Protests have erupted from hospital staff and the local community after a senior doctor, who has worked at Zithulele Hospital in the Eastern Cape for nearly 10 years, was instructed to instead report to the Nelson Mandela Academic Hospital in Mthatha.
Mkhululi Ndamase, spokesperson for Health MEC Nomakhosazana Meth, confirmed that family physician Nick Fine has been removed from the remote rural hospital, writes Sue Segar in Spotlight, the unexpected decision following a turbulent two years sparked by the appointment of Nolubabalo Fatyela as the facility’s CEO.
Nearly two years ago, after a tense period of conflict between the CEO and hospital staff, popular clinical manager Dr Ben Gaunt had eventually also accepted a transfer (in mid-2022), the move igniting a protest at the hospital by unhappy residents in support of Gaunt.
Similarly, last week nurses and other hospital staff protested after Fine was asked to report to Nelson Mandela Academic Hospital: they handed over a petition to the Eastern Cape Department of Health for Fine’s return to Zithulele, and also demanded the removal of the CEO.
“We demand Dr Nicholas Fine back with immediate effect; we demand [the] district manager take back Mrs Fatyela [to] wherever, we don’t need her anymore,” reads a section of the petition seen by Spotlight.
Fine did not respond to messages, but he is understood to have taken leave. Fatyela also declined to respond to questions.
A community member who was one of the leaders of the 2022 protests at Zithulele said there was unhappiness over how Fatyela was managing the hospital.
The person said that the district manager, Nomvume Ntshanga, had arrived at the hospital on 28 May when staff protested. “We listed our concerns in a petition which we gave her. She has promised to come back on 12 June … she said Dr Fine can
continue to work here until she comes with the answers on 12 June.”.”
‘Not transferred’
Ndamase told Spotlght that Fine originally had applied to Nelson Mandela Academic Hospital where he was employed before being seconded to Zithulele.
“Therefore, Fine has not been transferred from Zithulele Hospital” but had been “recalled by Nelson Mandela Academic Hospital” where he is responsible for mentoring and training students in family medicine.
“Whether or not Dr Fine will be seconded back to Zithulele is an internal departmental process. This is an employee and employer matter. But for now, he has been recalled to his original post at Nelson Mandela Academic Hospital.”
Ndamase added that none of the four formally recognised trade unions at Zithulele Hospital was aware of protests by their members.
Spotlight attempted to speak to union leaders at the hospital, but none was willing to be interviewed. An intermediary said they declined because “the matter is very sensitive and there is friction between the unions inside the hospital”.
The petition to the department also complained about Fatyela’s accommodation in a luxury Mthatha hotel.
In response, Ndamase said: “The department can confirm Mrs Fatyela had to temporarily leave Zithulele Hospital because of safety reasons. The department cannot divulge its supply chain management process. The relevant stakeholders are aware of where the rental money is being paid. We can also confirm that the rental money is not used for anyone’s personal use but for the upkeep of the facility.”
Responding to the petition’s call for Fatyela to be replaced, Ndamase said: “The department has no reason to transfer the CEO as she has been carrying out her duties with utmost diligence, even when her safety was under threat.”
Ndamase confirmed the department planed to hold meetings about the impasse at Zithulele “within the first two weeks of June”.
‘Great cost’
Dr Karl le Roux, who worked at Zithulele for 16 years, said Fine’s transfer would come at great cost to the patients as well as the doctor and nursing teams.
Le Roux was embroiled in the dispute at Zithulele in which Gaunt clashed with Fatyela. He left the hospital soon after Gaunt and is due to become a member of parliament representing the DA.
It is possible that both Meth and Le Roux could serve on the portfolio committee of health in the new parliament.
“Nick is hard working and compassionate. He has good relationships with people at the hospital. He’s certainly at Zithulele because he wants to make a difference and help people, and is also really important for the supervision of the two family medicine registrars currently training at Zithulele,” he said.
According to Le Roux, Fine is contracted as a registrar by Nelson Mandela Academic Hospital but as part of his training was allocated to Zithulele.
“The agreement was because there were no posts at Zithulele. Nelson Mandela were kind enough to appoint him and second him out but it was part of the whole training process … part of it was that he was also supervising two of the family medicine registrars at Zithulele.”
Notwithstanding that the process is legal, Le Roux questioned who would initiate a request for Fine to be sent back to the hospital from which he had been seconded.
He suggested that the hospital CEO had used a technicality to try to oust Fine, and described the decision as counter-intuitive. “This … will really lower the morale of an already fragile team of doctors and nurses at Zithulele, which is why they’ve come out to protest.
“But the worst part is the harm it does to the poor patients, and the way it destroys what was an excellent hospital that has been very difficult to build up over 17 years.
“If this continues, it will destroy the hospital. It is extraordinary that nurses and other staff are protesting to support a white doctor and demanding that the CEO must go. That sort of thing is not done lightly.”
See more from MedicalBrief archives:
Lessons learned from Zithulele
Cut link between political leaders and managers to save health service
Rural doctors go the extra mile. Then swim a river