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.

Health4Sale Response: Motsoaledi asks treasury to investigate Buthelezi EMS

By Marcus Low and Anso Thom

Health Minister Dr Aaron Motsoaledi has asked treasury to investigate the procurement of ambulance services from Buthelezi EMS, a controversial private ambulance company that has been awarded large contracts in the Free State and North West.

Spotlight this week published two articles on alleged overcharging and tender irregularities involving Buthelezi EMS and the health department in the North West as part of our Health4Sale series of investigative articles. Next week we will be turning the spotlight on Buthelezi EMS in the Free State.

Motsoaledi last night told Spotlight that he wrote to the Minister of Finance to request that the Chief Procurement Officer at National Treasury investigates the procurement of services from both Buthelezi EMS and the Gupta-linked Mediosa (also known as Cureva) in both the Free State and North West.

Motsoaledi stressed that the treasury investigation is specifically into the procurement processes and suspected corruption. He also confirmed that the treasury investigation has already started.

Not adding value

In terms of medical need, Motsoaledi said that there is no debate at all and that Buthelezi EMS and Mediosa are not adding value and that they are in fact causing more problems. He also said that it is not national policy to use private service providers for emergency medical services.

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

A new tender for outsourced private ambulances in the Free State was advertised in October 2017. Spotlight however understands that the award of that tender has been delayed and that Buthelezi EMS continues to be paid on a month-to-month basis.

Motsoaledi told Spotlight that he is in daily contact with Free State MEC for Health Butana Komphela about the situation. “I told him it is wrong for them to privatise ambulance services. They must run them on their own.”

“The plan from my side is that treasury after this investigation must make a clear ruling that the procurement of private ambulance services should not happen,” he said.

No Section 100 intervention

Motsoaledi indicated that a Section 100 intervention whereby the Provincial Departments of Health in Free State and North West would be placed under national administration is not currently being considered. He explained that under section 100 the political leaders in the province stays in place and that national assumes responsibility without authority. He referred to his experience when the Limpopo Department of Health was under Section 100 administration. In that case four provincial heads of department that various National Ministers believed should be removed were not removed because only the Premier of the province had the authority to remove them.

“In Limpopo we were only able to stabilise the finances because of treasury, but the human resources we could not touch because that authority does not lie with us,” he said.

The Head of the North West Department of Health Thabo Lekalakala, implicated in Spotlight’s 2-part investigation into emergency medical services in the province, was suspended yesterday by the embattled North West Premier Supra Mahumapelo. Previously Mahumapelo had refused to heed Motsoaledi’s call to suspend him, placing him on special leave.

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

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.

Heading For The Rocks?

By Ufrieda Ho

One year into his tenure as MEC for Health in the Free State, Butana Khompela

State MEC for Health, Butana Khompela. Picture: Sabrina Dean.

is still to exorcise the ghosts that have made the province one of the worst-performing when it comes to health.

Khompela came into his role in October 2016 – replacing Dr Benny Malakoane, who was moved to the Department of Economic, Small Business Development, Tourism and Environmental Affairs. Malakoane’s exit from the Department of Health was met with relief – pure celebration, even – from activists and many Free State locals, desperate for improvement in the state health services.

Their elation at seeing the back of Malakoane was because his track record in the department was woeful at best. He was routinely and widely called out for abuse of power, and for a leadership and management style that smacked of bullying and arrogance. So bad was Malakoane (who served as MEC even while he faced charges of fraud, corruption and money laundering) that the Treatment Action Campaign (TAC) embarked on the intensive, two-year-long #FireBenny campaign. Finally, Malakoane was removed (albeit only sideways) and sent off with a farcical pat on the back from ANC leadership.

It’s to these choppy waters that Khompela has been brought to steady the ship of an almost wrecked department, which remains under provincial administration. Its one-time top academic hospital, the Universitas Academic Hospital in Bloemfontein, tumbled to the bottom of the pile in the country in the October 2016 findings of the Office of Health Standards Compliance (OHSC).

TAC notes also that a large number of vacancies remain unfilled. The information for appointments and vacancies on the Provincial Department of Health’s website simply shows ‘n/a’ under ‘current financial year information’. Just looking at the available data from the 2015/2016 financial year, however, reveals that there were 20 952 posts approved and 17 810 filled, leaving a shortfall of 3 142 vacancies – about 15% of posts – even in the previous year.

Another lingering issue is the reinstatement of Community Health Workers (CHWs). There remains a black mark against the department for its shameful handling of the protests by CHWs that led to the BopheloHouse94 court case last year, eventually ending with a court ruling in favour of the 94 CHWs.

Also ongoing is the issue of the use of the Buthelezi ambulances and emergency medical services in the Free State, despite the tender granted to the company being irregular, and the services being slammed for their dysfunctionality.

For the 2017/2018 year, the Department of Health was assigned R9.77 billion from the provincial budget. The budget only benefited from a small year-on-year increase of 8%.

In his budget address, Khompela said that “corruption is a cancer”, and promised to root it out – also, to bring down the staff bill from 65.8% to the 60% national target. He trumpeted successes in the province’s HIV programme, despite these efforts falling short of their targets, as well as the acquisition of a helicopter and an additional 12 maternity ambulances for the province.

Delivered in air-conditioned chambers, budget-speech promises don’t always match up to on-the-ground realities. TAC district organiser Mary Nyathi says that under Khompela, little has changed. “We still hear cases every day of someone going to the hospital at 2am to be in the queue, and only seeing someone round about 5pm,” she reports. “We have clinics where the roofs are leaking; and even where they have done upgrades, there are no doctors in the buildings to see to the patients.”

Nyathi routinely hears of scheduled operations being delayed without explanation, and says that while TAC hasn’t had reports of ARV stock-outs, there are routine drug shortages. “I want Khompela to come out of his office and come to the people, so he can understand and see for himself how bad the problems are,” she says.

“It is heartbreaking that things are not changing. For me, in the lower classes of society, I need these hospitals – tomorrow, it could be me.”

