COVID-19: How clinic closures disrupt health services in PE
The temporary closure of clinics in Nelson Mandela Bay Metro, whenever a staff member tests positive for COVID-19, has disrupted healthcare services at many of these clinics and at least two hospitals. This often means patients, mostly women, children and the elderly, are left stranded because they rarely have the means to go to a different clinic further away.
At times visibly frail patients are advised to visit nearby clinics until their local facilities reopen. Often it doesn’t end there. Some people seeking treatment and medication at nearby clinics are referred to yet other facilities when the required medicine is not available or when patient numbers are too large.
Some people simply give up.
From pillar to post
Bongiswa Mbatsha from New Brighton attends New Brighton Clinic for her antenatal checks-ups. “The constant closure of clinics due to the COVID-19 pandemic is becoming a problem because sometimes patients are being forced to leave without being treated,” she tells Spotlight. “Patients are now sent from pillar to post to access healthcare, more especially when visiting alternative clinics such as Tshangana or Empilweni Clinic. Nurses constantly refuse to assist patients from other facilities because they have a huge workload.”
This week Health Minister Dr Zweli Mkhize was on a two-day visit to the Nelson Mandela Bay Metro where he inspected health facilities. It has been reported that obstetric services at hospitals such as Dora Nginza Hospital have huge backlogs due to the clinics closing.
Thobeka Peter, a patient at Soweto-on-Sea Clinic, says she was turned back at her clinic when she took her baby for a routine immunisation in June.
“Last month I had an appointment for an immunisation injection for my four week old baby boy, but a security guard said the clinic was closed because one of the nurses had been infected with COVID-19,” she says. “I was not given an alternative date to come back for the immunisation. I was concerned about the health of my son because immunisations injection is important at his age. We can’t afford to skip it.”
Spotlight previously reported that national immunisation rates for children under five years have dropped dramatically over the lockdown period, sparking fears of an outbreak of deadly childhood infectious diseases including measles.
A nurse assistant at New Brighton Clinic who asked not to be identified, said health workers are working under very dangerous conditions. “We are working under life-threatening conditions. Once a health worker is diagnosed with COVID-19, that influences the decision to close clinics,” she says. “When a colleague has contracted the virus, we can’t risk working as we have to isolate ourselves and get tested. This is meant to protect the vulnerable members of the community from contracting this virus. Safety of patients is of paramount importance to us and we take this decision with them in mind.”
She says people must understand that health workers should be safe at all times. “Should nurses or doctors come into contact with those who’ve tested positive for COVID-19, this will risk the lives of those we treat on a daily basis who are not positive.”
According to Nelson Mandela Bay Metro’s District Manager for Health, Darlene de Vos, 337 primary healthcare workers in the NMB Metro have tested positive for COVID-19 by 21 July and three staff members have died.
It starts with cleanliness
De Vos paints a more positive picture of the situation and says the health facilities are improving compared to when the outbreak started.
“There is a glimmer of hope as clinics are operating far better than they were last month. The department could not afford to have health facilities shutting down even if our personnel tested positive for COVID-19. Clinics’ closures resulted from an unfortunate situation created by fear and anxiety causing panic among staff. Also, there were and still are some areas that lack enough knowledge amongst our own personnel which we are vigorously trying to address,” says de Vos.
“When COVID-19 started, everybody was in a state of panic. Even in health facilities when there was one infection, the staff would close the facility and demand it to be decontaminated because they were scared,” says de Vos. “The department of health has developed guidelines for cleaning and disinfecting of all facilities, as a way of dealing with spontaneous closures of healthcare institutions.”
De Vos says the department of health has a cleaning protocol since every health facility has to deal with various infections daily. “Our normal standard cleaning procedures include disinfecting protocols that are as applicable to COVID-19 as there are for any other infectious condition. Also, the National Institute for Communicable Diseases has made it clear that they do not promote the spraying of facilities.”
Health Minister Dr Zweli Mkhize during his visit at Livingstone Hospital this week, slammed unhygienic conditions in health facilities as a result of poor management. “The question of quality of care starts with cleanliness,” he said.
“Anyone who walks into a hospital that is dirty gets even sicker than they were before they got in. It’s a simple, basic issue. We need to focus on that. It’s a question of how the hospital is being managed.”
