Opinion: The devastating cost of the North West strikes

There aren’t bodies to count or graves to mourn over, but the North West health sector strikes last year did claim its share of victims and did set in motion a ripple effect of tragedies.

They are tragedies that tell the story of how a strike turned not just violent but vicious, and how it was allowed to rage out of control till it reached a terrible turning point – one where everyone is a loser.

The headlines and photos of mayhem from a year ago may be old news now, but people who need health services to deliver are still counting the costs. Doctors and medical staff are adamant the strike did lead to deaths or at the very least severely compromised patients’ healthcare.

Senior personnel at the Tshepong Hospital in Klerksdorp, Prof Ebrahim Variava and Dr Alistair Calver, kept an informal list from the weeks when the strikes hit their hospital hardest in that first quarter of last year.

On the list are the dozens of patients who were unable to receive their medicines because people were prevented from entering the hospital during the strikes. Some patients had to be discharged prematurely because there were not enough nurses to attend to them. Others were redirected to nearby hospitals – their fate remains unknown. Some patients never returned to have their surgical procedures and the hospital has not been able to track them.

“We could have a worse scenario on our hands than the Life Esidemeni tragedy,” says Calver.

Variava and Calver are among the 73 doctors who felt compelled to write an open letter of concern that was published in various publications in April 2018. Taking a stand publicly was a turning point. It was an acknowledgement that doctors had become direct targets – more casualties of the strike.

At Tshepong doctors were barred from getting to their patients. They were verbally abused, harassed, pushed and shoved as they tried to treat patients at the hospital.

As the strike deepened last year, striking workers from Nehawu were joined by those from Saftu (South African Federation of Trade Unions). At around the same time there were general service delivery riots calling for the axing of then Premier Supra Mahumapelo and other North West government officials. Thugs piggybacked on the chaos of labour action and the political dissent with looting and rioting, adding to the perfect storm of mayhem that marked that first part of 2018 in the province.

It was the thugs who surrounded vehicles headed to the hospitals and clinics. They tried to extort money from doctors by demanding R20 from each driver to pass on the roads that they had barricaded with burning tyres and large rocks.

Variava recounts being racially abused when he tried to appeal to strikers to allow doctors to attend to patients. Instead what was believed to be Nehawu members made pejorative comments about his surname, asking “If he had Gupta links” before shouting him down from being allowed to address strikers who had gathered in a hall inside the hospital.

Community service doctor Hanrie van Niekerk from Tshepong Hospital remembers at the height of the North West province strikes the lengths non-striking staff went to in order to get to patients. Some arrived before 6am before the strikers stirred, others arrived incognito and at one point doctors tried to get access to the hospital via helicopter. Their plans were thwarted when striking staff piled furniture, dustbins and other objects onto the helipad.

“I remember a young woman in casualty who was a resus case. It was just me, two intern doctors and general ward nurses. The senior doctors couldn’t get into the hospital and the general ward nurses didn’t know what to do in casualty. I had to get advice and instructions by phone, we could have lost our patient,” she says.

Young doctors like Van Niekerk stand to be casualties too. They are the ones the country needs to retain in the public healthcare system. Many, already frustrated with the lack of resources and support for their jobs, feel they don’t need the added stress of being targets during strikes. While Van Niekerk says she has no intention of leaving the public sector, she admits she felt threatened on many occasions during the strikes. She refused to stay away from her patients though, forcing her anxious husband to insist on driving her to and from the hospital every day during the strikes.

“Even in a war a hospital is not a target, but in the North West the strikers were in the wards and in the theatres trying to force us and patients out,” she says. Damage to infrastructure and loss of resources also count as casualties.

Variava and Calver, like many other doctors and nurses, do believe in the right to strike, also in many of the demands their striking colleagues made. Variava says it’s wrong that they have been ignored for the longest time. But hospitals, clinics and other healthcare facilities and non-striking staff cannot be reduced to pawns.

They say what’s needed are for new service level agreements to be negotiated with unions. Variava also calls for a Human Rights Commission inquiry into the extent of deaths and casualties as a direct and indirect consequence of the strikes in the North West province.

He says there must be consequences for those who vandalise property, threaten people, incite violence and those who use labour action as cover for criminal activity that includes extortion, looting, robbery and assault. To date no one has been arrested and prosecuted for these criminal acts.

In the aftermath of the strikes bitterness lingers. Broken relationships are a casualty too. It was patently obvious at a Unisa College of Law Biotechnology and Medical Law Flagship discussion group held at the end of October. The event was titled “The right to strike in the public healthcare sector: South Africa’s healthcare battlefield” – ‘battlefield’ not being hyperbole.

The expert panel included lawyer Suemeya Hanif from ENSAfrica, Professor Ames Dhai, director of the Steve Biko Centre for Bioethics at the University of Witwatersrand, Sibongile Tshabalala, national chairperson of Treatment Action Campaign (TAC) and Professor Chris Lundgren, anaesthesiologist and bioethicist from the Faculty of Health Sciences at the University of Witwatersrand.

The panel condemned the violence from the strikes, recalling incidents like clean linen being deliberately strewn outside laundries, garbage bins being tipped inside hospital lobbies and doctors being assaulted, harassed and robbed as they were walking to their cars. It wasn’t just the North West hospitals either, but also Charlotte Maxeke and Baragwanath Hospital in Gauteng.

The Unisa gathering was aimed at sharpening the focus on the legal framework that is in place for labour disputes. It should be adhered to, not disregarded as more casualties get chalked up.

Both Lundgren and Tshabalala said they believed that the real toll on patients and staff is still to be revealed.

The panellists called for new rules of engagement with unions, also for shifting the “battlefield” away from hospital and healthcare facilities.

It was one nurse’s comment from the floor during that day’s discussion that showed just how deeply the fault lines and failings in healthcare run. The man who identified himself as a nurse and a Nehawu member said: “Patients are not my first priority; they are ‘a’ priority. There are some of us who refused to take the nurse’s pledge because this is just a job for us.”

This nurse too is a casualty as a person who sees a profession of caring and healing as little more than a pay cheque. He is a casualty stuck in the cycle of endless fighting for fairer pay, improved work conditions and better career opportunities.

Organised labour is also a casualty, winning only Pyrrhic victories and increasingly losing public sympathy and support as the legitimacy of strikes grows fuzzier. What “victories” labour has had in the North West has come at the cost of others’ wellbeing and rights. Nehawu leadership’s worn excuses of “distancing themselves” from rogue members of their organisation doesn’t cut it anymore. They knew what was happening and their response to it was feeble and mealy-mouthed. Nehawu spokesperson Khaya Xaba’s failure to respond to questions sent to him by Spotlight also show contempt for the media and disrespect for the public who deserve answers and open communication.