Her hope is that Khompela will prove to be a better communicator than his predecessor, and that he will demonstrate a willingness to listen and to collaborate. For Thabo Mahlatse, TAC provincial organiser, poor infrastructure and shortage of medicines and personnel continue to be the bane of the people of the Free State. “We want Khompela to show leadership and accountability, and come up with a plan on implementation – not just what they say in speeches,” he says.

Khompela’s had a mixed response from others, too. Some consider him an approachable man, and a person who is sensitive to the dire health challenges in the province. He gets a thumbs-up even from his political opponents: the Democratic Alliance, the official opposition in the province.

Mariette Pittaway, DA member of the Provincial Legislature, says that in the past year, she’s found him accessible and prepared to help. “I have sometimes had to call him to intervene in very dire cases, and he has always tried to help,” says Pittaway. “The saddest part for him is that he has inherited a mess; and every day I receive another desperate case, or another complaint.”

But another Bloemfontein NGO that’s operated in the HIV/Aids support arena for the past 10 years says Komphela and his team have repeatedly fobbed them off, instead of agreeing to meetings. “There’s a lack of communication, and a lack of good faith,” says the co-ordinator, who did not want to be named. She adds: “There still seems to be a lot of smoke and mirrors in the Department of Health, and no appreciation of the value of what the NGO sector is doing.”

Smoke and mirrors and a desperate need for clarity are features that extend to parts of Komphela’s official Facebook bio page, still active despite not having being updated since 2013. The 53-year-old Komphela was born in Kroonstad and grew up in a farming community, one of 11 children. His brother is the celebrity footballer, coach and Lamborghini-loving Steve Komphela. He is married to Cecilia Nombuyiselo, and they have a grown-up son and a teenaged daughter.

According to the information on the page, Butana Khompela became an activist while just a school pupil. His bio data says he was among those detained along with three teachers during the 1976 uprising – if that timeframe is correct, it would mean he was only 10 years old that June.

The bio write-up goes on to say that as a 19-year old in 1984, he took a job as an admin clerk in the Department of Home Affairs, and later became an interpreter at the local court. But by 1990, Khompela had apparently shot up the political ladder. If his own Facebook page is correct, he was mayor of Kroonstad between 1990 and 1992 (two years before the end of apartheid, and when Khompela would have been just 25).

It must be remembered that Kroonstad in those years was gripped by politically motivated assassinations and violent terror, thanks to the Three Million Gang and the Self-Defence Units (SDUs). Khompela’s name is absent from the story of this period – and the mayor of Moakeng (Kroonstad) at the time was Caswell Koekoe.

His bio information goes on to add that Khompela represented Kroonstad when the ANC held its first conference in Durban-Westville, after being unbanned in 1990. He also took part in the Codesa talks, it says.

What is clear is that Khompela is an ANC party loyalist. By the time democracy dawned in 1994, he had been made a director in special education in the Department of Education. His Facebook page continues to map out a political career trajectory that includes becoming a member of the Free State Legislature, moving up the ladder to a position in the National Assembly before becoming chairman of the Portfolio Committee on Sport.

After 10 years in this post he was back in the Free State to become a member of the legislature once more, before becoming MEC responsible for Police, Roads and Transport and now MEC for Health.

During his time on the Portfolio Committee for Sport, Komphela was outspoken about transformation, and infamously raised the ire of the South African Council of Churches after he took vicious aim at then-Archbishop Desmond Tutu, calling him “treacherous”, and warning him not to confuse transformation with tokenism. He also locked horns with the likes of Moss Mashinini, who headed up SASCOC, and was slated as “slanderous” and “racist” for his take-no-prisoners approach to transformation in sport.

Back then, Komphela earned a reputation for being something of a firebrand and a hothead. Other adjectives linked to the man include ‘irascible’, ‘power-hungry’ and ‘meddling’. But he was unapologetic, putting his outbursts down to being a man who calls a spade a spade, and someone who made transformation in sport a priority.

Since grabbing headlines for his time serving on the portfolio committee, Komphela’s column centimetres have been dominated by his connection to a Robben Island ferry business in which he has ownership. In August 2008 the Mail and Guardian reported on Komphela’s interest in bidding for a ferry business operating from Cape Town’s mainland to Robben Island. It ended in a commercial dispute, said the newspaper, and the vessel involved became a white elephant (not unlike some of the brand-new hospitals in the Free State), stranded in a Cape Town boatyard.

In June this year, Times Live reported that the MEC – who is chairman of Meltt, a business consortium – had bought a R60-million vessel to be a “back-up” ferry for tourists. The concern is that Komphela will have an unfair political advantage over other bidders and operators.

But people waiting for surgery, or desperate to be seen by a doctor or to have an equipped ambulance arrive in an emergency, would prefer Komphela to spend more time getting the health department ship-shape, rather than being focused on cashing in on the tourist spend in Cape Town.

* In May this year, numerous requests were made for an interview of any kind with the MEC. His spokesperson and his communications team responded, saying that they would try to make it happen. Despite much to-ing and fro-ing, with emails, calls and messages, it didn’t. Email questions were also sent to spokesperson Mondli Mvambi – among them, questions asking for clarity on the information on the MEC’s Facebook page, as well details of his plan of action for the Free State Health Department. No response has been received.

 

Orthopaedic nightmare in the Free State

By Anso Thom, Spotlight

Whistleblowers say patients with broken legs, arms and other serious orthopaedic conditions are being sent home in the Free State because the buckling health system is simply unable to cope with the numbers. Health workers are told there is no money to bring in outside help to reduce the waiting lists.

A week ago, when a team of outside health workers were paid to work a weekend at Bloemfontein’s Pelonomi Hospital in an attempt to reduce the waiting list, at least 40 patients were sent home because there was simply no capacity to get to them.

“Imagine this, for six weeks these patients have been lying in hospital beds

with well-meaning doctors assuring them that their surgery was imminent, only to be told that you will no longer be operated on and that this means you bones will no re-attach properly or that your ankle will remain partially dislocated,” said a health worker, who asked to remain anonymous for fear of reprisals.