According to de Vos, her department is training cleaning staff, including nursing staff, on COVID-19 cleaning protocols and teaching them about occupational health safety measures. She says this training would help when the metro reaches its COVID-19 peak.
“We are very concerned about the peak period and our staff are going to be infected, but that doesn’t mean that the facilities must be closed, instead we should be ready when the peak comes,” she says.
Another resident, Morgan Breakfast from Motherwell, is among the patients who were referred to other facilities. “I have been turned away a couple of times at Motherwell Community Health Centre when I was supposed to remove surgical sutures and collect medication. We don’t have a clinic at NU29 in Motherwell. We only rely on a mobile clinic which doesn’t have my medication. It costs me R26 to get to the clinic and back. It is a heavy burden because I’m unemployed. When I don’t have bus fare it takes me nearly one hour to walk to the clinic and it is very painful to walk such a long distance.”
Nqaba Nkanjeni, a TB patient at Thanduxolo Clinic in NU 10, Motherwell says, “The situation is made worse by non-availability of people who monitor queues at health facilities because people are not observing social distancing. I suspect,” he says, “that our nurses are using COVID-19 as a scapegoat because services were poor in our clinic even long before the outbreak of COVID-19”.
“Nurses only take a minimal number of elderly and frail people. Some patients are being forced to leave without being treated,” says Nkanjeni.
A nurse working at Kwazakhele clinic, who preferred not to be identified, said their clinic is one of few clinics in the metro that has not yet closed since the start of lockdown. “When neighbouring clinics are affected by COVID-19, we see an influx of patients. Bear in mind we have our own long queues because we normally don’t explain to our patients about the alternative collection method of collecting their medication. We fear that it will make it difficult for us to track them. We only gave them two months’ supply so that we can be able to monitor their progress.”
The action plans
According to de Vos, clinics are never closed all at the same time. “We have put measures in place in an attempt to meet our patients’ needs during those closures for example when Motherwell Community Health Centre was closed, arrangements were made for pregnant women who needed to deliver to be taken to Kwazakhele Clinic and trauma cases to Dora Nginza Hospital,” says de Vos.
“When our facilities were closed, we instructed nurses from the closed facility to follow their patients to neighbouring clinics. To follow a patient means nurses must move with their patients to the nearest facility in order to relieve pressure on that clinic that already has their own client base.”
De Vos admits that following patients’ is not always successful because sometimes the staff refused to work in other facilities.
“We have dealt with staff members who have refused to relocate with patients as we had to invoke the labour relations legislation.”
De Vos says they plan to notify and educate people not to come and queue at clinics early in the morning as that doesn’t help because clinics open at 8am.
“We are looking at putting systems in place where we will be providing a delivery service to people’s homes who are on chronic medication so that they don’t have to unnecessarily come to clinics and put themselves at risk. We are getting assistance from community health workers. We don’t have transport for patients and most of our clinics are less than 5km from one another,” de Vos explains.
De Vos says they encourage the more stable patients to enrol under the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme to reduce patients’ travel times as there is no need for them to leave homes early and incur travelling costs to get to hospitals or clinics. “The CCMDD programme is well established in the Metro as there are currently 26 426 patients already registered and over 40 collecting points.”
Dr Mthandeki Xamlashe, Head of Medical Service in the province, agrees it is important for patients to take advantage of the CCMDD programme because it reduces the number of patients flocking to clinics.
“The deadly virus is expected to peak in the province and the virus is now at a stage where it is not only affecting us, but it infecting us,” he says.
“We had problems at our clinics that are constantly closed due to COVID-19 cases. Patients can go to their nearest clinics to collect chronic medication because patients’ information is centrally stored,” he says.
Xamlashe says the CCDMM programme also has contingency plans for when an independent pharmacist gets sick and has to close for days or weeks.
“All the clinics in the province have a uniform package. If a patient cannot access medication [or care] from their local clinic, alternatively they can go to a nearby clinic. We do sometimes experience connectivity challenges in remote areas, but those cases are now manageable,” Xamlashe says.
Neither Xamlashe nor de Vos would say how many clinics had to temporarily close during lockdown.
As of 16 July the city had recorded 14 655 confirmed cases and 240 confirmed COVID-19 deaths.