Health Management Public Health & Health Systems

The Eastern Cape exodus

The Eastern Cape’€™s latest health MEC appears to be set on preventing public scrutiny of its troubled provincial hospitals, and staff are too intimidated to speak out. In the meantime institutions are haemorrhaging nurses and doctors.

The conditions at many Eastern Cape hospitals are very poor and health workers fear to speak out as retribution from the province is swift.

Ironically, the province’€™s health services have deteriorated over the past decade of democracy with patients flocking to neighbouring provinces in the hope of receiving better treatment.


Huge staff shortages, rundown hospitals, shortages of essential medicine, poor management and a lack of infrastructure are just some of the issues that health workers complain about. But none will go on record with their complaints.


Numerous changes in top leadership have also exacerbated the problem.

Health MEC Dr Bevan Goqwana was finally fired in April after a tempestuous term that saw him being charged with fraud at one stage.

His replacement, Nomsa Jajula, and her departmental staff seem determined to block the media from access to the province’€™s health facilities.

It took six weeks of dogged persistence before Health-e was given permission to visit East London’€™s Cecilia Makiwane Hospital, one of the largest institutions in the province.


But when Health-e was at the hospital, the health department’€™s director of communications Mzukisi Ndara suddenly reneged on an agreement to let us speak to management, claiming that the journalist was ‘€œpushing an agenda’€.

Cecilia Makiwane Hospital is part of what is now called the East London Hospital Complex. Established in 2002, it consists of the Frere and Cecilia Makiwane Hospitals and the East London Mental Health Unit.


The massive complex serves a population of almost three million people, yet specialists rotate through the hospitals as there are not enough skilled staff to keep services going at both Cecilia Makiwane and Frere simulataneously.

Health minister Dr Manto Tshabalala-Msimang recently revealed in Parliament that 58 percent of doctors’€™ posts are vacant at the 1 724-bed Cecilia Makiwane. Fifty six doctors resigned last year alone, which is a clear indication of among others dysfunctional management.


Almost two-fifths of the medical specialists’€™ posts are also vacant, and over one in five nurses posts are vacant, said the Minister ‘€“ although local nurses say this figure is much higher.


The province may well be touchy about Cecilia Makiwane as it could be facing a massive law suit for negligence from four mothers who lost their babies during a power failure.


The four babies were in the intensive care unit at the time.

Although the hospital initially admitted to the mothers that the emergency generators had failed to kick in during the power failure, incredibly no one has been held accountable for this.


Tshabalala-Msimang recently visited the hospital and exonerated the hospital staff from blame, while also announcing that parents of the dead babies would not be compensated.


However, mothers Leander Boutcher and Siphokazi Citashe, who both lost their first-born children, intend taking legal action against the department.

Citashe, 25, said Premier Nosimo Balindlela had told her personally that it was the hospital’€™s fault.


‘€œThe premier said that the hospital generators are quite old. She said she would help the family with all kinds of expenses including the baby’€™s burial,’€ said Citashe, adding that all the families had received was R5000.

Meanwhile, Boutcher, who is only 18, has taken to cutting herself on her arms in an attempt to alleviate her enormous sense of grief.


Nurses at Cecilia Makiwane Hospital refused to speak on the record even though Health-e had provincial permission to interview them.


 ‘€œIf they know I talked to you, I can kiss my job goodbye. Not that I care so much because no one cares about us. But you know, I need this job,’€ said one.


Morale amongst the nurses was low. They were particularly bitter about their poor salaries, saying they had to work extremely hard because of staff shortages. They were also fed up that very few of them qualified for the ‘€œscarce skills’€ allowance introduced in 2003.


The nurses’€™ home was filthy and many windows were broken.

At the hospital’€™s burns unit, the stench was unbearable and there was no air conditioning.


A sole nurse was in the ward to care for the 30 patients. Burn victims need specialised attention as they are highly susceptible to infection

At Mthatha General Hospital in the poverty-stricken north east of the province, a third of doctors’€™ posts are vacant and almost 40% of pharmacists’€™ posts are vacant.


The hospital serves about 2,5-million people, and acts as a referral hospital for over 20 district hospitals.


A massive 348 nurses and 68 doctors have resigned from Mthatha in the past three years.


When Health-e visited Mthatha earlier this year, AIDS patients were dying while waiting for antiretroviral drugs as only 10 new patients a week were accepted to the treatment programme.


The then MEC Goqwana ordered staff to work overtime to remedy the situation after it was exposed by Health-e. But the hospital’€™s Dr Anele Mani said that since Goqwana’€™s removal from office, the programme had gone back to a snail’€™s pace.


At the time of Health-e’€™s visit, patients were sprawled all over the reception area, some emergency cases on stretchers or sitting on benches with drips on their arms waiting to be admitted.


Dust bins were overflowing and toilets were filthy.

In Mthatha’€™s backyard stands the R500 million state-of-the-art Nelson Mandela Hospital, a tertiary institution supposed to alleviate the pressure on Mthatha.


But it is a white elephant as it has been unable to attract skilled staff.

At Sipetu, a district hospital near Mount Frere that refers patients to Mthatha, there is only one doctor and not a single ambulance for a population of about 200 000.


The back-jarring dirt road to Sipetu can only be reached by bakkie as minibus taxis refuse to use the road.


Malnutrition is one of the most a serious problems, especially for children.

The operating theatre has not been working for more than a year, so not even run of the mill Caesarian sections can be done.


The ARV programme has not been rolled out because there is no one to dispense the drugs. Volunteers dispense medication as no pharmacists want to work at the 147-bed rural hospital.


One of the foreign doctors who works nearby, Dr Ogo Chukwu Anizoba from Nigeria said Sipetu hospital is in dire need of resources and that he was surprised that such a hospital could exist in well resourced South Africa.


‘€œI never really imagined I would find what I saw at Sipetu,’€ says Anizoba referring to the terrible state the hospital is in.


Meanwhile advocacy groups in the province say it’€™s extremely hard to work with the health department management in the province.


Public Service Accountability Monitor researcher Thokozile Madonko says alarm bells have been ringing at all levels throughout the Eastern Cape public health sector since 1996.


‘€œAt the heart of the department’s problems has been its consistent failure to undertake rigorous strategic planning exercises, which has resulted in it being unable to properly manage its finances,’€ says Madonko.


‘€œThis has led to the Department routinely incurring significant over-and under-spending, which severely hampers effective service delivery.’€

Meanwhile, the Treatment Action Campaign co-ordinator Phillip Mokoena says that ‘€œaccess to information is a big struggle’€.


‘€œWe can’€™t get hold of government reports in terms of the progress especially with the ARV programme,’€ he says, adding that the new MEC has been instrumental in blocking information.


Related stories:


Hospitals in crisis

There’€™s no room

A study in neglect

Thinking out of the box

How to grow your own nurses



About the author

Yolisa Njamela