The plight of a Northern KwaZulu-Natal man who fell through a roof and broke his femur echoes the stories of thousands of patients who depend on the services of ill-equipped state hospitals, a crisis which a leading health expert partly blames on political appointments and “substantial corruption” in the public health sector.
It also calls into question the viability of the National Health Insurance (NHI), they say.
Mail & Guardian reports that Bruce Wilson (54) was initially admitted to Hlabisa Hospital after waiting four hours for an ambulance after the accident on 4 October.
“When we got there he needed an X-ray, but the radiographer was rude to a point where I had to help my husband on to the bed, and they were manhandling him as if there were no broken bone,” his wife Karina said.
The couple had anticipated he would not have to wait too long for surgery, because of the severity of the injury, but he was told he had to wait until 7 October to be transferred to Ngwelezana Hospital, outside Empangeni, where the operation would be done.
His wife said they were told there was a shortage of ambulances.
“By then we knew how dangerous it would be to even try to transport him ourselves as we could rupture the main artery in his leg; he needed an ambulance and professionals,” she said.
The couple hired a private ambulance after the state ambulance refused to transport Wilson because he would “take up too much space” as he needed to lie down. But when they arrived at Ngwelezana, there was no bed for him.
They eventually found a bed for him, “but a few hours later he phoned and said no one knew when he would have the operation", Karina said, adding that a broken femur should be repaired within 24 to 48 hours of the break.
Wilson described a crowded and under-resourced rural hospital where windows remain shut to keep out the heat on hot days, linen was dirty, and some patients had been in hospital for more than two weeks in the same clothing.
“A patient next to me was released but left the bed soaked in urine. The ward was designed for five beds, not seven, so the bed was 1.2m away, stinking,” he said.
Wilson said nursing staff were “very frustrated” and some had “lost their zest to be helpful”, although others were “angels”.
He had no idea when he would be operated on because new patients, mostly children and older people, were pushed to the front of the queue, while he continued to wait.
After the Mail & Guardian sent questions to the KwaZulu-Natal Department of Health about the state of emergency services and why Wilson had to wait so long for surgery, he was told his operation would be on 22 October – 19 days after his accident.
KwaZulu-Natal Health spokesperson Ntokozo Maphisa said it was “important to state that planned patient transport is available and there are standing protocols for transfer … between facilities. It is not clear why this patient could not be transported.
“Ngwelezana Hospital serves a large catchment area, including only King Cetshwayo, Umkhanyakude, greater Zululand, and other surrounding areas… and the orthopaedic department usually operates at full capacity.”
Wilson was discharged on 25 October but said this week he has no idea how the operation went.
“No X-rays were taken after surgery. The recovery will be longer due to not having the op in the first 24 to 48 hours; and the muscles have lost all capability,” he said.
He was discharged with crutches because the hospital did not have a walker.
“No exercises were given to me to do at home so I am trying to figure it out on my own until the end of January, when I have my first appointment with the physiotherapist,” he said.
Commenting on resources in the province, as well as Gauteng, the Eastern Cape and the Western Cape, University of the Witwatersrand health economist Alex van den Heever said there is no continuously updated public database of health facilities, emergency vehicles and health professionals in the country.
“As a consequence, no systematic analysis of provincial services is possible,” he said.
Asked how equipped provincial health services are ahead of the implementation of the NHI, Van den Heever said information on the public and private health systems does exist and should be publicly available but is not.
“The performance decline in all but the Western Cape has resulted from leadership appointments unrelated to the mandate or mission of provincial health services,” he said. “The political appointments into provincial health administrations has resulted in substantial levels of corruption, which is reflected in the irregular expenditure levels.
“It is likely that the corruption levels exceed what can be tracked as irregular expenditure. There is no evidence this tendency will change in the near future as there is apparently no political will to address it.”
Van den Heever said there is also no financial appraisal of the NHI nor any indication of target levels of service provision.
“The NHI also has no clear implementation pathway. Importantly, emergency transport services are not a national competency and cannot fall under the NHI. As things stand, there is no national plan or framework to address critical care services.”
See more from MedicalBrief archives:
Four gunshot wounds but a two-week wait for surgery at George Mukhari Academic Hospital
6,000 surgical patients in Gauteng face up to 3-year wait
Patients are bearing the brunt of SA’s inadequate health services