South Africa: Dire Conditions At Mthatha General and Nessie Knight Hospitals

29 September 2020

The dire state of health infrastructure and services in the Eastern Cape has made headlines during the COVID-19 pandemic and triggered promises of government intervention, but in some hospitals those providing and receiving healthcare note little to no improvement.

Recently, deputy Public Protector Kholeka Gcaleka visited healthcare facilities in the province to assess the situation. Spotlight traced some of her footsteps and caught up with staff and healthcare users at two hospitals.

Nessie Night Hospital

At the Nessie Knight hospital in Qumbu in OR Tambo District, visibly sick patients queue for hours to consult doctors or nurses.

The hospital buildings appear dilapidated, with exposed electricity cables hanging from walls and paint peeling off in places. In some wards there are broken windows and obviously damaged plumbing.

Hygiene at the 80-bed district hospital has also been compromised after the only laundry machine broke down recently. We understand that the hospital now has a van to ferry the laundry to other nearby hospitals to be washed.

A history of oversight and inspections

In 2013, the Eastern Cape health department announced a multimillion rand upgrade of the Nessie Knight Hospital. Then in 2014, when Parliament's Select Committee on Health finished an oversight visit to this and other facilities, MPs highlighted various challenges in a report, including poorly ventilated wards, the state of disrepair of the building, and that nurses were housed in caravans behind the hospital.

Six years later, the upgrading of staff accommodation seems to be the only area in which progress has been made.

In its report for the 2015/16 financial year, the Office of Health Standards Compliance (OHSC) flagged Nessie Knight Hospital as performing particularly poorly. The facility received scores of less than 40% for cleanliness, patient safety, and waiting times.

In the OHSC chairperson's foreword it states "inspections findings are presented to health establishments management teams for their attention and Service Quality Improvement Plans with remedial actions [must be] submitted to [the] Office and the plans and implementation monitored [to] make sure quality service compliance is achieved".

But whether any of this has happened at Nessie Night Hospital since the 2015/2016 OHSC report is unclear.

Spokesperson for the OHSC, Ricardo Mahlakanya, says the OHSC is "mandated to conduct routine inspections to monitor compliance in health establishments every year (every financial year)". "Once a particular facility has been inspected, we go and come back after four years. Other inspections are conducted if [the] health facility is problematic and there are reasonable grounds of serious breaches of norms and standards, including the findings of the Health Ombudsman."

He notes, however, there are a list of facilities that need to be inspected and "the truth of the matter [is] we can't go to all facilities". "We mainly target the ones that have high risk and the findings of our inspections are shared with respective health stakeholders to take corrective actions," he says. "Currently inspectors are going around the province and other provinces doing inspections in the health facilities to see what is lacking and how the department can improve on them."

In August 2020, Gcaleka visited Nessie Knight and other hospitals in the province and reportedly found conditions to be depressing. Spokesperson in the Office of the Public Protector, Oupa Segalwe, told Spotlight a report is being compiled after Gcaleka's visit to Nessie Knight Hospital and Mthatha Hospital among others. "Those implicated must be granted an opportunity to comment on the draft first before it is made public and the report will be out soon," he said.

Concerns at Mthatha General

Like Nessie Knight Hospital, Mthatha General Hospital has also been subjected to scrutiny and oversight by the OHSC, MPLs and MPs over the years. The hospital was also recently visited by Gcaleka.

The hospital has been operating without a permanent CEO and a head of clinical services since last year. Spotlight saw patients waiting long hours in hospital corridors due to limited space in the run-down facility. The visit was during South Africa's COVID-19 lockdown when social distancing is encouraged.

A hospital staff member who does not want to be identified for fear of losing his/her job, said besides the ageing infrastructure, "[they] are facing a dire shortage of PPEs for staff working in high-risk areas". "The lack of communication from management regarding safety and wellbeing of staff is a heavy burden on us," says the staff member.

Some patients are also not happy.

One patient, Asakho Phingilili from Mthatha, said she was sent home without being treated. She bemoaned the "long queues, poor service and the lack of communication to patients by the staff".

"I arrived here as early as 8am, but I have not been attended to. I am shocked that nurses are just walking in corridors. Last month, I was here again, and it took me more than five hours only to be told that I must come the following day. I'm sick and tired of poor service at this hospital. I use lots of taxi fare to come here," she says.