Nehawu’s reputation is a casualty and so is that of police officers who stood by as acts of violence and criminality took place before their eyes during the strikes. The same goes for the Provincial Department of Health as a whole and for health minister Aaron Motsoaledi. Motsoaledi acted too slowly in the North West, leaving many to question if he was simply letting politics play out as the ANC faced its own internal struggles over the messy ousting of the then premier. It added more barbs to the thorny narrative that outlying, rural areas are relegated lower down government’s priority list.

The North West is still under administration, as it has been since May last year. The strikes proved to be the straw that broke the camel’s back, turning government structures and departments into casualties – casualties unable to serve the citizens of the province even at the basic level of services provided prior to the strikes.

The strikes cemented in place a web of failings – sticky, tangled and toxic. Right at the centre of this web of tragedy is the patients and their families. The ultimate casualties are the mothers who rock babies with brain damage to sleep in their arms knowing their children would have been born fine if there had been functioning operating theatres where they could have delivered their babies.

It’s the people who died at home not able to face thugs who had barricaded hospital gates or those who were forced to leave hospital too soon and later died of complications. It’s the people who grapple with the anxiety of knowing they face new medical challenges having defaulted on treatment they could not access on time. It’s the patients in the North West who today still will wait an extra hour or two in a queue or be told to come back next month as backlogs are worked through.

They’ll likely be told the standard excuse now: “It’s because of the strikes from last year”.

Health Minister should be given greater powers

By Dr Ndiviwe Mphothulo

We need to amend the National Health Act (No. 61 of 2003) so as to give the Minister of Health greater powers to intervene in provinces and avert disasters in provinces. If we do not, the Minister’s hands will remain tied when it comes to the next Life Esidimeni, the ongoing oncology crisis, and the non-placement of medical interns, argues Dr Ndiviwe Mphothulo.

In 1994 a democratic government was finally elected in South Africa. Soon after, section 27 of the Bill of Rights in the Constitution of South Africa placed an obligation on the this democratically elected government to develop legislation and implement measures to ensure that the rights (including the right to access healthcare services) enshrined in the constitution are realised.

The first task of this democratic government was to do away with the historical injustices of the past. The fragmented, apartheid South African healthcare system that had 14 health departments serving four different races was abolished by the new government in 1994.

The South African public healthcare system has made a number of major advances since 1994. These include, but are not limited to;

  • free primary health care,
  • greater parity in district expenditure,
  • the essential drugs programme,
  • choice on termination of pregnancy,
  • the hospital revitalisation programme,
  • anti‐tobacco legislation,
  • an improved immunisation programme,
  • community service for graduating healthcare professionals,
  • training of Clinical associates,
  • improved malaria control, and
  • the biggest ARV treatment program in the world.

With all these commendable gains, our health system still faces major challenges. These include:

  1. the quadruple disease burden of explosive HIV and TB epidemics, a high burden of chronic illness, injury and violence, and the epidemic of maternal, neonatal and child mortality,
  2. Severe shortages of doctors and other healthcare professionals in the public sector, and in rural areas,
  3. the current funding model which sees South Africa having a two-tier healthcare system: the private sector providing for 16% of the population but utilising a greater proportion of health GDP compared to the public sector that provides for 84% of the population.
  4. Poor leadership and governance in provinces.

According to the World Health Organisation (WHO) the functions and objectives of a healthcare system are to impact positively on the health status of its community. To achieve the objectives of responsiveness, fair contribution and distribution, new financing mechanisms will be required to provide the much-needed funds to health systems across the world – but critically, it will also require leadership and stewardship.

The crisis in the North West Province, where the department of health was facing near collapse (due to poor procurement procedures), interns and community service doctors and pharmacists not getting placed due to lack of budget for their posts in different provinces, the near collapse of oncology services in KwaZulu Natal, the Life Esidimeni saga in Gauteng, doctors not receiving salaries in other provinces, all point to poor leadership, collapsed governance and lack of stewardship in provinces.

Some parts of the National Health Act (No. 61 of 2003) make it impossible for the National Department of Health (NDoH) to intervene in provinces. According to the act, one of the responsibilities of the health minister is to “endeavour to protect, promote, improve and maintain the health of the population (within the limits of available resources).

But the people who drafted this act never envisaged the potential negative consequences of giving powers to provinces. As pointed out by Minister of Health Dr Aaron Motsoaledi on various occasions, the Minister of health is unable to deal with the following issues:

  • The Human resource system,
  • financial management and budgeting,
  • procurement procedures, and
  • maintenance of infrastructure.

This means that legally speaking the Minister can do little more than watch as tragedies like Life Esidimeni unfold, as Interns are not placed at various hospitals, as oncology services in provinces collapse, and as crises in provincial health systems deepen. The Minister has no legal powers to intervene except for asking cabinet to place provincial departments under administration or holding provinces to account through the office of the health ombudsman. This situation is clearly untenable.

We urgently need to amend the National Health Act (No. 61 of 2003) so as to give the minister more powers to intervene in provinces and avert disasters in provinces.

Note: Mphothulo is writing in his personal capacity. He is the North West Representative of the Rural Doctors Association of South Africa, a board Member of the Southern African HIV Clinicians Society, and South Africa’s 2015 rural doctor of the year.

How rural stereotypes are being broken in Bulungula

By Ufrieda Ho

Note: This is part two of our Bulungula special feature. Click here for part 1.

A registered nurse, a social worker and one more carer – these are the people

The duo of Bongezwa Sontundu and Khunjulwa Mbi head up the Bulungula health programme

on the human resource wish list for the Bulungula Incubator health programme in the Eastern Cape.

It’s not asking for the moon, but health programme manager Bongezwa Sontundu says the added capacity would mean the four villages covered by the incubator would each have five nomakhayas dedicated to their communities. The addition of a nurse and social worker would help carers with expert input for cases that get tricky.

“We hear many problems and we see many things,” says Sontundu. Nomakhayas, like so many Community Health Workers (CHWs), often become part of the families they visit because it’s becomes a relationship of deep trust and intimate knowledge of the other.

Community health workers (CHWs) are drawn from their communities. They become the people that villagers lean on for everything from medical advice, to problems with a troubled teen, to organising an ID, sometimes helping with providing a meal or getting a sponge bath. In the villages in this remote part of the Wild Coast, it also includes helping many ill people up and down the hills of the coastal villages to get to the ferry that’s the only way to cross the Xhora River to get to the nearest clinic. In emergencies a taxi can be called but it will set a family back R800 for the trip, says Sontundu. An ambulance service exists but its reliability is always questionable and unreliable.

Nomakhayas are the consistent and reliable presence here and this adds to them being an essential element of achieving primary healthcare goals, especially in rural or remote areas.

Meaningful work

The view from the Bulungula Incubator looks out to its neighbours of other huts in the area

Rejane Woodroffe, the director and founding member of the Bulungula Incubator, says their CHW programme represents a form of meaningful work for low-skilled workers. The majority of those in the BI group don’t have high school qualifications. In turn though, their service to their communities helps many who have the least access to healthcare to stop from falling through the system’s cracks.