What was more disturbing for the health workers who spoke to Spotlight was the fact that last year there was millions to run a dodgy, illegal stem cell practice in the Pelonomi orthopaedics department, but there was no money to bring in extra health workers to reduce the waiting list.

“It simply cannot continue like this, patients wait for 40 days for simple, straightforward treatment for fractures. Their lives are destroyed, it is an untenable situation,” said a doctor.

The Regenesis scandal

Spotlight reported towards the end of last year that illegal stem cell experimental treatment was being provided at Pelonomi Hospital, a state hospital in Bloemfontein. The issue was also investigated by Carte Blanche who produced an insert.

Shortly after SECTION27 and the Treatment Action Campaign brought details of the Regenesis project to the attention of the national Director-General of Health Precious Matsoso, the Medicines Control Council (MCC) suspended the unlawful stem cell experimentation at Pelonomi.

At the same time the Free State Department of Health cancelled its contract with the stem cell company, ReGenesis Biotechnologies following a list of questions sent by Spotlight in connection with the involvement of controversial Health MEC Dr Benny Malakoane. Before the expose, the Free State department of Health was set to spend tens of millions of Rands on unproven and potentially dangerous stem cell therapies for the treatment of musculoskeletal diseases in its orthopaedic knee patients at two hospitals. The treatment was run by a private company called ReGenesis Biotechnologies and has started on June 1, 2016.

A service level contract (seen by Spotlight) between the Free State Department of Health and ReGenesis Biotechnologies indicated that the service would be provided in Pelonomi hospital in Bloemfontein and Boitumelo hospital in Kroonstad. The department would pay R30 000 per client, with a guaranteed supply of one thousand patients per year. This adds up to R30-million per year and R90-million over the three years of the contract.

MCC investigation

MCC Chairperson Professor Helen Rees confirmed to Spotlight at the time that inspectors had been to the Pelonomi site: “Our concern was that the service level agreement made reference to medicines, injections and therapeutic research.”

She said the informed consent documents referred to the patients giving permission for stem cell therapy, permission for stem cells to be removed, concentrated and re-injected and for their stem cells to be given to another person.

The contract at the time stated that the Free State Department of Health and ReGenesis would establish a project management committee consisting of the MEC of Health as Chairperson as well as the CEOs of Pelonomi and Boitumelo hospitals, COOs and representatives from ReGenesis. It reveals that the committee shall meet monthly for the duration of the Agreement to “track progress, resolve pertinent matters to the effective and seamless treatment of patients”.

Days after the revelations Free State Premier Ace Magashule reshuffled his Cabinet and Malakoane was shifted from health. Since then, Spotlight have sent questions to the MECs spokespeople and the Premier’s people. All these attempts have elicited zero responses.

It is crucial to understand where this case is, has there been an investigation, what are the findings, will anyone be charged, was Malakoane due to benefit from this contract, were proper tender procedures followed, and so on.

A well-placed source in the Free State has shared a list of names of relevant persons who needs to be investigated. They include hospital CEOs who allegedly participated in the scheme, hospital managers who requested the waiting lists and who contacted the patients, doctors and their secretaries who played a key role in running this scheme, a doctor who reportedly gave instructions for the order forms to go through, an individual who gave the financial permissions and two heads at Bophelo House (health department head office) who were involved.

A Bloemfontein doctor said they were aware of patients who suffered due to this treatment, with reports of some dying.

Registrar of Medicines, Dr Joey Gouws recently confirmed that Department of Health inspectors have laid criminal charges against Stander “for the sale of unregistered medicine and or conduct of a clinical trial without obtaining the necessary authorization from the MCC.”

Gouws said they were in no position to advise on the status of the police investigation. She also confirmed that the MCC had reported Stander to the Health Professions Council of South Africa (HPCSA). At the time of going to print, the HPCSA had not responded to queries requesting an update on the charges.

Collapse of orthopaedics

More recently Spotlight has received information that orthopaedic services in

An overcrowded watiting area at Pelonomi Hospital is at times turned into a hospital ward where desperate patients can
wait days to be transferred to a hospital bed

the province are in a state of collapse with a running surgery waiting list at Pelonomi Hospital of over 130 patients (excluding those who have lost faith, packed up and returned home, despite the consequences), on most days.

There are adults with trauma fractures, children with broken limbs and elderly patients with fractured hips. They are lying in overflowing hospital beds and in the passageways on trolleys and on the floor (see photos).

A health worker said that young doctors are facing abuse from frustrated patients who are in limbo, waiting for surgery which does not happen.

This is not the first time the province has faced this problem. In the past the province has been able to reduce the waiting lists significantly by buying in locums at a cost of about R6-million per annum. This is small change compared to what the province was prepared to fork out for the illegal and dangerous Regenesis project.

The domino effect of long waiting lists for orthopaedics is more complications, septic bed sores for the elderly, children left disabled and adults losing their jobs.

A doctor explained that Pelonomi is facing increasing pressure as peripheral hospitals no longer have skilled specialists to do the surgery.  The hospital is also taking in referrals from the Northern Cape and Lesotho.

Sources allege that the hospital CEO, Ms Ramadula (a nursing sister) is not disclosing the current state of affairs to the provincial government for fear of reprisals.

“Hospital management are misleading their heads who in turn mislead the national Director-General, who because of incorrect information, misleads the national health minister,” a health worker added.

Stander still practicing

Dr Wian Stander, the controversial owner of Regenesis, the company that entered into a questionable partnership with the Free State Department of Health to conduct unlawful stem cell experimentation at Pelonomi hospital in Bloemfontein is still practicing and active.

This is despite charges with the South African Police Services and the Health Professions Council of South Africa.

Registrar of Medicines, Dr Joey Gouws has confirmed that Department of Health inspectors have laid criminal charges against Stander “for the sale of unregistered medicine and or conduct of a clinical trial without obtaining the necessary authorization from the MCC.”

