The Orsmond TB Hospital in Nelson Mandela Bay was closed two years ago because of dwindling patient numbers and with plans to repurpose it as a psychiatric facility – but little progress has been made with this transition.
Since its closure of the facility, writes Luvuyo Mehlwana in Spotlight, R67m has been forked out to 45 former Orsmond staff who refused to be transferred to other facilities in the same district, according to Eastern Cape Health MEC Nomakhosazana Meth.
She said staff were “afforded an opportunity to choose the facilities at which they preferred to be placed”, but 45 of them refused to go anywhere.
A labour dispute is under way, and an agreement reached with them that in the interim, while the bigger organisation-wide service delivery optimisation and organogram is under review, the remaining staff “will be gainfully employed”.
Spokesperson Mkhululi Ndamase confirmed the Orsmond staff had been paid their full salaries and benefits for two years.
“The department continues to engage with trade unions to find a solution to this impasse. The department is concerned about staff shortages and doing its best to address it, including hiring new staff and placing employees where they are most needed.”
DA Shadow Minister of Health in the province Jane Cowley, said: “Until the issue of staff relocation is resolved, nothing will happen.
“The only thing that will follow is the hospital will be vandalised and expensive equipment damaged because the department is too hesitant to make a decision. Those individuals should have received written warnings…the department cannot afford to pay people who are not working.”
Trend of closing TB hospitals
The closure and repurposing of the Orsmond TB Hospital is not an isolated incident, three TB facilities in Mpumalanga will be repurposed.
Also in the Eastern Cape, Empilweni TB Hospital in New Brighton was closed in 2020 as Covid-19 rates were skyrocketing in Nelson Mandela Bay. It has since been converted into a district hospital.
On 1 July, Makhanda’s only TB hospital, Temba TB Hospital, also shut its doors. It was in premises rented from the Grahamstown TB Care Society, but it was “too expensive”, according to the provincial government.
The 31 staff and patients have since been moved to a wing at the busy Settler’s Hospital, in the same town.
The only remaining dedicated TB hospital in Nelson Mandela Bay is the 227-bed Jose Pearson Hospital in Bethelsdorp. But, as Siziwe Ntsabo, acting CEO of Jose Pearson told MPLs during an oversight visit recently, the hospital has its own challenges – exacerbated by the transfer of patients from Empilweni and Orsmond.
“Issues include limited oxygen supply, broken windows, and blocked plumbing,” said Ntsabo. “Since 2019, 61 jobs have been vacant at the hospital, including executive, operational, and quality assurance positions.”
Despite operating without a board, the hospital has a 72% treatment success rate. “This is attributable,” said Ntsabo, “to the new (DR-TB treatment) regimen – of bedaquiline, pretomanid, linezolid and levofloxacin, reducing the number of tablets patients take during their treatment journey from 2 918 tablets to 734 per course.”
Reduced need
In her budget speech on 15 March last year, Meth said low levels of hospital admissions for TB, coupled with a lack of district hospital and psychiatric facilities, had prompted the decision to close and repurpose the hospitals.
“Nelson Mandela Bay has three TB hospitals, yet there are only 118 patients requiring hospitalisation,” she said at the time. “There is no district hospital and no psychiatric facility in the region. It seems rational to consolidate the TB patients into one facility and repurpose the other two … for a designated district hospital and a psychiatric facility.”
One reason for the reduced demand is simply that TB rates are declining. The department’s 2021/22 Annual Performance Plan shows the number of new TB cases in the province dropped from 976 per 100 000 in 2014 to 747 per 100 000 population in 2018.
By last year, Meth said in her budget speech, the department had reached 92/91/79 of its TB targets, meaning 92% of people with TB have been tested, 91% of those started treatment, and 79% of those were successfully treated.
“Patients needing hospitalisation have been consistently dropping,” said Ndamase. “The low-bed utilisation rate is attributable to the efficacy of the therapeutic agents used to treat drug-resistant TB patients.
“Also, the GeneXpert diagnostic test, which is a rapid test for the diagnosis of TB and Rifampicin resistance, has contributed to progress. This means people with TB are diagnosed before they get sick and are started on treatment. This means many patients do not qualify for hospital admission because they are treated at clinics closer to their homes.
“Even our modern 120-bed Khotsong TB Hospital (in Matatiele) has only 12 TB patients. And Themba TB Hospital has 10 bed patients.”
The closures are also a result of a policy introduced by the National Department of Health in 2011, and updated in 2019, whereby several previously centralised TB services were to be progressively decentralised to primary healthcare facilities.
In an article co-authored by Dr Norbert Ndjeka, who leads the national Health Department’s TB programme, the authors describe decentralisation as …taking TB services …and screening, testing, and treatment …closer to where people live.
Decentralisation, the authors write, has “produced better treatment outcomes for DR-TB patients and helped reduce DR-TB care costs”.
Shifting resources
Closing these hospitals makes sense when looking at the TB cure rates, a former matron who worked for 34 years in three TB hospitals in the province, told Spotlight.
“The Orsmond TB hospital was poorly maintained and not safe for patients and staff. It would be beneficial if the department, given its dire financial situation, channelled resources from these closed hospitals to other areas that need them most,” she said.
“Primary healthcare is where most TB patients are tested and treated. People need to be educated, in their communities, that TB is a deadly disease, but that with proper care, it can usually be cured, and there will be no need for hospitalisation.
“Most patients can be treated at home, and manage their own treatment, but if they don’t take the pills, TB can be fatal, or morph into drug-resistant strains.”
Ndamase said consultations were “ongoing with social partners regarding the repurposing of facilities”.
“It would be malicious to imply repurposing means TB services have come to a halt – it simply means, instead of an entire hospital dedicated to TB services when fewer and fewer people are being admitted, sections of certain facilities will be dedicated to TB patients”.
Cowley, however, is sceptical. “While millions are being paid to idle staff at defunct TB hospitals, there is a shortage of personnel and fewer people going to communities to check on TB patients, meaning a shortage of data.
“During Covid-19, many TB patients defaulted on their treatment, and I don’t think all them have been accounted for. If it is true that TB patient numbers have dropped to the point where these facilities may no longer be necessary, then it is a good thing,” she said.
She suspects the department did this to cut costs “because it is not financially viable to run a hospital with low bed utilisation”.
“We know this department is not always transparent about the number of TB cases.”
Differing transitions
Orsmond’s transition from TB hospital to psychiatric facility has clearly been a bumpy one. Some of the staff, sitting in an open garage at the facility surrounded by overgrown grass, refused to be interviewed by Spotlight. They accused the media of not exposing the department and highlighting their plight.
By contrast, one worker at Empilweni Hospital said their transfer from a TB hospital to a district hospital was “handled with care”.
“The hospital is more of a step-down hospital, as we receive patients from Dora Nginza and Livingstone Hospital. We have fewer than 30 patients, and staff far outnumber the patients. Some of them don’t have any work, but they report daily for the sake of coming to work,” Spotlight was told.
Lunga Ntshebe, chairperson of the Grahamstown TB Care Society, said the closure of the Themba TB hospital took the society by surprise.
“To keep TB patient numbers low, the department stopped admitting these patients to the facility before its relocation… to create the impression Makhanda does not need a TB hospital.”
See more from MedicalBrief archives:
DA: Orsmond TB Hospital in Uitenhage in danger of collapse
Hospital staff who refused to be reallocated get R67m for doing nothing
Doctors urge crisis management as Eastern Cape Hospitals collapse
Expert urges active case-finding to start early TB treatment and save lives