The dire state of healthcare

2018-06-10 09:52
The Far East Rand Hospital in Springs had a reputation for overcrowing, bad management and negative staff attitudes, but things seem to have improved. PHOTO: Rosetta Msimango

The Far East Rand Hospital in Springs had a reputation for overcrowing, bad management and negative staff attitudes, but things seem to have improved. PHOTO: Rosetta Msimango

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It’s a waiting game – shuffling between a cold hospital bench and steel chairs in a winding queue to receive help. And it’s a hard game on a winter morning, more so for the ill.

City Press joined the queues at the Far East Rand Hospital in Springs, Gauteng, one of only five health facilities out of 649 across the country that the Office of Health Standards Compliance inspected and found to be compliant with the health department’s norms and standards. It scored a grade A compliance rating of 80%.

The office’s latest inspection report was tabled in Parliament this week, the day Health Minister Aaron Motsoaledi briefed the media to address increasing claims of an impending “collapse” of the country’s health system.

Far East Rand Hospital has a checkered history of overcrowding and poor sanitation in one of its wards. To see if things had improved, City Press joined all the queues – for patients to open or recover their files; for admission; at the out-patient department; and to get medication.

In the triage queue at 10:00, we waited for an hour for a nurse to assess us. Patients shuffling along the benches became irritated as nurses routinely went out for 10-minute breaks without informing those who waited about when, or if, they would be back. But they were otherwise helpful, and the surroundings were clean and the floors were routinely mopped.

As a nurse helped a visibly confused and difficult patient emerging from the X-ray department, an elderly patient behind us complained of having waited in the wrong queue before reaching the triage line.

The hospital is well signposted and there are information boards on illnesses, lists of the institution’s values, the names of its managers and information about patients’ rights.

After assessment at triage, it was a 40-minute wait in another queue to open a file before we reached the front desk, where the process took 15 minutes. Then it was off to the outpatient department, where City Press, Patient 64, was sent for a blood pressure check. But in the small cubicle, the nurse saw in the file that this had been done already and sent us to the queue to see the doctor.

At 14:30, four-and-a-half hours after we started, the queue lined the corridors leading to the consultation rooms. We left because it became clear that there were still many more hours of waiting ahead of us.

Sisi Dhlamini (41), who gave birth at the hospital earlier this month, said she was satisfied with the service she received there.

“I started coming here when I was seven months pregnant and the doctors have treated me well. The ward I was in was clean and we received all the basics we needed. The nurses changed our linen and we had hot water,” she said.

“The only thing I could say was a bad experience was the food. Sometimes there was no sugar and we’d have to drink tea without sugar. And the bread was dry and had no butter. Otherwise, the treatment was fine.”

Pitso Kokwano (63), who was admitted for a few days last week and returned for a check-up, said he was also treated well, but that his family had to bring him a blanket.

On Tuesday, Motsoaledi said the health system was not on the verge of collapse, but that it was “very distressed”.

"Shock and crisis"

Health Ombudsman Professor Malegapuru Makgoba this week said that his office received 2 000 healthcare-related complaints – 800 of which were from Gauteng – and complaints about the ongoing crisis in KwaZulu-Natal, which cannot provide sufficient treatment for cancer patients.

The SA Committee of Medical Deans has called on government to take drastic steps to “address the systemic failures in the provincial health departments as a matter of priority”. It referred to the health department in North West having been placed under administration.

Russell Rensburg, programme manager for health systems and budget at the Rural Health Advocacy Project, said the sector was in “shock and crisis”, and everyone needed to work together to find solutions instead of only raising the alarm.

“It feels like we’re pointing at a kid in the corner who has wet his pants and we are laughing at him. We too – as citizens – have agency. A crisis is an opportunity for imagination and innovation. We need to relook at how we do things. We have an opportunity to reform and recreate.”

Rensburg said the sector needed an “honest diagnosis”.

“We need to look at the capacity of human resources in the sector. How are professionals being spread out across facilities? From there, we can look at our infrastructure. Do we really need more hospitals, or do we need resources within the hospitals and revitalisation?

“We need to look at whether we are spending money correctly and on the right things. We’ve seen a lot of underallocation of funds for district health services and a lot of money spent on procurement, which manifests in situations such as the Mediosa scandal – paying enormous amounts for services we don’t need or that aren’t used.”

Sasha Stevenson, head of health for nongovernmental organisation Section27, agreed with the assessment that the system was in crisis.

“However, one of the difficulties is that the word is overused and often loses its meaning. Yes, while there are things going right, such as the massive antiretroviral programme, there are still enormous issues that continue.”

One such problem was filling critical posts, she said.

“If you don’t have enough doctors and nurses, service delivery is impacted and that’s where medico-legal claims come in because facilities are under pressure. We’re often focused on the minister and what he should do, but we also need leadership from a provincial level.

“Provincial MECs need to step up and recognise that rampant corruption and leakage of funds has a direct impact on service delivery. It’s important that we stop that leakage of funds.”

Rensburg said the health system needed reform.

“We need to start changing the narrative. Let’s look and see how we can change things and then develop a system we want.”

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