She also confirmed that the MCC had reported Stander to the Health Professions Council of South Africa (HPCSA).

Calls made by Spotlight to Stander’s Integrated Medical Centre in Bryanston and his Slimming Clinic in Pretoria were unsuccessful. Both landline numbers were not working, even though the websites advertising everything from weight loss to integrative cancer treatment, botox and the sale of vitamins were still live.

A further search found a GP practice in Pretoria where a woman answered stating that it was the rooms of Dr Stander. She said he only consulted at this Pretoria practice on Tuesday. She indicated that he consulted at the Centre of Advanced Medicine in Sandton every second Wednesday.

Stander’s active Facebook page reveals that he has among others been a speaker at a business breakfast in the Free State. He continues to share events linked to his slimming clinic which has the same address as the Centre of Advanced Medicine.

A further search on the Centre of Advance Medicine website (a practice with various specialists listed), links to Regenerative Medicine which in turn links to a ReGenesis page. A search also reveals that ReGenesis continues to be a co-sponsor in a popular train run series in and around Bloemfontein.

 

 

 

 

 

 

 

 

 

 

 

 

Opinion: Return of the quacks

By Anso Thom, Spotlight Editor

For a long time, South Africa has been a country where charlatans are able to flourish and peddle dangerous remedies for all kinds of ailments.

Take a trip on a public train or a walk down a road in our city centres and you will easily find pamphlets marketing remedies for anything, from enlarging penises to bringing back lost lovers. Even more seriously, the city lamp poles are plastered in posters offering cheap pregnancy termination services. Poor people stand on street corners for hours offering pamphlets and directions to the closest ‘doctor’. All illegal, all dangerous, but almost all operating with impunity.

The reasons these quacks proliferate are many. Not so long ago we had a president and health minister who created an enabling environment for them. President Thabo Mbeki questioned the efficacy of lifesaving anti-AIDS medication, told people they were toxic, and dragged his feet when it came to signing into policy the rollout of these medicines for the thousands who were suffering and dying.

His Health Minister, a medical doctor, Dr Manto Tshabalala-Msimang spoke often and passionately about the so-called healing properties of beetroot, garlic, lemon and olive oil. People sniggered, referred to her as Dr Beetroot and shook their heads.

But what Mbeki and Tshabalala-Msimang had done successfully, was to sow seeds of doubt. Many, many people living with HIV, desperate for a remedy not only to control the virus, but to exorcise it from their battered bodies, turned to the quacks, who promised to do so. What was criminal was that these ‘doctors’ were operating with the tacit support of the leaders who had the power to close them down.

They included the likes of German multi-vitamin peddler Matthias Rath; KwaZulu-Natal truck driver and seller of a concoction called uBhejane (the recipe of which he said was revealed to him in a dream by his ancestors) Zeblon Gwala and the likes of Tine van der Maas a barefoot Dutch nurse who pushed lemon, garlic, beetroot and olive oil concoctions at the behest of the health minister, or Belgian eccentric Kim Cools who continues to claim that he had injected himself with the HI virus but remains negative due to his remedies (see previous Spotlight).

Activists told stories and journalists wrote articles of the heartache these people had caused – the undignified deaths of mothers who left families orphaned as they dumped their antiretrovirals for Rath vitamins, the fatal and excruciating suffering of the much-loved DJ Khabzela after the health minister sent Van der Maas to heal him, or the illegal Rath clinical trials conducted on poor people, made to strip, have their photographs taken and give their blood.

And then there was Virodene – a powerful chemical detergent peddled by a bunch of crazy scientists as a cure for AIDS, which had as its cheerleader President Mbeki.

Mbeki and Tshabalala-Msimang were not alone in the rejection of proven treatments. Tshabalala-Msimang’s MECs either turned a blind eye to the fact that people were being used as guinea pigs, or did everything in their power to deny poor people access to lifesaving drugs.

Sibongile Manana was the MEC of Health in Mpumalanga at the height of the denialism years from 1999 to 2003. Now she is a Member of Parliament. As MEC she gave the Greater Rape Intervention Project (GRIP) in Nelspruit hell. She bullied Rob Ferreira Hospital’s Dr Thys von Mollendorff, a gentle caring doctor whose only crime was to try and help rape survivors. He offered them a dignified, safe space in his hospital where they were given the option of accessing legal, tested antiretrovirals to prevent infection. But Manana hounded Von Mollendorff and GRIP out of the hospital and treated them like criminals, dragging them to court and evicting them from the hospital.

Penny Nkonyeni, MEC for Health in KwaZulu-Natal during the Manto years, often rolled out the red carpet for her Minister. She printed quack pamphlets for distribution, hounded doctors who dared to offer pregnant mothers the option of treatment to prevent transmission of HIV to their babies, and she was a willing partner in finding crooked NGOs prepared to run illegal clinical trials using quack concoctions. Nkonyeni was later the speaker in the provincial parliament and Education MEC before being removed in a Cabinet reshuffle earlier this year. She indicated she was joining the private sector.

The examples are many and for those who were there, these memories are painful. Those who were there made a pact saying, never again.

Fast forward to 2016 

Dr Benny Malakoane is a medical doctor and was until recently Health MEC in the Free State. Over a three-and-a-half year period he oversaw the collapse of the public health-care system in the province, and turned the state machinery on elderly community health workers who were asking inconvenient questions, while facing multiple charges of fraud and corruption (these cases are still ongoing due to continued delays).It now appears that, much like Manana and Nkonyeni, Malakoane enabled a quack to operate with impunity in a state hospital, using unsuspecting state patients as guinea pigs in an illegal stem cell trial. In fact, this operation had been signed and sealed in a three-year contract which was due to further impoverish the Free State health system and enrich the shareholders of ReGenesis Health with millions of rands.

Questions must be asked over the enthusiasm of the MEC in signing this contract and personally overseeing its implementation. One has to ask how the MEC could be so enthusiastic in rolling out an untested stem cell intervention in the Pelonomi hospital’s orthopaedic department while his health system is collapsing and failing to get basic medicines to clinics and hospitals.

