Already long surgical waiting lists in the Northern Cape appear to have ballooned in recent months. In May, the province’s health MEC, Maruping Lekwene, told the provincial legislature that the waiting lists stood at just under 4,000. According to more recent figures from the department’s 2023/24 first quarterly report, the backlog is now 6,373 – an increase of more than 50% from May.

Department spokesperson Lulu Mxekezo confirmed to Spotlight  last week that the surgical backlogs had indeed increased from about 4,000 to about 6,000. She said the numbers fluctuate because the need increases daily.

“The shortage of specialised theatre staff makes it impossible for us to utilise all theatres daily to perform the procedures,” said Mxekezo, adding that the department will not compromise the safety and lives of patients and operate in theatres with no specialised theatre staff.

The increase in the backlog came despite the outsourcing of some surgical services in the province. Lekwene told the legislature that the Northern Cape health department pays Gauteng-based Medicomed (captured as Medicore-Mets in the legislature minutes) R400,000 per month to help with orthopaedic surgeries at Robert Mangaliso Sobukwe (RMS) Hospital in Kimberly on a month-to-month basis. The company supplied the department with specialised theatre nurses – a scarce skill in the province. In May, Lekwene told legislators that the company had assisted in 57 surgeries over two weeks.

The surgical backlog comes despite the provincial department of health outsourcing some surgical services to the private sector, including orthopaedic surgeries at Robert Mangaliso Sobukwe Hospital (previously Kimberley Hospital). (Photo: Emile Hendricks / Spotlight)

Lack of theatre staff

The quarterly report said the backlog is fuelled by the lack of theatre staff at RMS Hospital, and that the private sector was called in to fill this gap. 

When asked by Izak Fritz, DA member of the provincial legislature, why the department does not appoint specialist nurses instead of outsourcing these services, Lekwene said there are not enough theatre specialist nurses in the province.

“For us to take this route, it means that we need to have internal capacity. For instance, we will have a neurosurgeon but we will not have an anaesthetist. We have nurses, but we do not have theatre specialist nurses,” he said. 

The hospital has four fully equipped theatres but patients do not get help.

He said they do not enjoy outsourcing, but that because of the urgency and the growing backlog the department has to act swiftly. “However, as soon as the backlog has been reduced we will try to use our internal staff.” 

Lekwene also told the legislature that the backlog was mostly caused by the Covid-19 pandemic. “Remember that for two years during Covid-19, hospitals were closed.”

The Northern Cape health MEC said the growing surgical backlog is due to a lack of specialised theatre staff and the Covid-19 pandemic shutting down hospital services. (Photo: Emile Hendricks / Spotlight)

Left stranded

Some workers at RMS Hospital said the long waiting list has left many patients frustrated and stranded. One doctor described the situation to Spotlight as “dire”. 

“The hospital has four fully equipped theatres but patients do not get help,” he said. He asked not to be named for fear of losing his job. 

“Yes, we do have a shortage of nurses, but it is not as bad as they say. We are available as doctors, but without the help from nurses we are unable to perform surgeries at all,” he said.

When you have a fracture you must be able to go to theatre immediately, but in this province you have to wait months before you receive help.

The doctor said that the list of patients who need emergency surgery is longer than 30. For ordinary surgeries such as hip replacements there were patients who had been in hospital for more than 18 months, while some had been waiting for cataract surgery for five years. 

A surgical nurse prepares for surgery at Robert Mangaliso Sobukwe Hospital in the Northern Cape, where the surgical backlog is putting strain on patients and healthcare workers. (Photo: Emile Hendricks / Spotlight)

A strain on staff and patients

Dennis Segano, provincial chairperson of the Health and Other Services Personnel Trade Union in South Africa, said the surgery backlog is putting a strain on both nurses and patients.

He said the main problems that they see at RMS Hospital are a shortage of specialised theatre nurses and a lack of equipment. “When you enter the theatres there are enough doctors but not enough nurses,” he said. “We have a problem with our theatre nurses who are often outsourced by the service provider to work during their surgery marathons at the RMS Hospital, but have to wait three months or sometimes even six months before they can get paid.”

