Surgical waiting lists are not unexpected in the context of the COVID-19 pandemic, but the situation is particularly acute in the Free State, for reasons not directly related to COVID-19, writes Refilwe Mochoari for Spotlight.
According to a doctor at a large hospital in Mangaung, hundreds of patients are awaiting surgery, some for as long as six weeks. One woman has been waiting for seven months for a hip prosthesis after a car accident.
The doctor said fractures that should be operated on within 48 hours were often not operated on in time. This can lead to various complications.
One reason for the long waiting lists, said the doctor, was that equipment and devices required for surgery were frequently out of stock, possibly relating to a procurement freeze after a National Treasury directive on 3 March.
The directive has since been retracted after a clarification from the Constitutional Court.
A nurse in an orthopaedic ward at a hospital in Mangaung said there was a shortage of nurses and specialists, which was why patients wait so long to be taken to theatre. “This is where patients suffer the most in the hospital,” she said.
“First they are forced to be in the waiting room because of a bed shortage; when they eventually gets beds after days in the waiting room, they can stay there for months waiting for surgery. When they are told their operation has been scheduled, they are told not to eat food beforehand, only for the surgery to be cancelled, so they go without food for a day or two. We see these things, but cannot talk because we fear for our jobs.”
The situation at Pelonomi
When Spotlight visited Pelonomi Hospital in Mangaung earlier in June, we found patients sleeping on the floor in the waiting room of the orthopaedic ward, some on old mattresses, some on chairs, some in wheelchairs. Some wore plaster casts. It was cold and not everyone had blankets.
One patient said they had been waiting there for days because there were no beds.
Mmathabo Mokoena from Edenburg, outside Bloemfontein, told Spotlight she had been sleeping on a chair since 30 May and was allocated a bed only on 14 June. When Spotlight checked on 17 June, Mokoena had been discharged and was on her way home without having had her surgery.
Her first visit to Pelonomi hospital was on 13 May. “I fractured my hand and went to Edenburg clinic and then was taken to Pelonomi by ambulance. The orthopaedic clinic X-rayed me and a plaster cast was put on my hand. I was told to come back on 30 May for a follow-up,” she said.
“On 30 May when they did another X-ray on me, they realised they made a mistake; my bones were not properly connected which is why I had been in pain since 13 May when they put on the plaster cast. I was immediately referred to ward 5, and sat on a chair from then until 14 June when I was finally allocated a bed. Today, on 17 June, I have been discharged, but did not get an operation. They did nothing on my hand. When I ask why I was discharged, they said my hand does not need surgery anymore. They say I am healed. Just like that. So I have been here for nothing.”
Another patient, Masego Legetho, had been in the waiting room from 1 June waiting for surgery on an ankle fracture, and the insertion of screws and plates. On 17 June, she was still in hospital awaiting surgery.
“I don’t live far from here. I asked the nurses if I can at least go home for a peaceful sleep, but they tell me that is not how it works,” she told Spotlight. “I am in pain. It is cold here. We bath with cold water and share bathrooms with males. This is the most uncomfortable situation I have ever been in.”
Just one of many problems
Mariette Pittaway, health spokesperson for the DA in the Free State, said the orthopaedic surgery waiting lists were just one of many problems the department faces. She said Free State MEC for Health Montseng Tsiu and head of the Free State Health Department Godfrey Mahlatsi blatantly ignore this crisis. “They don’t care,” she says. “The department is negligent, has no regard for the livelihood and well-being of patients.”
In Boitumelo Hospital in Kroonstad, she said, one patient had been in hospital for seven months awaiting surgery. “She was in a car accident in December 2021 and has been in hospital since then. She broke her knee, pelvic socket and pelvis. A surgeon said she would need a hip prosthesis.
“Every week she is prepared for surgery only to be told it has been cancelled. There is a new story every week. Sometimes there are no aircons in theatre, sometimes the doctor is sick, or sometimes they say they don’t have apparatus to sterilise equipment. On 15 June, she went into theatre again. This time she was cut open but closed again without doing any work being done. She is still in hospital.
“I have written to the HOD and the MEC about this patient but they ignore me. Every week there is an excuse as to why the procedure was not done.”
Health department responds
Spotlight asked the Free State Department of Health how long waiting lists are and the current average waiting times for surgery at large hospitals like Pelonomi and Universitas.
Departmental spokesperson Mondli Mvambi did not provide specifics. “All patients are evaluated at point of care (emergency rooms and clinics) and triaged using international criteria. Emergencies that are considered life-threatening are taken to theatre within usually 30 minutes to an hour. Emergencies classified as urgent are operated usually within six hours.”
He did not provide any details on the length of surgical waiting lists as we requested.
“Patients requiring elective surgery are all seen at clinics, a triage system is applied with certain conditions getting priority over other conditions. (For) example, cancer surgery gets priority over cosmetic surgery. Some elective non-urgent surgery will then be delayed to prioritise more urgent cases.”
In February, the department released a media statement saying that some district hospitals, including Boitumelo Hospital in Kroonstad, Dihlabeng Hospital in Bethlehem, and Mofumahadi Manapo Hospital in Qwaqwa, had been provided with orthopaedic equipment to avoid unnecessary referrals to Pelonomi Hospital.
Theatre space was also reportedly prepared at Alfred Nzula Hospital in Trompsburg for pre-booked patients, including those on the backlog list at Pelenomi Hospital.
“The high volumes of trauma, injury and violence overwhelm our staffing levels and require more theatre space, time and resources,” the department said at the time. “There are currently 66 patients Pelonomi is trying to schedule for orthopaedic surgeries this week, including those referred for surgery at Albert Nzula District Hospital. Pelonomi did 251 surgeries in November 2021, 250 in December 2021, 253 surgeries in January 2022, and so far 134 for February 2022.”
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