“A lot of what the nomakhayas do is about re-inforcing common sense and practical ways to live a healthier lifestyle,” says Woodroffe.

From the outset, the BI’s key focus has been on maternal and child health. Woodroffe says it’s a pragmatic intervention that delivers true “developmental bang for your buck”. BI has to make an annual budget from funders of R7 million really count.

She says: “If you start from day one that a woman finds out she’s pregnant and you ensure that that woman gets the right information and care for her and her baby, that kid will grow up to have the best chance of access to having a flourishing life.”

Low cost interventions

The interventions at pregnancy stage are relatively low cost, Woodroffe adds. It’s making pregnancy tests and multi-vitamins available, making sure the mothers to be have good information on nutrition and healthy living and that they attend scheduled clinic visits and antenatal classes.

It’s the nomakhayas who fulfil these roles and they continue to be instrumental when the child is born, honing in on monitoring everything to ensure that children are meeting their developmental milestones.

“It’s the normal things any mother would do, but with the nomakhayas’ assistance mothers can be encouraged to quit smoking or drinking or to eat better. The nomakhayas also monitor children’s growth, what’s going on in the home and they can alert a nurse if they suspect a medical condition,” says Woodroffe.

The nomakhayas are also at the next step of a child’s development – helping at play groups for toddlers and helping prepare them to join one of five pre-primary schools in the area that are run by BI. They even meet with parents for BI programmes like toy making from recycled objects. BI is also working to introduce appropriate technology like an app-based hearing test for children and has already launched online learning for primary school children.

The returns on investing in a child in utero are immense says Woodroffe. She knows this first hand too. The BI’s office in Nqileni, where she’s based, is a rondavel surrounded by other rondavels that are the pre-primary school for the village. All around Woodroffe, every school day, are children making puzzles in their well-resourced library, learning to write their names or reading with a teacher. It’s a no-fee paying school but parents are required to be on a roster to cook the two meals a day provided for the children. It’s a philosophy of putting value on community responsibility not on the amount of money someone has.

After their meals the children rush down the slope from their classrooms to a

Good hygiene habits instilled in the young ones is a key focus of wellbeing and health for the Bulungula Incubator’s health programme

trench where they brush their teeth after eating. There’s no running water here, but it’s no excuse for neglecting good hygiene habits. This too builds a value system that emphasises doing rather than focusing on deficiencies.

There’s laughter and giggles, learning and playing – all proof that the BI’s vision is spot on.

More proof that they’re on the right track came this autumn with the announcement that two girls who came through the BI pre-primary ranks in previous years have been shortlisted to attend the prestigious Oprah Winfrey School in Gauteng.

Hope and opportunity

The Bulungula College, another BI project, is also getting ready to open its doors for its first intake of Grade 10 – 12 school children next year. The nearest high school is about 20km away. Parents often can’t afford boarding fees or taxi fares and many children simply drop out.

“We have to give young people hope and opportunities and together with all our partners and collaborators the opening of the college is now happening and it’s a huge project for us,” Woodroffe says.

The college is a bit of a full-circle moment – closing that loop from the foetus in its mother’s womb to a fully grown high school child, ready to take on the world because many hands have helped to get her to that point.

 

 

 

 

 

How “Nomakhayas” beat a scabies outbreak

By Ufrieda Ho

“Nomakhayas are coming, nomakhayas are coming,” the children’s shouts

A nomakhaya tries out a new backpack made especially for the bulky scales they carry on their home visits

interrupt the quiet of a sunny autumn afternoon. The shouts are announcement, also greeting for the community health workers making their way up hills of the coastal villages along the Eastern Cape’s Wild Coast.

Of late there’s been newfound respect and appreciation for these local caregivers, the so-called nomakhayas, who are part of the healthcare arm of the Bulungula Incubator (BI), the not for profit that has started several community development projects in the region for the past almost 15 years.

Over the last few weeks this brigade of 19 women has been instrumental in eradicating a stubborn scourge of scabies that’s left few homesteads untouched, and resulted in at least one reported death of a child in the area.

The success and tenacity of this brigade of CHWs has been a powerful reminder of how effective implementation of primary healthcare comes down to strong community networks, collaboration and commitment.

Re-infection happened faster than eradication could be achieved

At the height of the scabies outbreak old and young were left were affected with the extremely itchy pimples left from the burrowing mites. In extreme cases scabies can affect the proper functioning of the kidneys (Pic: Bulungula Incubator).

Scabies is a skin condition caused by a burrowing mite (undetectable to the human eye) that lays its eggs under the skin. It leaves its human hosts with an intense itchy rash and a trail of tiny pimples. While the skin condition is easily treatable with common topical creams and preparations, the problem with the outbreak in these four villages – where there isn’t access to running water – was that re-infection happened faster than eradication could be achieved.

The local clinics and hospitals could only hand out medication, but were at a loss on how to eradicate scabies completely. When scratched sores become infected they can turn septic and pose bigger health risks.

Bongezwa Sontundu, health programme manager at the Bulungula Incubator, remembers how by the beginning of the year the scabies outbreak had taken over the four villages of Mgojweni, Nqileni, Tshezi and Folokwe that is home to about 6 500 people.

She says: “It was very bad because people would go to the clinics get the creams but it seemed like it was not working and they would just scratch and scratch.”

Photos she and health programme assistant Khunjulwa Mbi have of the worst cases they saw, reveal the extent of the outbreak. Both young and old people were affected and some people scratched till the blistered sores became raw, infected and painful.

Dr Ben Gaunt, clinical manager of the Zithulele Hospital, about 35 minutes from the Bulungula Incubator says the scabies outbreak in the region had started to rear its head in 2016. Then it just spread. For about the last nearly two years it has been endless frustration for medical staff.

“It’s a relatively simple condition to treat and it’s not life-threatening, but when it goes wrong and sores become infected it can lead to a reaction that causes problems with the kidneys.

“We saw an increased number of cases of kidney problems especially in children,” says Gaunt, confirming the death of at least one child linked to complications arising from a scabies infection.

How the programme worked

The eradication programme the BI carers undertook involved carrying out an intensive and systematic cleaning regime.

Sontundu explains that they first needed clear discussions for buy-in from the community. Then a team of five carers arrived at an earmarked homestead where the occupants would have cauldrons of boiling water on the go in time for the nomakhayas’ arrival on the appointed day. Clothes, linen, curtains and towels were boiled in the water while bedding and mats were taken out of the huts to be aired and sunned.

Items that could not be washed were placed into closed black plastic bags for three days to ensure any mites or mite eggs would be suffocated.

