Doctor Ben Gaunt, who led a team that transformed Zithulele Hospital in a Wild Coast village from a struggling public health facility into a poster child for excellence, left the post in 2022 after a decade of service.
Bhekisisa's Sean Christie spoke to Gaunt a year after he – with his wife Taryn and three children – left his dream job, under considerable duress, after the appointment of a controversial CEO.
The couple had worked in Zithulele hospital, about 100km from Mthatha, since 2005 (respectively as clinical manager and medical officer in charge of paediatrics), helping to transform it from an understaffed, somewhat dysfunctional 55-bed facility into a celebrated 150-bed hospital with a multidisciplinary clinical team of 40 people.
In 2022, the hospital became mired in scandal and chaos and the Gaunts and several other senior Zithulele clinicians reluctantly left or resigned.
For many of the role-players, including the Gaunts, it was a damaging, distressing time.
Now in a new home in Port Alfred, Gaunt, who’s still with the Eastern Cape Health Department, today as its clinical medico-legal adviser, said: “Instead of dwelling on negativity I would rather focus on the lessons Zithulele taught us, and how these can be applied not only in my own life but in the public health system.”
For Gaunt’s testimony to make fullest sense, however, it is necessary to examine both the recent past and his own journey in healthcare.
Gaunt was born in Zimbabwe, then Rhodesia, in 1975, and as a toddler moved with his parents and sister to Cape Town.
He attended Westerford High School in Newlands, where one of his friends was Karl Le Roux, with whom Gaunt would one day work side by side at Zithulele Hospital.
“My parents … were not activists, but they’ve always been generous and open-handed in their engagement with society, and I think that this kind of posture rubbed off on me.”
The church was a significant part of this upbringing. “My mother became one of few women to be ordained in the Presbyterian Church,” says Gaunt, who studied medicine at the University of Cape Town, and in his second year met the woman he would marry, Taryn Brown, the daughter of church ministers from KwaZulu-Natal.
Helplessness of SA’s HIV denialism
When Gaunt graduated in 1999, he was not yet aware that Zithulele existed. He interned at New Somerset Hospital in Cape Town, before moving with Taryn to Empangeni, northern KwaZulu-Natal, where they both worked as junior doctors in Ngwelezana Hospital, “…with open passageways and cavernous, old Nightingale-style wards”.
“What I took away from there was probably five years or even 10 years’ clinical experience compressed into two,” he recalls.
Like clinicians across the public service at the turn of the century, the Gaunts witnessed the ravages of an HIV epidemic about which he could do very little, because then-President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang did not believe HIV caused Aids, thus ensuring South African patients were denied access to life-saving treatment.
“In the paediatric ward there was only piped oxygen accessible against one wall. We called the line of cots ‘death row’. Often, we simply turned adults away because there was little point admitting them when we could do so little to help.”
How he started at Zithulele
After Gaunt began to exhibit signs of burnout at Ngwelezana, the couple decided to resign and take jobs in New Zealand. “We recovered thoroughly but remained convinced our calling was to rural Africa,” he says.
Back in South Africa, he demonstrated the seriousness of his intent by taking a job in obstetrics in Empangeni, “an important piece in the puzzle of rural preparation. It makes for much of the after-hours work at a rural hospital”.
The couple planned to add experience in HIV medicine to their preparation, as antiretroviral treatment (ARVs) had finally become available, but found themselves quite suddenly in the rural Eastern Cape exploring an opportunity to work at Madwaleni Hospital.
Ultimately, the authorities offered posts at Zithulele, and the Gaunts accepted.
When they arrived in July 2005, they found a hospital beset by challenges.
“The pharmacy was out of stock of many essential items, and run by untrained staff. Medical equipment – including essentials like laryngoscopes – was either broken or missing, and the ‘high protein diet’ was plain bread and mielie-pap. Services were run down and minimalist; many patients who should have been treatable were sent to the referral hospital in Mthatha.”
Righting some of these issues required an extraordinary personal investment.
The Gaunts were frequently at the hospital for 36 hours at a time, and in one of their first new year periods, Gaunt was on call for seven nights out of eight – “on duty for 186 out of 201 hours.”
In time, things would become less relentless. The arrival of doctor friends Karl and Sally Le Roux in 2006 helped spread the load, and in 2007 three new doctors doing community service, two pharmacists, two occupational therapists, a physiotherapist, social worker and a dentist joined the team.
The hospital was developing a “sticky core – people who came, and stuck”, enabling a shift from a survival mindset “to where it was possible to plan for the expansion and improvement of services”.
Improvements
It wasn’t long before the area’s healthcare picture began improving.
In 2005, 745 women gave birth in the hospital – within a decade, this had risen to more than 2 000 births annually, reflecting increasing trust in their services. In the paediatric ward, in-hospital mortality decreased more than five-fold. A growing ARV programme meant people had stronger immune systems, were less susceptible to TB. Hospital services and the broader community were being supported by non-governmental organisations, including the Jabulani Rural Health Foundation, founded by the Gaunts and Le Rouxs.
