Rural doctors bedevilled by politics

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Mseleni Provincial Hospital is in the sticks in a distant corner of northern KwaZulu-Natal, yet this remote state hospital is renowned in specialist medical circles for its stewardship of the strange Mseleni joint disease. This crippling form of endemic osteoarthritis, cause unknown, is curiously confined only to the local population, to whose long-suffering joints it brings stiffness and agonising pain.

Noseweek reports that the rare condition targets mainly the hip and, at Mseleni, Dr Victor Fredlund and Dr Kobus Viljoen regularly performed two total hip replacements every Wednesday. Until, that is, the day they set about filling 20 vacancies for general orderlies who are required to keep the hospital running smoothly.

The report says recruitment of the orderlies fell to Fredlund, its 60-year-old London-trained CEO and recent winner of the Rural Doctors of South Africa’s Lifetime Achiever Award. Guitar-playing Fredlund, who can speak and sing in fluent Zulu, has worked at the former mission hospital for 35 years – his entire career.

With poverty endemic in this isolated spot, 60km from the Mozambique border, the locals survive on fish they catch from Lake Sibhayi and the crops they grow. So when 20 rare vacancies came up at Mseleni Hospital the 2,720 hopefuls who applied felt strongly that the jobs should go to locals, a view loudly reinforced by politicians at rowdy rallies in the area.

The report says when it emerged that two of the applicants were not in fact locals and had falsified their addresses, these firebrand politicians didn’t hesitate to puff the tinder into full-scale conflagration. At a rowdy public meeting in a community hall – that would not have been built without Fredlund’s personal drive and enthusiasm – one politico accused the CEO and his management of corruption over the orderlies’ recruitment, including the taking of backhanders in return for jobs. Wildly, the politician screamed for Mseleni Hospital to be torched.

A long list of historical grievances was produced. Two ANC candidates in the local government elections, one a former Mseleni Hospital staffer, Zenzele Ngubane, vied with one another to heap on the vitriol as they demanded the heads of Fredlund, the hospital matron, its human resources officer and the systems manager. Without further ado, all four were put on enforced leave by the provincial health department. Fredlund’s removal was “for his own safety” bureaucrats continued to insist, long after any perceived threat to the veteran had evaporated.

The report says while Fredlund, a devout Christian, sat at home for months there were no hip replacement operations at Mseleni. Fredlund’s co-surgeon Kobus Viljoen, standing in as CEO, was too busy keeping the 184-bed hospital running to be able to perform major surgery. In protest at his boss’s treatment Viljoen stopped shaving on 3 March, the day he took over, mowing off his impressive beard only when Fredlund was cleared of all charges six months later.

“It was just bizarre,” says Fredlund, who displays no rancour at his treatment. “The charge was that I wilfully and deliberately abused my power in dismissing a guy who failed to declare an assault conviction in his job application, and that I withdrew the applications of two others who had allegedly falsified their addresses. But that is precisely what head office had advised me to do!”

Fredlund instructed the 20 general orderlies he had appointed, as well as five suspended managers, to return to work.

But the, the report says, the provincial health department then instructed him to bring charges against his chief matron, HR manager and systems manager, for their roles in hiring the orderlies in the first place. It was nonsense from hell.

“My real frustration is that this is distracting from the battle of fighting disease and poverty,” Fredlund said at the time. “If you’re looking for a battle there are plenty of things out there to fight, not each other.

“I run quite a proficient clinical team and I’m not indispensable. There just wasn’t that much senior cover in my absence. I cannot say how many patients died or not, because I wasn’t there. But one friend of mine, a local pastor and patient, died while I was away. My medical staff did a fantastic job in my absence under extreme pressure and abuse. But they were trying to save a sinking ship.”

The report says until the KwaZulu-Natal Provincial Health Department “took our management apart and planted an atom bomb” as Fredlund put it, Mseleni Hospital had been widely lauded. It had recently won the Batho Pele Service Delivery Award, a national honour across all government departments. Before that, it scooped the KZN Premier’s Service Excellence Award, and before that, the KZN Health MEC’s Service Excellence Award.