Two nearby households would be cleaned in the same way on the next day of

The nomakhayas’ systematic cleaning programme proved to be the most successful intervention to halt the cycle of reinfection of scabies in the villages. (Pic: Bulungula Incubator)

the programme and on the third day a fourth household would be tackled. Also on the fourth day the team would return to the first household to start the medical treatment of the occupants of the home. All the occupants had to follow the same chemical treatment regime at the same time. The treatment that’s applied topically had to be repeated after 24-hours and again on the fifth day of the eradication programme.

Sontundu says following these quite strict guidelines required the oversight and implementation of the nomakhayas. It had to be meticulous to ensure the mites, in whatever phase of their breeding cycle, could be killed at the same time.

“You can imagine if we asked people to do this all work without the help of four or five carers – they wouldn’t do it,” she says.

It was the co-ordinated and structured efforts of the nomakhayas that finally halted the cycle of reinfection of “ukhwekhwe”, the Xhosa term for scabies.

For Gaunt it’s been a relief. He says: “We have seen an across the board decline of scabies cases. The efforts by the nomakhayas show that they are one of two arms to efficient rural health care – nurses being the other.

“When CHWs are supervised and supported they have hugely positive impacts on the communities,” says Gaunt.

Some months after the intervention programme the BI carers are doing usual rounds at the home of Gogo Nophamethe Mdoseni and the six other people who live in the homestead.

Mdoseni’s usual day includes looking after her two-year old grandson Akahlulwa, grinding dried corn at the rondavel on a hill that has a view stretching beyond the crashing waves of the Indian Ocean.

Outside her rondavel her blankets, mattresses and mats are spread out on a sloping hill catching the rays of the midday sun. Other items are draped over the igoqo, the stockpile of wooden sticks that become a makeshift washing line.

“The people know now what they can do themselves to keep the scabies from coming back,” says Mbi, as Mdoseni invites the carers into her home for a mug of sweetened mageu and sweet potatoes straight from the coal fire she’s been stoking outside her hut.

“When the nomakhayas came here and said they were going to start cleaning I just let them do it, but I didn’t think it would change anything because the scabies had been a problem for many months already,” says Mdoseni in Xhosa.

“Then after a few days we all stopped itching and everyone was scratching less and I was very happy that it worked,” says Mdoseni.

She lifts up Akahlulwa’s shirt, there are still a faint line of scars from the scabies pimples that he scratched uncontrollably months before. She breaks into a big smile and so do the nomakhayas. The carers eat the sweet potatoes; they smile a little but don’t dwell on taking too much credit for just having done their jobs.

Before they leave, they bring out their scales and their exercise books, making notes about ailments and checking the general condition of the members of the household – it’s their usual routine.

Sontundu says the BI carers have since they started in 2011 served as an early warning health system in the community. They receive basic first aid training and health and hygiene training. They’re equipped to monitor health problems and being part of the community they understand the things that can affect a family here – everything from domestic violence, depression, alcohol abuse and food insecurity.

“Things are working well here now,” says Sontundu.

At a monthly meeting day at the newly built Bulungula College, the latest in a line of projects spearheaded by the incubator, the carers meet to report back to Mbi. One of the newest recruits is Boniswa Mahlaleni.

“People I haven’t met before are sometimes scared of me. They think that we nomakhaya are like a health police, nagging at them to take their medicines,” she says in Xhosa.

But over the six months she’s been with the programme Mahlaleni’s learnt that patience and persistence pays. She’ll keep donning her navy blue clothes, the signature colour of the carers, keep packing in her patient files and her scale to weigh patients and she’ll keep climbing the hills, knocking on doors or waiting for the local children to announce her arrival. It makes a difference, she knows, it can even save a life.

 

Ambulance bases of shame

An ambulance base has to comply with a certain set of minimum requirements contained in among others the National Health Act. At the end of last year, the Department of Health published a new set of regulations which detail exactly what the requirements are for an ambulance base.

The new regulations can be read here

Spotlight recently sent a photojournalist to four Buthelezi EMS bases. Two in the North West, Klerksdorp and Potchefstroom; one in the Free State, Bloemfontein; and what is suspected to be a central base or headquarters in Eikenhof, Johannesburg.

Images from Bloemfontein and Potchefstroom specifically, show filthy yards, bare insides with no evidence that it is an ambulance base and further evidence that safety and hygiene is not a priority. The images are published alongside our series of investigative articles #Health4Sale.

Picture credit: Spotlight

Health4Sale Part 6: Magashule cleared way for controversial private ambulance company to cash in

By Marcus Low and Anso Thom, Spotlight

Buthelezi EMS netted more than R15-million from two suspect back-dated price increases from the Free State Department of Health, apparently without much scrutiny. Documents that Spotlight has had sight of reveal how the increases were signed off during a five-day period, when it seems the Free State Department of Health was temporarily taken out of administration by decree of then Premier Ace Magashule. The Democratic Alliance told Spotlight that they will ask the Public Protector to investigate.

Five days in February

According to a response by the Free State Department of Health to questions posed by Spotlight, the department was under administration by the provincial treasury for almost four years from 17 March 2014 to 15 February 2018. Among others, this means that the accounting officer, the person who ultimately signs off on all health spending, was not the head of the provincial department of health, but the head of the provincial treasury.

Yet, contrary to what the department told Spotlight, this was not the case for

Ace Magashule
Photographer: Khothatso Mokone

five days in February 2017. In a signed memorandum dated 3 February 2017 seen by Spotlight, then Free State Premier Ace Magashule effectively takes the provincial department of health out of administration for five days by appointing the head of the department of health, Dr David Motau, as acting accounting officer from 6 February 2017 to 10 February 2017. In this five -day window, Motau signs off on what procurement experts describe as two highly unusual back-dated 8.5% price increases for Buthelezi EMS.

When asked about the five days that the Free State Department of Health was taken out of administration, Mariette Pittaway, Democratic Alliance (DA) member of the Free State legislature and spokesperson on Health, told Spotlight: “The DA is fully aware of this. We are in possession of a copy of this appointment letter and are compiling a case docket to submit to the office of the public protector for further investigation.”

Red lights over price increases

The first price increase, signed off by Motau on 10 February 2017 grants Buthelezi EMS an 8.5% price increase for their inter-facility transfer service. Critically, the price-increase is back-dated to April 2016.

Where government contracts allow for back-dating of increases, they typically do not allow for backdating beyond the date at which the increase was applied for. It could be that this specific contract has more flexible conditions attached to it, but in that case the question would arise as to why Buthelezi EMS was granted such an unusually favourable contract.

Free State Department of Health spokesperson Mondli Mvambi has previously said that the Department of Health paid Buthelezi EMS a total of R204 million in the 2016/2017 financial year. It is not clear whether or not this includes the 8.5% increase. Either way, the increase would amount to a back-payment of between R15-million and R17-million. (Spotlight previously reported on how the Free State Department of Health overspent its emergency medical services budget by around 100% during the period in question. It is this budget line that paid for the increases.)

