||29 July 2012 07:00
|Show: ||Carte Blanche|
The Eastern Cape... wild, rugged and breathtakingly beautiful... But the biggest blot on this picturesque landscape is the deepening healthcare crisis. The province boasts one of the highest infant mortality and maternal death rates in the world.
It's hardly surprising. In 2006 we first reported on disappearing babies, neglect and suffering at Dora Nginza maternity [hospital]. A year later we exposed how more than a hundred babies had died at Frere Hospital in one year.
[Carte Blanche 12 August 2007] Eric Johnson: 'It was a fully grown baby. An hour ago it was kicking. So I ask you... To me they are just taking lives.'
Despite the statistics, State doctors in the province have remained stoically silent... until now.
Derek Watts (Carte Blanche presenter): "At the end of June more than 20 medical specialists took a stand and called a media conference in Port Elizabeth. They said that the serious staff shortages were forcing them to play God."
Defying government orders not to address the media, the so-called 'rebel doctors' explained that staff shortages were forcing them to cut back on essential services.
Dr Basil Brown (Cardiologist): "With effect from the 1st of July we will only be able to offer emergency services to patients. As in the case of the surgical disciplines, no elective or cold surgery will be performed."
At the same time 7 000 contract doctors were lashing out publically.
Dr Phophi Ramathuba (South African Medical Association): "We have not been getting salaries - some of us, for the past six months. And the way we've been surviving would be through the colleagues who would then donate some of their food to us. And I mean we've been living like beggars."
Morale amongst clinical staff is at an all-time low according to anaesthetist, Dr Peter Alexandros, who says he'll face the consequences of speaking out.
Dr Peter Alexandros (Anaesthetist): "This is our chance now for something to happen, to have people look at the Eastern Cape. We really feel strongly that we're the forgotten people down here."
He's worked in the PE [Port Elizabeth] hospital complex for 25 years and feels a moral obligation to sound the alarm.
Dr Alexandros: "If I just talk about the Port Elizabeth provincial hospital, they have closed the casualty. There are instances of the public not being adequately notified that the casualty is closed... of people having heart attacks up the road here, arriving here in the middle of the night and there is no casualty, there is nobody here."
Dr Basil Brown, a retired cardiologist who has stayed at his post only because there is no-one to replace him, says that Livingstone Hospital is also radically understaffed.
Dr Basil Brown (Cardiologist): "At Livingstone we have a state-of-the-art accident and trauma unit, which was built and was commissioned as part of the 2010 FIFA World Cup preparations. Now that unit is standing virtually empty now, because the staff that is required to run that unit was not appointed."
Clinical staff shortages means waiting times are increasing and doctors are often forced to send patients away.
Dr Brown: "I've got patients in this month, who have been given dates for surgery, who are not going to be done. The date they got to be done this month they were given in February of this year. They are now going to have to be postponed sometime to the end of the year, if they are lucky."
His colleague, Dr Lungile Pepeta, the only paediatric cardiologist in the province, says the doctor ratio is untenable.
Dr Lungile Pepeta (Paediatric Cardiologist): "In the First World, there needs to be one paediatric cardiologist per 500 000 population. In this setup here in this province there is one paediatric cardiologist per seven million. The service that I'm offering is for the whole province."
Lungile says he can't keep up with the demand for his time to operate on children.
Dr Pepeta: "At the end of the day, patients and parents have got a relationship with the doctor directly and if something happens they look you in the eyes and say, 'You let my child down.' And there is nothing you can do about it."
Derek: "And that happens?"
Dr Pepeta: "It happens a lot, 'Doctor, why my child was not operated on?'"
The Superintendent General for Health in the province Dr Siva Pillay, sympathises with the doctors' plight.
Dr Siva Pillay (SG Health: Eastern Cape): "I'm sure the doctors, because they are unhappy now, are going to blame management and say that we never made a conducive environment for them. And I sympathise with them; I do empathise with them because I do believe it is true."
Derek: "But hold on... Where does the Superintendent General Dr Siva Pillay feature in all of this? He was shown as the saviour of the Eastern Cape hospitals in our story last year."
We dubbed him 'Dr Cleanup' when he vowed to rid the department of corruption last year, firing over 900 staff, including his CFO. Although mired in controversy through his business dealings with architect friend Edgardo Gamaleri, the new Head of Department appeared to have his heart in the right place.
[Carte Blanche 13 November 2011] Dr Pillay: "We are not here for ourselves. We are here to make a better life for the people out there."
Derek: "But it seems Siva's efforts to clean up the province haven't made him very popular. He says he's been left powerless; they've cut his budget and reneged on financial agreements."
