Philani Clinic – A timeline of failure

by  Ntiski Mpulo

A few meters from the entrance to Philani Clinic in Queenstown, opposite the

Peeling paint welcomes patients

gate, is a black-walled tavern. On weekdays, it’s as quiet as a church; but on weekends, music bursts out of its dark interior, cars line the street and patrons dance between them, holding beer cans and bottles.

The gates of the clinic are not secured, so anyone from the tavern is free to wander in; there is but one security guard on the premises. This poses a significant risk to the patients and nursing staff of the clinic.

“When we work on weekends, the drunks come and harass us,” says Sister Annelise Koti. “I don’t feel safe at all.”

Traditionally, the clinic opened from 08:00 till 16:30 on weekdays. Since 2013, following a directive from then-MEC for Health Sicelo Gqobana, nurses at Philani Clinic were instructed by the sub-district manager, Nonceba Bhabha to begin working weekends and public holidays.

The nurses have been forced to work on weekends without compensation, and this is taking a toll. Four nurses have resigned or been fired since this unilateral decision was handed down from the district office, leaving only eight nurses rotating shifts to cover weekends. On any given day, there should be three nurses at the clinic; because of staff shortages, only two nurses work on weekends.

The nurses have questioned the decision to operate seven days a week, and have requested written confirmation from the district manager that this was indeed mandated by the department. A memorandum from the district manager to the superintendent-general confirms that the resolution to open the clinic on weekends was never signed.

“We requested the minutes of this meeting,” explains Sister Koti. “We also asked for a policy that we should work extended hours, and we asked that we would be paid for public holidays and weekends.”

empty chairs on the
weekend while nuirses are forced to be on duty without pay

The sub-district manager did not respond to their requests. Instead, according to Sister Koti, pressure was placed on the operational manager.

“She said we must comply, and complain later. She never gave us options for contesting this thing,” says Koti.

“We asked them to give us something in writing to cover us if anything happens,” she says. “For example, there could be a medico-legal claim against one of us, and we wanted to be covered. The department of health will deny you. They will say, ‘You asked to work weekends yourselves.’”

Nurses’ pleas fall on deaf ears 

Nurses at Philani Clinic report being subjected to victimisation from the district office. They have repeatedly asked their union representatives to intervene on their behalf, with little progress in resolving the issue.

“In 2015, when we spoke with the unions, suddenly the minutes emerged,” explains Koti. “But these did not specifically refer to Philani Clinic operating for seven days a week. They said in the minutes that they were preparing for opening 24 hours. But we said, ‘You can’t prepare for 24 hours with such old infrastructure. This is an old clinic.’”

The clinic is over 100 years old, and badly maintained. Paint peels off the wall where damp is creeping up from beneath the ground. The foundation is reportedly sinking. A memorandum from the clinic committee states that there is often no water available; the clinic is equipped with a rainwater tank, which runs empty and is not refilled. The memorandum also cites insufficient equipment, including a fax machine that has been without ink for nearly five years.

The clinic has been the site of contention in the last three years, with residents forcing it to be closed on several occasions. The reasons for the shutdown are numerous; clinic committee member Luyanda Nogemane places the blame squarely on the unresponsive stance taken by the MEC for Health, Phumla Dyantyi. He claims that Dyantyi has placed politically connected individuals at the district office, instead of people who care about the community.

On 30 November 2016 the committee wrote a letter to Dyantyi, accompanied by 68 signatures. However, the matter remains unresolved.

The community shut the clinic for a day in March 2017, then again in May and

a rubbish dump right outside the clinic.

June of that year, citing the non-payment of nurses as one of the key issues. “We took our grievances to Bisho, and met with Mr Myezo,” says Koti.

The HR manager called a senior manager at the district office and was told that the nurses had been paid. He advised them to set up a memorandum of understanding between the nurses and the district, but this has not been put in place. Instead, the district office issued notices stating that the nurses were off duty without authorisation, and began withdrawing money from their salaries – amounting to as much as R1 500 – if they did not report for duty on weekends. At that time, Eastern Cape Health Department spokesperson Sizwe Kupelo is reported to have said that payments to the nurses were not completed because the nurses had not submitted claim forms – but Sister Koti tells a different story.

“They targeted us,” says Koti. “In April they withdrew the money. The HR clerk would bring ‘leave without pay’ forms, which we refused to sign.”

