It has been a very dark week in the Eastern Cape as all the unheeded warnings, the hidden agendas, patchy leadership and years of procrastination and misguided priorities all seemed to hit at once, creating a perfect storm and confirming what many knew and feared: when disaster comes to the Eastern Cape, it arrives at full strength.
Daily Maverick reports that it also forces us to ask what it will take for the national government to intervene in a province in crisis? Do they need people dying in the streets? Tick. A 1,000-bed hospital that is not used because staff weren’t appointed in time? Tick. A maternity hospital in crisis because staff are not arriving at work? Tick. R10m in COVID-19 funding for scooters that, it turns out, will only be ready in three years? Tick.
Hospitals around the province are full. Both public and private hospitals are battling an increase in patients and a decrease in staff numbers as COVID-19 takes a deadly toll on overstretched health workers.
Daily Maverick says calls are growing for MEC of Health Sindiswa Gomba to be fired – but frankly, at this stage of the health emergency, the question must be raised if a new political head will help at all. The crises we are experiencing are not the making of COVID-19: It is the confluence of years of corruption, inefficiency, maladministration and cadre deployment at every level of provincial and local government.
It says it was a collapse waiting to happen. It took a tiny, malicious virus to bring us to the brink.
News24 reports that Eastern Cape Premier Oscar Mabuyane has admitted the province's hospitals are "overwhelmed" in the fight against COVID-19, and has asked national government for the support of the South African National Defence Force medical team.
Health Department superintendent general Dr Thobile Mbengashe said projections show the province needs 10,000 beds to deal with the COVID-19 storm when the virus peaks in the province in the next three months.
They will also need 3,000 ICU beds for the peak in July, August and September. Mabuyane, who warned that the virus is going to get worse, said the province was building one field hospital with 500 beds for all six district municipalities and two metros. He said this was "to ensure that we are prepared for the surge of patients with COVID-19 infections".
Mabuyane said: "This will give us a combined total of 4 000 medical beds throughout the province. These are not normal beds. These are medical beds with all required medical resources and high care medical equipment to save lives. We have recruited an additional 1 000 nurses and over 5,000 community (health workers).
Over the past few weeks, we have seen a systemic collapse of the Eastern Cape health system which has placed thousands of lives in mortal danger. The Democratic Alliance (DA) writes in a statement on the Polity site that is why it had written to the Health Minister, Dr Zweli Mkhize, two weeks ago, making the case for the Eastern Cape Health Department to be placed under administration according to Section 100 of the Constitution.
The DA said: The pace of intervention in this province is causing more senseless loss of lives.
In an effort to escalate this matter, the DA will now include the leader of government business, Deputy President David Mabuza and make the case for urgent intervention in the province.
This morning, the DA conducted an oversight inspection at Cecelia Makiwane Hospital (CMH) to see first-hand the issues which the hospitals in the province are grappling with, over and above the surging numbers of the pandemic. Issues such as chronic staff shortages, dangerous lack of oxygen supply, insufficient personal protective equipment (PPE) are only some of the key matters.
During our visit this morning we were also made aware that CMH is only operating with 2 ICU beds dedicated for COVID-19 patients. While there are plans to add 12 more ICU beds, this has yet to happen despite the rising numbers.
This government cannot simply ignore the plight of thousands of people in the Eastern Cape who are dying due to years of neglect of the health system. As the various parts of the country experience the crushing effects of this pandemic, every effort must be made to ensure that the system serves people as much as possible. Failure to do so is in direct contravention of the Constitution. The right to health is not being realised due to sheer state neglect.
The DA shadow MEC for health in the province, Jane Cowley also writes that the Fort England Psychiatric Hospital, in Makhanda, has a full 40 bed unit to accommodate patients who test positive for COVID-19, but not a single professional nurse to work in it.
Cowley writes that, despite a formal request to the Health Department for staff to manage this unit and to provide all the necessary equipment, including oxygen, nothing has been forthcoming.
She says as with many other health institutions across the province, Fort England have suffered from high staff infection rates, with more than 50 healthcare workers testing positive adding to the challenge that healthcare workers who wish to be tested, to ensure that they are negative and can thus return to work, are told they will only be tested if they are symptomatic. A further challenge is the uncertainty around when they will receive further stocks of Personal Protective Equipment (PPE) which has resulted in them having to re-use disposable items in contravention of Covid-19 guidelines.
And, Cowley writes, the Uitenhage Provincial Hospital has been severely underfunded, because the Eastern Cape Health Department has incorrectly allocated funds to it as a district hospital, when it is, in fact, officially gazetted as a regional hospital.