The Medicines Control Council led by Professor Helen Rees intervened within days of health minster Dr Aaron Motsoaledi becoming aware of this contract. It is refreshing and heartening to know and see in action the difference an ethical, incorruptible and no nonsense health minister and medical doctor can make. If only we had someone like Dr Motsoaledi in the early 2000s.

The MCC swiftly closed the ReGenesis operations at Pelonomi and have made it clear that according to the information they have, an illegal trial was being conducted, using an untested intervention.

For now, the operations have been brought to a halt and the Free State Department of Health has cancelled the contract. The MCC has sent ReGenesis a comprehensive list of questions, and Free State Premier Ace Magashule has been left with the task of holding his MEC accountable. Don’t get your hopes up.

Within a day of the information being revealed by Spotlight and the investigative television show, Carte Blanche, Free State premier Ace Magashule shifted his Health MEC to Economic and Small Business Development, Tourism and Environmental Affairs, and installed his former Police, Roads and Transport MEC Butana Kompela as the health custodian.

However, we cannot allow another quack enabler to get away without being held accountable.

The Free State Department of Health and Premier Magashule have to provide answers to some very serious questions. For instance, why did the Free State Department of Health publish a tender for stem cell therapy in the first place? On what basis was ReGenesis appointed in June? Why was Malakoane so closely involved with the project, chairing the board that would provide oversight of the work and research done by ReGenesis?

Simply shifting Malakoane to another post doesn’t make these questions go away. For there to be any accountability we need answers to these questions. The people of the Free State are not guinea pigs. They are not pawns in an alleged scam to enrich charlatans.

Not on our watch. The ball is in your court Premier Magashule.

 

Communities in crisis

By Treatment Action Campaign

The Treatment Action Campaign has shared the following stories with Spotlight from their provincial operations in KwaZulu-Natal, Limpopo, Mpumalanga and the Free State. Elsewhere in this issue of Spotlight we take an in-depth look at Gauteng – which is therefore not included here.

France, KwaZulu-Natal

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Branch members go door to door in France to find out how people in the community cope without a clinic.

The community of France in KwaZulu-Natal does not have a clinic. A mobile clinic comes to the community just once a month. But most people don’t use it; some don’t even know about it. Instead they travel by taxi to other clinics – if they can find the money. Sometimes they must lie about where they live in order to see a nurse, or they simply go without medicines and health services altogether. Only certain community caregivers can deliver medicines to patients, if they have an ID, and if the patient is being treated at the mobile clinic. The rest, however ill, have to collect medicines themselves. It seems people are defaulting on ARVs, TB treatment and other chronic medicines as a result. We can never have #treatment4all – or #EndTB – when people can’t even get to the clinic. TAC members have asked the people of France how only having a mobile clinic affects them. The resounding response is that once a month is not enough. To resolve service deficiencies such as this one, which keep the dual epidemics burning, health system challenges must be addressed in the National Health Department’s test-and-treat plan and within the new National Strategic Plan on HIV, TB and STIs. Otherwise we are doomed.  #FranceNeedsAClinic.

Khujwana, Limpopo

Within a few hours of walking door to door through the streets of Khujwana it is clear there is a major problem. Every home has a story to tell – a story of frustration and suffering, a story of failure.

While the local clinic looks functional, even ‘pleasant’, from the outside with its solid infrastructure and garden, inside it s a totally different matter. Many patients report ongoing stockouts and shortages of their medicines. They wait for hours before being seen by anyone – there is a shortage of nurses and no doctors ever come. Some go to other clinics altogether. People report incidences of nurses treating them badly, being rude or, worse, negligent. Mothers report the indignity of having been mistreated, or unattended to, in the midst of labour. Khujwana Clinic is failing the people and the community it is meant to serve. Tired of this situation, the community is mobilising. Testimonies from community members who try to use the clinic are being gathered. Local stakeholders are coming together to draw attention to the major shortcomings. All they want is a clinic that can give them the health-care services they need. They are clear: They will continue to escalate this issue until they #FixKhujwanaClinic.

Boekenhouthoek, Mpumalanga

The local TAC branch in Boekenhouthoek receives ongoing complaints about the local clinic. People

In Boekhouthoek a TAC branch member takes testimony from a community member struggling to access health services.
In Boekhouthoek a TAC branch member takes testimony from a community member struggling to access health services.

report waiting for long periods of time, with or without being seen. There aren’t enough nurses stationed in the clinic exacerbating this issue. The clinic is too small, and people wait outside while waiting to be seen. The clinic is faced with regular stockouts and shortages of medicines meaning people are often sent home empty handed. Some community members choose to go to different clinics altogether. A luxury that many of those unemployed people who live in the area cannot afford. Traditional leaders confirm these conditions, from personal experience. One woman spoke of never receiving a TB diagnosis, months after taking a test. One man spoke of misdiagnosis. Another had never been told he had HIV, yet had been prescribed ARVs for more than four years with serious side effects. People reported of nurses being rude to them in moments of severe vulnerability. The TAC Boekenhouthoek branch is monitoring the clinic and gathering information from residents about the challenges they face. How can we reach #treatment4all if clinics run out of medicines? Or if people don’t want to use them because of the lengthy waits and poor service? The reality is that the dysfunction in our health-care system will stop the new HIV guidelines on test-and-treat from being a success. We need significant investment into stronger systems in order to respond to the HIV and TB epidemics. #BetterBoekenClinic

Phuthaditjhaba, Free State

Members of the TAC in Phuthaditjhaba have reported serious problems at Manapo Hospital that are putting people’s right to access health care in serious jeopardy. This report followed a strike by frustrated, overburdened staff members, including doctors, nurses, physiotherapists, porters, cleaners, and kitchen staff, who claimed to have not received pay for significant amounts of overtime since 2015. TAC members investigated the hospital and spoke to many patients entering and exiting the facility. Reports of long waiting times, a lack of nurses, doctors, and other staff being stretched beyond their capacity, and medicine shortages, were common.

