Violence against staff – doctors, nurses, paramedics – and patients, has become an occupational hazard at government hospitals and clinics in South Africa. After numerous reports of staff who have been bitten, punched, robbed, assaulted, or killed, Gauteng Health has announced new plans to tackle security lapses.
The initiative was recently announced by Motalatale Modiba, spokesperson for the Gauteng Department of Health, writes Thabo Molelekwa for Spotlight.
The lack of security at public healthcare facilities is not new, with several cases of robberies and assaults in several provinces – not just Gauteng. Last year the fatal shooting of a nurse at Tembisa Hospital sparked an outcry among health worker unions over the safety of their members.
The department’s announcement prompted questions by organised labour and an opposition politician about whether the authorities have lost trust in the multi-million rand security measures already in place to protect both personnel and patients, with some arguing that security guards, rather than healthcare workers, should be responsible for safety.
However, said Modiba, the training of staff has nothing to do with security companies’ contacts.
“Security personnel are non-medical personnel, so their presence does not substitute the need to ensure employees are empowered with techniques to handle difficult patients,” he told Spotlight.
‘Just a tick-box exercise’
The training plans, however, have inspired little confidence among healthcare workers.
According to the nurses’ union Denosa’s Gauteng provincial secretary, Bongani Mazibuko, this will not address safety concerns.
“It’s just a tick-box exercise to say the employer is trying to do something. The root cause of these attacks is the influx of mental health patients and the mixing of mental health patients with medical patients,” he said.
In April, the department released a statement saying a number of incidents had been reported at Weskoppies Psychiatric Hospital, with 21 cases since January 2022.
At Carletonville Hospital there were nine incidents, another nine at the Far East Rand Hospital, seven at Chris Hani Baragwanath, four at Thelle Mogoerane Hospital, and three at Kopanong Hospital. There were also isolated incidents at other facilities.
Modiba said that training staff to protect themselves was a practical step, and that learning to manage violent mental health patients was generic to the training of doctors and psychiatric nurses as regulated by the Health Professions Council of South Africa.
“A special course on managing these patients will be rolled out from the second quarter of the 2023-2024 financial year, based on a similar course attended by one of the healthcare workers in the UK. He will work at Sterkfontein Hospital as the main facilitator, working with employees from the Regional Training Centres, the Office of Health Standards Compliance (OHSC), and wellness practitioners,” said Modiba.
He said the department was also working with the police.
Sama ‘concerned’
Meanwhile, after a scoping review study, the South African Medical Association (Sama) recently published a report outlining the nature and extent of violence against healthcare workers between 2012 and 2022. The study found an increase in violent acts, the most affected being doctors, nurses and paramedics.
Female staff were disproportionately affected and most of the incidents were in Gauteng.
Sama chairperson Dr Mvuyisi Mzukwa said the association was “deeply concerned” about the safety of healthcare professionals.
“This report was designed to sensitise all stakeholders about crime targeting healthcare workers … including the National Department of Health, to initiate intersectoral solutions to limit and prevent safety threats,” Mzukwa said.
Sama’s report found eight murders of healthcare workers reported in the media, “with six of them (or 75%) occurring among doctors”. One nurse and one paramedic were also murdered in the set period.
“Of all the 45 media reports examined, only 17 arrests (38%) were reported, and only two resulting in successful prosecution.”
Dozens of incidents
MEC for Health & Wellness Nomantu Nkomo-Ralehoko said there had been 61 incidents reported in health facilities between January 2022 and April 2023. Most were attributed to mental healthcare users, while others related to aggressive patients, as well as angry relatives and patients linked to criminal activities.
Nkomo-Ralehoko said training staff on how to respond to aggression and violence was one element of their intervention, and that the department would be installing CCTV cameras at strategic locations.
But security concerns in Gauteng’s public health facilities are also fuelled by systemic and contract management issues – something the MEC vowed to address.
In March, responding to concerns over these multi-million-rand security contracts that are rolled over year on year without a proper tender, Nkomo-Ralehoko acknowledged the situation was unacceptable. The department spends more than R59m on month-to-month security contracts.
“These are rolled over irregularly as there is no contract in place; only service level agreements are used,” she said.
