#Vote4Health: More than a bucket and a plaster to fix rural healthcare

By Kathryn Cleary and Zizo Zikali

The rolling hills and valleys surrounding Holy Cross Hospital make transport to the hospital a challenge for residents. There is a critical reliance on local taxis and other public transportation. Photo: Kathryn Cleary, Spotlight

As the seasons change and summer becomes a more distant memory, May elections creep closer and closer for the country. Campaign posters line the roadways and fight for space on telephone poles of every city and village. While citizens gear up to cast their votes, some lie in hospital waiting areas hour after hour in dire need of quality care. For some, a trip to the hospital may seem like a breeze, but for others, particularly in the rural Eastern Cape, a hospital visit can be a herculean task.

Despite years of intervention at Holy Cross Hospital in Flagstaff, Eastern Cape, there is still a long way to go. Though government emergency interventions have made some impact, for Holy Cross a much more permanent solution is needed. Interventions in 2013 and 2017 have created a plaster over the issues, but the single bucket filled with water in the hospital’s waiting area tells a different story. Holy Cross Hospital highlights the systemic failures of the rural public healthcare system – it will take much more than a bucket and a plaster to fix.

8pm, a yellow Sunfoil bucket filled with water sits in the corner of the main waiting area of Holy Cross Hospital. There appears to be two cups on top of the bucket for patients, visitors and waiting families to use to drink. Spotlight and Health-e were informed of this ‘bucket system’ by a patient earlier in the day outside of the hospital grounds.

Ahead of the 2019 elections, Spotlight and Health-e journalists worked together to see if anything had really changed at the hospital after the interventions in 2013 and 2017. Although our journalists were denied permission to formally visit the hospital by the Department of Health; patients and community members outside the hospital premises were willing to speak.

The main entrance to Holy Cross Hospital, 23km from the centre of Flagstaff, Eastern Cape. The road to the hospital is smooth tar; wrapping around hillsides and down steep valleys of rural Transkei. The entrance is frequented by taxis constantly dropping off and picking up prospective patients and families.

Sizakele Theophilus Hlongwana is the local Ward Councillor; residents within his ward were behind protest action in 2017 which lead to an intervention by the MEC. “Post 2017 community strike there has been a slight change”, said Hlongwana. “Waiting hours have been reduced depending which day of the week it is.”

One patient told Health-e that there must be a shortage of beds at the hospital because patients were forced to sleep on benches in the waiting area.

Ntuthuzelo Maganya of Mtshayelo Village had a serious head injury in January of this year and was rushed to hospital.

“On arrival I was put on a drip and told to move from the bed to a bench so that a patient who is sicker could have the bed.”

“I stayed there all night waiting for the doctor who arrived around 7 am. The doctor attended to me and transferred me to Nelson Mandela Hospital, I slept for the second night on the bench while I was waiting for an ambulance to Mthatha.”

Maganya was not the only person to complain about a shortage of beds and sleeping on benches. During an evening visit to the hospital several families were spreading blankets out on the floor in order to sleep, anxiously waiting for ambulances and transport vehicles to Mthatha. Mthatha is over 160kms away, almost 3 hours on steep winding roads.

One family declined to speak, fearing they would lose their spot on the next available ambulance.

A patient transport vehicle arrived at the hospital by 8:30pm that evening, dropping off a full load of patients and their family members.

A birds-eye view of Holy Cross Hospital, 23km from the centre of Flagstaff, Eastern Cape. Spotlight and Health-e were denied permission to visit the hospital by the Department of Health. Photo: Kathryn Cleary, Spotlight

After numerous attempts, the Department of Health failed to respond to questions from Spotlight and Health-e; the questions were directed to the hospital’s current CEO and queried staff shortages and vacancies, water and infrastructure issues, the ongoing investigation of the Hospital Board, and the outcome and recommendations of a 2017 task team report into Holy Cross Hospital.

The Department of Health did not provide the task team report to media, as a result Spotlight has filed a PAIA request to obtain access to the document.

Small improvements since 2017

A NEHAWU leader at the hospital said there had been improvement at the hospital since the MEC’s intervention in 2017. Former MEC Dr Pumza Dyantyi intervened after disruptive protests at the hospital in 2017 and appointed a task team – it is that task team’s report we have not been given access to.

“Generally [things] are better in terms of assistance from the Bhisho offices, but in terms of the District it is still the same. If you look at systems, they are too centralised.”

