Patients endure shocking treatment as Mpumalanga health system crumbles
Years of poor management has resulted in an exodus of doctors from Mpumalanga, while a change in curriculum means there are no community service doctors this year to fill in the gaps.
The serious shortage of doctors in Mpumalanga’s public hospitals is continuing to cause misery for patients, yet the health department has failed to draw in private doctors who are willing to help.
Last year, Standerton Hospital was run by 19 community service doctors. But this year, there are no community service doctors because of a change to the curriculum requiring students to do a second year of internship.
Now the entire 200-bed hospital is run by five doctors. In mid-January, the hospital announced that there would be no doctors on call after hours as they had already worked their pre-approved monthly overtime.
Private doctors in Standerton are having to deal with patients who have developed serious health problems as a result of poor treatment at the government hospital.
Dr Gerhard Herbst, who has practiced in the town for 37 years, tells of Esther Morajane who was rushed in for an emergency caesarian after hours. A sessional doctor cut right through her bladder, to the womb.
‘He delivered the baby through the bladder, sewed the womb up but sewed the bladder to the womb. He left the front of her bladder open,’ says Herbst.
Morajane was discharged after three days, but her next week at home alone was hell.
‘I was in pain all over my body. I had cramps in my stomach, and the cut from the operation was starting to leak. My stomach was swollen. My whole lower body went numb,’ says Morajane.
‘She went back to hospital and they took her back to theatre,’ says Herbst. ‘They drained 7.5 litres of urine out of her abdominal cavity. They called in my partner. He operated on her for three hours to repair her bladder. It was in tatters as if a bomb had exploded inside her. She could have been dead. It is unthinkable, unthinkable.’
Morajane is still in pain. It hurts when she urinates. She is only 23 years old, but doesn’t know if she will be able to have any more children. She is waiting for her husband to get his meagre salary at month-end so she can go to a private doctor.
Meanwhile, the hospital and the provincial Department of Health admit that there was a mistake ‘which is not unusual’¦and can be repaired’. They say they are investigating and ‘corrective action will be recommended’.
The only reason Standerton Hospital’s Wellness Clinic for people with HIV/AIDS has not collapsed is Dr Molepi Mohale, a private GP, has stepped in to help.
Since January, he has left his practice for a number of hours each week to help patients ‘ but has not been paid a cent so far despite appeals to the hospital’s CEO.
‘I’ve got a passion to do HIV work,’ explains Mohale. ‘Some of the patients are very, very sick. There are people who are being brought on blankets, who can’t walk.’
Only a doctor can prescribe antiretroviral drugs, says Mohale. ‘We advocate adherence, but due to a fault of our own, patients miss a dose or two. They get up at 5am and travel that far only to be told there is no doctor to see them.’
But Mohale does not blame the hospital’s doctors. In fact, he says they have an impossible job.
‘You have five doctors working day and night,’ he says. ‘At one point, one doctor is alone to run hospital. Who do you call if you need to do a surgical procedure because you need three doctors for that?’
Yet outside the hospital gates are 18 GPs who are ‘dynamic, experienced and prepared to work’, he adds.
Dr Joel Mavuso, former medical manager of Themba Hospital outside Nelspruit, resigned last October because he couldn’t take the way his doctors were being treated.
‘Because of a shortage of doctors, working conditions are very poor. Hours are long, patient load is massive, interns are often unsupervised, there is poor equipment,’ says Mavuso.
‘Some hospitals don’t even have a radiographer to do X-rays. Then there is the question of pay: doctors in the province are among the lowest paid in the country. It takes the department up to four months to pay overtime and if a doctor has worked more than 80 hours of overtime per month, he won’t be paid.’
The situation is just as bad at Nelspruit’s Rob Ferreira Hospital. Dolly Mathebula was sent there for tests by her private doctor, Dr Eric Khumalo, who suspected she might have meningitis.
But the doctor attending to her could not do a proper lumbar puncture (test to extract spinal fluid using an injection), and after three attempts, called another doctor to help him take out the needle.
‘When my brother came to fetch me, he found me bleeding all over,’ said Mathebula.
She felt something was wrong because she couldn’t move her lower limbs. Even now, she walks with difficulty and gets terrible headaches.
Mathebula was discharged after two days but her family took her back to the hospital and they then kept her there for two weeks.
Dr Khumalo says he has complained to the hospital but was told that Mathebula’s file was missing. When her brother took up the matter with the hospital, it arranged a temporary disability grant for Mathebula. She was sent for an MRI scan at a private clinic at the state’s expense and the Department of Health said it showed no damage from the lumbar puncture.
In another case, Robert Shongwe was injured in a car accident in February and taken to Rob Ferreira. His arm felt dead, but the casualty doctor said his X-rays showed no damage. He was released with a neck brace and told to return in two days.
‘I’m crying, saying why’¦and he never give me nothing, tablets for the pain, nothing,’ said Shongwe.
Luckily, Shongwe was still on duty during the accident, so his employer took him to a private clinic and Workmen’s Compensation paid.
From an MRI, it turned out that Shongwe had a slipped disk and an injured spinal cord and needed an operation.
‘The doctor told me if he never made the operation then my arm was going to be paralysed,’ said Shongwe.
The Department of Health said Rob Ferreira Hospital did not have an MRI scanner or a specialist radiologist and that Shongwe’s X-rays on the night of the accident did not show the damage for which he had to seek treatment elsewhere.
In the past, doctors could refer patients to the better-equipped Witbank Hospital. But the head of surgery sent out a letter in January to say that other hospitals must no longer refer patients as they don’t have the doctors to operate.
December Manana, a provincial National Education, Health and Allied Workers Union (Nehawu) leader, says the situation in the province is ‘very unsatisfactory’.
‘Recently we had a situation at KwaMhlanga hospital where nurses who are not skilled in maternity were charged by the nursing council for mistakes they made. Now nurses and doctors are no longer willing to work in particular wards,’ says Manana.
In eight years, the province has had five MECs. Current Health MEC William Lubisi was MEC briefly in 2004. He returned to head the health department a year ago.
‘I wasn’t happy to be honest with you,’ says Lubisi. ‘It was shocking to see the situation having gone to that level, but I am very positive that the situation will change and will improve to the satisfaction of everybody.
‘We do have a team that is committed, dedicated, and if we work with the team and assist them to do what they can do, I am sure the situation will improve.’
But Dr Mavuso, former medical manager of Themba Hospital, is skeptical. He attended a meeting with the MEC a year ago where two key problems plaguing doctors were identified and the department was instructed to address them by last June. There has been no progress.
‘There are two things that the MEC had identified that were chasing doctors away and gave instruction in the presence of everybody to the head of department to address them,’ says Mavuso.
‘One was that the realisation that our salaries were below what Limpopo was getting. A junior guy at Limpopo would earn more than a senior guy here. The other was the slow rate of paying for overtime.’
Last month, the head of department Dr Confidence Moloko left ‘by mutual agreement’, according to Lubisi. Moloko is blamed for many of the province’s problems.
However, shortly after announcing his resignation, Moloko denied that health services were in a bad way and claimed that the people of the province had access to adequate healthcare, as enshrined in the Constitution.
However, a number of stakeholders believe Moloko’s departure will lead to improvements. But for patients such as Esther Morajane and Dolly Mathebula, this will simply be too late. ‘ Health-e News Service.
* Lombard produced a TV documentary on the doctors’ shortage in Mpumalanga which was broadcast on April 20th on Carte Blanche.