Fear and loathing in the Free State

Metallic cut-outs of roses line the main road that leads into Bloemfontein. This is the city of roses, but nothing smells sweet about its healthcare system.

People call hospitals ‘mortuaries’ here because they can’t trust the service they get. They wait for hours to see a doctor, even for emergencies. They can’t expect to heal after visiting a clinic or hospital, and even a little kindness is unavailable.

At Bongani Hospital in Welkom, a woman brings in her 26-year-old sister who has tried to commit suicide. It takes 18 hours before she is seen to. When she is finally given a bed she uses blankets her family has brought in. There is no counselling, not a shoulder to cry on. Her tears just keep falling.

Peggy Phiri (40), a resident of Thabong, noticed blood coming out of her belly button at the end of July last year. She was admitted to Bongani Hospital and was diagnosed with a hernia, operated on, and discharged. A year later, her tummy is bloated, she’s in constant pain and she bandages up her abdomen because excretement and menstrual blood seep from the wound. Peggy’s embarrassed by the smell, and cries as she tells her story. The Bongani Hospital gave her a follow-up check-up, X-rayed her and told her to take headache tablets for the pain. They had done their job, ‘finished and klaar’, that’s what they said. If she wants any more help she can travel two-and-a-half hours to the Universitas Hospital in Bloemfontein, they said.

The stories of Peggy and the 26-year-old woman are just two among dozens. The thread that runs through them is that of a broken system, of dismissive or poorly trained staff; ambulances that arrive two or three hours late, if they ever arrive; doctors who are no-shows or unaccountable; facilities that have not been maintained, with no supplies or medicines for even the most basic procedures, and, ultimately not a single person who will take responsibility.

In July 2014, the Free State Health Department was deemed unfit to manage its own budget. The Mail & Guardian reported that the department had racked up around R700- million in debt, and the problems had started as far back as 2008. No heads have rolled. The provincial treasury has since taken over authority of the financial management, but is still to provide any reportback, even as suppliers, staff and community healthcare workers remain unpaid and left in the dark about their futures.

Despite a volley of emails, whatsapp messages, phone calls and messages left with personal assistants and communications people, both the provincial treasury and the premier’s office failed to respond to requests for interviews or to answer questions put to them.

The lack of transparency, accountability and administrative will are not unexpected. Bureaucracy, though, is shifting to become increasingly insidious as officials choose to hide behind procedure and protocol, centralised communications and endless levels of filters. It makes governance impenetrable and allows officials to dodge responsibility for their actions (or inactions). The ugly twin of this is self-censorship. Fewer and fewer people are prepared to speak out and to take a stand because they fear for their safety or the security of their jobs.

Throughout the province, words like ‘fiefdom’, ‘mafia’, and ‘thugs’ are heard in reference to the government and how the province is being run. Politics is a show here in the Free State – full of sound and fury, signifying nothing. In this vacuum, people turn to another dangerous form of ‘leadership’ and ‘hope’ in the form of new churches.

The rise of some charismatic churches presents a new challenge for healthcare workers working to halt the spread of HIV and to make sure people adhere to their drug regimes. The Free State has seen the spread of churches that preach that God will heal people from HIV, so they should stop their treatment. The faithful will be healed, they insist. It is a confusing message for patients who are already frustrated and desperate because of the significant hurdles in accessing drugs and medical care.

The multiple collapses in the healthcare system, persistent high unemployment, unfulfilled promises from politicians and even the false hope in divine intervention, or the promise in the supposed deep pockets of a sugar daddy, create the conditions for a disaster that will bring the Free State to its knees.