Madwaleni, a 180-bed rural hospital, which as recently as three years ago had one of the best antiretroviral treatment programmes in Africa, is now operating with one Dutch doctor, who is only able to see complicated HIV and TB cases.

The overworked doctor has indicated that she will resign unless the situation improves, leaving the hospital with no doctor.

Two Clinical Associates, in their first year of employment, are working unsupervised.

There is no doctor to handle any emergency cases including maternity, trauma or any other health issues that fall outside complex HIV or TB cases.

Madwaleni is on the Wild Coast, about 100km from Mthatha and 220km from East London.

Ongoing efforts for at least two years by former doctors, health workers and other personnel, to have the hospital fully staffed have failed amid a debilitating moratorium on the appointment of critical staff in the Eastern Cape.

‘€œThe doctor at the hospital is reporting that she is signing more death certificates than ever before. There is a humanitarian crisis at Madwaleni,’€ said one source.

Dr Tom Boyles, a former doctor at Madwaleni and one of the key people trying to address the crisis, said that until there was a stable hospital manager and clinical manager the recruitment and retention of staff will continue to be hugely problematic.

‘€œEven if the current staffing crisis is solved the hospital is likely return to its current state within a year if the positions remain unfilled. The most important action is that competent people are recruited and retained in these vital positions,’€ he said.

Madwaleni has not had a hospital or clinical manager of a number of years.

Livingstone, a tertiary hospital in Port Elizabeth, has been unable to replace specialists and medical officers lost through attrition due to the moratorium.

Many health workers who have managed to navigate the system and be appointed have either not been paid for months or are only being paid part of their salaries.

Last week the Legal Resources (LRC) sent letters to Treasury MEC Phumulo Masualle and Health MEC Sicelo Gqobana.

Representing concerned health care workers and community members, the LRC pointed out that Madwaleni’€™s organogram made provision for 14 doctors.

It accuses the Treasury department of imposing budget cuts that have led or contributed to the staffing crises in these hospital, adding that the ‘€œnear closure’€ of these hospitals was having a significantly negative impact on the provision of health care in the province, in particular due to the extensive delays in appointing medical staff.

The letter warns that the staffing crises at the hospitals are ‘€œextremely urgent’€ and failure to resolve these issues amounts to a violation of the rights of access to health care services.

‘€œService delivery to the communities that these hospitals serve is, and certainly will be, virtually non-existent,’€ Sarah Sephton said in the LRC letter to Treasury.

In the letter to the health department, the LRC points out that several letters had been sent to the MEC and others to highlight the challenges at Madwaleni.

Questions posed by the LRC included among other details on steps being taken to remedy the crisis including the replacement of staff, plans to avoid similar crises in future. The letter also asks for the provincial plan in regard to human resources as required by the National Health Act as well as details on the most current approved establishment of post as required by the Public Service Regulations to be released.

Both departments have been given until this Friday to respond or face litigation.

Eastern Cape health department spokesperson Sizwe Kupelo said he was unaware of the letter and declined to comment.