All not well at Piet Retief
At first glance Piet Retief’s hospital looks like a facility that stands proud. It’s clean, modern and operational. It’s also strangely quiet – it’s the silence that reveals the problem.
The hospital sees about 25 to 30 patients a day. Meanwhile, a few hundreds metres away where the crumbling old Piet Retief Hospital barely stands, up to 400 patients a day queue for up to six hours to be seen by a doctor. Some arrive even earlier to try to be at the front of the queue before the doors open at 7.30am.
Here the ceilings have weeping stains from leaking roofs, smashed windows stay unrepaired, linoleum in wards peel off the floors, doors lie where they came off their hinges, stacked gurneys pile up on a patch of overgrown grass and leaking pipes create permanent swamps. Patients stand in queues, there are no benches or chairs for more than about the first dozen people in the queue.
This is the Piet Retief Hospital’s wellness clinic where 9 000 people are enrolled for ARV treatment. It’s also where the national priority programmes dealing with TB, STIs, male medical circumcision and cervical cancer screening are dealt with. MDR-TB patients and patients sick from defaulting on their ARV treatment are hospitalised here.
Something went wrong with the stats and the planning nine years ago as the new hospital was being built – that disconnect between the Public Works Department and the Department of Health. The bed numbers were downgraded from 240 to 179 and in reality only about 145 beds are currently usable, says outgoing hospital CEO Deon Swigelaar. The mess up in the numbers mean the wellness clinic could not be absorbed into the new hospital.
The old hospital as wellness clinic, was always meant to be a temporary measure, but it hasn’t turned out that way. “We have a ticking time bomb on our hands,” admits Swigelaar of the old hospital still running as the heart of the hospital, while the new hospital is underutilised.
As his five-year tenure as CEO comes to an end, he has his first meeting with a Treatment Action Campaign (TAC) representative at the hospital. He acknowledges that the biggest failing has been the lack of real communication between people’s needs and what is delivered to them.
“The problem is that we are not asking people what they need, we are just assuming that we’re doing the right thing from head office or from sitting in our boardrooms,” he says. It also comes down to what Swigelaar calls a lack of administrative will, lack of commitment to the job, bureaucracy, limited powers for administrators at a district and provincial level, silo mentality between departments and a lack of continuity in leadership. It translates to the hospital not being able to directly employ staff above a certain payscale, unfilled vacancies or people expected to fill in in acting capacities, and even the lack of buy-in from staff to alter their work hours to accommodate things like voluntary medical male circumcision procedures for school boys over weekends. (Piet Retief Hospital has the capacity to perform about 300 voluntary male medical circumcision procedures a month, its current count is around 30) or the fact that patients seen by doctors at the old hospital must collect medicines at the pharmacy at the new hospital and are then required to walk back to the old hospital to drop off their files.
“Your confidentiality does go out of the door if you are walking around with your file in your hand, and if you are ill you don’t want to be walking between the two hospitals,” says Swigelaar. He adds: “I wish that we could have met before,” he says of working with the TAC in the district. “We all want the same the results at the end of the day,” he says.
The region has also seen three MECs for health in one year, seven HODs in 15 years, which means a lack of continuity and institutional memory in dealing with health in the province.
The reality doesn’t add up to what’s touted as success stories for the district. Statistics and data stand for little when people are not getting the care they need and they have no way to change the status quo. The ticking time bomb Swigelaar speaks of is what’s real and it should be a loud enough wake-up call.