After being stabbed in the forehead, one teenager reported not seeing a doctor after seven days of waiting. Another teenager had been stabbed in the upper chest four days earlier. He was also still waiting to see a doctor. A woman with a homemade sling and swollen wrist left the hospital in pain to return to the clinic. One man, falling in and out of consciousness, was told to return to casualty with a referral letter. Outside the hospital, visibly injured patients could be seen wandering the grounds in their pyjamas. After taking a rest on the grass, one young man with bandages across his face struggled to stand up and had to be assisted by two other patients to get onto his feet before limping back inside. Portable toilets remain outside the hospital after a water crisis the month before. It is unclear whether the water shortages continue. A TAC member helped a man with crutches who struggled to climb up the metal steps to enter the toilet. If urgent action is not taken to turn around this crisis, the TAC will be forced yet again to embark on a campaign of civil disobedience in order to save the lives of those reliant on the failing public health-care system. #FSHealthCrisis

 

 

 

 

Illegal experiment scandal rocks Free State health

By Anso Thom and Marcus Low

CEO of Regenesis, Dr Wian Stander
CEO of Regenesis, Dr Wian Stander

The Medicines Control Council (MCC) this week suspended what appears to be unlawful stem cell experimentation at Pelonomi, a state hospital in Bloemfontein. At the same time the Free State Department of Health has cancelled its contract with the stem cell company, ReGenesis Biotechnologies following a list of questions sent by Spotlight in connection with the involvement of controversial Health MEC Dr Benny Malakoane.

Until a week ago the Free State department of Health was set to spend tens of millions of Rands on unproven and potentially dangerous stem cell therapies for the treatment of musco-skeletetal diseases in its orthopaedic knee patients at two hospitals. The treatment was run by a private company called ReGenesis Biotechnologies and has started on June 1.

A service level contract (seen by Spotlight) between the Free State Department of Health and ReGenesis Biotechnologies indicated that the service would be provided in Pelonomi hospital in Bloemfontein and Boitumelo hospital in Kroonstad. The department would pay R30 000 per client, with a guaranteed supply of one thousand patients per year. This adds up to R30-million per year and R90-million over the three years of the contract.

Spotlight sent the MEC’s office a number of questions over a week ago. We delayed going to print as Malakoane’s spokesperson Mondli Mvambi requested that he be given time to investigate. On Thursday this week Mvambi sent an email stating the following: “Our response to all your questions is that after careful consideration, the Free State Department of Health has decided to cancel the ReGenesis Biotechnologies contract with immediate effect. We will not comment any further on this contract as it is now sub judice.”

Mvambi would not explain why the case was now sub judice.

Questions Spotlight sent to ReGenesis went unanswered, despite an initial request from ReGenesis CEO and the doctor carrying out the procedure Wian Stander that the questions be e-mailed to “Chevonne”. Stander is also listed as the “Owner and Integrative Medical Practitioner” of the Slimming Clinic in Bryanston. According to the website of the Slimming Clinic he has done talks on Holistic Medicine and Healthy Ageing in South Africa over the past few years.

MCC investigation

MCC Chairperson Professor Helen Rees confirmed to Spotlight that inspectors had been to the Pelonomi site last Friday and again on Monday.

“Our concern was that the service level agreement made reference to medicines, injections and therapeutic research,” said Rees.

She said the informed consent documents referred to the patients giving permission for stem cell therapy, permission for stem cells to be removed, concentrated and re-injected and for their stem cells to be given to another person.”

“This is not a proven therapy and we were concerned about the reference to research as well as the fact that stem cells will be given to other persons. This led to questions whether this was in fact a clinical trial and if it was, the MCC has not given permission for it to be conducted,” said Rees, adding that their first priority was the safety of patients. Medical research that has not been approved by the MCC is unlawful in South Africa.

“We have asked Dr Stander to stop enrolling patients and now await a response to the information we have requested from him,” Rees said. She said that “injecting anything into a patient comes with risk as you always run the risk of introducing infection.

The contract

The contract seen by Spotlight states that ReGenesis “shall provide the department with the clinical governance and treatment protocols at the onset of the service on 1 June 2016.”

The contract also states that the Free State Department of Health and ReGenesis would establish a project management committee consisting of the MEC of Health as Chairperson as well as the CEOs of Pelonomi and Boitumelo hospitals, COOs and representatives from ReGenesis. It reveals that the committee shall meet monthly for the duration of the Agreement to “track progress, resolve pertinent matters to the effective and seamless treatment of patients”.

The contract states that this agreement would run until 30 June 2019 with the department in essence guaranteeing 1 000 patients per annum, paying ReGenesis R30 000 for each treatment. There is provision in the contract for ReGenesis to motivate for treatment in excess R30 000. The contract also stipulates an upfront payment of a percentage of the cost of the three year contract, which also makes provision for a price increase after the first year. The Department also undertakes in the contract to supply ReGenesis with all consumables required.

A source close to the MCC investigation confirmed that they have been unable to find evidence of a tender. However, Carte Blanche claimed last that a tender had been published in April seeking a service provider who can provide “cell based stem cell regenerative medicine and therapeutic research services”. Head of Department Dr David Motau confirmed to Carte Blanche that the contract had been cancelled.

Stem cell therapy for knee problems

Substantial research is being done around the world into various stem cell therapies  including for the treatment of arthritis and osteoarthritis of the knee. A search of the literature however shows no evidence from phase III trials indicating that any form of stem cell therapy is safe and effective for the treatment of knee problems. With few exceptions, medical treatments are only approved for use in humans once compelling evidence is available from phase III trials.

In the case of stem cell therapies caution is particularly important given some reported cases of tumour formation associated with such treatments. In a recent letter in the New England Journal of Medicine doctors warn against the risks associated with unproven stem cell treatments. Outlining a specific case, they write: “This case and others in which tumors have  developed in the context of stem-cell tourism (a trend in which patients travel for the purpose of obtaining therapy) illustrate an extremely serious complication of introducing proliferating stem cells into patients.”

