Working for access to quality public healthcare in South Africa since 1998
7 March 2018

KwaMhlanga Hospital – failing the people who rely on it

7th March 2018

‘I will never forget the night when I pleaded with nurses to remove my stillborn child from the side of the bed where I was sleeping. I was told there is no other place where they can put my child.’

Last week, Nomvula* spoke of the deep pain she felt on the night she gave birth to her stillborn baby at a public inquiry organised by the Treatment Action Campaign on 28 February 2018. Instead of going directly to KwaMhlanga Hospital, the ambulance that picked her up was delayed as it went to collect another patient. Nomvula was forced to give birth inside the ambulance without the assistance of doctors in the hospital. Her trauma was worsened as she was left to sleep next to the stillborn child the entire night.

After arriving at Witbank Hospital, I was taken back to surgery. It was during this second operation that the doctors at Witbank found cotton wool left inside my womb at KwaMhlanga Hospital during my C-Section.’

After giving birth at KwaMhlanga Hospital, Lebo* was in severe pain, bleeding, and freezing cold. She was transferred to Witbank Hospital where doctors found the cotton wool left inside her after her caesarean at KwaMhlanga Hospital. As a result of this negligence, her entire womb had to be removed. She was in recovery at Witbank for two months, and to this day experiences physical pain from the surgeries.  

When I arrived back at the hospital to check on my daughter, I found her with the drip wrapped around her neck. I rushed to the nurses to ask for help, but it was already too late as my child had passed away.’

Thandi* remembered the tragic night she left her daughter in the care of people she thought she could trust, health workers at KwaMhlanga Hospital. She believes if her daughter had been checked on during the night she would be alive today.

When Bongani’s* child was sick, he sought medical help at KwaMhlanga Hospital. The doctors told him that the child should have been admitted, but that the hospital was full and there were no beds available. This meant I was forced to take my child to Steve Biko Hospital where my child was finally admitted and diagnosed with kidney failure.’

* not real names – their identities have been protected at their request.

A recent fact-finding mission and engagement with the community has highlighted a number of ongoing concerns with the service provision at KwaMhlanga Hospital in Nkangala including overcrowding, long waiting times, negligence and bad staff attitudes.

The inquiry revealed the extent of this dysfunction, as we heard a number of emotional testimonies from community members who faced undignified, low quality, and at times life-threatening services when trying to use the hospital. Most people say that they prefer to use Steve Biko Hospital or Garankuwa Hospital. They call KwaMhlanga Hospital “HlalaKwabafileyo” – meaning ‘to stay in the place of the dead’. Ultimately the inquiry showed that KwaMhlanga Hospital is failing the people who rely upon it.

The Hospital CEO and the District Health Department were in attendance to hear these stories and respond in terms of their plans and intentions in improving this.

Report into the state of healthcare at KwaMhlanga Hospital

21 individuals spoke out at the public inquiry. In addition, inputs were made by TAC, NAPWA, SACP and the Traditional Healers Organisation. The evidence reflects the serious shortcomings within healthcare delivery at KwaMhlanga Hospital that must be urgently addressed including the following:

1. There are not enough doctors, nurses, pharmacists and other hospital staff that prevent the fulfilment of the right of access to healthcare services. According to the State of the Province Address in 2016/17, there were more than 50% of vacancies in the hospital. According to the Hospital CEO, only 369 are filled, leaving about 600 positions vacant. This translates to more than 61% of the workforce. This is the major cause of long waiting times and significant overcrowding – at times reportedly more than 8 hours – or where patients in critical conditions are left in chairs to wait, longer hospital stays, higher risk of deaths, and increased pressure on the few staff in place. The overburdening of staff is a major contributor to the worsening of staff attitudes at the hospital. In addition, there have been a number of complaints regarding medical negligence. Furthermore, sometimes staff are reported to not wear name tags, complicating the laying of complaints.

2. The hospital infrastructure lacks adequate space required for people to wait, which exacerbates the issue of overcrowding. People line the squashed waiting area of the hospital waiting to be seen for many hours. On one fact finding mission, a number of wheelchair users were found squashed together with knees pressing into the back of each other’s chairs. The maternity ward is majorly overcrowded with too few beds – after giving birth women are rotated out of the few maternity ward beds and made to sit on a hard chair for 6 hours for observation wearing merely dirty light sheets. The Intensive Care Unit is not functioning at all and has no equipment. The overcrowding at the hospital will only exacerbate the issue of coinfections, poor TB and drug resistant-TB infection control.

