Frere Hospital, while 15 corpses had to be moved to the Mdantsane forensic department. 

Eastern Cape health MEC Nomakhosazana Meth in a statement released following the incident at Cecilia Makiwane listed various other incidents where she said criminals targeted health facilities. Among these were Dordrecht Hospital where “criminals stole municipal electrical cables”, resulting in a disruption of services. At Marjorie Parrish TB Hospital in Port Alfred, Meth said electrical cables were also stolen and Fort Beaufort Hospital had water copper pipes in the theatre ablution section stolen. Also at Zithulele Hospital on Christmas Day in 2022, a nurse was shot dead at the hospital, leaving other staff traumatised.

In the statement, Meth said staff at KwaDwesi Clinic and Tshangana Clinic have also been robbed and a burglary reported at the Gqeberha Lilitha Nursing College where “13 electrical plugs and switches were stripped and vandalised”. “Wiring of the sound system and wiring from toilets to passages were also stolen.” More recently, in April, a truck delivering medication in the Nelson Mandela Bay Metro was hijacked while offloading at NU 8 Clinic in Motherwell. Meth condemned the incident.

Security a ‘priority’

According to figures provided by the Eastern Cape health department, there were 120 burglaries at health facilities in Nelson Mandela Bay in the past 22 months. Between 11 September 2022 and February 2023, the department recorded four assaults on healthcare workers.

Meth, in her budget speech in March, said the department was awarded an incentive grant of R78.8-million by Treasury as a “recognition of compliance with the conditions of the Health Facilities Revitalisation Grant”. The department “has resolved to utilise this budget to upgrade security at our facilities to safeguard our patients, staff, and assets”, Meth said. She did not elaborate on the planned security upgrades.

Gunshot injuries have increased in Motherwell and all these patients are coming to us and our security guards are not armed in case anyone comes in and wants to finish a patient.

Spotlight asked Eastern Cape health spokesperson Yonela Dekeda for details about this, rising concerns over security and safety at facilities, the department’s spending on security contracts, and other plans to address the concerns. Dekeda did not provide substantive answers on the department’s spending on existing security measures and security contracts. Instead, she referred Spotlight to the department’s website for details of the tenders awarded. The last tender for security that Spotlight could see – 64 guards for 24-hour security at Frere Hospital, was published in July 2022.

But Dekeda did say, however, that security threats are a huge concern for the department. 

“The issue of security is a priority for the department and that is why the department plans in the medium to long term to establish a hybrid of physical security guards and automated systems. The automated systems will consist of security technology, such as CCTV cameras, automated entrance systems and alarms. The system will restrict and clearly identify those who’ve entered the health facilities,” she said.

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“Nelson Mandela Bay is one of the districts prioritised to pilot the hybrid solution because of the high crime rate in that area. The department is working closely with the police as security guards appointed cannot be armed due to the health environment. All incidents that occurred in the health facilities are reported to the police for investigation.”

According to Dekeda, the health department enters into service-level agreements with various security contractors. “Districts have been clustered according to size and service provision to enable the multiple supplier appointments to focus on specific areas. The security guards are then deployed in line with the risk assessment,” she said. “All bids that are issued indicate that the department reserves the right to reduce the number of guards once an automated system is implemented, so the funds for physically securing guards will be channelled to an automated system.” 

Spotlight visited several hospitals and clinics across Nelson Mandela Bay and at many facilities found there were security guards at the gates who searched vehicles but visitors were not always checked for dangerous weapons. At the Livingstone, Dora Nginza and Port Elizabeth Provincial hospitals there are security guards at almost every corner and visitors sometimes are scanned with a metal detector.

Calls to beef up security

Referring to the incident at Cradock Hospital in February, Denosa’s provincial secretary, Veli Sinqana, said: “The husband forcefully entered the Cradock hospital and brutally attacked the nurse at the hospital. The perpetrator also injured the security personnel who had come to assist before he left the facility. We believe the incident is like many other incidents that took place inside healthcare facilities and highlight the continued poor state of safety at the hands of the department of health with no consequences at all. Because this incident is not happening for the first time and there continue not to be any improvements in cases where this had happened, Denosa is consulting its legal department for possible action against the department for its negligence and total disregard for the Occupational Health and Safety Act (OHSA),” said Sinqana. 

EFF member of the Eastern Cape legislature, Zilindile Vena, called on the provincial government to beef up security urgently to fight crime in the province’s health facilities.

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“In our response to the State of the Province Address, we raised the issue of crime in our health facilities and crime in general with the premier. We are deeply concerned about the safety and well-being of patients and staff in every provincial clinic and hospital in the province, particularly in Nelson Mandela Bay. To prevent anything that could affect the proper functioning of the facilities, the department needs further security measures,” he said.

We have security guards in the casualty ward, but they are not up to the task… They only have pepper spray and a baton stick to protect themselves.

“The high level of crime in our province is a cause for concern. For example, no one knew that the truck that was hijacked in Motherwell had medication except workers. Nobody will take a weapon and hijack a truck without knowing what’s inside. We call on communities to take ownership of government properties and protect healthcare workers against criminals,” said Vena.

Scared to come to work

A nurse at the Motherwell Community Health Centre, who asked not to be named since she is not allowed to talk to the media without permission, said: “Working [the] night shift is a challenge, especially on weekends. We need to treat intoxicated and aggressive patients who are accompanied by their friends. Sometimes they ask us to leave everything and take care of them first and if we refuse, we will be verbally threatened or assaulted. Almost every nurse in this clinic, if not all, can relate that they have been targeted by rude patients.

“We are scared to come to work but we come because we are employed [but] we don’t feel safe. Gunshot injuries have increased in Motherwell and all these patients are coming to us and our security guards are not armed in case anyone comes in and wants to finish a patient. It is high time that the department should allow security guards to be armed. Our security guards are also under attack when they come to help us in the event of an attack,” she said.

Another nurse in the same facility said: “Despite several attacks on nurses, little has been done by the department. We have security guards in the casualty ward, but they are not up to the task, as they are not armed. They only have pepper spray and a baton stick to protect themselves. They can’t confront a person armed with a firearm when they don’t have firearms themselves.”

“Healthcare workers,” the nurse said, “continually become the subject of patients’ rage. The violence has something to do with longer waiting times experienced by patients due to a shortage of staff. When we take a long time to attend to patients owing to being busy with other commitments, maybe due to shortage of staff or other administrative reasons, that inevitably escalates to frustration and violence among the patients. The department needs to employ more nurses to reduce waiting periods and improve the turnaround time in healthcare facilities and that will reduce the frustration of patients,” she said.

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Aphelele Boltina, a patient at the Motherwell Community Health Centre, told Spotlight: “Between Motherwell, Kamvelihle and Wells Estate, Motherwell CHC is the only clinic that is open for 24 hours. I believe many clinics in the township should operate for 24 hours, but because of the high levels of violence and a lack of security, that is becoming impossible. Apart from targeting the health facilities’ properties, it shocked me that people beat up a nurse that helped them. Hospitals and clinics are supposed to be a place of healing, but it seems that healthcare workers are being exposed to violence.”

According to a security guard, who did not want to be identified either because they are not allowed to speak to the media, many clinics in Nelson Mandela Bay do not have night-shift guards. “The few that do have guards typically have one or two guards, making them a vulnerable target for criminals. Our job is to observe and if we see potential danger, we call the police for back-up, as we can’t confront thugs. The thing targeted mostly by thugs is copper cables and pipes,” he said. DM

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