Holy Cross: Some progress, but all is not well
NSP Review COMMENT:
The Treatment Action Campaign has for years drawn attention to the poor state of health services in the Eastern Cape. Two years ago the NSP Review published a special investigative report titled Death and Dying which highlighted the challenges and state of collapse. The national health minister responded immediately also requesting that parts of the report, which highlighted the death of a baby in Holy Cross hospital following failures at various stages of his treatment, be redacted to allow him time to investigate. We complied in the interest of affording the health department an opportunity to address the issues highlighted. The newly established Office of Health Standards Compliance did launch its own investigation into Holy Cross, the minster dispatched a high level team to the hospital and there are reports of some improvements on the surface, but below the surface the challenges continue. In this issue we returned to the Eastern Cape to monitor progress and while there are pockets of hope, the province is by no means out the woods. The Eastern Cape Health Crisis Action Coalition, of which the TAC and SECTION are members, will continue to focus on the challenges in this province.
Over the years Holy Cross has been in the news for all the wrong reasons. In a special NSP Review Report Death and Dying, released in September 2013 we wrote about the sad death of a toddler who died in the hospital. The attending doctor told a story of failure at several stages including lack of oxygen and access to emergency services.
While there are signs of improvement, the hospital is by no means out of the woods. The hospital situated 20 km outside Flagstaff in the northern Eastern Cape is battling various challenges and during an NSP Review visit in August we were told of a lack of access to running water – devastating for a hospital.
The latest water shortage has lasted one week but according to Dr James Whitehead, a physician stationed at Holy Cross, the longest period the hospital has been without water is six weeks. Hospital staff rely on the meagre supply of 20 000 liters in tanks provided by the municipality, which also supplies the community. With this limited supply, they must ensure that patients receive medication, are fed and that bed linen is washed. A member of the cleaning staff complains that detergents and other cleaning chemicals have not been ordered putting patients at greater risk. “At times we wipe the floors and surfaces with only water,” he explains, “But now while there is no water, we use nothing.”
The water crisis at Holy Cross hospital predates a visit in 2013 by the Eastern Cape Health Crisis Action Coalition (ECHCAC) and yet it persists. It is only one of a litany of issues identified by the Office of the Health Standards Compliance (OHSC) as critical to the turnaround of the hospital, which, it found, was on the brink of total failure.
Built in 1923 by missionaries, the hospital has been the centre of the community for nearly century but according to staff, it continually fails the people of Flagstaff.
A tour of the hospital premises portrays a polished image: the teaching facility is pristine, new desks and computer equipment gleam – the result of a building upgrade completed in 2007. But, beneath the facade lurks the reality that led to the hospital receiving only a 43 percent grade from the OHSC in October 2014, based on its scores on critical issues like infrastructure, human resources, equipment, medication, food preparation, TB services and emergency medical services.
The hospital is keen to demonstrate that they have made significant strides in snatching the hospital from the precipice. The management acknowledge that there are areas that are not up to standard and they try to minimise the severity of some of the issues that still persist. These include staff accommodation, which is in an appalling state. According to a member of the board, the accommodation situation is at crisis level, with frequent sewerage blockages, exacerbated by water shortages and electricity outages. Doctors share accommodation – three per house – or live in pre-fabricated homes, while the nurses’ homes are old and dilapidated.In addition to complaints about their living conditions, doctors are concerned by the lack of skilled personnel at management level. Until recently, there was no CEO, no clinical manager and no nursing services manager. Mrs Gloria Mazeka was appointed acting CEO in September 2014.
The hospital has four or five permanent doctors, one of whom is Dr Whitehead – the acting clinical manager until Dr Yeye was appointed on 1 September 2015, bringing the total number of doctors to six in a hospital which serves 100 000 people. As a result of the shortage of doctors, the clinicians are required to work unpaid overtime during evenings and weekends, according to Dr Whitehead. He recalls an incident in which he was told to report for duty by the district manager or face disciplinary action even though he had given the hospital three weeks’ notice that he would not be available for a shift that weekend.
Dr. Whitehead says the doctors are willing to assist in times of need, however the chronic shortage is exacerbated by the belligerent attitude of management.
“It’s sad when management doesn’t say: ‘We’re in trouble, we don’t have money and we know we haven’t paid you for six months but we promise to fix this.’ That is not the attitude, they just send you a letter threatening you with disciplinary action”
(Image: Gary Horlor)
He says. “I attended a training session in Bizana at which there were about 15 South African doctors. I asked them: ‘Why in South Africa do you have people with no clinic experience running hospitals?’,” says Dr Whitehead. In response he was told that non-clinicians are less likely to complain, and they tend to say whatever the deputy director general, the superintendent general or the district manager asks them to say. They paper over the cracks in the system. “But patients are the ones who suffer. Unfortunately it is only when children or pregnant women die that things happen, but patients on all the wards are at risk,” he says. “There are dramatic incidents every week, patients dying for no reason. I had a tirade at my nurses because they had given 12 litres of dextrose without any potassium, so the lady just fell over, dead. On another occasion they’d not given furosemide over the weekend to a patient because they couldn’t get the stock, so she died. “There are ongoing issues of stock levels and things not working but we deal with them as best we can,” says Dr Whitehead. “The thing I find saddest is that we (and management) should be working together but there is this constant battle with each other, for no reason.“I’ve never met so many dedicated clinicians. We have great doctors, a fantastic physiotherapist and pharmacist.”