The source said they received the report last December, and the hospital had implemented the majority of the recommendations. They added that management had improved under a new CEO as well as patient care, but transport and ambulance services remained a critical issue.

Due to a lack of specialist doctors, many Holy Cross patients are referred to Nelson Mandela Academic Hospital in Mthatha.

“The issue is that most specialised local doctors don’t want to work here”, they said. “I can’t say the actual cause”.

The Department of Health was queried as to how many vacancies and resignations the hospital had within the last year, but no response was provided.

Another issue emphasised by the NEHAWU Chairperson was the crumbling infrastructure of the hospital; attributing it to burst water pipes. The source confirmed that the bucket of water in the hospital’s waiting area was a reality, and that while some wards had aqua coolers for drinking water, others were without. These complaints follow a major R105 million refurbishment of the hospital completed in January 2012.

Insights into the 2017 task team report

Echoing the sentiments of NEHAWU, a source from the Hospital Board provided more insight into the 2017 task team’s report.

“I can assure you, since after the toyi-toyi, we tried to respond to all of the things that were part of the report by the task team.”, said Aubrey Ruleni, Chairperson of the Holy Cross Hospital Board.

Ruleni said that the recommendations made in the report were implemented to the best of the hospital’s ability; changes were made in management and the Hospital Board.

“We are trying our best”, he said.

“One of the things raised in that report was that the Hospital Board doesn’t go to people [in the community], so as a result people lack information. We needed to address that and we did.”

Following the 2017 intervention the Hospital Board was put under investigation, according to Ruleni this is still ongoing.

Ruleni added that the CEO at the time of the 2017 protests had been removed. “The CEO ultimately left the hospital, [they were] taken by the Department to another hospital. According to the findings, nothing was done wrong by the CEO, it was [community] allegations and those allegations were not proved positive.”

Ruleni stated that he was unaware of any incident where a doctor had resigned or transferred as a result of mismanagement or poor treatment.

“The problem we have [is that] some doctors don’t want to stay for a long time in the rural areas. Sometimes it’s not because there is a problem with the hospital, but maybe because they do not enjoy being in the rural areas,” Ruleni said. “The issue of doctors, they come and they go, it’s not a new thing and it’s happening to all hospitals.”

Regarding emergency medical services in the Flagstaff area, Ruleni said that the closest ambulance service was 60km away in Mount Ayliff. The lack of EMS in rural areas of the Eastern Cape has been reported on in depth by Spotlight and Section27.

“We are striving, trying our best to solve that [and] to have our own resources.”, said Ruleni. “Because at the end of the day we don’t know what’s going to happen, [and] when. That is a problem.”

Ruleni emphasised frustration with supply chain management in the province; stating that it was a challenge for paperwork to go through Bhisho nearly 6 hours away, when there are qualified people in the local area capable of doing the work.

“We are still trying to engage the Department to assist us.”, he said.

Holy Cross and the NHI

Thinking forward about the proposed National Health Insurance (NHI), Ruleni says that it cannot be properly executed at Holy Cross unless basic infrastructure is upgraded.

“The problem of water at Holy Cross Hospital is caused by the old pipes. Anytime, I can get a call that there is a burst pipe. We are trying to sensitise the Department about that.”

“We really welcome NHI, but the infrastructure must be upgraded. When we talk about the NHI, you are talking about the issue of those people who cannot afford to have medical aid. If the situation is as it is now, I don’t think it’s going to work.”

Like many other rural hospitals, without improved infrastructure and supply chain management, the NHI remains a pipe dream.

“As much as I welcome it as a good idea, in the rural areas we are still having challenges.”, said Ruleni.

“I would like to see Holy Cross Hospital stand on its own, [and] not be managed by somebody in a certain corner. Also, we would like to see the people around the area to support whatever initiatives.”

“Sometimes the people are vandalising even the fencing, so if the people can assist us to stop [that from happening]. If they assist us, Holy Cross is moving in the right direction.”

A sign points to Holy Cross Hospital, a right turn takes residents uphill on a tar road leading to the main entrance. Photo: Kathryn Cleary, Spotlight

*Kathryn Cleary is a health journalist with Grocott’s Mail in Makhanda, Eastern Cape and was commissioned by Spotlight to write this article.

*Zizo Zikali is a citizen journalist with Health-e News and is based in Flagstaff.

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