The report says thus did a weak-kneed provincial health department, desperate to dampen the rage of ignorant, self-serving politicians, abandon Fredlund, a tireless public servant who had led the provision of primary health care to a community of 90,000 people since 1981.

However, the report says, this remarkable man has not been entirely without support. At one stage the local chief, Inkosi KT Nxumalo, intervened, berating the ranting political agitators and threatening to banish them from the district if they continued to “act like children”. The chief invited Fredlund and his wife Rachel over for supper, apologising for what had happened.

The report says Rachel Fredlund is as committed to the local community as her husband. She provided the impetus for the building of a direly-needed HIV/Aids orphanage near the hospital. In Jun, 2015 an electrical fault caused a fire that destroyed the facility, with one child fatality. The 55 orphans were farmed out to institutions across the country and Rachel Fredlund has already raised R2m of the R3m needed for its rebuilding.

The report says switch now to Grahamstown, bastion of Rhodes University and supposed centre of civilisation in the Eastern Cape. There one can find Fort England Psychiatric Hospital, the 313-bed state relic is one of the oldest mental institutions in South Africa, established in 1894. Its facilities include a drug rehab unit and a maximum security ward for the treatment and rehabilitation of high-risk state patients referred by the courts.

This time it’s the unions that are after this hospital’s CEO, Dr Roger Walsh, baying for his dismissal and the removal of his name from the board at the main gate and at the entrance to his office.

Last July, 30 chanting members of three unions – the National Education, Health and Allied Workers’ Union (Nehawu), the Democratic Nursing Organisation of SA (Denosa) and the National Union of Public Service and Allied Workers (Nupsaw) – stormed the wards, flourishing sticks and blowing whistles. They ordered hospital workers out on strike, threatened to burn their homes and at one stage allegedly assaulted Walsh.

Days later the situation escalated, according to a memo from hospital managers addressed to Eastern Cape Department of Health bosses. It reported “ongoing industrial action, widespread intimidation, forced removal of staff from wards, offices and essential services, and threats of violence to clinical staff who were attempting to prepare food in the kitchen and dispense medication in the wards.”

Patients – some, “extremely disturbed and needing constant supervision” – plus 26 prisoners and some of the “most difficult and dangerous” state patients in the country – were left confused and vulnerable. “Without proper supervision there a danger of violence, escapes and relapsing of psychosis going unnoticed,” the memo warned the Bhisho health department bosses.

What was the problem? Walsh’s woes began shortly after his arrival in 2013, when he tackled mounting tension over nurses’ scope of practice at the institution. This resulted in a one-day strike, to which the new CEO responded with a no-work-no-pay ruling.

Under orders to reduce costs, Walsh raised the ire of the unions when he switched seven cleaners from double-pay Sunday shifts to Mondays – and increased their number of working days from four to the normal five days a week. Although this immediately improved Fort England’s “national core standards” score for cleanliness, shop stewards were enraged that cleaners had to work a full week and called off negotiations until Walsh was fired.

The report says Eastern Cape Health MEC Dr Thobile Mbengashe was swift to oblige, saying Walsh’s removal was “in the best interests of patients, continued service-delivery and his own safety”.

Walsh resisted department officials’ suggestions that he be redeployed to health department headquarters in Bhisho. The department has refused to reinstate him at Fort England, although two advocate-led probes have cleared him of a long list of spurious union charges.

An independent inquiry by advocate Amelia da Silva, commissioned by the department, yielded a 150-page report that has been kept under wraps. However, Grocott’s Mail, Grahamstown’s vibrant community newspaper, got its hands on a summary of its findings. This stated that Da Silva had found no evidence to support allegations of mismanagement, corruption or negligence by hospital management. Neither had disciplinary procedures been flouted.

“The lack of communication between management and the labour force appears to have originated from a time when the workforce stopped attending ITU meetings after November 2015,” reads the summary. “The reason for the withdrawal of the workforce is that management took decisions without consultation and the workforce felt marginalised and excluded.”