The United States Food and Drug Administration has warned consumers against using unregistered stem cell therapies. They have also sent warning letters to companies providing certain kinds of stem cell therapies and in 2012 won a court case against the company Regenerative Sciences in which the court affirmed the FDA’s authority to regulate stem cell therapies making use of a patient’s own cells.

Spotlight will continue to run a series of articles on this investigation www.spotlightnsp.co.za

Buthelezi EMS remains a problem and a mystery

By Ufrieda Ho

The Free State’s health care system – in tatters in so many places – also has one recurring nightmare: Buthelezi Emergency Medical Services, to whom public emergency services have been outsourced.

Why did the province’s services needed to be outsourced or supplemented in the first place? Secondly, was Buthelezi the best company to land the tender, and, thirdly, why are the on-going complaints about the company’s service – since it got the contract at the beginning of 2014 – falling on deaf ears?

According to the Democratic Alliance’s questions put to MEC Benny Malakoane in August 2014, there were 106 ambulance and emergency services vehicles in the province, 54 were being serviced in workshops and 28 were about to be added to the fleet.

Repairs and maintenance on Buthelezi Emergency Medical Services take place in a backyard in a house that is the base for Buthelezi EMS in Bloemfontein.
Repairs and maintenance on Buthelezi Emergency Medical Services take place in a backyard in a house that is the base for Buthelezi EMS in Bloemfontein

That year, Buthelezi EMS had been given the tender that comprises 47 ambulances for district and regional hospitals. Its staff was expected to have “basic life support and intermediate life support” training. This tender was also intended for emergency inter-facility transport, not for call-outs. According to a health department response to a DA question, billing is done according to the skill level of the paramedic attending to the patient.

The contract is ongoing and by November of 2014 – the first 11 months of the contract was worth R32 million to Buthelezi.

Mariette Pittaway, DA member of the Free State Provincial Legislature said: “We still cannot understand why we were not servicing our existing fleet properly instead of spending that amount of money on an outsourced service.”

Pittaway says she’s never without fresh complaints about the services rendered by Buthelezi EMS. This is what worries her most.

“We hear about ambulances arriving to pick up sick babies without incubators. We also hear that some clinics and hospitals are left without their blood-pressure machines and other equipment because they’ve had to hand them over to the ambulance staff. We’ve also heard how hospitals wait for up to two hours for an ambulance to arrive and, in one incident, the excuse for a delay in Gastron was that the ambulance had a flat tyre and the driver had to wait for a spare tyre to arrive. This kind of things is just not acceptable,” says Pittaway.

A matron who spoke to Spotlight had her own horror stories that mirror Pittaway’s slew. She said they routinely give surgical gloves and drip kits to the Buthelezi EMS paramedics who are simply not properly equipped to do the job.

“They ask us for these basic things and then we get a bill for anything between R3500 and R4800 per patient,” she says.

In a letter written by a doctor in the Xhariep area more complaints emerge. The letter details how a Buthelezi ambulance, supposedly with an advance life support paramedic in attendance, was ordered for a 1,2kg premature newborn at 4pm. The ambulance arrived at 7pm to transport the baby to Pelonomi Hospital in Bloemfontein.

“The paramedic was handed the baby for transfer, but they had the wrong oxygen cylinder. The ambulance had to drive back to Bloemfontein to fetch the correct oxygen pin index cylinder. Unfortunately the patient deteriorated and passed away at 12.30am. The ambulance arrived after the patient passed away,” the letter read.

It concluded: “We’ve had numerous problems with Buthelezi Ambulance Service in the past few months”.

In Bloemfontein this autumn, Spotlight visited the Buthelezi offices, situated in a house on the industrial outskirts of the city centre. Ambulances appeared to be serviced or repaired in the backyard. This is a clear compromise of safety standards for emergency medical services.

Outside Welkom, Spotlight saw Buthelezi ambulance vehicles and staff parked under trees. Tender stipulations require EMS private companies to have proper facilities where paramedics can take a shower, have a nap and recharge and refresh properly in-between assignments.

Pittaway says it’s clear that Buthelezi EMS is plagued with problems, yet they continue to be defended by the department of health and continue to cost Free State taxpayers millions of rands.

“We will continue to ask the questions because we don’t feel that we’ve been given good enough answers. We haven’t been able to pinpoint that the premier Ace Magashule and Health MEC Benny Malakoane have direct relationships with Buthelezi EMS, but we believe that how the tender was given out is problematic. We will keep up the pressure,” says Pittaway.

Spotlight’s questions to Buthelezi EMS remained unanswered by the time of going to print.

Welcome to the twilight zone: fear and abandonment in the Free State’s health system

By Mary-Jane Matsolo

Activist Mary-Jane Matsolo last year heard “saddening and horrific” stories from the more than 50 people who testified during the People’s Commission of Inquiry into the Free State Healthcare System. She recently entered the field to assess whether anything had changed. These are her notes.

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Activist Mary-Jane Matsolo

First stop: Free State Psychiatric Hospital in Bloemfontein

I feel like I’ve been teleported into a scene from the X-files: the openness of the space – a huge, unoccupied, neglected piece of land, deserted buildings, dry, brown grass growing long all over the place. Not a single patient or staff member in sight. The only sign of life is the odd security guard.

After the sixth circuit around the premises I’m convinced I’ve entered the twilight zone. I begin to imagine patients chained to their beds inside these empty buildings and I think about all those people we’ve reached out to for information about the health care system, but who felt shackled by intimidation and refused to speak to us. This province is far from free, as its name implies.

There are spooky looking houses here. Not patient wards: stand-alone houses in which, perhaps, doctors or matrons once lived. They’re creepy. It feels as though, like in a horror movie, faces might appear at the windows.

Next stop: Reitz

About four hours’ drive from Bloemfontein, we found a community caught in nostalgic memories of days gone by when they once had a fully functional hospital.

