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Under the governance of exceptional doctors over almost 20 years, Zithulele Hospital – one of South Africa’s best performing hospitals in a deep rural district near Mqanduli, Eastern Cape, and the recipient of multiple awards – became an institution that inspired hope for our country, particularly given the largely collapsing public healthcare sector around it. Veterans Dr Ben Gaunt and his wife Taryn, an MO with considerable paediatric experience, and researcher/clinician Dr Karl le Roux and his wife Sally, who led the development of the hospital’s ARV programme, provided the ‘glue’ which by 2021 had attracted and retained a team of 45 clinical professionals including 16 doctors, with junior community service doctors and interns lining up for rare supervised rural clinical experience. However, since the appointment of a nurse as the CEO 10 months ago and the resultant toxicity permeating the environment, a clinical staffing crisis is looming. This article first appeared on Med Brief Africa. – Nadya Swart
Politics threaten to ruin SA’s top rural hospital
By Chris Bateman
One of SouthOne of South Africa’s best performing deep rural district hospitals, the multiple award winning Zithulele Hospital, 100 km from Mthatha, is on the brink of slowly imploding.
A clinical staffing crisis is looming as resignations start, following conflict between the clinician cohort and the new CEO, a registered nurse appointed 10 months ago. Both sides have traded allegations of corruption and mismanagement. The situation spiraled recently as community protests in support of the 10 remaining doctors were staged weekly outside the hospital. With patients arbitrarily discharged to surrounding clinics on the CEO’s instructions and against medical advice, the hospital is headed for a service delivery implosion with dire patient care implications. According to the disgruntled clinicians, the local headman and a ward councilor have aligned themselves with the new CEO. The environment has turned toxic after 10 months of ongoing confrontations with the ‘authoritarian’ new CEO, Ms Nolubabalo Fatyela, who claims doctors are resisting change, racist and not following policy. Collectively the hospital stands to lose over 100 years of medical experience.
Ironically and perhaps tellingly, excavations have just begun alongside the hospital for a R890 million complete rebuild of the hospital to world class standards, of which R280 million has been set aside for small and medium enterprises, touted as providing 200 jobs over two to five years. MedBrief Africa’s on-site sources claim rural community members have been warned by allies of the CEO that unless they sign a petition supporting the CEO, they’ll be excluded from working on the new building project. The 150-bed hospital has 16 referring clinics and serves a population of some 125 000 people in one of the most impoverished districts in the country. Joblessness is rife.
Clinical manager, Dr Ben Gaunt and his wife Taryn, an MO with considerable paediatric experience, are 17-year veterans of the hospital, while researcher/clinician Dr Karl le Roux, a former chairperson of the Rural Doctors Association of SA, and his wife Sally, who led the development of the hospital’s ARV programme, joined them 16 years ago. Together they provided the ‘glue’ which by 2021 had attracted and retained a team of 45 clinical professionals including 16 doctors, with junior community service doctors and interns lining up for rare supervised rural clinical experience. The resulting holistic, multi-disciplinary team was unmatched in South Africa, having garnered three Discovery Health awards and numerous grants, including a thriving research centre adjoining the hospital. Overseas researchers regularly visited to partner local doctors in field work. The two doctor couples, strongly motivated by their deep Christian faith, have recruited and helped set up half a dozen well-funded NGOs delivering nutrition, education and supportive healthcare services. Sally le Roux founded and now runs a 75-learner school, (Grade RR to Grade Seven), where she is the principal, while doing sessional paediatric work at the hospital. Her colleague Taryn home schools her children while doing paediatric sessions and supervising junior doctors. All are resigning from their posts.
Contacted while on temporary incapacity leave, (suffering near burn-out), Gaunt confirmed the situation to MedBrief Africa. He has applied for transfer, hoping to work for the Eastern Cape Department of Health elsewhere. The Le Rouxs are on notice to vacate their hospital home by the end of September. Four of the remaining six experienced doctors have said they’ll follow unless the CEO is replaced, and none of the current community service doctors plan to stay. The doctors are deeply involved with an appreciative, supportive community, the Gaunts’ having adopted a local child into their family. Gaunt has written a book called Hope, a Goat and a Hospital, recounting their pioneering experiences and providing a resource for doctors considering rural careers.
He told Medbrief Africa, “I experienced severe anxiety and needed to be booked off work due to the conflictual environment– you reach a point where you have to take off before you fall to pieces.” The Gaunt and Le Roux families are currently considering what their futures hold, away from Zithulele. Gaunt has brought a defamation action against some of the unions for broadcasting that he received a kick-back in the erection of a local cellphone tower, was stealing hospital electricity and manipulated NGOs for personal gain. An investigation last year found the allegations to be without merit. Instead, it found that he put nearly half a million of his own money into the Jabulani Foundation, which supports the ARV work. Despite this, the CEO repeated these claims, adding more of her own, says Gaunt. He’s taken legal advice on further defamation action.
Matters came to a head at a June 14th meeting that included the provincial Health MEC’s chief of staff, the deputy director-general of Clinical Services, the hospital management and board, local chiefs, ward councillors and clinic representatives. The CEO’s input at the sometimes chaotic gathering was typified as, “trying to style all of this as uncovering Gaunt’s corrupt schemes, and calling him racist, deviant and corrupt,” said a source.
