While health officials in North West debate what defines a “crisis” of essential medicine supplies, *Tendai is panicking. Two weeks without drugs for her thyroid condition and her debilitating symptoms are back.
Tendai is a patient at Klerksdorp/Tshepong Hospital. In January, a loss of appetite, swollen feet, shaking and constant thirst saw her seek help at the hospital. She was diagnosed and prescribed medicines for long-term treatment for an overactive thyroid.
“The medicines helped me so much and all my symptoms stopped,” she says.
Since January, she’s made monthly trips to the hospital to pick up her two medicines, paying R40 each time. But in the middle of April, her usual hospital visit ended with a nightmare of worry. The pharmacy could only dispense one of her drugs.
“They gave me a piece of paper and told me to phone before coming to the hospital because they didn’t know when they would have the medicine. I have been phoning every day and now it’s been two weeks,” she says.
Tendai tried to source carbimazole at private pharmacies. For 100 tablets, she says, the price is about R800 and she needs 350 tablets of the drug a month. She cannot afford it.
“I’m hurt and my symptoms are back. I don’t know what I can do – only to watch myself die,” she says. Doctors say that her condition could become so severe that it could weaken her heart and threaten her life.
Tendai is one of dozens of patients whose lives are at risk as various medicines on the province’s essential drugs list are not available.
Physicians at Klerksdorp/Tshepong and Rustenburg hospitals who spoke to Spotlight believe that the province only has about 40% to 50% of the items on the essential drugs list.
One doctor at Rustenburg Hospital says it should never drop below 75%: “It means I know I can’t do the best for my patients. It’s very demoralising for the staff.”Read: Covid-19: Is South Africa prepared for medicine shortages?
Drug shortages include painkillers, vitamin B12, calcium tablets, iron tablets, the flu vaccine, urine test sticks, antibiotics and drugs to treat hypertension, diabetes, epilepsy, psychiatric conditions, cryptococcal meningitis, epilepsy and pneumonia. Drugs used for sedating and paralysing patients for intubation in intensive care are also not available.
Doctors have flagged these problems for at least two years and say the shortages have occurred intermittently for the past few years. In 2018, the province’s medicines depot in Mahikeng was at the centre of a go-slow that severely compromised healthcare services that year.
Since then, Spotlight understands, the depot has run suboptimally. There have been problems with staff being suspended, staff shortages, and alleged incompetence and maladministration. Suppliers have gone unpaid, leading to terminated service agreements.
Some companies that won tenders could not meet their obligations, but have not been penalised or forced to pay back money. An accrual system now means new budgets are used to pay old debts, inevitably leading to shortfalls towards the end of each financial year.
‘Our duty to say when things are not right’
Doctors who spoke to Spotlight asked not to be identified for fear of being singled out as “troublemakers” and “complainers”. There is also a fear that being identified will make them easy targets for officials who would rather go after them than address the problems.
However, the four doctors who spoke to Spotlight say they “cannot in good conscience remain silent”. They have followed all the official channels to raise their concerns.
“After Life Esidimeni [the tragedy in 2016 when 144 mental health patients died when the Gauteng department of health moved about 1 700 of them from Life Esidimeni facilities to unsuitable facilities), the ombudsman criticised doctors for not speaking out. It set a precedent and it should be our duty to say when things are not right, and we know our patients are being turned away at the pharmacy windows,” one doctor says.
Impact on healthcare services
A doctor at Klerksdorp/Tshepong Hospital relates how they delay discharging patients so they can receive life-saving drugs intravenously.
“Administering drugs intravenously comes with hospital stays of about R2 700 a day instead of sending people home with medicines. It’s a case of being penny wise and pound foolish,” the doctor says.
“I also have no doubt that we will see HIV patients returning to hospital with meningitis because we are not able to give them fluconazole, which is an antifungal treatment that fights opportunistic diseases in HIV-positive people,” the doctor says. “It’s the same with urine testing – because there are no urine test strips, doctors have to order expensive blood tests instead. It comes with high costs and delays, so there are infections that are not getting picked up early.”
Another doctor says that, for some conditions, there just are no alternative medicines, and switching one medicine for another often means having to restabilise patients on a new drug regimen.
Some pharmacists are already resorting to dispensing smaller quantities of drugs to patients and asking them to return more frequently in the hope that stocks will be replenished by their next visit. Sometimes, as in Tendai’s case, they have nothing at all to give their patients.
Before South Africa’s Covid-19 coronavirus lockdown, patients from Rustenburg Hospital often turned to sourcing medicines at public facilities in Pretoria or Johannesburg. That avenue has been cut off because travel across provincial borders is restricted.
One doctor says that Covid-19 preparations and the procurement of personal protective equipment have come at the expense of maintaining stock on the essential drugs list in the province.
“We know that, without the drugs needed in ICU, we will not be able to cope if our Covid-19 cases spike,” another doctor says.
Polaki Mokatsane, the deputy director-general for health in North West, acknowledges that there are long-standing systemic problems, but believes that they are getting things back on track.
Mokatsane says that, with the new financial year having started last month, he expects all debts to suppliers to be settled by the end of this month so contracts and supplies can resume. However, he confirms a huge backlog in the processing of individual invoices.
“Four staff members were suspended at the end of last year and we did have HR issues. But we now have two staffers who I believe can get us to where we want to be. The problem is that there wasn’t proper forecasting with some of our drugs and that’s why we ran out of stock,” he says.
He adds that they have focused on improving communication with hospitals, improving buying-out options for emergency supplies and widening networks to source medicines across facilities in the province.
“If you ask me if we have a crisis with supplies of essential drugs, I will say no, we only have challenges,” says Mokatsane, who was the chief executive at Klerksdorp/Tshepong Hospital before taking on the deputy director-general role in September.
He sounds assured, but many physicians in his province are unconvinced that a turnaround is imminent. And, for people like Tendai, who go home from the pharmacy empty-handed, his words are difficult to believe.
*Full name withheld
Note: In this article, four different medical doctors are quoted anonymously. While Spotlight generally avoids making use of unnamed sources, we make exceptions where we consider the fears expressed by the sources to be valid, the information provided to be reliable, and the publication of the information to clearly be in the public interest.
This article was produced by Spotlight – health journalism in the public interest.