The second price increase relates to a contract between the Free State Department of Health and Buthelezi HEMS, a joint venture between Buthelezi EMS and HALO Aviation. Internal departmental documents show that on 10 February 2017 this price increase is both recommended by Motau in his capacity as Head of the Provincial Department of Health and approved by Motau in his temporary capacity as accounting officer.

This increase is also backdated, but to October 2016. According to internal departmental documents that Spotlight has had sight of, this price increase was only applied for on 27 January 2017.

Also raising red flags, is a letter dated 24 January 2017 in which the departmental bid adjudication committee expresses its support for Buthelezi HEMS’s requested increase. As noted above, according to the department’s own documents this increase was only applied for by the service provider Buthelezi HEMS, three days later on the 27th.

Motivation for increases

While the back-dating of increases raises eyebrows, normal price increases are not straight-forward either. Where government contracts allow for increases, they either happen simply as a matter of course since it is priced into the original contract, or they do not happen as a matter of course, in which case the increase requires a detailed motivation with supporting evidence (as in this case).

Spotlight asked the Free State Department of Health for the full documentary justification for the rate increases given to Buthelezi EMS. The department’s response, signed off by Motau, was simply: “Rate increases are based on the annual Price adjustments and price schedules”. A request for clarification of this answer was not responded to.

Internal departmental documents seen by Spotlight show departmental officials making the case for the increase granted to Buthelezi HEMS (the joint venture) only in broad terms. The key motivation also signed by Chief Director Supply Chain and Asset Management Nelisiwe Phitsane, a senior procurement officer in the department and wife of Tafetso Bernard Phitsane – a senior ANC member in the province and known ally of Magashule – motivates the increase by referring in relatively broad terms to import duties, currency fluctuations, inflation and increases in fuel prices.

The internal departmental documents seen by Spotlight make no reference to any more detailed justification for the increase – as is typically required for such increases in government contracts. There is, for example, no records of specific imported items of which the cost may have increased and how those increases impacted the cost of delivering an aeromedical service to the province. Spotlight asked the Free State Department of Health to share any documentation they may have in support of the increase granted to Buthelezi HEMS (the joint venture). No such documentation was shared by the given deadline.

It emerged last week that Minister of Health Dr Aaron Motsoaledi had asked National Treasury to investigate the Free State’s ground ambulance contract with Buthelezi EMS. In previous articles in the Health4Sale series Spotlight described various complaints about the service provided by the company and various irregularities around the Free State tender. Spotlight also previously published a two-part investigation into similar concerns around Buthelezi EMS in the North West.

Spotlight contacted African National Congress Spokesperson Pule Mabe as well as Ace Magashule’s personal assistant in an unsuccessful attempt to get comment from Magashule. Messages were also left on two different numbers we have for Magashule.

Read more here:

Health4Sale: North West blows HIV money on controversial private ambulance service

Health4Sale: NorthWest pays double for dubious private ambulance service

Health4Sale: Mpumalanga department of health broke rules for controversial ambulance company

Health4Sale: Motsoaledi asks treasury to investigate Buthelezi EMS

Health4Sale Part 4: Buthelezi EMS running a taxi service, not an ambulance service – Doctors and nurses

North West doctors release open letter calling for end to closure of health services

Health4Sale part 5: Controversial private ambulance company in line for new Free State tender

Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

 

 

Health4Sale part 5: Controversial private ambulance company in line for new Free State tender

By Marcus Low and Anso Thom, Spotlight

A Gauteng-based ambulance operator, Buthelezi EMS, that is currently the subject of both Hawks and Treasury investigations has scored road and air ambulance contracts in the so-called Premier league provinces amounting to over a Billion Rand since 2013 and they are frontrunners to secure a lucrative new three year tender for Emergency Medical Services in the Free State.

National Health Minister Dr Aaron Motsoaledi last Thursday told Spotlight that he asked Treasury to investigate the Free State and North West’s contracts with Buthelezi EMS. He also made it clear that he did not want the new Free State tender to be awarded at all and that the national department is not in favour of outsourcing ambulance services to private companies. Yet, on Friday afternoon the Free State Department of health told Spotlight that the award of the tender for outsourced ambulance services is going ahead and that the evaluation of bids is at an advanced stage. Free State Health MEC Butana Khompela previously said that he does not want to re-appoint Buthelezi EMS, but he too hasn’t given any indication that the new tender will not be awarded.

The director of a rival ground ambulance company told Spotlight that industry rumours are that another company will front for Buthelezi EMS in the Free State and that such fronting is nothing new in the industry. While Spotlight  could not find any evidence of fronting, Companies and Intellectual Property Commission records paint a complicated web of connections. So, for example, Thapelo Buthelezi of Buthelezi EMS and Clifford Mahlo, director of High Care EMS, are also listed as co-directors of two other companies. Both Buthelezi and Mahlo were previously co-directors of ambulance companies with Thomas Maponya, the director of Maponya 911 Rescue.

Several well-placed sources have told Spotlight that Buthelezi has been receiving special briefings from health department officials in the Free State.

Spotlight has also this week visited a smallholding in Eikenhof, Johannesburg, where at least 20 new ambulances appear to be in the processes of being branded as “B EMS” ambulances. These ambulances have Free State number plates and the emergency telephone number on the side of the ambulances is the same as that on Buthelezi’s ambulances in the Free State – and not the same as those seen on ambulances at the Klerksdorp base in the North West. (see pictures)

Aerial pics and the pics over the wall of ambulances: Buthelezi EMS’ new ambulances on a smallholding in Eikenhof in the south of Johannesburg waiting to be branded.

The Free State Department of Health denies that Buthelezi has been given any advance notice of the outcome of the new tender.

Spotlight has also been told that Buthelezi arrived 15 minutes late for the tender briefing for the new tender in November, but that a senior Free State health official opened the door after he phoned them. Invitations to these meetings explicitly state that the doors will be locked at the starting time and no late-comers will be let in. When Spotlight asked the Department about this, they responded that “No bidder/s was allowed entry after 15 minutes after the meeting has started.”

As it stands, Buthelezi EMS’s previous contract with the Free State Department of Health is being extended on a month-to-month basis until the new tender is awarded or the relevant services is absorbed back into the department.

The controversial rise of Buthelezi EMS

Prior to Buthelezi’s arrival, the Free State was doing remarkably well with their

Orange wall: Buthelezi EMS’ control centre based in a house about 1km from where the new ambulances are being branded.

government-run inter-facility transfer service. In August 2013 Professor Martiens Schoon reported in the South African Medical Journal that maternal mortality in the province decreased from 279/100 000 live births during 2011 to 152/100 000 live births during 2012. The improvement was mainly ascribed to the department procuring 48 new vehicles (18 dedicated to maternity care) and the use of these vehicles to transport women with pregnancy complications. For a while, this state-run programme was held up as an example for other provinces.

