Doctors in North West Province have broken their silence over the ongoing health crisis in the province, calling for urgent intervention to resolve the impasse which is placing millions of lives at risk. Meanwhile, the army has been deployed to end the often violent strikers’ blockade of Mahikeng medical depot, which supplies to 22 hospitals and an estimated 400 clinics.
Daily Maverick report that a “letter of concern” has been sent to the Presidency, the national and provincial departments of health, and the North West premier’s office, by nearly 100 doctors based in North West, who said that as caregivers they had been silent for too long.
“We have taken an oath to ‘do no harm’, and in our silence we have contributed to harm. This cannot go on as we are concerned about methods used which include closure of healthcare facilities that affect the health of our society,” the letter reads.
The report says members of the National Education Health and Allied Workers’ Union (Nehawu) have been on strike for over a month, protesting over several issues, among them a controversial R180m contract awarded to Mediosa, a Gupta-linked company.
The strike action, according to the doctors’ letter, has resulted in the: closure of the main medical store, which has left health institutions unable to procure medication and surgical sundries, resulting in shortages which has compromised of patient care; closure of clinics and hospitals particularly in Lehurutshe, Zeerust, Mahikeng and surrounding areas and has left communities in these areas without access to preventative and obstetric treatment, as well as both acute and chronic surgical care; and intimidation by striking individuals of non-striking healthcare workers, who have been threatened and intimidated with physical violence and forced to leave patients unattended.
The doctors' letter says the inclusion of calls for the premier to resign as part of this strike action is impacting on finding a resolution to the health crisis. “The grievances of the striking employees are valid and supported, however the modus operandi is condemned, particularly the shutting down of health service provision,” the report says the doctors’ letter states.
As essential medical supplies dry up in hundreds of health centres in North West, authorities are deploying army personnel to escort medicine delivery trucks. “There are talks with the union, first to allow the trucks that deliver medication to pass. We have also engaged law enforcement agencies to assist with direct deliveries,” North West Health spokesperson Tebogo Lekgethwane said.
The report says millions of people’s lives are in danger as essential medication cannot be delivered to other depots and to health centres in the province as efforts to do so have been frustrated by striking union members who are blocking the trucks. “Well, from our side it’s clearly a matter of failure to manage properly that has resulted in the whole crisis,” North West Nehawu spokesperson Patrick Makhafane said. “It’s very bad that instead of resolving issues they have to resort to delivering services through soldiers. It’s a clear sign of acceptance of failure to manage.”
In a statement last week Stop Stockouts Project (SSP) said the organisation and other stakeholders were engaging the provincial as well as the national department of health to try to come up with a solution to the crisis. SSP said 394 clinics in the province are unable to provide essential medicine to patients. In short supply are vaccinations, injectable contraceptives, HIV, Tuberculosis, and epilepsy drugs, as well as high blood pressure medication. Several types of antibiotics and government-branded condoms were also not available to be dispensed.
SSP said in the report that its affiliate, the Treatment Action Campaign (TAC), had already started engaging with the national leadership of the labour unions involved to resolve the impasse. Vuyokazi Gonyela of Section27 said pharmacists and facility managers at the centres they visited reported having no Panado, vaccinations, co-trimoxazole, AZT, 3TC, Nevirapine, Efavirenz, Alluvia, injectable contraceptives and condoms.
The report says the impact of the shortage of medication on the people is severe, especially for the poor who often cannot afford to go to private health practitioners. Activists are concerned that the shortages would have a detrimental effect on mortality levels, and the quality of life of people with HIV and other chronic conditions. A failure to take antiretroviral treatment consistently leads to drug resistance which limits treatment options for HIV patients in the future. A lack of contraception would also lead to unplanned and unwanted pregnancies as well as raising the risk of sexual transmitted infections.
Glenda Muzenda of SSP said the situation required “urgent intervention”. “They could think about even using whatever stocks are available from different provinces just to make sure that there is supply for now for patients who we know have gone a week without their medicines and that compromises their health.” Muzenda raised concern, especially in relation to HIV patients. She said it was very important that their treatment cycle is not broken.
If somebody who is on HIV treatment does not take the medication for several days, resistance to the drugs begins to build. “The next time you take that medication it might not work as good as it should. It could have health implications for you. Your immune system is compromised again. That is what we are concerned about,” Muzenda said.
Doctors Without Borders’ Sean Christie said in the report that during the cause of the organisation’s outreach team’s work they came across an HIV positive child who did not have medicine. “The child was in a really bad state and the parents were distraught,” Christie said. Christie did not want to be drawn on administrative issues in the province possibly being the cause of the medicine crisis.
Section27 said the futile trips patients made to health centres only to find empty shelves was also a financial burden to patients. It is also a psychological burden as patients often have fears of involuntary defaulting on their treatment.
