It’s no secret that the state of rural healthcare in South Africa is deplorable. So news that a beacon of light amid this chaotic absence of structure, Zithulele District Hospital in the Eastern Cape, is facing political turmoil is particularly distressing. Originally a mission hospital which retains some of that ethos, the hospital was carried by committed husband and wife doctor teams who spent between 15 and 17 years of their lives in uplifting the community via education, nutrition and health. Since the appointment of a new nurse CEO 10 months ago, however, politics has reared its ugly head and threatened the continuation of the services on offer. Policy appears, once again, to have subsumed genuine attempts to provide much needed healthcare. And no one appears to be intervening to stop the damage. This story first appeared in MedBrief Africa. – Nadya Swart
ANC policies – a toxic healthcare mix for SA’s poorest
By Chris Bateman
Adherence to policies of the ANC’s tripartite alliance is slowly destroying rural healthcare delivery in South Africa as cadre deployment and government backing of unions consistently undermine service delivery and patient care.
In my 22 years as a healthcare writer with a strong interest in rural public healthcare, I’ve seen many dramatic examples of newly appointed hospital CEOs, often with no more than a nursing diploma, disrupting the smooth running of district rural hospitals and working out veteran clinical managers who’ve dedicated their lives to serving rural populations. Where doctors are CEOs, they often fall victim to political and/or union ambitions. The inevitable result is increased mortality and morbidity, long waiting times, and all-round suffering with a steep drop in the quality of patient care.
Throw in a union opposed to any changes, a new clinical manager or CEO trying to improve patient care and/or budgetary performance (like rescheduling lucrative weekend shifts), and I’ll bet money that the relevant provincial health MEC will back the disruptive union and suspend the clinical manager, (all the while citing compromised patient care). I’m not even talking about the Thabo Mbeki/Manto Tshabalala-Msimang Aids denialist years where slavish Health MEC acolytes widely victimised rural doctors dispensing ARVs, whipping up public sentiment against them and encouraging placard bearing union protests. When it comes to victimisation of clinicians, nothing much has changed since I began with the SA Medical Journal as news editor in 2000. And it’s not just insane Aids denialists wreaking havoc, it’s a policy driven culture that subsumes and outlasts all shorter-term maverick phenomena.
Whether it be the manager of a patient overwhelmed hospital in a major Eastern Cape township who’s seldom at his desk and co-owns a local township funeral parlour business (no conflict of interest there), or a health MEC who suspends the newly appointed clinical manager of a psychiatric hospital (on full pay) for more than six months after union members run rampant through his wards, assaulting him in his office, the pattern is the same. One far northern KwaZulu-Natal CEO (of Mseleni Hospital), Dr Victor Fredlund, made history by discovering what has become known as Mseleni hip disease, pioneering its surgical correction. Revered as the ‘singing doctor,” he was feted by locals for his proclivity to play the guitar and sing Zulu gospel songs, having dedicated his life to uplifting the local community, going way beyond his primary clinical duties. After being accused of a swathe of trumped-up mismanagement charges involving clerical staff appointments, he and his local schoolteacher wife were worked out by a combination of councillors, provincial officials and their union affiliates.
Help rejected
Upon his recent return to visit a year later, he was asked by his colleagues to scrub up for a particularly tricky operation – only to be virtually manhandled out of theatre on the CEO’s orders, having being told he was ‘no longer on the staff complement.”
The catalyst for this editorial, or the straw that broke this camel’s back, was my witnessing the slow implosion of what is arguably, (but probably not for much longer), the country’s most successful deep rural hospital, a beacon of hope for any aspirant multi-disciplinary rural outfit in any low to middle-income country: Zithulele District Hospital on the coast some 100km from Mthatha. I hardly need to say that the trouble started with the appointment of a new nurse CEO 10 months ago. Since then, the core double husband and wife doctor team who’ve devoted between 15 and 17 years of their lives to uplifting the community via education, nutrition and health, have virtually burnt out due to the sudden toxic extra load – with 10 others among the more experienced 14 doctor team now also set to resign1. Never mind the young community service doctors unusually wanting to leave at the end of their compulsory two-year tenure there. The context? Simple; nothing breeds success like success. An R890 million hospital upgrade is about to begin, and a sudden alliance has been formed between the local chief, a district councillor and the new CEO. Their target? The doctor leadership cohort. Yes, the UCT-educated Gaunt and Le Roux doctor couples have facilitated half a dozen highly effective NGOs delivering education, nutrition and HIV treatment and yes, the clinical community is closely knit via their daily battles to save lives and heal patients in the largely impoverished 125 000-strong community. Perhaps they’ve become used to running things their (highly successful and efficient) way. But – and I can’t help seeing it any other way – they appear to be obstacles to an entirely different agenda. One hospital translator told me, when I queried what might be driving the behaviour of the local headman and councillor: “They want those buildings the doctors are living in to run their businesses– and the money that’s coming with the new hospital upgrade.”
Tellingly, there have been weekly community protests outside the hospital gates in support of the doctors.
Leveraging poverty
A R280 million portion of the hospital upgrade is being allocated to SMMEs and locals are allegedly being told that if they don’t sign a petition in favour of the new CEO, they will not get any of the 200-odd construction jobs soon to be on offer. Meanwhile, the clinical manager, Dr Ben Gaunt, is suing the local union for defamation and considering another claim against the CEO herself for repeating allegations that he received backhanders in the recent erection of a cellphone tower and that he’s a dishonest racist bent on securing profits for himself and his fellow doctors via the multiple NGOs they’ve facilitated and invested in.
With multiple awards to its name, Zithulele Hospital attracts researchers and doctors from across the nation and well beyond. How much longer will depend on the interventional skills of the province’s stellar director general, Dr Rolene Wagner, (who originally helped the pioneering couple staff the hospital as Eastern Cape Human Resources chief).
I can only wish her luck with the local ‘Bisho mafia,” allegedly behind an assassination attempt and home burglary of one of her predecessors, Dr Siva Pillay, who resigned after a courageous but ultimately futile attempt to reform healthcare in her province.
Pillay is a Buddhist now super specialising and was sanguine about the prospects of his own death at the time. The Zithulele doctor leaders are devout Christians, living out their faith.
God help us all.
- Chris Bateman was news editor of Izindaba, the news section of the SA Medical Journal from 2000 to 2016 and spent the prior decade covering provincial and national politics for the Cape Times after graduating from covering the Cape Flats townships during the ‘struggle years.’ He’s a fluent Nguni linguist and grew up at a trading store in deep rural KwaZulu-Natal.
Citations;
1. Bateman, C. Politics threaten to ruin SA’s top rural hospital. Medbrief Africa, 15 July, 2022.
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