Then everything changed when late in 2013 the province decided to outsource its inter-facility transfer ambulance service to a private company. Well placed sources in the province say that this move coincided with the scaling down of the province’s own capacity building efforts in relation to emergency medical services.

The Free State Department of Health claims a tender was advertised, but Spotlight can find no record of this tender advertisement anywhere online or in a newspaper. Netcare 911, a company that would have liked to bid, says they never saw the tender advertisement despite subscribing to various systems that would alert them to such tenders. Spotlight twice asked the Free State Department of Health where the tender was advertised. Both times they dodged the question, merely saying that “The requirement to advertise tenders on-line by law only came into effect in 2016.” They did provide Spotlight with a copy of the province’s tender bulletin, but there is no indication where it was published.

According to Mariette Pittaway, Democratic Alliance (DA) member of the Free State legislature and spokesperson on Health, the DA has also struggled to get hold of documents relating to the tender. “I have requested these documents from the HOD and MEC of Health in a portfolio meeting, when this was not forthcoming, I submitted written questions, which remains unanswered,” she told Spotlight. “There is a general disregard by the FS Executive Council, save for MEC Finance, to answer written questions submitted to them within the stipulated 10 working day period as contained in the Standing Rules and Orders. When questions are replied to, they lack detail and substance, and the tone is generally dismissive. When we raise issues in Committee, which is constitutionally mandated to do oversight, and has the power to subpoena, the ANC uses its majority to protect MECs and dismiss DA concerns. So in effect the legislature is dysfunctional in this regard.”

Buthelezi EMS was awarded the contract in December 2013 – with the contract signed on 20 December, around the festive season. What followed was ballooning expenditure and, according to a range of sources, a decline in the quality of services (see the previous article in this series for details). The Free State and North West are the only two provinces to outsource their ground ambulance service – the North West gave Buthelezi a three-year contract in March 2016.

“The DA is of the strong view that the Buthelezi EMS contract is irregular, over-priced, ineffective and could possibly have links to ANC politicians, since the ANC has been on the defensive over this contract from the very beginning,” Pittaway told Spotlight.

How costs ballooned

Spotlight investigations show that although the North West has been a good source of income for Buthelezi’s EMS operations, his stronghold and springboard into the so-called Premier League provinces (Free State, North West and Mpumalanga) has been via the Free State. We wrote previously about how Buthelezi was awarded a Free State air ambulance contract, that North West, Mpumalanga and Limpopo all piggy-backed on.

Spotlight calculates that Buthelezi EMS has received well over R1-billion in revenue from government contracts, mostly in the Free State and North West,  over the last four years – with annual revenue rising sharply over time.

In February Mondli Mvambi, spokesperson for the Free State Department of Health was quoted in the media as stating that the department had paid a total of R613-million to Buthelezi EMS since the 2013/2014 financial year. The breakdown given was as follows:

  • 2013/2014 R4 million
  • 2014/2015 R99 million
  • 2015/2016 R159 million
  • 2016/2017 R204 million
  • 2017/2018 R147 million (Not yet full-year figures)

The year-on-year increases in the above figures raise eyebrows since the service Buthelezi EMS is contracted to provide does not change year-on-year. While some increase from the first to the second year might be explained by teething and scaling-up challenges, the steady increase over multiple years suggest another cause.

Spotlight asked the Free State Department of Health what the budget and what the overspend/underspend on Inter-facility Hospital Transfers was per financial year since 2015. We received the following response signed off by head of department David Motau: “Budget R531 297,000 (Total EMS budget); IFT expenditure R843 132,80 (for both Inter-Facility Hospital and Aeromedical)”

This response is incompatible with the figures previously given by Mvambi. It is also not clear which year it refers to. Spotlight wrote back to the department to request clarification, but the department failed to respond.

Spotlight has however had sight of internal Free State government figures that indicated extreme overspending on the province’s emergency medical services budget:

  • In 2015/2016 the department spent R152 million on EMS, overspending their budget by R88 million.
  • In 2016/2017 the department spent R163 million on EMS, overspending their budget by R86 million.
  • By the time the figures were generated, the EMS expenditure for the 2017/2018 financial year up to that point was R161, already overspending the budget by R117 million.

A pattern of alleged overcharging

The dramatic overspend in the Free State suggests that the province is either being charged more than expected (with invoices inflated as in the case in the North West) or the service is being used much more than anticipated. Almost everyone Spotlight spoke to suggests the former. While Buthelezi EMS’s quoted rates are in line with the industry, it is on the billing side where red lights start going off.

A senior healthcare worker based at a Free State hospital alleges that Buthelezi EMS often transports multiple patients in a single ambulance as part of their inter-facility transfer service. Sometimes as many as five patients will be transported in one ambulance, but Buthelezi would allegedly then bill as if five different ambulances were used and write invoices with five different reference numbers. This pattern was confirmed by more than one healthcare worker we spoke to. (See the previous article in this series for more on the impact this has on patients) At other times, patients who could safely be transported in cars are allegedly transported at great cost in ambulances.

It is also alleged that Buthelezi often charges for distances that are longer than the actual distances travelled. Spotlight was told of a case where a 2km trip was charged for as a 100km transfer. While we have not seen invoices proving such overcharging in the Free State, essentially the same allegations were repeated to us by senior hospital management as well as a well-placed person in the Department of Health in the province. This is also in line with what has been happening in the North West. Part of the problem seems to be that Buthelezi EMS often does not have Advanced Life Support (ALS) capacity in all the districts that they are supposed to – and that as a result ALS vehicles and staff must be sent from other districts – thus increasing both cost and waiting times.

There has also been a shift in the Free State whereby from the 2016/2017 financial year invoices are submitted to the provincial emergency medical services Department in Mangaung, rather than to hospitals as the case was before. According to Motau, the payment of these invoices was at the same time shifted from hospital budgets to the provincial emergency medical services budget. Some senior doctors complain that this shift has made it much harder for hospitals to verify that government is not being overcharged.

Spotlight sent Mr Buthelezi a long list of questions about overcharging and a number of other issues. Mr Buthelezi did not respond to any of the specific questions, but sent Spotlight an e-mail that has been published in full with a previous article in the Health4Sale series which can be read here.

No website, many companies

Despite having had revenues of over a billion Rand in the last four years, Buthelezi EMS does not have a website. The www.ButheleziEMS.co.za domain has been registered, but the site has remained under construction for the more than two years that the company has been on Spotlight’s radar. Some posts are made on the company’s Facebook page, but the kind of information one expects to find on a company with this level of revenue is nowhere to be found online.

In addition, CIPC records and invoices that the company has submitted in North West (see previous article) indicate that technically Buthelezi EMS is sometimes one company, and sometimes another. In the North West the company name on invoices did not correspond to the company registration number on the same invoices.