On progress with the new security tender, Modiba said it had been advertised and has since closed. “The evaluation committee has been appointed …We are still on course to complete this within this financial year,” Modiba said.
Denosa’s Mazibuko said that in-sourcing security services, separating mental health patients from other patients, and ensuring mental health patients were admitted only to institutions that could commit them, should be prioritised.
Jack Bloom, the DA’s health spokesperson in Gauteng, said the department was failing in its basic responsibility to provide a safe working environment for staff and patients.
“A huge amount of money is spent on security companies that don’t do their job,” he said.
Healthcare providers should not have to defend themselves against attacks because that is what security guards were supposed to do, he pointed out.
“There needs to be a complete overhaul of security arrangements at our hospitals, with a professional assessment of what should be provided at a reasonable cost.”
Proper training
But Zano Kunene, writing for Bhekisisa, said one of the reasons why hospitals and clinics are not safe is that the security guards aren’t trained for the various situations in which they frequently find themselves.
Between 2017 and 2022, about 200 violent incidents at public hospitals were reported across four provinces. And that’s only issues that were big enough to get noticed. Petty crimes like theft from patients or staff, verbal abuse or cases where a situation is diffused, fall by the wayside.
To make hospitals safe, security guards need training to help them deal with angry, emotional or aggressive situations, apart from general safety issues like protecting property and monitoring access.
Most of the time they’re ill-equipped to handle their duties, because to get a job as a security guard at a hospital, tenders require personnel to have only general training; the same as guards working at, for example, residential complexes or shopping malls.
Moreover, any setting-specific training, like knowing how to deal with aggressive patients, is up to the company that is awarded the contract.
‘Not everyone is a criminal’
To work as a security officer in this country, the person must be registered with the Private Security Industry Regulatory Authority (PSiRA) and have completed a training course with an accredited providers.
Training is offered at five grading levels, the most basic, grade E, being patrolling skills, how to use radios, handle firearms and equipment like fire extinguishers, and self-defence. An A-grade guard can work as a supervisor and manage security staff working in a facility like a hospital.
Most guard jobs at state hospitals and clinics need at least a grade C qualification, meaning they should know how to handle access registers, search people entering the facility and ensuring everyone on the premises is safe.
Tasks include controlling access at gates and doors, apprehending thieves, making sure portable equipment doesn’t get stolen, patient files are kept safe, monitoring CCTV cameras around the facility and handling emergencies such as a protest.
Dealing with upset or distraught family or impatient visitors requires a different approach.
Marié Venn, a doctor who previously worked in the psychiatric ward of a public hospital in Cape Town, said the generally required qualification of safety staff doesn’t equip them to deal with the human side of managing risks.
After undergoing some life-threatening incidents at the hospital, she launched Conquer Crisis, which teaches health workers and security guards who work at hospitals the skills to diffuse dangerous situations without force.
“It’s important to educate them on what kinds of patients we see, and that everyone at a hospital (a patient or visitor) is not necessarily a criminal,” she said.
Special safety skills
Every facility has to identify the types of skills their security guards need, said Ugasvaree Subramaney, head of the clinical unit at Sterkfontein Hospital.
For example, mental health institution guards should have a general idea of the type of behaviour different patients may display, to help them understand when a patient could become agitated and know how to manage them correctly.
But in an emergency unit in a children’s ward, for instance, guards should know how to handle children who are upset or lash out without using force: this requires different skills from handling an adult patient or visitor.
Safe spaces
To improve the management of dangerous situations at hospitals and clinics, the Western Cape Health Department created a course to train security officers at its facilities.
The course is still being tested, but once it’s up and running, guards will be able to complete it either online (data free) or in-person, without having to pay for the training.
Mark van der Heever, deputy director of communications at the Western Cape Health Department, said guards would learn – in a single two- to three-hour session – how to handle challenging situations with de-escalation techniques and how to communicate well with people in a healthcare setting.
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See more from MedicalBrief archives:
More violent incidents reported at Soweto mental health hospital
Spate of violent crime sees security beefed up at Gauteng Hospital
Patients, staff, traumatised after hospital robbery
Increasing violent attacks put state healthcare workers at risk
Nurse’s alleged killer appears in Tembisa court