Cowley says that this is an unnecessary bureaucratic nightmare in the midst of the COVID-19 pandemic. Wards stand empty at Uitenhage Provincial, while other hospitals across the metro have become overcrowded battlegrounds against the disease.
The hospital is supposed to offer general specialist services and a platform for training and research, but they are only receiving the budget and the staff organogram of a district hospital, which is far smaller and offers less services.
The crisis at some Nelson Mandela Bay hospitals is escalating as doctors are having to clean wards and wash bed linen, while dirt stands in hallways amid crippling staff shortages. News24 reports that nursing staff at Livingstone Hospital have told a shocking tale of overwhelmed staff and overflowing wards that are manned by just two nurses.
At Uitenhage Hospital one nurse is quoted as saying they have had to be creative with space and use offices to treat outpatients. She said community members have taken charge, volunteering to clean the hospital.
The report says at Livingstone Hospital, dirt and used surgical equipment covered the floors. In one of its pharmacies, the entrance was covered with used sanitisers, surgical gloves and needles. Beds covered in dirty mattresses were also lined up in corridors. In another ward, dried blood spots covered the floor as staff wheeled patients across the filth. In the elevators, gloves and dirty bed covers were nestled against each corner while the stairway was stained with blood.
Two weeks ago, nurses, cooks, porters and cleaners at the hospital went on a go-slow that lasted for 10 days, the nurse said. The frontline staff are calling for overtime pay. Nurses at Dora Ngiza Hospital went on a go-slow after patient admissions shot up as a result of COVID-19, complaining of being overwhelmed and short-staffed.
Provincial health department spokesperson Sizwe Kupelo said in the report that staff issues have been resolved, and that protocols of dealing with COVID-19 patients were explained to the staff. Kupelo previously blamed the staff shortage at Livingstone Hospital on the demand for overtime pay at the hospital, News24 reported. He also claimed that when outsourced cleaners were sent in to clean the hospital, they were allegedly threatened by striking staff.
Screening protocols are falling through the cracks at Livingstone Hospital, common areas are not being regularly sanitised and staff are not wearing their personal protective equipment (PPE) properly, increasing the risk of COVID-19 spreading through the Port Elizabeth hospital and into the community, reports The Times. These warnings, contained in an internal audit report commissioned by the Eastern Cape Health Department, coincide with a sudden increase in the number of coronavirus infections and deaths in Nelson Mandela Bay.
The audit report recommends swift and decisive action to fix the problems, but though it was handed over to Livingstone Hospital management a week ago, nothing has changed, according to an informed source. The report highlights lack of consequence as a major driver for the problems at the hospital in Korsten.
The report also highlights poor screening controls. “We observed that all visitors are not screened daily upon entry to the facility,” it says. “Therefore, there is no full record of everyone who visited the facility on a particular day, and a person who might have coronavirus symptoms may be allowed to enter. Furthermore, staff are not screened daily before they start a shift. Temperatures are not taken at the administration block due to a lack of thermometers.”
The report notes further that Livingstone Hospital does not have an appointed compliance officer. “The cause is oversight by management and shortage of staff, and the effect is no monitoring of the screening team and no accountability if the screening team is not functioning, as required by guidelines.”
The Eastern Cape healthcare system has collapsed. This is according to doctors and healthcare workers who are employed in the province. “We are sitting with a situation where patients are lying in the corridors of hospitals like Livingstone in Port Elizabeth and are dying, and there may soon be a similar situation Dora Nginza in Zwide,” a doctor is quoted in City Press as saying. The doctors spoke on condition of anonymity, fearing being fired for speaking out about the conditions in the Eastern Cape.
They said nothing had come of the promises made by the Eastern Cape Health Department. Weeks ago, the department pledged to appoint more personnel, but nothing has happened. The same went for its promise to avail staff of additional personal protective equipment. There are only two state ambulances currently servicing the whole of Port Elizabeth. In addition, there is a major shortage of basic medical necessities, such as adult nappies.
The report says this comes amid warnings from experts – including Professor Lungile Pepeta, dean of Nelson Mandela University’s faculty of health sciences – that the number of COVID-19 cases in the Eastern Cape could double within the next 10 days.
Andre Bothma, head manager of Netcare’s hospital division in the Eastern Cape, confirmed that the group’s Greenacres Hospital in Port Elizabeth and Cuyler Hospital in Uitenhage would halt all elective surgeries for the time being. “We have made the decision so we can make more beds available in the ICU for COVID-19 cases, because we expect a drastic increase in the province,” said Bothma. “This decision will be implemented from this week, and operations at these facilities will only be carried out in exceptional cases.”