Thapelo Buthelezi is, or has been, a director of at least six different companies all named as variations of Buthelezi EMS.

  1. Buthelezi EMS CC
  2. Buthelezi EMS (PTY) LTD
  3. B EMS CC (Currently some ambulances are being rebranded as B EMS)
  4. Buthelezi HEMS CC
  5. Buthelezi Helicopter EMS (PTY) LTD
  6. Buthelezi One Stop Emergency Medical Services CC

A number of these companies have been in deregistration due to the non-filing of annual returns. Failure to file annual returns would result in companies not having a valid tax clearance certificate, and thus not be eligible for government contracts. The Free State contracts we have seen do not contain registration numbers – which makes it hard to verify with which of the various companies the Free State are in fact contracted. In the North West, the name of the company on Buthelezi’s invoices did not correspond with the company registration number on the same invoices.

Apart from the above, he is listed as a director of at least 14 other companies, including amongst others Ndizani Funeral Services, TSB Motors, Thapelo Buthelezi Hospital, TSB Medics, Ikanyezi Trading and Construction and Mt Ararat Apostles (a non-profit).

Read more here:

Health4Sale: North West blows HIV money on controversial private ambulance service

Health4Sale: NorthWest pays double for dubious private ambulance service

Health4Sale: Mpumalanga department of health broke rules for controversial ambulance company

Health4Sale: Motsoaledi asks treasury to investigate Buthelezi EMS

Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

North West doctors release open letter calling for end to closure of health services

Over 70 North West doctors have released an open letter expressing their concern over the impact the ongoing labour action is having on the delivery of health services. Although they support the grievances of the protestors, the doctors said that as “care givers, we have been silent for too long. We have taken an oath to “do no harm” and in our silence, we have contributed to harm. This cannot go on as we are concerned about methods used which include closure of health care facilities that affect the health of our society.”

Read the full letter here: Letter of Concern Health Crisis NWP (iii).

Health4Sale Part 4: Buthelezi EMS running a taxi service, not an ambulance service – Doctors and nurses

By Anso Thom and Marcus Low, Spotlight

Doctors and nurses in the Free State and North West have accused Buthelezi EMS, the private company contracted to run provincial ambulance services, of operating like a minibus taxi and “drop and go” service. They accuse the company of providing limited medical support and expertise during transport, leaving the desperately sick and injured, including babies, unassisted and putting people’s lives at risk.

Buthelezi EMS has landed lucrative state tenders worth hundreds of millions to run hospital and clinic transfer services in the Free State and North West. Last week Spotlight reported that Minister of Health Dr Aaron Motsoaledi had asked Treasury to investigate the procurement of Buthelezi EMS’s services in the two provinces. This is in addition to a Hawks investigation and a forensic investigation instituted by North West Premier Supra Mahumapelo.

An aerial shot of the Bloemfontein ambulance base, likely to be the busiest and “largest” base Buthelezi EMS runs in the Free State and North West.

Nurses and doctors have revealed a litany of failures, some life threatening, with common complaints extreme waiting times of up to six hours (even when patients, often babies, are critical), overcrowded ambulances, poor staff attitudes, poorly equipped staff on the ambulances and in the call centres, lack of equipment, extremely poor medical skills, no medical care while patients are in transit and a lack of compassion for patients.

A visit by a Spotlight photographer to the company’s Bloemfontein, Klerksdorp and Potchefstroom ambulance bases, also showed that the services are run from tiny, rented houses with the bare minimum and in some instances dirty, messy yards, not resembling what would be expected of a professional ambulance base (see accompanying photographs).

All the doctors and nurses who spoke to Spotlight asked to remain anonymous for fear of losing their government jobs. Names of specific hospitals have also been omitted as it will make it easy to trace the sources.

Patients squashed into ambulances

A senior doctor based at a Free State hospital alleges that Buthelezi EMS often transports multiple patients in a single ambulance. Sometimes as many as five patients will be transported in one ambulance, but Buthelezi will allegedly then bill with five different patient reference numbers as if five different ambulances were used and five different trips undertaken. This pattern was confirmed by all healthcare workers Spotlight spoke to in both provinces.

One Free State doctor said that it had become the norm for Buthelezi ambulances to arrive at their hospital with several patients squashed inside. “But we are not allowed to complain, if we do it simply goes nowhere or we are harassed by Buthelezi staff and our patients suffer,” the doctor said.

Another doctor said even if there were sick patients who needed to be transferred to a hospital Buthelezi ambulances would not transport the patient, but wait for the vehicle to first fill up.

The overloading of ambulances could also at times place patients at risk and infringe on the dignity of patients. Spotlight was for example told of an instance where a woman with birth complications had to share the back of the ambulance with a male patient not known to her. In another instance a patient with a broken leg had to ride in the front of the ambulance because the back was full. At other times, patients who could safely be transported in cars are transported at great cost in ambulances.

Lack of skills and equipment

A North West trauma nurse said she had a case where two severely ill women arrived in the same ambulance. During the handover Buthelezi staff told the nurse that the women both had bleeding complications from their pregnancies. The nurse conducted a pregnancy test on one of the patients after she suspected something else was wrong. The woman was not pregnant and the problem was completely unrelated to what she was told.

The nurse said lack of equipment was a major problem. She said patients almost never arrived with oxygen, drips or connected to any monitoring equipment. “They mostly don’t have equipment, not IV drips, not drip bags, not saturation monitors (used to measure if patients need oxygen), nothing.”

She said the problem was that Buthelezi staff exercised no medical care or procedures on patients while in transit. “They’re a taxi service and they are always impatient to drop and go,” she said.

Long waiting times

The nurse said a clinic sister recently had to wait four hours for an ambulance to collect a severely ill new-born baby.

“They run a taxi service, not an EMS service,” said a Free State doctor.

All healthcare workers Spotlight spoke to said that they waited hours for Buthelezi to arrive.

One North West nurse in a large town said they waited on average three to four hours for a Buthelezi ambulance to arrive, even though the hospital is not far away. “When we contact the call centre, we are not told how long they will take, we are simply made to wait. The staff also mostly have terrible attitudes when they arrive or when we follow-up with the call centre to find out where they are,” said the nurse.

The service level agreement (SLA) between the North West Department of Health and Buthelezi EMS explicitly states that “The Service Provider must ensure that its call centre gives the NWDoH a reference number and estimated time of arrival of the ambulance for each call.”

The SLA also sets out a schedule of required response times for different levels of emergency. The longest response time allowed for (for the least serious calls) is 60 minutes (measured from when the call centre receives the call). The SLA states that response times in excess of those on the schedule will result in financial penalties against the service provider. As with most aspects of this contract, it appears these penalties has not been enforced.

