Waiting lists for surgery in the Northern Cape have ballooned to nearly 6 500, up from the just under 4 000 recorded in May and reported by provincial Health MEC Maruping Lekwene to the provincial legislature at the time.
The latest figures from the Department of Health’s 2023/24 first quarterly report show that the surgical backlog is now sitting at 6 373, writes Refilwe Mochoari for Spotlight.
Department spokesperson Lulu Mxekezo said that the numbers fluctuate, as the need continues to increase on a daily basis.
“The shortage of specialised theatre staff makes it impossible for us to utilise all theatres daily,” she said, adding that the department would not compromise the safety and lives of patients and operate in theatres with no specialised theatre staff.
The rising backlog numbers are despite the outsourcing of some surgical services in the province. Lekwene told the legislature that the department pays Gauteng-based Medicomed (captured as Medicore-Mets in the legislature minutes) R400 000 per month to assist with orthopaedic surgeries at Robert Mangaliso Sobukwe (RMS) Hospital in Kimberly on a month-to-month basis.
He said the company supplies the department with specialised theatre nurses, a scarce skill in the province. In May, Lekwene told legislators the company had helped with 57 surgeries over a two-week period.
Lack of theatre staff
When asked by Izak Fritz, DA member of the provincial legislature, why the department did not appoint specialist nurses instead of outsourcing these services, Lekwene said there were not enough theatre specialist nurses in the province.
“For us to take this route, it means we need to have internal capacity. For instance, we will have a neurosurgeon but no anaesthetist. We have nurses, but no theatre specialist nurses,” he said.
Outsourcing was not what their preferred choice, he added, but because of the urgency and the growing backlog, the department has no option but to act swiftly. “However, as soon as the backlog has been reduced, we will try to use our internal staff.”
Lekwene reminded the legislature that the backlog was mostly caused by the pandemic, when for two years during Covid-19, hospitals were closed, he said.
Left stranded
Staff at RMS said the long waiting list frustrated patients, with one doctor calling the situation “dire”.
“The hospital has four fully equipped theatres but patients do not get help,” he said “Yes, we do have a shortage of nurses, but it is not as bad as they say. We are available as doctors, but without the help from nurses, we are unable to perform surgeries at all.”
Currently, there were more than 30 patients needing emergency surgery. For ordinary operations, like hip replacements, some patients have been in hospital for more than 18 months, while others have been waiting five years for cataract surgery.
Strain on staff and patients
Dennis Segano, provincial chairperson of Health and Other Services Personnel Trade Union in South Africa (Hospersa), said the surgery backlog was putting a strain on both nurses and patients.
He said the main problems at RMS were the shortage of specialised theatre nurses and a lack of equipment.
“For the theatres, there are enough doctors but not enough nurses,” he said. “We have a problem in that theatre nurses, who are often outsourced by the service provider to work during their surgery marathons at the RMS hospital, have to wait three months or sometimes even six months before being paid.”
Spotlight asked Mxekezo about the late payment allegations but had not received a response by the time of publication.
“We don’t know why the government is not appointing nurses instead of paying a service provider,” Segano said.
“The system is burdened, the nurses in orthopaedic wards are burdened, and we feel sad for the patients who have to spend months in hospital. When you have a fracture, you should be able to go to theatre immediately, but in this province, you wait months before getting help.”
Outside assistance
In October last year, disaster relief organisation Gift of the Givers sent a team of theatre nurses and anaesthetists to assist with the backlog at RMS. According to Ali Sablay, the organisation’s project manager, they performed 72 operations on 72 patients during the catch-up drive.
When asked about long-term plans to reduce the pressure, Mxekezo said the operationalisation of theatres in district hospitals with specialised theatre staff would help reduce the backlog at RMS, as many patients are transferred from districts.
Segano agreed that a long-term solution was to equip district hospitals with decent theatres and specialised theatre nurses.
“Minor fractures must be dealt with at district hospitals. RMS Hospital must only perform serious surgeries,” he said. “If the department can prioritise Harry Surtie Hospital and De Aar Hospital with theatre staff and equipment, RMS Hospital will operate much better and the patients will be helped. It is wrong to send all Northern Cape patients to one hospital in Kimberly.”
“Permanent employment of theatre staff will also assist in stabilising the surgical backlogs,” Mxekezo said.
Sceptical opposition
Fritz told Spotlight the DA has repeatedly highlighted surgery backlogs at RMS, the province’s only tertiary facility.
“Looking at nursing appointments, we see a trend whereby more nurses’ contracts are terminated each year than the number of nurses who actually get appointed,” he said. “In effect, the hospital only operationalises four of its nine theatres.
“Despite agreements with private agencies for surgery marathons to help tackle the backlogs, this only has a limited impact because of the inability to use more theatres and unavailability of beds for recovery.”
The reality was that the people needing elective surgery often have to wait years to be attended to while their condition progresses, he added. “Only when their case becomes an emergency can they be bumped up the list, and by then, their disease has worsened and their hopes of a full recovery are minimised.”
Wynand Boshoff, the Freedom Front Plus’s (FF+) provincial leader, told Spotlight the department was riddled with mismanagement and a culture that aimed for anything but service delivery.
He said the FF+ was not only approached by patients, but also by doctors on a regular basis who wanted to leave because of management that had completely abandoned services.
“It is clear more is needed than the appointment of a new minister or a new HoD, as the legacy of mismanagement overwhelms individual role players. A comprehensive investigation and steadfast disciplinary action is needed,” he said. “Repeat offenders should not be tolerated in the department, not even in the most humble of positions.”
The Northern Cape Department of Health has had several acting heads in the past three years and several senior officials have and are facing charges in court.
Current HoD is Dr Alastair Kantani, who has been acting in the position since 8 September after the arrests of seven officials, including former head Dr Dion Theys who now occupies the post of medical director in the department.
Spotlight article – Surgery backlog in Northern Cape getting worse (Creative Commons Licence)
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