The report says the doctors’ letter highlights risks for patients with TB, HIV and chronic diseases as well as those requiring emergency surgery or who were experiencing high-risk pregnancies. “Many psychiatric patients are not being treated, which may make Life Esidimeni numbers look insignificant,” the letter reads.
And, the report says, although the problem is currently most prevalent in North West, the province is not the only one to experience stockouts. Section27 said it was closely monitoring the situation in other provinces, but said Mpumalanga also has shortages. In the past stockouts have been experienced in the Northern Cape and Gauteng.
To address the shortages facility managers at health centres in North West are sharing medication between patients so that they at least have some medication. According to the project, staff at the centres have low morale as they are unable to provide for their patients’ needs. Those who are able are being encouraged to buy their medication privately.
“Maladministration has played a huge role in everything that is happening there,” Gonyela is quoted in the report as saying.
SSP said the organisation and other stakeholders were engaging the provincial and national departments of health to try to come up with a solution to the crisis.
Motsoaledi must prevent a repeat of the Esidimeni tragedy in the North West. This is according to Patricia Kopane, the Democratic Alliance (DA) Shadow Minister of Health who says that the DA will write to Motsoaledi to urgently request that he ensure proper staffing and resources at the Klerksdorp/Tshepong Hospital Complex in Klerksdorp.
Kopane sayd: “During our oversight inspection, we were shocked when doctors asked us for urgent help on the eve of a planned strike by Nehawu which would see nurses down their tools. The strike in Klerksdorp is scheduled to begin tomorrow.
“The doctors indicated that they are extremely concerned for the lives of patients who are currently receiving critical care. The complex (which includes Klerksdorp Hospital) has more than 1 000 beds.
“Without professional nursing staff and proper care, these patients’ lives are at risk. Professional medical staff said this can escalate into ‘a tragedy that will have a bigger aftermath than the deaths at the Esidimeni Health Care Centre’.
“Nehawu is demanding that North West Premier, Supra Mahumapelo, steps down. During our visit, a group of members barged into the hospital complex singing and dancing amongst the waiting patients. The hospital management confirmed they do not have enough security staff to keep order and that they will have to make use of freelance nurses once the strikes begin.
“At the Khuma Clinic, in Stilfontein, there is a lack of chronic medications and some patients have been sent home without medication.”
The Mahikeng Ministers’ Fellowship (MMF) has welcomed the deployment of members of the South African National Defense Force’s (SANDF) health services to Mahikeng Provincial Hospital to alleviate the looming health care crisis. The Citizen quotes MMF chair pastor Moss Tlalang as expressing the hope that the intervention would also be extended to other facilities across the province where there might be a need. “We hope to see further roll-out of national government intervention towards resolution of the health employees’ strike, as well as renewed efforts to address workers’ grievances while political processes and broader consultations to address governance issues and corruption allegations unfold,” Tlalang said.
The report says the intervention announced by President Cyril Ramaphosa had given hope and calmed the volatile situation and should be fast-tracked to “frustrate violent criminal elements determined to hijack genuine service delivery concerns”.
The MMF task team had in its effort to mediate in the protracted strike by Nehawu visited Mahikeng Provincial Hospital earlier in the week to be appraised of the problems in health services provision after most clinics in the provincial capital had been closed, Tlalang said.
The North West Health Department had earlier welcomed the arrival of the SANDF Health Services wing to the province’s health facilities, particularly around Mahikeng amid ongoing violent protests by residents calling for the removal of premier Supra Mahumapelo.
The Citizen reports that members of Nehawu have been on strike in the province since 26 February, demanding the dismissal of the head of the Health Department, Dr Thabo Lekalakala, the termination of contracts for companies issued by the department, a bonus payment of five percent for all employees in the department, among others.
The strike has paralysed health services in the provincial capital Mahikeng, igniting mass protests after two people died at Motshioa Stad clinic.
The report says Mahumapelo suspended Lekalakala on Thursday of last week after the release of a preliminary report into allegations of impropriety against him in the awarding of a Health Department contract to Mediosa, which is linked to the controversial Gupta family.
Spokesperson Lekgethwane said: “It’s been weeks since the province has been experiencing unprecedented pressure on the health system due to disruptions that occurred in a number of health facilities. The latest community protests contributed immensely to the challenges faced by the department.”
Lekgethwane said the environment had not been conducive for some of the department’s health professionals especially nurses, to provide uninterrupted health services as they feared for their lives since the protests started.
“MEC Dr Magome Masike has since been engaged in talks with the National Ministry, the SANDF and authorities in the country to avail the services of the military health services.”
Just when he was breathing a sigh of relief after the army’s health services – a team of nurses and doctors – took over collapsed health services at Mahikeng Provincial Hospital, Health Minister Aaron Motsoaledi was told more health professionals were downing tools in other areas. City Press reports that this comes as the more than month-old Nehawu strike gained momentum.