Gaunt told the meeting, which was officially recorded, that he had stood up to her when he thought patient care was being affected. “When she started intervening in the ARV clinic, saying I was favoring my wife, I put my foot down. Then she pulled out all the stops, bringing in an outside NGO and using an unethical doctor who turfed patients out without referral letters or clinical notes, breaking patient confidentiality and taking patient files. Drug resistant TB patients, people on third line treatment and complicated two-year-old kids on TB treatment were discharged to clinics on the CEO’s authority, while patients were turned away at the hospital’s doors.” The hospital has never turned patients away from its casualty before. “It’s a trust cycle with the community, which has taken years to build and is now quickly being broken down,” Gaunt explains. He says doctors earlier agreed to try and accelerate down-referrals of ARV patients, but only on clinical grounds.
The meeting agreed that the CEO’s conduct would be officially probed, the outcome of which is still pending, two weeks after the target date.
Moral injury of bureaucratic interference
Gaunt added, “For doctors it’s about the moral injury in not being able to provide the services we should.”
He attempted to return to work after a short leave of absence, presenting a sick note from his psychiatrist recommending him as fit to work clinically but not administratively or in any one-on-one situations with the CEO, but was told by her “you’re employed as the clinical manager, so it’s all or nothing.”
Gaunt said when they first arrived at Zithulele Hospital in 2005, it was a run-down building with 55 beds, themselves, two commserve doctors and a radiographer.
“Today we have 150 beds with an average 73% occupancy rate. Maternal deliveries, always a good marker of care, were at 745 in the 2005/6 financial year. Last year we did 2,400 deliveries,” he added.
Karl le Roux said they all worked fruitfully for many years under the previous CEO, Nontsikelelo Matebese, which refuted Fatyela’s claim that Gaunt was ‘racist and refuses to submit to a black woman.”
Le Roux told MedBrief Africa that he worked nine hours per week in the maternity ward while running the research centre, while his wife Sally did four hours per week in the HIV paediatric clinic. She drew no income from running the local school. An Eastern Cape Health Department moratorium on all sessional posts had given the CEO the opportunity to ‘work them out’ when their contracts end.
He adds, “After six years of working up to 80 hours a week, I said to Ben I needed some balance. Luckily, he understood and got me working three days a week in the hospital and two in research, which gave the space to continue for another 10 years. I could never have done the job he has for 17 years. It’s relentless and the politics are (now) toxic. The state relies on exceptional people to keep these hospitals running,” he said.
“What breaks our hearts is that this arrogance and rule-based approach which prioritises tick boxes over patient care means more kids and mothers will die, either from poor ARV access and adherence or reduced and/or inexperienced maternal care. We’ll revert to looking like many other rural Eastern Cape hospitals,” Le Roux added.
All four doctors agree that if the CEO left, things could ‘still be rescued,” because the foundations were strong and the hospital still had many committed staff, but warned that if her tenure continued, the hospital would be ‘run into the ground within two years.’
Le Roux said anybody who stood up to Fatyela, ‘gets the same treatment Ben got.”
Scared translator speaks out
An unofficial spokesman for 12 staff employed by the Jabulani Foundation and assisting in the hospital’s ARV, Occupational Therapy and Outpatients departments said they received 24 hours’ notice to vacate the hospital from Fatyela on Thursday, July 7th.
“I can’t give you my name because of threats. When Fatyela arrived in September last year, the local chief, Avuyile Dudumayo and Councillor Phumelele Methu told her lies about Dr Gaunt and they’ve been trying to get all the white doctors out ever since. She is racist. Before Fatyela came, patients were all seen by 4pm. Now many wait till the next morning to be seen because there aren’t enough doctors. Patients are dying and babies are being stillborn – it’s a mess.”
Asked what he thought was behind the conflict, he said, “We heard they want those buildings to start their businesses and the doctors are standing in their way. They can also see hospital construction money will come out and they know Dr Gaunt will interrupt them on that. The community is suffering and can see what’s going on. They support the doctors,” he said.
Responding to the hospital’s clinical attrition and reported translator sacking, Fatyela said, “You cannot be concerned with patient care. I don’t have any right to fire any NGO employee. If you want to write anything about Zithulele I can give you the name of the right person. I won’t respond to your questions. I’m an employee. If you want to write hearsay…I’m going to suspend this call.”
MedBrief Africa was not afforded the time to put any other claims to her.
Yonela Dekeda, a spokesman for the Eastern Cape Health Department, confirmed that an investigation was underway following complaints by the doctors and the CEO. Once the findings were made, “we will objectively agree on the next steps to be taken,” she said.
She added, “Despite the tensions that are being addressed, all parties have the health and care of the community we serve at the centre of their concerns. Our focus is to ensure that we render the best and safest care by an engaged and inspired hospital team. The CEO has some really good ideas about improving the services while the clinical team, many of whom have been there for several years, are passionate and committed and seen as an integral part of the community.”
Dekeda said it was important for the foundation they had established to be built upon.
She denied any doctor resignations besides one who had resigned late last year, (before the arrival of the current CEO), and another who resigned earlier this year, “due to personal problems.”
She said Dr Gaunt had agreed to take up ‘an exciting role,’ in the department’s medico-legal programme while the head of department had agreed with Dr Gaunt and the CEO that they would “ensure continuity of the clinical leadership at Zithulelele.”
“We are requesting calmness during the period until all the issues are finalised and can assure the public that quality health services have not been interrupted,”
Dr Rolene Wagner, director general of health for the Eastern Cape, is intimately involved in defusing the conflict. As provincial human resources chief when the couple first arrived, she helped them source critically needed extra clinical staff.
- 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.
- To see the youtube video entitled, “Zithulele – A Rural Healthcare Success Story,” go to https://youtu.be/FrIzQwGhgZU
- Eskom outages pose life-threatening hurdles in deep rural hospitals
- Politics subsumes genuine healthcare, with no effort to intervene
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