Eastern Cape hospitals are battling to stay afloat, with seemingly little hope of catching up on massive surgical backlogs, and the Health Department owing millions in unpaid debt, which is contributing to an equipment supply shortage and increasing the numbers of desperate patients on long waiting lists, writes MedicalBrief.
With 1 600 patients on the list at Frere Hospital in East London – and theatre time only for three or four knee, hip or shoulder replacement surgeries a month – patients can expect to wait up to a decade for operations, while children wait a year, reports Daily Maverick.
Seven years ago, the provincial Health Department abandoned a plan to increase Frere Hospital’s capacity for orthopaedic surgery – because of the cost implications. Now the waiting list for joint surgery (arthroplasty) – operations to replace knee, hip and shoulder joints – is 10 years.
More than 60 children have been waiting for more than a year for their orthopaedic surgeries.
Health MEC Nomakhosazana Meth said seven years ago, plans were drawn up to double the number of orthopaedic theatres from two to four and replace a 40-bed prefab ward that had been condemned as unsafe.
But funds have never been available to complete these projects – and this year will be no different.
She said the waiting list for more than 1 600 patients in need of arthroplasties is long – nine, “but realistically”, 10 years. The only theatre time available is once a month and doctors can fix only three to four joints at a time.
The department is implementing a plan to train doctors to take over simple surgeries at district hospitals, she said. This would include below-the-knee amputations, wound surgery, orchidectomies (the removal of one or both testicles), lymph node biopsies, drainage of abscesses, tendon repairs and ectopic pregnancies.
Appendectomies and hernia repairs would also be handled at district level.
Plans are also under way to improve the anaesthetic services at all provincial hospitals, she said.
Aside from Livingstone Hospital in Gqeberha and the Bedford Orthopaedic Hospital in Mthatha, Frere is a major centre for orthopaedic surgery in the province, however, orthopaedic services have been in crisis for months.
In February, the Health Department agreed to pay staff three months’ overtime to catch up on the theatre list at Bedford, after it almost shut down due to a debilitating water crisis that has persisted since late last year. However, many patients are still waiting for their surgeries.
“We have to leave the province or leave town to have surgery,” said a patient at Bedford, where operations are also hampered by water and equipment problems.
Another patient hasn’t had surgery because of an “inconsistent water supply”, and because the X-ray machine is broken.
Implant shortage
At Livingstone Hospital, as MedicalBrief reported last week, the orthopaedic department has been issuing letters to patients with broken bones and deformities telling them there is nothing it can do for them, as no surgical equipment or implants are available, and giving them the contact number for the Presidential Hotline.
This is because implant suppliers have stopped supplying the hospital, due to them being owed tens of millions in outstanding payments.
News24 reports that Eastern Cape Health owes the companies R52m, National Health Laboratory Service R102m, and SA National Blood Services more than R23m.
Some of the debt dates back as far as 2019.
The MedicalBrief report described the angst of exhausted interns, caught between overworked seniors, understocked basic medical supplies/equipment and turf-protecting nurses at the Port Elizabeth Hospital complex, who were toughing it out in a dysfunctional administration, with almost zero accountability among support staff and severely compromised patient care.
One described 36 patients sitting and sleeping in chairs in the orthopaedic department “overflow room” at Livingstone Hospital, several for a week at a time, while waiting for an available bed. He said operations were often cancelled because interns couldn’t get through the volume of patients requiring wheeling down for essential pre-op scans, with angry surgeons castigating them.
Metal implant plates were either not ordered or underbudgeted for by departmental officials, resulting in badly broken bones being “cemented” or stabilised, and the patient being sent home.
The interns said they had to scour the hospital for basic medicines, cannulas, syringes, forceps and urine dip sticks, with ECG machines absent or out of order in most wards. They said that in the wards, the “simplest things” were missing.
See more from MedicalBrief archives:
Interns caught in crossfire of 'broken' Port Elizabeth Hospital system
Doctors direct orthopaedic patients to Presidential hotline
DA: Dramatically reduced budget leaves Livingstone Hospital hamstrung
Nehawu criticises conditions at PE’s Livingstone Hospital
Psychiatric patients go hungry and barefoot at Eastern Cape hospital