Serious threats were reported at hospitals in Lehurutshe and Taung. And, the report says, nurses at Mahikeng Hospital were forced to down tools by either joining the strike or, according to Motsoaledi, they stayed away because of threats from pro-strike colleagues.
Over the last few days, family members were forced to remove some of the seriously ill-patients from deserted wards in Mahikeng. The hospital has also become overburdened after at least five clinics were forced to close their doors two weeks ago.
The report says Mahikeng was plunged into scenes of chaotic violence last week with communities demanding Mahumapelo’s removal.
The other challenge for the Health Department was that the pharmaceutical depot in Mahikeng, which supplies all clinics and hospitals across the province, was also closed as part of the strike. But the report quotes Motsoaledi as saying that the depot has since been taken over by army officials and that chronic medication and other medical supplies have already started moving.
With 40 nurses already deployed by the army at Mahikeng Hospital and 17 more still expected, Motsoaledi said a lot of work has already been done. Seven doctors have also been deployed and nine more are on their way. Motsoaledi said in the last 24 hours the soldiers already delivered 21 new-born babies – including six caesarean births.
“The situation is normalising there but unfortunately I can’t say the health situation is normalising. The report in the morning was that trouble was starting elsewhere all over the province in areas where there is no strike … health workers were being followed home and intimidated,” he said. “It is a very grave situation in as far as health is concerned. We have secured Mahikeng but all other districts are now starting, so we need to develop a plan and discuss with the army because their mandate was Mahikeng and the medical supply depot. This is a bigger problem perhaps than health.”
Motsoaledi said they were aware of Nehawu’s demands, adding that they will “meet those that are health-related but other demands are beyond the department of health”. “There is no way I can meet a demand as a minister of health that the Premier (Mahumapelo) must go. Even the demand that the HOD (head of department) must go.
“I am the one who said I don’t think this HOD should continue running health services in the province because he is running them down. In terms of the law, both myself and the MEC of health have got no power to remove, suspend or even hire an HOD.”
“I am happy at long last, but after a lot of damage, that I understand (Lekalakala) has been suspended (which is something) I demanded more than a month ago. I told Nehawu they should know it is not the MEC and myself who are not willing to meet their demands but are there political problems which need to be resolved somewhere,” Motsoaledi is quoted in the report as saying.
“I am happy that the President (Cyril Ramaphosa) and officials of the ANC have been here and we’re leaving everything in their hands. I just want to secure services for people who are sick.”
Ambulances were prevented from entering Tshepong Hospital as protests continued to flare up in the North West, reports The Times. Professor Ebrahim Variyava‚ a doctor at the hospital‚ is quoted as saying that protesters had been burning tyres outside. “We are really concerned that our patients who are in ICU‚ in the various wards‚ are not going to be seen by clinicians – and I am uncertain about how many nurses there still are‚ because the nurses would have been on from last night‚” he said.
The report says it was not immediately clear if the protest was related to an ongoing health worker’s strike in the province or calls for a shutdown by Saftu.
The Rural Health Advocacy Project tweeted on Wednesday that there was “chaos” outside Tshepong Hospital. Th report says there were also unconfirmed reports of gunshots in the area.
The protests are spilling to other areas of the province and, The Citizen reports, police in the province are investigating a case of murder after a 16-year-old died during the protest action on Monday. The ANC senior leadership is expected to descend on the province in an effort to address the unrest.
The report says the protests have spread to various parts of North West, including Stella, where a municipal building was set alight as protesting residents demanded better service delivery. A resident in Stella is quoted as saying that protesters not only wanted employment opportunities for local youth but had issues with housing and toilets.
The report quotes Motsoaledi as saying that deploying the army was a temporary solution and that the Health Department would be meeting unions in the province to hold discussions. Meanwhile, ANC secretary-general Ace Magashule said the party was still engaged in talks over ways to resolve the issue of Mahumapelo stepping down as the province’s premier.
[link url="https://www.dailymaverick.co.za/article/2018-04-24-doctors-call-for-urgent-national-intervention/"]Daily Maverick report[/link]
[link url="https://citizen.co.za/news/south-africa/1902342/mahikeng-church-leaders-welcome-deployment-of-military-health-services/"]The Citizen report[/link]
[link url="https://citizen.co.za/news/south-africa/1902236/sandf-intervenes-at-north-west-health-facilities-amid-violent-protests/"]The Citizen report[/link]
[link url="https://city-press.news24.com/News/army-takes-over-mahikeng-hospital-as-health-services-close-to-collapse-20180423"]City Press report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-04-25-chaos-around-hospital-in-north-west/"]The Times report[/link]
[link url="https://citizen.co.za/news/south-africa/1904620/violent-north-west-protests-spread-to-different-parts-of-the-province/"]The Citizen report[/link]