#Vote4Health: Seven years of struggle at Holy Cross Hospital

The main entrance to Holy Cross Hospital, 23km from the centre of Flagstaff, Eastern Cape.

By Kathryn Cleary and Zizo Zikali

The long-suffering Holy Cross Hospital outside Flagstaff, Eastern Cape, has a troubling history. The hospital services eleven traditional houses, (roughly 100 villages) in the Ingquza Hill Local Municipality, part of the OR Tambo District. As part of the #Vote4Health series, Spotlight and Health-e News re-visited the hospital after years of turmoil. The visit follows NSP Review’s harrowing 2013 ‘Death and Dying’ report – as well as drastic water shortages, near collapse of the hospital and numerous government interventions.

While Holy Cross hospital has a longer history, our timeline starts in January 2012 as a R105 million refurbishment of the hospital is completed. The refurbishment forms part of the broader Department of Health Hospital Revitalisation Programme.

January 2012, refurbishment of Holy Cross Hospital finishes.

13 September 2013, NSP Review, a Section27 and Treatment Action Campaign (TAC) publication (now known as Spotlight), publishes a comprehensive report titled “Death and Dying in the Eastern Cape.” The report details heartbreaking accounts of poor service delivery in the Eastern Cape’s public health sector. One story, Baby Ikho: He should have lived, tells the story of a toddler’s final hours in Holy Cross Hospital after being admitted with a chest infection. With oxygen needed to save his life, the story recalls the attending doctor, Dr Dingeman Rijken, tearfully watching, helpless, as  the last few ounces of oxygen in the hospital ran out, leaving Ikho gasping for air, and eventually passing away. Baby Ikho’s story was read by many, including some at the Department of Health, the Health Professions Council of South Africa (HPCSA) and the Office of Health Standards and Compliance (OHSC). The story was later redacted in the published version of the report to permit further investigation by the National Department of Health.

19 September 2013, Minister of Health Aaron Motsoaledi responds publicly to the report. In a media briefing Motsoaledi confirms that the Department was aware of the challenges faced by the Eastern Cape; particularly the deplorable state of public healthcare services in the OR Tambo District. The report prompted an urgent investigation by the National Department of Health. The investigative team’s findings included gross shortages of vital medical equipment in the maternal ward, including an absence of fetal heart monitors and thermometers; poor staff attitudes towards patients and other staff, as well as poor management and financial corruption.

Motsoaledi recommended that the CEO and Nursing Services Manager be suspended and put under investigation immediately, and for the Hospital Administrator to be investigated. Further, he urged that the CEO and Nursing Services Manager be reported to the South African Nursing Council (SANC).

Additional recommendations included a forensic audit of the hospital and an intervention at the District level. Vital medical equipment was also to be purchased and distributed to Holy Cross as well as 13 District, 2 Regional and 3 Specialised hospitals in OR Tambo. This was scheduled to occur the week after the media briefing, 23 September 2013.

2014, the OHSC issues an inspection report scoring Holy Cross Hospital at 43 percent, a failing score.

21 October 2015, Spotlight publishes a follow-up story titled “Holy Cross: Some progress, but all is not well”. The article highlights the devastating water shortages at the hospital, lasting at times for over a week. A Doctor quoted in the story recalled a water outage for six weeks; having dire consequences for patients and staff.

Other issues included staff accommodation, staff shortages, a lack of permanent staff and a faulty top-down management system. A source in the story claimed that the centralisation of the provincial management system was inefficient, and that sending paperwork off to Mthatha for signatures was impractical.

2016 the OHSC scores Holy Cross Hospital at 60 percent. While still below the OHSC pass level of 80 percent it is nevertheless a marked improvement from 2014.

2016-2017, the OHSC issues another inspection report rating the Eastern Cape at 43 percent, and Eastern Cape hospitals at 50 percent. Nationally, the Eastern Cape had the lowest score.

January 2017, Holy Cross residents take their frustrations to the streets demanding improved health services at the hospital. Residents barricade the road linking the hospital to the R61 with burning tyres; everything was brought to a stand-still, including ambulances and patient transport vehicles.

The leader of the strike, Dumisani Mbangatha states that grievances included long queues, poor staff attitudes, a shortage of medicine (as a result patients were sent home without their medication), and nepotism.

Mbangatha and residents also demand that (now former) CEO Gloria Mazeka should be removed from her position.

Mbangatha added that according to the hospital’s organogram, the Board of Directors was to report to the community, however there were no open lines of communication between the Board and the community.

In response to community uproar (now former) MEC Dr Pumza Dyantyi visited the hospital. Dyantyi received a memorandum from the community and asked a task team to further investigate allegations.

6 April 2017, MEC Dr Pumza Dyantyi returns to Holy Cross to receive the task team report.

10 April 2017, In an article titled ‘The hell suffered by patients at Holy Cross Hospital’, Health-e reports that the water crisis and other issues at Holy Cross are far from over.

August 2017, Holy Cross Hospital NEHAWU Chairperson Mthandwa Zitha says that the functionality of the hospital had been compromised due to a lack of non-permanent senior management officials. At the time, Holy Cross had only an Acting Hospital Administrator, and critical posts such as Chief Medical Officer and Nursing Services Manager were vacant. Zitha recommended that a situational analysis be conducted concerning the high rate of staff turnover at the hospital.

Adding to this, the hospital’s DENOSA Chairperson Mzolisi Ludumo, said the issue of vacant positions in management is not a challenge solely faced by Holy Cross, but that District hospitals such as Holy Cross, St Patrick’s and Grenville experienced similar challenges in human resources.

December 2017, Health-e reports that soon nurses at Holy Cross could be left without accommodation. Nurses residing in trust houses (used as nurses homes) were notified to vacate the properties before 2 January 2018, the eviction notice was from the Anglican Church Authorities who claimed that the land on which the nurses’ homes were situated was owned by the church. The then Anglican Bishop Thanduxolo Magadla claimed that they wanted to renovate the buildings to create decent accommodation for the nurses who in turn would pay rentals to the church.

According to former hospital board chairperson Mthuthuzeli Sinukela, the eviction process was unpleasant and nurses complained of harassment during the process.

February 2019, Health-e further reports that there was a dispute about the rightful owners of the land where the trust houses are located; the dispute was between NEHAWU, the Anglican Church, the traditional leaders and the community.

The community claimed that the hospital land belonged to the community, while the traditional leaders said the church is the rightful owner have a title deed to prove it. However, NEHAWU Chairperson Mthanndwa Zitha claimed that the houses were built by the Department of Health many years ago to accommodate hospital staff.

Ingquza Hill Traditional Council Thandisizwe Mgwili confirmed that the rightful owner of the hospital land is the church.

April 2019, a copy of the 2017 investigative task team report is requested from the Eastern Cape Department of Health. Failing to respond to queries from Spotlight, a PAIA request for the document was later submitted on 9 April.

In April 2019 Spotlight and Health-e also publishes a new article on the situation at Holy Cross and a timeline of events at the hospital over the last seven years (the document you are now reading).