Sunday Times (Johannesburg) - Sunday 17 March 2002
Kerry Cullinan

But the single Cuban doctor on duty in outpatients this Saturday night is only seeing emergency cases - and there are already nine people crammed into a tiny consulting room and three waiting outside.

"I have been sleeping here, and I am hungry," says the elderly Ngangele, raising himself slowly off a bench. The abdominal pains that could not be diagnosed by doctors at Emadwaleni Hospital are growing more intense. But nurses say he will probably only see a doctor on Monday.

Umtata General is classified as a regional hospital and is meant to offer specialised care to patients referred to it from at least 15 district hospitals in the vicinity.

On a recent weekend visit, the hospital had run out of disinfectant, antiseptic cream, anti-tetanus injections, gauze and the re-agent necessary to process HIV tests. It also suffers periodic shortages of essential drugs such as antibiotics.

There are not enough doctors, patients are sharing beds and nurses say they are overwhelmed by their workload and depressed by poor working conditions.

Health indicators in the former Transkei are extremely poor, and services have deteriorated since 1994 - thanks mainly to drastic budget cuts and poor management.

According to research published by Health Systems Trust, 80 children out of 1 000 die before they reach the age of five in the Eastern Cape. This is the worst rate in the country.

Former Eastern Cape Health MEC Dr Trudy Thomas, who resigned from the ANC last year in protest against deteriorating health services, says the province's operational health costs were slashed from R797-million in 1997/98 to R350-million in 1999/2000.

The Eastern Cape now spends R70 a patient in the public sector, while the national average is R147.

Doctors joke that the health service is "like Hollywood, because everyone is in acting positions" - from MEC Max Mamase (his predecessor faces over 1 000 charges of fraud) to district managers and hospital superintendents.

"We really are not managing," says Sister Koleka Yako, head of the 45-bed male medical ward in Umtata. "It is impossible to take care of all the patients with only three nurses, so we attend to those who are critical and those who need post-operative care."

That weekend, 91 mothers were sharing 48 beds in the maternity ward, some lying top-to-toe.

Nonceba* has been in the ward since early January after giving birth to a premature baby. She has heart problems but has shared her bed with countless kicking strangers since she was admitted.

"It is terrible. There is always noise and there is no space," says Nonceba, looking exhausted and pale.

Sister Mandisa Mntwana says that at times there are 120 women in the ward, with four nurses in attendance at night. The stench of blood and body fluids hangs heavily in the air, and clean linen is in short supply.

In the nursery, six abandoned babies lie in little plastic cots ranged along a wall. Twin boys, believed to be about four months old, are both simply tagged Nozukile after their mother who died in childbirth.

"All they (babies) get is porridge and the glucose water from the intravenous drips," says Mntwana.

In the outpatients' department, urine and blood splatter the corridor. Bins are overflowing, and a used needle lies on the floor.

"Patients must bring relatives with them to outpatients to save them from falling off the bed, bring them water and all that. If you don't have a relative, it's too bad," says chief professional nurse Vuyiswa Ngwentle.

"Some patients are supposed to be hospitalised but there are no beds," confirms Ngwentle.

Casualty Sister Ntombizoxolo Topu sees up to 80 patients pass through her department a night - mainly gunshot, stab and car accident victims.

"There are five nurses and three doctors, two in the operating theatre," says Topu. "We are trying very hard but there is a shortage of staff.

"There is also a gross shortage of sheets and blankets and sometimes essential drugs."

There are no gauze bandages, and Topu and her staff are applying thin sanitary pads to patients' wounds. Anti-tetanus injections and antiseptic cream are also out of stock.

"It is very depressing," says Topu. "We want to meet the needs of the patients but we can't because of lack of staff and equipment. Staff resign, die or retire and they are never replaced. Things are getting worse and worse."

About four hours' drive from Umtata lies Greenville Hospital. Attractive and clean, the former missionary hospital appears to be an island of tranquillity compared to the chaotic Umtata.

However, the reason for the peaceful atmosphere is the fact that the hospital, in the Bizana district, has virtually no patients.

"People know there is only one doctor, so they prefer to go somewhere else," says Sister Nomsa Bhengu.

The hospital last had a superintendent in "about 1995", says Bhengu. No one knows where the matron in charge of hospital services is. The only doctor is in Bisho for two days of meetings. Last year, when he took three months' study leave, the hospital was reduced to a ghost facility, say nurses.

The TB ward has 40 beds, eight nurses and 16 patients. The maternity ward has 16 beds and two patients. At outpatients, there are nine nurses and two patients. The busiest ward is the female medical ward, which can take 45 patients but has 35.

"The day is too long. We are not doing our job," says Sister Zingiswa Mzobe, who has been at Greenville since 1974 and remembers when the hospital operated with five doctors and "many" patients.

Like Greenville, Rietvlei in the Umzimkulu area, is also a district hospital. But unlike Greenville, the 220-bed Rietvlei has a superintendent, five fulltime doctors and a full complement of patients.

Acting superintendent Dr Nigel Hoffman says it has taken him 21 months to cut through the red tape to secure the services of two foreign doctors to bolster his staff complement.

Despite Rietvlei's many problems, Hoffman is not the kind of person to complain. He and his wife, Clare, also a doctor, have been at Rietvlei for 14 years.

"It has been a difficult two years because of the changes to district boundaries. It would also be good to have a long-term vision of where we are going. But it is too easy to focus on the problems and lose sight of what we can do," he says.

However, Hoffman says efficiency is seriously hampered by two factors. The first is that the hospital administration is powerless to deal with staff disciplinary problems.

"Many staff don't want to do a full day's work, which means there is more pressure on those who do work hard.

"There is a huge backlog of outstanding disciplinary hearings, even minor cases, all of which have to be heard at higher levels. Dismissal cases have to be heard at head office. Those who face disciplinary charges know they can get away with not doing what they are supposed to."

The second problem is a chronic lack of transport, which prevents medical staff from reaching those who need it most. The one ambulance stationed at Rietvlei has done 400 000km and doubles up as a delivery vehicle.

MEC Mamase's spokesman, Mahlubandile Mageda, said his department was aware of the problems at Umtata General and had appointed a CEO about a month ago to improve the situation.

"We know that Umtata is overcrowded and short-staffed. We are in the process of filling critical posts for doctors," said Mageda. "Professional nurses and even cleaners are also going to be recruited.

"We have advertised for over 800 posts since December but so far we only have about 300 applications. But by the end of April, we expect Umtata to have all the required staff."

Mageda added that some of the problems stemmed from "irresponsible management" caused by managers from the former homelands "only thinking about their own stomachs and not about services".

"There is even underspending in health because managers are only working for a salary. There is no spirit of batho pele ("people first")."

He conceded that there had been a backlog of up to 600 labour cases , but that his department had employed someone to handle these.

The province is planning to "devolve powers to districts, municipalities and institutions to deal with disciplinary matters".

Mageda said no one in his office even knew where Greenville was, but he would ensure that provincial officials evaluated the hospital.

But it is hard to have confidence in Mageda's promises as the province has consistently failed over a number of years to improve the quality of health services. Perhaps it is time for national political intervention to prevent the few functional facilities in the former Transkei from being destroyed - costing more poor South Africans their lives. - Health-e News Service

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