A task team investigation into the children’€™s deaths has revealed that fatalities in the Eastern Cape’€™s Ukhahlamba district were not due to any particular disease outbreak or exposure to contaminated water as initially suspected, but rather that the health service available was hopelessly defective.

The report, which took four months to be released, was finally handed over to the Democratic Alliance (DA) this week after an appeal was made to the new Health Minister Barbara Hogan.

The task team, consisting of three paediatric specialists in the employ of the Health Department, revealed that there had been 95 childhood deaths in the district in 2006, 76 in 2007 and a staggering 140 in the first three months of 2008.

‘€œAt present there is no evidence to suggest an outbreak of any infectious diseases or other specifically defined event and this increase in childhood mortality is most likely a reflection of poor health care to a vulnerable community,’€ the task team wrote in their 18-page report dated April 18.

The task team painted a grim picture of Empilisweni Hospital children’€™s ward where most of the deaths occurred:

–             There is no access control;

–             The structure and layout of the physical facility is inappropriate ‘€“ no nurses station or work surfaces, no play or stimulation facilities, no separation of ‘€œclean’€ and ‘€œdirty’€ areas and through traffic to the occupational health and safety office. The toilet is next to the kitchen, the linen and dressing rooms next to the sluice room and all the ‘€œdirty’€ areas directly opposite patient cubicles;

–             There are inadequate and inappropriate services in the overcrowded ward and cubicles ‘€“ no oxygen and suction points, too few electrical sockets, no elbow taps, no basins or showers and too few toilets in the patient ablutions (three toilets for 20 children and their mothers), limited storage space and an unacceptable ward kitchen;

–             Extremely limited clinical equipment;

–             Cubicles are overcrowded and no provision exists for lodger mothers, who pay R30 to sleep on the floor next to their children;

–             Staffing deployment and rotation does not promote effective care, with few nurses dedicated to the children’€™s ward and doctors who rotate every two months;

–             There are limited policies and no protocols or access to appropriate clinical reference materials or guidelines;

–             Clinical practices are ineffectual or dangerous especially with respect to infection control and the preparation and distribution of infant feeds and medicines.

The task team audit of 45 of the deaths revealed that most of the deaths were of infants who were self referred and died within 48 hours of admission to hospital. The dominant diagnoses were diarrhoeal disease, pneumonia and malnutrition.

The majority of the children were never weighed, their nutritional status was not assessed nor their HIV status established.

The task team described management in the three hospitals where the 45 assesse deaths occurred (the others being Burgersdorp and Umlamli) as ‘€œpoor’€.

Not a single record included the prescribing or administration of infant feeds and fluid management was badly documented. Three of the children appeared to have died from fluid overload due to inappropriate and unregulated fluid administration.

The reassessment of children outside the daily ward round was also uncommon.

In the end the task team found that: ‘€œThese deaths are more likely the result of poor care of a vulnerable impoverished community with high rates of malnutrition among the infants and poor utilisation of the available health services.’€

A report was also drawn up to document the then Health Minister Manto Tshabalala-Msimang’€™s visit to the district on 30 May, 2008.

Her visit was ostensibly because ‘€œseveral questions remained unanswered’€ following the reports submitted to her office.

One of the questions the Minister wanted answered was why the province was only alerted to the spike in deaths on April 15 and who was to blame for the deaths.

According to a report detailing the Minister’€™s visit a local councillor said that a community member in Barkly East raised the alarm after a higher than normal number of baby burials in the area.

This coincided with the release of environmental health reports which said the water quality was poor, leading to speculation that the baby deaths were due to contaminated water sources.

The MEC Nomsa Jajula was reportedly informed of the high number of deaths on April 15 and she convened an investigation team, but news of the deaths was leaked to the media before it could get off the ground.

‘€œThe National Department of Health became aware of the high number of deaths through the media. This again points to the lack of an adequate surveillance, notification and health information system,’€ the report said.

The report revealed that the district had become aware of the increase in deaths in January already, but ‘€œwere under the impression that they were adequately managing the problem’€ and did not report it to their provincial counterparts.

Ukhahhlamba, situated on the borders of the Free State, Northern Cape, Lesotho and KwaZulu-Natal, has poor sanitation with 11% of the just more than 350 000 residents still using the bucket system and poor access to clean water with over 30% of the community relying on unprotected springs.

This means that surface contamination with sewerage in turn contaminates the springs during the rainy season.

Water quality results on reticulated water indicated that during the periods December 2007 to March 2008, when the child deaths were at their peak, the Ecoli count was high throughout the district. Nothing was done to address this.

Many of the children were also found to be from child-headed households or were being cared for by a grandparent.

The Department of Home Affairs also failed to service the community with few children accessing child support grants.

Taxis in the community do not include the clinics as part of their route with patients going directly to hospitals. This also causes patients to only report once they are very ill.

Tshabalala-Msimang’€™s report confirmed that many of the children who died had malnutrition.

In a ‘€œTop Secret’€ progress report dated 15 September the Deputy Director General for Clinical Services in the Eastern Cape Dr N Diliza said they had managed to get a ‘€œdrastic reduction’€ of hospital admissions of children and deaths of children under 5 years due to diarrhoea with dehydration since May 2008.

Diliza ascribed this to a ‘€œfocused, sustained and integrated strategy involving both preventative and developmental interventions’€ in the district.

The department had also procured infection control equipment, identified isolation wards, stocked pharmacies with diarrhoea drugs and established Oral Rehydration Corners.

Over 500 food parcels were delivered to families in Senqu. The department made three nurse and one doctor appointment.

The DA this week welcomed the decision by Hogan to release the reports stating she ‘€œseems to have brought a new spirit of openness and accountability to the Department. We look forward to more constructive engagement with her in the future, and in particular in seeing that never again will there be a repeat of the tragedy that these reports describe.’€

DA spokesperson Mike Waters said it was notable that many of the problems did not arise because of inadequate funding, but were simply a question of poor management.

‘€œThat this situation should have been allowed to persist unchecked is simply inexcusable,’€ he said.   ‘€“ health-e news service