“I’ve often been asked, ‘What made the difference at Zithulele?’ The first answer I give is ‘commitment to our patients’, which was linked to a deep conviction that people in rural areas deserve the same services as urban people.
“It’s about finding the balance between being clinical and dispassionate, and really seeing the person in front of you.”
Healing power of holding a stillborn baby
Gaunt is clearly a person of action, but also, “very conscious that I wear rose-tinted glasses, and it is just a question of what shade I am wearing at any particular time”.
At Zithulele, he came to depend on people he refers to as “cultural bridges” to understand what was happening around him, “because we were ignorant”.
He and Taryn sought out people “who didn’t treat us with suspicion … to engage with us and help us to understand this deeply rural, traditional, political culture”.
An illustrative example was the issue of dealing with stillbirth.
“The prevailing practice among midwives in Zithulele was that we don’t hold the dead baby, and yet when we unpicked it, a lot of people agreed that holding the dead baby had probably been commonplace around the world for a very long time.
“We started to understand that the grieving process often requires that a woman – who wants to – needs to hold their baby and actually bond with it. Specific cultures may have specific views on the matter, but each of us in our own culture is an individual with individual needs,” he observes.
To inculcate an attentive, intuitive and caring culture at Zithulele, Gaunt realised it was vital to first recognise the humanity of the carer.
“The bureaucracy loses sight of that, but people are your greatest asset … you need to look after them, which includes recognising the importance of things like mental health.
“I wouldn’t say I have faced serious mental health issues but especially at Zithulele, I definitely felt more stretched,” he says, adding his wife encouraged him to take action at a particularly stressful time in 2014.
Mentorship breakfasts
From 2015, mental health and other relevant issues were discussed among “Zithuleleans” at monthly “mentorship breakfasts”.
“Instead of a team ward round on a Friday morning, once a month we cooked breakfast together, and everyone would speak for a few minutes about whatever mutually agreed question we had posed ourselves: ‘Why did we get into medicine? Can you remember an incident in medical school that shaped your career’, or ‘What is the role of women in healthcare?’
“People loved it, we learned a lot about each other,” says Gaunt, adding interventions like this “were mostly accidental, stumbled upon” but they started to add up to a personal view of leadership, “probably best summarised as values-based leadership”.
“As the team started to grow, we realised we are different people with different perspectives. And we found ourselves needing to sit down and ask, ‘What are our core values?’
“We wrote them down as the clinical team, and that took quite a long time to seep into the rest of the hospital, because we didn’t have the authority or mandate to run that process for everyone else. But in the end they were incredibly useful,” he says, reciting them quickly: “prioritising patient care, multidisciplinary teamwork, respectful relationships, quality care, continual learning, and a hopeful attitude”.
Saying goodbye
In 2022, the hospital’s new CEO insisted on ways of working that were anathema to the clinical culture fostered for so many years by the Gaunts, Le Rouxs and others.
The confrontation, which centred around the CEO’s insistence that hospital patients be referred by a clinic and not be allowed to simply walk in, and that children with complicated HIV had to be sent to clinics, was given added intensity by accusations of racism, the threat of mass resignations and a community protest or two, to the extent that the CEO was ordered to temporarily transfer; by then, Gaunt had already requested secondment.
Ultimately, to avoid further damage to health and well-being, the Gaunts departed.
“I have had plenty of time to reflect and allow the personal resentment side of things to fall away – I keep returning to the fact that all of us in the public service face a decision: are we here to follow the government rules to the letter, even if doing so is morally, ethically and perhaps even practically wrong, or are we here to put people first?
“Issues in healthcare outstrip our ability to update our policies,” he says, making an example of drug-resistant tuberculosis (DR-TB), which, for a long time, was supposed to be managed in hospitals, even though doctors knew it was transmissible and that this approach contributed to the spread of the disease.
To save lives, rural doctors, including at Zithulele, started managing DR-TB in the community.
“In the end, it should be simple – we are here to serve people, but of course it isn’t, and there are many ways of dealing with the frustration that can arise from that,” says Gaunt, admitting he often wonders if he could have stuck it out at Zithulele.
“The fact is that the news cycle moves on yet patients are still experiencing the same realities. Once you’re out you’re out, and the people who are still working are the ones making the difference.”
Equally, there is a time to move on, and Gaunt appears to have made peace with the fact that his moment had arrived. His entire bearing seems to ask the question, “Where can I help next?”
See more from MedicalBrief archives:
Cut link between political leaders and managers to save health service
Rural doctors go the extra mile. Then swim a river
MEC condemns attack on hospital doctor by protestors
Nurses union threatens legal action over security concerns