The report says the advocate’s report summed up the overall situation as one of workplace conflict. It recommended that independent HR professionals and conflict management experts be engaged to resolve the impasse.

One striking worker told Grocott’s Mail that CEO Walsh was “arrogant. He takes decisions without consulting. It’s his way or no way.”

Denosa member Ntombizodidi Ngcosini said: “This [unhappiness] has been a long-standing problem since 2014. It is the culture of our employer that they don’t take people seriously. We have been crying for a long time.”

However, an anonymous hospital worker told Grocott’s Mail: “This situation is beyond what Fort England can manage. It needs decisive leadership (from province) to resolve this. Look, Roger Walsh might not be popular, but he is the best CEO the institution has had for a long time.”

Following an earlier workers’ petition calling for Walsh’s removal back in November 2015, a letter to the health department signed by eight senior staff members said that “whilst there may be some that disagree with the leadership style of the CEO…” since Walsh arrived, “he has managed the institution with fairness, innovation, enthusiasm, energy and dedication. His commitment to Batho Pele principles, streamlining administrative and managerial efficiency, enriching the work conditions of all employees and, above all, improving the quality of patient care, is clear to us.”

The reports says today Walsh is still trapped in the ongoing lock-out impasse. His specialist physician wife Michelle has meanwhile accepted a post at Settlers’ Hospital in Grahamstown.

Last December seven top managers at Fort England hospital accused Bhisho of acting illegally in appointing an interim acting CEO while not suspending Walsh or placing him on special leave.

Commenting on these doctors’ tales, Dr Desmond Kegakilwe, chair of Rural Doctors’ Association of South Africa (RuSASA), describes Fort England’s Roger Walsh and Mseleni’s Victor Fredlund as dedicated, vocation-driven doctors who helped deliver healthcare independently of political dispensations or changes.

“But no matter how good and dedicated you are, you will always end up the victim when you are the obstacle to the agenda of corrupt individuals,” says Kegakilwe. “We’re going to be watching these and similar cases very carefully in future.”

The report says Dr Mzukisi Grootboom, chair of the South African Medical Association, has slammed the KwaZulu-Natal Health Department for “turning a blind eye for political expediency”. SAMA was “extremely perturbed” at the treatment meted out to doctors who had dedicated most of their lives to servicing needy communities, especially in a country with a dire shortage of rural doctors and basic healthcare services. SAMA, declares Grootboom, will not rest until doctors Fredlund and Walsh are fully reinstated and proper procedures followed.

KwaZulu-Natal Health Department spokesperson Sam Mkhwanazi is quoted in the report as saying: “There are ongoing disciplinary matters involving a number of officials from Mseleni Hospital. However, it is not the practice of the department to ventilate in the public [sic] internal and confidential matters which are employer/employee related.”

The report says the Eastern Cape Health Department refuses to explain itself, despite repeated email, SMS and voice message requests. Not surprising, considering the extent of skulduggery and political manoeuvring within this excuse for a provincial health authority.

The report says the latest victim of the toxic hellhole is deputy director-general Karen Campbell, Bhisho’s long-serving and highly-regarded human resources head, who became a target after challenging union pressure to forcibly upgrade swathes of healthcare workers, ostensibly to stave off strikes. She’s had to be hospitalised, a nervous wreck.

• As Noseweek went to press, the KZN health authorities launched another attack on Fredlund. This time, charging him with irregularly appointing clinic nurses in 2014. He has been “relieved of his duties” as CEO of Mseleni Hospital and the CEO of neighbouring Bethesda Hospitalis now overseeing both facilities. Fredland continues working at the hospital as mere medical officer while he awaits his next hearing on 17 January.

• The Port Elizabeth Labour Court is currently hearing a dispute involving a R2m Vodacom tender, for which the funds were allegedly misused by Bhisho to boost the salaries of senior admin staff and Nehawu members. This is in addition to the R40m of budget meant to be used to recruit vitally needed healthcare professionals that was allegedly also misappropriated to promote admin staff.

Noseweek report

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