A North West nurse said Buthelezi’s ambulance staff are not interested in the handover process. “They seem to consider themselves to be a taxi service who simply has to transport the patient. I have very rarely had a Buthelezi staff member show any interest in the patient, put up an IV drip, discuss the patient or even take their blood pressure, they don’t even listen when we do the handover,” the nurse said. She said nobody dared ask for proof of qualifications. This is necessary as certain patients require certain levels of care for example Advance Life Support.

Call centre problems

One nurse said they recently had a new-born baby who was in a critical

The Buthelezi EMS ambulance base in Bloemfontein, overcrowded and filthy. The Free State health department said it’s contract does not require for it to inspect the base, despite the fact that the company transports most of the province’s patients.

condition and in respiratory distress. Despite several desperate calls, an ambulance only arrived after three hours.  “When we contact the call centre, they ask us the age of the patient, the gender and what is wrong. I more often than not have to explain to them what the problem is and even then they will tell me they do not understand,” the nurse said.

A doctor said call centre staff often did not understand standard emergency medical terms. When he calls for an ambulance he would as an example not refer to a cranial injury, which is a widely accepted and understood medical term, especially in emergency medicine. “The call centre does not understand that, I have to just say brain injury. I also cannot say Caesarean section, I have to say – we did an operation for a baby – then the call centre agent kind of understands, sometimes,” the doctor said. A nurse had the same experience, saying that even after explaining medical conditions to call centre staff they still failed to understand.

Is the motivation money?

The Free State doctor also said when they called for an ambulance from the provincial government or other private service providers such as ER24 of Netcare 911, it would take 15 minutes to get a reference number as the handover was meticulous, however via Buthelezi the reference number is generated within minutes, adding that the motivation was not patient well-being but money. “We know that 2km trips could be charged at R3 000,” he said, adding that Buthelezi did not have enough ambulances or a presence (with Advanced Life Support paramedics) in sub-districts as required.

The allegation that Buthelezi EMS incorrectly charges thousands of Rands for short trips is confirmed by invoices submitted to the North West Department of Health that Spotlight have had sight of (and previously reported on here).

Sources inside the North West Department of Health confirmed that Buthelezi EMS only has sufficient advanced life support staff based in five of the 19 sub-districts where they are supposed to have such staff according to the service level agreement with the province. Apart from this, resulting in advanced life support often being severely delayed, it is also alleged that Buthelezi charges the province for the extra distance advanced life support vehicles and personnel must travel to sub-districts where there is no advanced life support in place. This state of affairs was confirmed by Free State doctors as well.

Ambulance bases

Spotlight sent a photographer to Buthelezi’s Bloemfontein ambulance base. The base does not have any external signage. The outside of the suburban house in Bloemfontein was in a shocking state with rubbish, mud and a yard full of ambulances, some seemingly no longer in running order. Aerial photographs show a backyard littered with rubbish and no sign of any waste disposal.

Spotlight asked the Free State Department of Health whether they visited and inspected Buthelezi’s ambulance bases. Head of Department David Motau responded “Sites visits was not a requirement as per the tender document”.

The Potchefstroom “base” is a house which is mostly empty inside, with only a

The Buthelezi EMS ambulance base in Bloemfontein, overcrowded and filthy. The Free State health department said it’s contract does not require for it to inspect the base, despite the fact that the company transports most of the province’s patients.

few bare beds used by staff to sleep in. The backyard of the house has rubbish dumped at the back door. None of ambulance bases appear to have dedicated medical waste areas that are marked biohazardous. Access to these waste areas must be controlled. Unsecured oxygen cylinders are seen lying in the corner of a room. Several horrified paramedics confirmed that oxygen cylinders must be safely locked up and secured. There has to be a sign which cautions that it is pressurized oxygen. The front porch has a derelict bed with no indication that this is a Buthelezi ambulance base. The entrance hall to the house has what appears to be a radio transmitter.

At the Klerksdorp “base” the only sign that it is a depot is two branded ambulances and a car parked in the road.

Mariette Pittaway Democratic Alliance member of the Free State legislature and spokesperson on Health, questioned whether the health department conducted regular checks on Buthelezi operations to ensure compliance with the provision under the National Health Act (No 61 of 2003). Some of these provisions deal with whether an operator is licensed and whether staff are being supervised by a Medical Services Manager. In terms of the base, the Act prescribes that the operator have sluice facilities for cleaning contaminated equipment and linen, have access to washing facilities, including medical-waste traps, have all the relevant equipment listed in the regulations. The Potchefstroom base had none of this. The Act also requires for there to be a log stating how many checks were conducted at the base and what were the findings of each.

Responses from Health Departments and Thapelo Buthelezi

Last week Minister Motsoaledi told Spotlight the following in relation to Buthelezi EMS and the Gupta-linked Mediosa: “On my side as health there is

The backyard of the house with rubbish dumped at the back door. None of ambulance bases appear to have dedicated medical waste areas that are marked biohazardous. Access to these waste areas must be controlled.

nothing to investigate in terms of whether it is serving the health needs etc. It is very clear, as clear as daylight, that we do not need this type of service.”

Asked about the complaints from healthcare workers Motau said: “The department is aware of only one formal complaint from Botshabelo and the matter was resolved. The department is not aware of ambulance (sic) being poorly equipped and overloaded.”

The North West health department has declined to comment to Spotlight on any Buthelezi-related matters, saying the matter is being investigated by the Hawks and the Premier’s office.

In addition to a previous round of questions, Spotlight also sent a list of the above allegations and complaints to Thapelo Buthelezi via email.  This was his Whatsapp response:

“There isn’t anything I can assist you with. More especially after you have lied to South Africans that you have published everything I said. I spoke about other provinces utilizing aero medical service without any formal contracts and you did not want to say anything about the matter. You are most probably avoiding to talk about that because it will tell South Africa the truth behind all the allegations. It is clear that you are after Buthelezi EMS, hence you can’t talk about other provinces’ aero medical contracts. You may carry on and publish whatever and continue to protect your buddies. This matter is being dealt with from a different platform. I’m also aware that one of your informers, (Spotlight omitted this name) is busy talking to different provinces, recruiting managers to support him in taking Buthelezi EMS down and give you a falsified information. I wish you could report the real events  and stop talking to the competitors. It is a common knowledge that the competitors will always give a negative info. However, I still maintain what I said earlier, we are working on publishing the truth and not nonsense you have been telling South Africa. Good luck!!!!!!”

Read more in this series:

Health4Sale: North West blows HIV money on controversial private ambulance service

Health4Sale: NorthWest pays double for dubious private ambulance service

Health4Sale: Mpumalanga department of health broke rules for controversial ambulance company

Health4Sale: Motsoaledi asks treasury to investigate Buthelezi EMS

Note: While Spotlight is published by SECTION27 and the Treatment Action Campaign, its editors have full editorial independence – independence that the editors guard jealously. Spotlight is a member of the South African Press Council.