Viwe Mawonga also shares her unhappiness with service at the hospital. "I arrived here in the morning, but no one seems willing to assist me and it is cold out here waiting with a baby. I only want a discharge letter and proof of birth," she says while cuddling her baby to keep it warm. "I don't know why they keep us here the whole day without performing such simple things."

Ongoing crisis

Coordinator for the Eastern Cape Health Crisis Action Coalition (ECHCAC), Thokozile Mhlongo, says poor healthcare infrastructure in the province is nothing new. She says it has been an ongoing crisis and the COVID-19 pandemic has highlighted these pre-existing issues. "Some of the province's healthcare infrastructure is old and not well maintained. Some of the buildings need to be demolished completely because they were built from mud and clay several decades ago," she says.

"We continue to receive alarming reports from both health care users and the healthcare workers about the dire state of public health facilities in the province. We will hold the department of health accountable because people are suffering and their dignity is being trampled upon every day in public health facilities. This is even compounded by the shortage of staff leading to some patients absconding and not taking their chronic medication. The lack of ambulances is another pressing issue," says Mhlongo.

On 29 July the ECHCAC and the Treatment Action Campaign marched to the health department's offices in Port Elizabeth, demanding that healthcare facilities across the province are improved.

Saying the right things

During a press briefing in August, Eastern Cape Premier, Oscar Mabuyane, acknowledged the poor conditions of the healthcare facilities in the province.

"For far too long the rural masses of our people in particular have been receiving healthcare service in facilities that were not conducive for the provision of quality healthcare. Even worse, our healthcare workers had to endure working in shabby healthcare facilities. I have seen some of these health facilities with my own eyes. It still boggles my mind how they maintained their status as healthcare facilities with their horrible state of infrastructure decay," Mabunyane said.

"We are working around the clock to find solutions to the challenges of our people, thus we had to reprioritise budget with the administration to raise funds for the refurbishment of our healthcare facilities. This is to make sure that beyond the COVID-19 pandemic we have healthcare facilities that inspire confidence and give hope to patients and their families that they will heal from their sickness when they are in our facilities," he said.

These promises had the same ring as those made by his predecessors.

In her term from 2009 to 2014, former Eastern Cape Premier, Noxolo Kiviet, also promised to improve the health profile of the province. However, it was the large-scale corruption in health costing the province millions that made headlines. Kiviet commissioned a forensic investigation that unearthed hundreds of ghost workers and public officials in the health department doing business with the provincial government illegally. In her annual state of the province address, she too promised infrastructure repairs of clinics and hospitals.

Phumulo Masualle, who took over as premier in 2014, ended his term claiming credit for among others "the implementation of the Service Transformation Plan to improve the quality of service in public health institutions in the Eastern Cape, which included the review and implementation of the turnaround strategy and plan for the community health centres and hospitals" as well as upgrading and revitalising health facilities.

That at least some facilities in the Eastern Cape have been upgraded is indisputable. Last year Spotlight reported on the impressive new Village Clinic in Lusikisiki, also in the OR Tambo district. The new Cecilia Makiwane Hospital unveiled in East London 2017 is also impressive, but, as reported last year, the mental health unit at Cecilia Makiwane had not been upgraded and remained in a terrible state. Following up on that story, we found that an investment of over R230 million announced by the province, though welcome, would only meet around half the province's needs regarding the upgrading of mental health facilities.

Unions remain sceptical

Provincial secretary of the National Education Health and Allied Workers' Union (Nehawu), Miki Jaceni, tells Spotlight they are monitoring the situation.

"According to reports we received from our members on the ground across the province, there is no improvement in our healthcare facilities. These promises made by the provincial government have been made before and commitment were also pronounced, but we did not see any fruitful results out of those promises," he says.

"We cannot rejoice because people are unsettled and want to see results. For a long time our members, especially the frontline workers, have suffered. They have been subjected to appalling conditions. Nurses, doctors and other hospital staff have died due to poor working conditions, hence even today we still demand that our members must be protected at all times because this intervention promises have been there, but there is no progress," he says.

*NOTE: The TAC is mentioned in this article. Spotlight is published by SECTION27 and the Treatment Action Campaign (TAC), but is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

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