The report says the province is currently in the process of finalising a service level contract to work in conjunction with Netcare, as has already been done in the Western Cape and Gauteng. Doctors at state hospitals say this cooperation will help, but it is most likely too late.
Pepeta has recommended that medical students be used to provide COVID-19 care.
Meanwhile, the department has also had to deal with nurses who abandoned their posts at the Dora Nginza Hospital in Port Elizabeth and at the Frere Hospital in East London, reports The Times. It is believed that among other things, the nurses were unhappy about being understaffed.
“No matter the grievances, abandoning patients can never be condoned. This placed expecting mothers and their unborn babies in grave danger,” said Kupelo. “One doctor at the respective wards at the two hospitals were left having to play God as they were left on their own.
“While their grievances are being addressed, including deploying more staff to ease the pressure on them, abandoning patients is unacceptable as health professionals have taken oaths,” Kupelo added.
The provincial health department said it would consult the national department on these grievances.
SA Medical Association (Sama) chair Dr Angelique Coetzee is quoted in a report in The Times as saying: “If there are not enough doctors or nursing staff, who is going to look after the patients? It simply cannot happen.”
Coetzee said the spreading of fake news and miscommunication was fuelling the fear among front line workers fighting the virus. “I think when they (health care workers) hear that one of their colleagues has tested positive, it creates such an uncertainty angst among health care workers and nurses that they don’t go to work out of fear, and it shouldn’t be like that. They need to understand the basics of the virus,” Coetzee said.
Coetzee said hospital management should have made sure that staff fully understood all the protocols and details concerning the virus.
Six clinics in Buffalo City Metro have been shut down as staff members test positive for COVID-19. A Daily Dispatch report says this was confirmed by Eastern Cape Health spokesperson Sizwe Kupelo who said that Mncotsho, Berlin, Ilitha, Ndevana, Quigney, and Frere Gateway clinics had all been temporarily closed. He said the department could not afford to have health centres shutting down during the pandemic, which has already killed over 2,000 people in South Africa.
“The national department (of health) is working on new regulations to deal with these spontaneous closures of healthcare facilities and the decontamination process. But we can't afford to close hospitals and clinics,” said Kupelo.
[link url="https://www.dailymaverick.co.za/article/2020-06-30-saving-eastern-cape-from-covid-19-existential-threat/?utm_medium=email&utm_campaign=First%20Thing%20Tuesday%2030%20June%202020%20Rain&utm_content=First%20Thing%20Tuesday%2030%20June%202020%20Rain+CID_87a2636f21cccbeb39c5b848213c7c5b&utm_source=TouchBasePro&utm_term=Saving%20Eastern%20Cape%20from%20Covid-19%20existential%20threat#gsc.tab=0"]Full Daily Maverick report[/link]
[link url="https://www.news24.com/news24/southafrica/news/covid-19-overwhelmed-eastern-cape-asks-for-sandf-medical-teams-help-20200701"]Full News24 report[/link]
[link url="https://www.polity.org.za/article/mkhize-must-place-eastern-cape-health-under-administration-or-accept-responsibility-for-preventable-deaths-2020-06-29"]Statement on the Polity site[/link]
[link url="https://www.news24.com/news24/southafrica/news/watch-covid-19-inside-a-nmb-hospital-where-dirt-stands-in-hallways-doctors-clean-wards-20200628"]Full News24 report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2020-06-29-safety-measures-not-observed-at-livingstone-hospital-report-warns/"]Full report in The Times[/link]
[link url="https://www.news24.com/citypress/news/eastern-cape-healthcare-has-collapsed-sick-people-are-fighting-each-other-20200628"]Full News24 report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2020-06-30-watch-eastern-cape-in-crosshairs-patients-abandoned-pupil-fooling-around-in-ward/"]Full report in The Times[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2020-07-01-covid-19-call-to-improve-advice-to-fearful-health-care-staff-staying-away-from-work/"]Full report in The Times[/link]
[link url="https://www.dispatchlive.co.za/news/2020-06-26-six-bcm-clinics-close-for-covid-19-clean/"]Full Daily Dispatch report[/link]
[link url="https://www.medicalbrief.co.za/archives/nehawu-criticises-conditions-at-pes-livingstone-hospital/"]Nehawu criticises conditions at PE’s Livingstone Hospital[/link]
[link url="https://www.medicalbrief.co.za/archives/furious-mkhize-steps-in-to-bolster-eastern-capes-weak-efforts-to-fight-covid-19/"]‘Furious’ Mkhize steps in to bolster Eastern Cape’s ‘weak’ efforts to fight COVID-19[/link]