#Vote4Health: No road to health in the Northern Cape
By Anso Thom, Marcus Low, Nomatter Ndebele and Thom Pierce (photographs)
Calvinia, Sutherland, Fraserburg, De Aar, Keimoes, Kakamas. Join Spotlight on a disturbing road-trip through the Northern Cape public healthcare system.
In November 2018 Spotlight travelled through the Northern Cape meeting with doctors, nurses, activists, politicians and community members. After months of follow-up and attempts to get comment from government, we have decided to publish the disturbing information we have. Below are some reflections on six towns we visited – also see our more in-depth feature on the Northern Cape here.
In November last year this town had two Community Service doctors only. It now has three Community Service doctors, a Congolese-qualified doctor and two private GPs doing sessional work in the hospital. One of the Community Service doctors now travel to Sutherland once every two weeks for a few hours, with no supervision.
Sutherland has no doctors after the last state doctor left at the end of November. A professional nurse Marguerite Jordaan who recently retired after 29 years in the service said it has been extremely challenging to deliver a 24 hour service at the 24 bed Community Health Centre which includes an eight bed maternity unit. What does she do when she has a serious case and there is no ambulance or doctor? “You pray a lot,” she smiles. “You do what you can and you hope for the best.” The Community Health Centre relies heavily on the nearby Southern African Large Telescope (SALT) operation to sponsor crucial basic medical supplies such as bandages, syringes, suture material and plasters.
About 110km on a corrugated dirt road east of Sutherland, Fraserburg also has no doctor and reports of several nursing staff simply not pitching for work on some days. A nurse told Spotlight that referring patients to hospitals was a massive challenge with ambulances often forced to transport up to eight patients to Calvinia or Upington. She recalls instances where Calvinia could not take on any surgical cases as they had no gauze. The nurse also said there has been times when the depot in Kimberley had no insulin and no drugs for epilepsy.
Both the outside and inside of The De Aar hospital building looks like a shiny pamphlet. The hedges that line the drive ways are trimmed, the signs on the hospital are gleaming in the afternoon light, the security guards at the gate are many, there isn’t any litter in sight- just paved walkways and seemingly unused red benches.
About a year ago, the old De Aar hospital was suddenly closed and almost overnight, the entire hospital was moved a few kilometres down the road to the new facility.
The old facility is now an empty lot, guarded day and night by two security guards.
Over five or six months, thieves have looted the hospital of what furniture was left. Pieces of the ceiling have been ripped out, corrugated iron roofing and other equipment ripped from the walls. Everything that is possibly worth anything has been removed.
The corridors are littered with patients files, sealed syringes, used syringes, medication packets, floppy computer discs, and other debris. Some say that the old hospital was supposed to be turned into a nurse’s home, but that the delay meant the thieves could take what they wanted.
Now De Aar, famous for being home to one of the country’s most important railway junctions, is home to what appears to be two mostly empty facilities, and a story that just doesn’t add up.
It does not really matter from which side you approach Keimoes, chances are you would have negotiated some serious dusty desert to reach the heart of the so-called Green Kalahari, an oasis resting lazily on the banks of the Orange River, also known as the Gariep. Fat, thick vines are luminous green with irrigated water glistening in the sun. The surroundings are bone dry, but the Gariep pumps more than enough of the lifegiving fluid to grow the best export sultanas as well as tons of wine grapes, pecan nuts, watermelons, peaches and lucerne. The manicured farm entrances all speak of prosperity, lush Bougainvillea and Cannas showing off several rainbow colours. Everything seems to grow and prosper and shine.
But scratch a little so you can see below the green, and the tranquil, almost fairytale-like picture dissolves. Driving towards Kakamas, the hospital sits on the edge of the town, in a dustier section of Keimoes off the main road. The brick building is tucked away towards the back of a large dusty yard and there is almost no human activity. There is also no security or a manned gate. A walk around the hospital’s exterior presents flung open doors with empty rooms filled with rubbish and waste, rubbish has also been dumped in the veld a few steps from the hospital and the morgue is behind rickety lock and key, no longer in use.
The health services inside the hospital appears to be in a similar state, despite the best efforts by those who bother to pitch up for work. Most parts of the hospital are deserted with some signs of its former heyday… “hospital” is actually not the correct term or even more correctly, Community Health Centre. There is no doctor. There are very few other health workers or staff such as cleaners. Community members speak of constant shortages of medicines and basic supplies such as bandages. Ambulances are glorified taxis between the hospital and Upington about 45km away. Two nurses and their assistants try to keep the 28-bed hospital running. Patients, admitted to the beds (including the six-bed “maternity” ward) are left to fend for themselves. A health worker who spoke to Spotlight admitted openly that they mostly have to ask family members to bath and feed patients. As we walk down a particular passage, the moaning from one of the rooms leads to a man lying on his side, staring into space, groaning in pain with no health worker to attend to him. In another room a young mother watches every breath from her baby in the cot. Further down another passage just past the room where women give birth, a chest freezer reveals buckets with human tissue. Read more in the main article.
In another wing, patients wait in the hospital’s now former theatre (the overhead lights are a giveaway), as the nurses try to get through the waiting queue. This is not a hospital, it is barely a health facility. The people of Keimoes deserve better.
(Spotlight visited an ambulance base in at the hospital which is basically a rundown little office with collapsing ceiling and electrical extensions running across the floor. A manager who spoke to Spotlight admitted that “the ambulances are more broken down than running”.
- A list of questions were sent to the MEC and the Northern Cape health department with specific questions on the state of Keimoes hospital. None were responded to.
From the outside Kakamas hospital is picture perfect. The image of the hospital is delicate, so delicate that if one looks a little bit harder. The hospital starts to unravel, from the inside out. There are session doctors in the hospital, but the theatre has been locked for years. There are doctors, but there are no oxygen tanks. Staff tell us there are no IV drips and very little drugs and other medical supplies.
They tell us that nepotism is rife, that friends are appointed into senior positions with no qualifications, that HR functions are a joke. Community activists, hospital staff and NGO workers spoke openly about the dysfunctional state of the hospital. “There is corruption everywhere” says NGO worker Caroline Booysen, “The only people that get help here are relatives or friends,” she said.
We are led down a green passage, with yellow doors alongside it, at the end of the passage are two doors, with the words “Theatre” painted on a panel above the door. At first glance, all seems well until you notice the big golden padlock dangling on a latch. The theatre is closed. And has been so for months.