Dr Pillay: "When you're busting corruption, when you're doing these things and getting things straight, you are going to upset a whole lot of people."
He inherited a R2.8 billion deficit at the beginning of his term and his agreement with government was that they would clear it. They reneged and then promised him an overdraft, but when he started rooting out corruption this was withdrawn. The DA Shadow Health MEC believes it's personal.
John Cupido (Democratic Alliance): "We have a situation where the MEC and the SG are not seeing eye-to-eye and what that causes is two centres of power. You've got the administrative centre of power and the political centre of power."
Health spokesman Sizwe Kupelo denies this.
[On phone] Sizwe Kupelo (Health Spokesman: Eastern Cape): "No, no, no, no! As far as I am concerned, there are no problems between the two [men]."
Section 27 spokesman Daygan Eager believes that a bloated administration is compounding problems.
Daygan Eager (Section 27): "The administration in the province is very top heavy. People need to be shifted out of the administration level at provincial level [and] sent down to district level. Where facilities have some capacity, they should be allowed to make their own decisions around spending and hiring and firing of staff."
And to make matters worse... for no apparent reason, the health budget has been cut by R400-million.
Daygan: "The allocated funds in the first instance aren't sufficient, so they are under-funded. But with the growing debt in the province, money owed to service providers for service delivered but not rendered - that has to be paid out of current budget."
The health platform that has been created and provincial treasury's expectations are out of kilter. They have to service 856 clinics, 91 community health centres and 95 hospitals.
The result is a radical staff shortfall, with a 45% vacancy rate that will cost R9.2-billion to fill.
John: "We have 27 000 vacancies as far as clinical positions are concerned in this province, of which 16 000 is for professional nurses who are excessively important because they are the first point of contact for many of the patients. 1 200 Doctors are needed - we just have a lot of people who aren't there."
But then again the province seems to battle with maths. The actual financial needs and the budgeted amounts don't correlate. Infrastructure has a R19.2-billion backlog and the maintenance budget falls short by R800-million annually...
which explains why these walls [on screen] go unpainted, why some operating theatres in PE Provincial are deserted and why doctors have to operate with leaking ceilings.
Dr Alexandros: "We have major problems just with the basic logistics. If you just look around here, I mean, this is an example of what's going wrong. Look at this - there are 10... 12 trolleys here... there's no maintenance done; there's no-one to do the work."
He also says that, as doctors, they are often baffled by the procurement process.
Dr Alexandros: "We will suddenly be landed with equipment that we haven't ordered, that's not up to scratch and we can't track how this has arrived here. And then it is: 'sorry, but that was the tender and that's what you're getting, and that's what you must make do with'."
Despite the obstacles, the department has managed to refurbish some of the wards and created some much needed new medical units like this one [on screen].
Derek: "This is a biplane cardiac catheterisation system. It is a fancy name and it is a fancy piece of equipment. You won't find it in other private clinics around the Eastern Cape. In fact, there aren't many around the country."
But it's a drop in the ocean and the budget just can't stretch far enough.
Dr Pillay: "And there's expectation that this platform must increase further, and therefore you'll have to rationalise the service delivery platform."
Derek: "It really is an untenable situation for a man with a vision to turn healthcare around. Siva Pillay has handed in his resignation, but even the DA doesn't think it's a good idea."
Derek: "Dr Pillay has resigned - should he go?"
John: "No, not at this stage because if I... unless they headhunt somebody from another province... I don't see anybody in this province who is capable of filling the shoes that he has had."
Pillay claims to be resigning, but still plans to try and pave a way forward by engaging with national government.
Dr Pillay: "We've spoken to the Department of Health nationally; we've spoken to the department of Treasury nationally. There is a re-look at our budget."
Let's hope there is the political will to make it happen before the province loses more doctors and lives.
Dr Pepeta: "It then pushes you to want to leave this State sector. You've got to balance your passion and the satisfaction that you get from doing this job against the frustration that you've got to go through. At the end of the day, you try and try and try and you just want to give up and you want to go."
Dr Brown: "Maybe that's where people should start thinking about going to the Constitutional Court and saying the health services is failing us."
IMPORTANT DISCLAIMER:While every attempt has been made to ensure this transcript or summary is accurate, Carte Blanche or its agents cannot be held liable for any claims arising out of inaccuracies caused by human error or electronic fault. This transcript was typed from a transcription recording unit and not from an original script, so due to the possibility of mishearing and the difficulty, in some cases, of identifying individual speakers, errors cannot be ruled out.