Welcome to the twilight zone: fear and abandonment in the Free State’s health system

By Mary-Jane Matsolo

Activist Mary-Jane Matsolo last year heard “saddening and horrific” stories from the more than 50 people who testified during the People’s Commission of Inquiry into the Free State Healthcare System. She recently entered the field to assess whether anything had changed. These are her notes.

First stop: Free State Psychiatric Hospital in Bloemfontein

I feel like I’ve been teleported into a scene from the X-files: the openness of the space – a huge, unoccupied, neglected piece of land, deserted buildings, dry, brown grass growing long all over the place. Not a single patient or staff member in sight. The only sign of life is the odd security guard.

After the sixth circuit around the premises I’m convinced I’ve entered the twilight zone. I begin to imagine patients chained to their beds inside these empty buildings and I think about all those people we’ve reached out to for information about the health care system, but who felt shackled by intimidation and refused to speak to us. This province is far from free, as its name implies.

There are spooky looking houses here. Not patient wards: stand-alone houses in which, perhaps, doctors or matrons once lived. They’re creepy. It feels as though, like in a horror movie, faces might appear at the windows.

Next stop: Reitz

About four hours’ drive from Bloemfontein, we found a community caught in nostalgic memories of days gone by when they once had a fully functional hospital.

Then abruptly, about 12 years ago, Nketoana Hospital was reduced to only two functions: the casualty unit and a partially functioning maternity unit. The residents still don’t understand the reasons why their beloved local hospital had its heart ripped out.

Now they have to travel to Bethlehem, about 55km away, only to be met by hostile nurses who, they say, discriminate against them by attending to them last and constantly asking them why they use they don’t use their own hospital in Reitz.

Then on to Nketoana Hospital

It was the next obvious and logical thing for us to do now: Nketoana Hospital.  What we saw was extremely confusing. Here was a well-maintained, fully equipped hospital. It seemed set to be able to run like a well-oiled machine and yet most of it was simply shut down.

Stepping into the theatre was like stumbling across the spot, on X-Files, where aliens are operated on – a place kept secret and which is only known about in files stamped “Top Secret” in some government official’s office somewhere.  Equipment stood around collecting dust. It looked as though the hospital had been evacuated suddenly.  Some wards have been turned into storage rooms: hospital beds lie unused on top of one another.

Qwaqwa was next

There’s been no water here since February. The drought has hit hard. We’re 93km from Bethlehem and our guesthouse has no water. How do hospitals and clinics function without water?

We were looking forward to hearing some of the wonderfully creative ways nurses and doctors were getting around this huge hurdle – caused by mother nature and not the provincial government this time – in their daily work.

We set out enthusiastically, eager to report on the innovations we were sure the staff would have come up with, but at the first clinic, the manager treated us with undisguised hostility, shutting us down and refusing to give us any information.

She referred us to the district clinic manager. The more we tried to explain our interest in how a facility was run without water, the more anxious she seemed to get. She got up, escorted us out of her office and watched us suspiciously. She even followed us to the bathroom when we needed to use the toilet and accused us of inspecting her facility.

She followed us to reception, obsessing that we sign the visitors’ register, and interrogating us about who we were and where we came from, even though we’d offered this information to her when we had introduced ourselves in her office.

We visited the district manager. We sat in her office for what felt like eternity while she refused to acknowledge our presence. Finally she spoke not to us, but down at us. It felt like we were in the principal’s office for bad behaviour. She gave us a firm lesson on having to make an appointment and about procedures that needed to be followed when seeking to talk to staff at clinics. We were told to consult Bophelo House – where the provincial health department is located in Bloemfontein – to gain a letter permitting us access to the clinics before coming to the facilities.

It was clear we were not going to get any information from these women. There was no getting through to them. It was as though they had been completely brainwashed.

The cloak-and-dagger theme, the mystery and spookiness, was carried right through to the staff.

The good nurses – the one who are tired of what things were like and desperate for change that would benefit their patients – were like “un-turned humans”: forthright and open. The “turned humans” were the nurses completely wrapped up in tight bureaucratic secrecy. They seemed to have lost sight entirely of why they became nurses in the first place.

As my travelling companion and I returned to the car, I said: “The not-so-free Free State.” A complete stranger hooked on to our conversation, asking who we were and what we were doing there.

Is this some sort of government agent? Is someone following us now?

The paranoia is infectious.

Mary Jane Matsolo is a Campaign officer for Treatment Action Campaign