3. Medicines are often unavailable due to shortages of medicines and as such people are regularly turned away from the pharmacy empty handed. Additionally, at times it is reported that the pharmacy remains closed entirely meaning people must return the next day for their prescriptions, if the pharmacy is then open. This endangers the lives and health of vulnerable people and discourages people from accessing healthcare and trusting in the hospital.

4. Often patients’ files are misplaced leading to delays in waiting times, diagnosis, and treatment of patients – ultimately leading to unnecessary suffering and worse health outcomes.

5. The provincial emergency medical services (EMS) and planned patient transport (PPT) systems are characterised by long waiting times, unreliability and indignity—all experienced in the most vulnerable and frightening moments of life for people who depend on these services. Reports show that people wait hours for ambulances to arrive, or they never arrive at all. According to Stats SA in 2011 the population of Thembisile Hani sub district was 310,458. Based on these figures (which are likely an underestimate in 2018) at the ratio of 1 ambulance per 10 000 population, this would require at least 31 ambulances. However, there are currently only 5 ambulances serving the sub district for all EMS needs.

Furthermore, in certain areas, there are no roads or street names, which further complicates and lengthens the time to access emergency services – it is at times impossible for critically ill patients to be transported to the nearest tar road or clinic to wait for an ambulance and this happens even at night putting the safety of the patient at even higher risk. In some areas, reports show that a number of patients can be collected and transported in one ambulance including men and women, and those with TB and DR-TB. This deprives patients of privacy and confidentiality – and further it could result in TB and other infection. In addition, some ambulances are reportedly in disrepair.

The full list of findings and TAC Mpumalanga’s demands to the Hospital CEO and district Department of Health can be accessed here.

Responses and commitments from KwaMhlanga Hospital and the district Department of Health

The Hospital CEO, the District Director, the Provincial Manager of EMS, and the PHC Manager amongst others, were all in attendance at the public inquiry. They stated on record that healthcare in the district is collapsing. The district Department blamed the shortages of staff, medicines and equipment on budgetary constraints. The district Department of Health committed to respond in writing to these issues by 15th March 2018. Their response will be published by TAC.

While both parties committed to engaging with TAC in terms of solving this crisis, we will be monitoring this progress. If our demands are not taken seriously, and no improvements are made, we will be forced to escalate our campaign and be back in our numbers. 

#FixKwaMhlangaHospital

 

For more information contact:

Nqobile Shabalala | TAC Mpumalanga Chairperson | nqobile.shabalala@tac.org.za | 071 886 7735

Bellinda Setshogelo | TAC Mpumalanga Provincial Manager | belinda@tac.org.za | 082 622 4481

Lotti Rutter | TAC Media Liaison | lotti.rutter@tac.org.za | 072 225 9675

Notes:

TAC Mpumalanga represents users of the public healthcare system and campaigns on critical issues related to the quality of and access to healthcare. The organisation currently has a network of 25 branches in the Nkangala, Ehlanzeni, and Gert Sibande districts in the province. Through these branches we monitor service delivery at a number of clinics and hospitals. Our members are the people who need the public health system to work, so they are the first to notice when it does not.

A summary table of findings and demands is available here.

TAC Mpumalanga has attempted to draw attention to this crisis and demand redress numerous times:

  1. 12 September 2015 – Memorandum issued to previous Head of Department, Mpumalanga Department of Health.
  2. 12 May 2016 – Nkangala District Health Assembly held where issues of KwaMhlanga Hospital were raised in front of officials from the district Department of Health.
  3. 6 May 2016 – Meeting between TAC and the MEC of Health to report on broad health challenges including the issues at KwaMhlanga Hospital.
  4. Between November 2017 and February 2018 – four community dialogues were hosted by TAC in Moloto, KwaMhlanga, Tweefontein, Kwaggafontein, where community members raised issues regarding KwaMhlanga Hospital in front of officials from the district Department of Health and KwaMhlanga hospital officials.