Caught between overworked seniors, understocked basic medical supplies/equipment and turf-protecting nurses, routinely exhausted interns at the Port Elizabeth Hospital complex are toughing it out in a dysfunctional administration, with almost zero accountability among support staff and severely compromised patient care.
Fourteen months into their tenure, they say the core purpose of internship: being taught skills, independence and developing confidence, is being undermined and compromised, writes Chris Bateman for MedicalBrief.
The norm for interns at Livingstone, Uitenhage and to a slightly lesser extent at Dora Nginza and PE provincial hospitals, is hours of wheeling patients around for scans and X-rays, waiting for dysfunctional lifts, mopping operating theatre floors, doing paperwork and performing nursing tasks. All complain of porters seldom, if ever, being available – (in spite of reportedly being adequately staffed).
The interns, who did not want to be named, 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.
“For example, I needed a naso-gastric tube. Gathering the equipment for that one task, like lubricant and syringe, can take an hour. Often there’s the wrong equipment, like adult needles for children. Or forms are missing. You walk into the stock room, and it’s stocked with the most unnecessary things. You expect to find sterile bandages, but you find boxes of chest drains. Nobody is managing where the stuff needs to be,” he said.
One intern, suturing the ankle wound of an HIV-positive patient by hand after failing to find a sterile kit and needle holder, pricked himself, resulting in a month of disconcerting post -exposure prophylaxis ARV treatment.
Another told of 36 patients sitting and sleeping in chairs in an 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.
Another added that “either patients take up a bed for several weeks waiting, or we send them home and reschedule. Often those sitting in the overflow room deteriorate and we have an emergency on our hands”.
Interns are paid around R43 000 per month, including “fixed overtime” of between 60 and 80 hours per month, though many, mostly in the obs/gynae and paediatric departments, do 100 hours per month, resulting in fewer people on call.
While there are counselling facilities available for doctors, emotional and physical burnout are rife because the service is seldom used. “There’s literally no time for it (counselling) – all you want to do is go home and sleep. Also, if you’re booked off for, say three weeks, you have to make that time up,” one intern said.
The scariest for one intern, (during the strike) was being left on call in the hospital overnight with scores of patients and almost all wards without nurses.
With senior staff often too busy and overworked to be on hand, interns, especially in high risk wards like obs/gynae, have to think fast and hope they make the right decisions.
“You need that guidance to be confident that you’re making the right decision. When it doesn’t happen, it’s scary. Also, we’re not exposed to natural deliveries. I mean, in theory we know what to do if a baby is in breach, but there just wasn’t enough time to practically be in the labour ward – instead I was doing admin because the senior didn’t want to. Next year I’m in Comserve – I need this experience and guidance now,” she fretted. Often after an emergency C-section, there was no bed available for the patient, drawing the ire of surgeons and seniors with interns acting as lightning rods.
She said there was a severe lack of accountability – “people really try, but the system is so broken. It needs to filter down from the top. The interns are supposed to be a supplementary service, not the backbone of everything”.
One intern said he was on duty one night when a patient with a chest drain went into distress. “He began decompensating. I had to look through three wards to find a chest drain. I had to close the hole in his chest with my hand while asking where we could find a drain,” he said.
“If they didn’t see us as ‘little run-arounds,’ and our seniors also drew blood and put up drips, it would help. Yes, that’s part of our job, but they leave early and let us finish up or write up discharge summaries. The more teamwork there is, the less burnt out and stressed we’d all be – and better able to render patient care,” she added, having just worked four weekends in a row.
One told of a Family Medicine departmental head put on “leave of absence” late last year after a physical confrontation with a peer, currently refusing to leave his post. Allegedly barred from engaging with patients, he was working with interns in an advisory teaching capacity, much to their chagrin. “He blatantly disregarded his suspension – and the interns are afraid of him. It’s a toxic situation with a lot of political debate, rivalry and people fighting for power. There are some big egos involved and a whole lot of red tape,” he added.
Observes Dr Siva Pillay, a former Health director-general of the Eastern Cape (2009-2012), and Foetal Medicine-accredited physician working pro bono in the PE hospital complex: “There’s no effective management. Unions rule the roost. When they can frog march CEOs and clinical managers out of hospitals and the court orders their reinstatement but the Health MEC is unwilling to enforce it, then nobody’s going to tell the nurse what to do. They don’t want to anger the union.”
He believes one of the root causes of the current Port Elizabeth Hospital Complex dysfunction can be traced back to the “eviction” of the Livingstone Hospital and PE Hospital Complex CEO Thulane Madonsela and his senior leadership by striking Nehawu members five years ago.
Madonsela and his senior colleagues obtained a court interdict allowing them to return to work, but the province’s political leadership failed to back them and they subsequently resigned.
This is not the first time an Eastern Health MEC and/or Health director-general have failed to back senior management, bowing instead to union pressure. Among others is the well-documented suspension of former Fort England Psychiatric Hospital CEO Dr Roger Walsh after a wildcat union strike in January 2016, and his subsequent Labour Court victory. Walsh was suspended by Health DG Dr Thobile Mbengashe, in spite of being cleared by a legal panel on 36 union-brought charges. He never got his job back and spent more than a year on full pay.
Spokesperson for the Eastern Cape Health Department Yonela Dekeda said the department “disputes the allegations that the training platform at the Port Elizabeth Hospital Complex as a whole has collapsed”.
The platform had retained its accreditation during an assessment by the HPCSA in October last year when recommendations were made to “further strengthen the training platform, providing support to both intern and supervisor”, including where the platform could be strengthened, all of which were currently being implemented. This included intern compliance to logbook completion.
The department had probed the senior doctor confrontation and was in the process of implementing all recommendations, including taking “appropriate disciplinary measures”.
See more from MedicalBrief archives:
Hospitals and patients bear the brunt of disruptive Nehawu strike
Doctors urge crisis management as Eastern Cape Hospitals collapse
EC Health ordered to reinstate hospital CEO immediately
Hospital infant deaths rocket but Bhisho’s not listening…