Then abruptly, about 12 years ago, Nketoana Hospital was reduced to only two functions: the casualty unit and a partially functioning maternity unit. The residents still don’t understand the reasons why their beloved local hospital had its heart ripped out.

Now they have to travel to Bethlehem, about 55km away, only to be met by hostile nurses who, they say, discriminate against them by attending to them last and constantly asking them why they use they don’t use their own hospital in Reitz.

Then on to Nketoana Hospital

It was the next obvious and logical thing for us to do now: Nketoana Hospital.  What we saw was extremely confusing. Here was a well-maintained, fully equipped hospital. It seemed set to be able to run like a well-oiled machine and yet most of it was simply shut down.

Stepping into the theatre was like stumbling across the spot, on X-Files, where aliens are operated on – a place kept secret and which is only known about in files stamped “Top Secret” in some government official’s office somewhere.  Equipment stood around collecting dust. It looked as though the hospital had been evacuated suddenly.  Some wards have been turned into storage rooms: hospital beds lie unused on top of one another.

Qwaqwa was next

There’s been no water here since February. The drought has hit hard. We’re 93km from Bethlehem and our guesthouse has no water. How do hospitals and clinics function without water?

We were looking forward to hearing some of the wonderfully creative ways nurses and doctors were getting around this huge hurdle – caused by mother nature and not the provincial government this time – in their daily work.

We set out enthusiastically, eager to report on the innovations we were sure the staff would have come up with, but at the first clinic, the manager treated us with undisguised hostility, shutting us down and refusing to give us any information.

She referred us to the district clinic manager. The more we tried to explain our interest in how a facility was run without water, the more anxious she seemed to get. She got up, escorted us out of her office and watched us suspiciously. She even followed us to the bathroom when we needed to use the toilet and accused us of inspecting her facility.

She followed us to reception, obsessing that we sign the visitors’ register, and interrogating us about who we were and where we came from, even though we’d offered this information to her when we had introduced ourselves in her office.

We visited the district manager. We sat in her office for what felt like eternity while she refused to acknowledge our presence. Finally she spoke not to us, but down at us. It felt like we were in the principal’s office for bad behaviour. She gave us a firm lesson on having to make an appointment and about procedures that needed to be followed when seeking to talk to staff at clinics. We were told to consult Bophelo House – where the provincial health department is located in Bloemfontein – to gain a letter permitting us access to the clinics before coming to the facilities.

It was clear we were not going to get any information from these women. There was no getting through to them. It was as though they had been completely brainwashed.

The cloak-and-dagger theme, the mystery and spookiness, was carried right through to the staff.

The good nurses – the one who are tired of what things were like and desperate for change that would benefit their patients – were like “un-turned humans”: forthright and open. The “turned humans” were the nurses completely wrapped up in tight bureaucratic secrecy. They seemed to have lost sight entirely of why they became nurses in the first place.

As my travelling companion and I returned to the car, I said: “The not-so-free Free State.” A complete stranger hooked on to our conversation, asking who we were and what we were doing there.

Is this some sort of government agent? Is someone following us now?

The paranoia is infectious.

Mary Jane Matsolo is a Campaign officer for Treatment Action Campaign

 

When a good idea becomes good news: adherence clubs in the Free State

By Ufrieda Ho

A simple well-managed idea is not only easing pressure on the Free State health care system and making HIV-positive patients’ lives easier – it also seems to be bringing down mortality rates amongst those with multi-drug resistant tuberculosis (MDR-TB).

Médecins Sans Frontières’ HIV adherence clubs have grown, in under two years, to include 11 000 member in the Mangaung district.

The idea was to create clubs of no more than 30 stable HIV patients (those with a viral load below 40) who meet every two months for less than an hour to collect their ARVs. Is this correct? Doesn’t undetectable viral load normally mean under 50, or is there a new test?

Their medicines are pre-packed by a trained facilitator, so there’s no risk of queuing for an entire day only to be told there are no drugs or that there are too many people to be helped.

At the club meetings, patients are weighed, given TB screening and are given a general health quiz. They can discuss issues among themselves, and facilitators also have the opportunity to raise any specific matters, like a change in medicine packaging.

Members fetch their medicine and leave the clinic before the hour’s up. It means they can get on with their day with minimal disruption.

Once a year they undergo a blood test at a clinic. This test is scheduled by their club.

“It means there 11 000 people who are not clogging up the queues in clinic and hospitals. The patients are properly management and it’s proving to be a system that’s working,” says Trudie Harrison, a coordinator at MosaMaria, the public benefit organisation affiliated to the Anglican Church that manages and facilitates the adherence clubs in the district.

“The aim now is to roll out to reach 21 clinics across the province in the next three years.”

The clubs are funded by Global Fund and Right to Care. Their support has translated into the purchase of four Wendy houses erected on clinic property. These structures serve as club meetings rooms and can also be used as extra facilities by the clinic.

“At some of our facilities we do two sessions a day. Our staff is also trained and salaried. They are not volunteers on a stipend and that model has been part of what’s made the clubs work.

“It also works that the club meetings happen at the clinic or hospital and not in a facility like a church hall. This removes some of the stigma that still exists around HIV/ AIDS,” says Harrison.

MosaMaria’s success with the adherence clubs has led to them partnering with the Naledi Hospice and the Hospice Palliative Care Association of South Africa, working to manage multi-drug resistant tuberculosis (MDR-TB).

The programme is aimed at reducing the rate of defaulting among MDR-TB patients and to reduce MDR-TB mortality rates.

MosaMaria has one nurse and two caregivers on the programme. They currently visit 11 patients to give them a daily injection and other medicine.

“This programme works because before, those with MDR-TB didn’t get treatment because they didn’t want to stay in hospitals. This way, the 24-month treatment can be administered by a nurse in the patient’s own home,” says Harrison.

Harrison says it’s too early to measure the success of the programme but she says that since October 2014 they have seen the mortality rate decline. It’s significant because MDR-TB patients only have a 50/50 chance of surviving.