Staff morale at the clinic is at an all-time low. Those who remain are burnt out. Between the three nurses on duty, they serve approximately 200 people per day; and on the weekends, when there are only two nurses on duty, there is no clerk to receive patients, so this task must also be performed by the nurses.

“We try not to let our issues affect the clients,” explains Koti. “Although clinic hours are 08:00 to 16:30, it is rare for us to leave at that time. We stay till after 6pm sometimes. We often don’t have time for lunch – forget about tea breaks.

“We want to be treated with dignity,” says Koti. “We have families too.”

 

 

The work of a nurse

By Mary-Jane Matsolo

‛There is a huge difference between a clinic nurse and a government hospital nurse. Clinic nurses usually do referrals, unlike us, we have to deal with it all – drips, oxygen tanks, two to four injections required to treat a patient with meningitis. We do all of it, from documenting how many patients we’ve seen, to arranging medicines to give to the patients, and monitoring and taking their vitals before doctors do their rounds in hospitals. That’s if a patient doesn’t come in that needs serious medical attention, which is also the work of a nurse – to resuscitate the patient, which could take anything from two to three hours,’ explains Sister Elinor Mpulo (name changed) .

A public hospital nurse’s day starts in the early hours, at 7 am, and usually doesn’t end until the late

hours of the evening. A double shift is also required in a 40-hour-week. The functions mentioned above should be completed before the doctors do their rounds at 8 am; whatever hasn’t been completed before has to be done after the doctors have left. Many days, come 12h00, a nurse hasn’t even had a tea break.

‘The conditions we work under strip away a nurse’s calling’

The TAC visited the Far East Rand Hospital in Springs after pictures of substandard conditions were sent in by field workers in the area. The images showed patients sleeping on the floor, beds with patients sleeping in passages, patients sleeping in bathrooms with non-functioning flushing toilets, and visible unprotected electrical wiring coming out of the walls.

We went to the hospital with the intention of questioning the CEO. He was not on the premises, and so we visited the wards to see the conditions for ourselves. What we saw, confirmed the evidence in the pictures.

Hoping to get information from patients about their experiences at the hospital, we found that a majority of them were mental health patients and unable to give us any substantial input. We asked to see to the nurse in charge of the ward who, unlike many in her position who are reluctant to open up about conditions they work under for fear of losing their jobs, or to protect the department, was willing to speak to us.

Sister Mpulo, who began nursing when she was 18 and who will soon retire at the age of 55, has seen it all. She spoke to us from the heart, listing the challenges at the hospital and with the entire system. She explained that the main reason behind the overcrowding at the hospital, resulting in some patients having to sleep on the floor and patient beds being moved into the bathroom area, is due to renovations that have been ongoing since 2014. Many patients that come through casualty are told the wards are full and there is a shortage of beds. They are given an option of being given medication and to go home, or to sleep on mattresses on the floor. If they agree to stay, they are made to sign a consent form, to cover the hospital. Up to 62 patients are squeezed into a ward with the capacity to take 31-46 people. Sometimes, the hospital closes admissions to regulate bed capacity.

Patients, regardless of their illness, and including mental health and TB patients, share wards. Some

A nurse walks down a Gauteng hospital passage way with a child in this file photo.
A nurse walks down a Gauteng hospital passage way with a child in this file photo.

TB patients waiting for test results don’t know their status when admitted, putting other patients and nurses at risk of contracting TB. Even the hospital’s TB wards, Sister Mpulo says, are overcrowded, with little to no ventilation. The only way nurses can protect themselves from being infected with TB is to wear their TB masks, something they are reluctant to do because they usually come in one size, are uncomfortable and, when temperatures are hot, it’s very hard to breath while working with them on.

Furthermore, the wards don’t have enough oxygen points, and there are not enough drip stands. All these conditions make the nurses’ work very difficult, and the people that suffer the most are the patients, says a visibly exhausted Mpulo.

When new doctors are employed, they know nothing about the patients and it’s up to the nurses to bring doctors up to speed on the patients’ records and to ensure that everything runs smoothly so the doctor doesn’t make a mistake.

‛We become burned out and our concentration levels are low. At least, in the last two months, the department has employed some nurses and doctors, which is good. We can only do so much – many nurses take sick leave before they reach a state of burnout. A nurse at a clinic is required to see one to eight patients but at a hospital level we see anything from 12-20 patients a day. The conditions we work under strip away a nurse’s calling,’ she says.