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Spotlight asked Mxekezo about the late payment allegations but had not received a response by the time of publication.

“We don’t know why the government is not appointing the nurses instead of paying a service provider,” Segano said. “The system is burdened, the nurses in orthopaedic wards are burdened and we feel sad for the patients who have to spend months in hospital. 

“As a patient, when you have a fracture you must be able to go to theatre immediately, but in this province you have to wait months before you receive help.”

Mxekezo said: “Stakeholders are also assisting us in performing theatre marathons to deal with the backlog.”

For example, in October 2022, disaster relief organisation Gift of the Givers sent a team of theatre nurses and anaesthetists to help with the backlog at RMS Hospital. According to Ali Sablay, the organisation’s project manager, they performed 72 operations on 72 patients during the catch-up drive.

The main entrance at the Robert Mangaliso Sobukwe Hospital – one of the hospitals in the Northern Cape with a growing surgical waiting list. (Photo: Emile Hendricks / Spotlight)

Long-term solution

When asked what the department’s long-term plans are to reduce the pressure, Mxekezo said the operationalisation of theatres in district hospitals with specialised theatre staff will help to minimise the backlog at RMS Hospital as many patients are transferred from districts.

Segano agreed that a long-term solution is to equip district hospitals with decent theatres and specialised theatre nurses.

“Minor fractures must be dealt with at district hospitals. RMS Hospital must only perform serious surgeries,” he said. “If the department can prioritise Harry Surtie Hospital and De Aar Hospital with theatre staff and equipment, RMS Hospital will operate much better and the patients will be helped. It is incorrect to send all patients of the Northern Cape to one hospital in Kimberley. They will not succeed.”

Mxekezo said: “Permanent employment of theatre staff will also assist in stabilising the surgical backlogs.”

Sceptical opposition

Fritz told Spotlight the DA is very concerned about the growing backlog in the Northern Cape and that it has repeatedly highlighted surgery backlogs at the province’s only tertiary facility, RMS Hospital.

“When one looks at nursing appointments at the RMS Hospital, we see a trend whereby more nurses’ contracts are terminated each year than the number of nurses who actually get appointed,” he said. “In effect, the hospital only operationalises four of its nine theatres.

“Despite agreements with private agencies for surgery marathons to help tackle the backlogs, this only has a limited impact because of the inability to operationalise more theatres and to ensure there is an availability of more beds for recovery.”

In October 2022, Gift of the Givers sent a team of theatre nurses and anaesthetists to assist with the backlog at Robert Mangaliso Sobukwe Hospital. (Photo: Emile Hendricks / Spotlight)

Fritz said people who need elective surgery often have to wait years to be attended to while their condition progresses. “Only when their case becomes an emergency can they be bumped up the list, and by that time their disease has become worse and their hopes of a full recovery are minimised.”

Wynand Boshoff, the Freedom Front Plus’s Northern Cape leader, told Spotlight last week that the problem with the department is that it is riddled with mismanagement and has a culture that aims for anything but service delivery.

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The FF+ was not only approached by patients, but also regularly by doctors who wanted to leave the health department because of management that had completely abandoned services.

“It is clear that more is needed than the appointment of a new minister or a new head of department, as the legacy of mismanagement overwhelms individual role players. A comprehensive investigation and steadfast disciplinary action are needed,” Boshoff said. “Repeat offenders should not be tolerated in the department, not even in the most humble of positions.” 

As Spotlight has reported, the Northern Cape health department has had several acting heads in the past three years and several senior officials have faced charges in court. The current head of department is Dr Alastair Kantani, who has been acting in the position since 8 September following the arrests of seven officials, including the former head, Dr Dion Theys, who now occupies the post of medical director in the department. In a statement by the department on 13 September, Lekwene said this action is informed by the constitutional responsibility to ensure relative stability in the delivery of healthcare services in the province. DM

This article was produced by Spotlight – in-depth, public interest health journalism.