Parliament for the People: Visit to Pelenomi Hospital in the Free State

On Monday, along with Deputy Shadow of Health Emmah More, DA MPL Basil Alexander and DA Councillor Arthur Terblanche, we visited the Pelonomi Regional Hospital in the Free State.

We were shocked by what we found -- especially the fact that there was no running water on some of the floors in the hospital. There is also a chronic shortage of staff, obsolete or inadequate medical equipment as well as severe shortages of medicine.

It is clear from our visit that despite recent assurances from Deputy Health Minister Dr Molefi Sefularo in the National Assembly (NA) that there are currently no problems with healthcare in the province, healthcare in the Free State is in a state of crisis. There is also a strong possibility that the province will once again run out of ARVs in the coming months.

What follows is an account of the most shocking things we found at the hospital as well as the action steps the DA will be taking in Parliament and in the Free State Provincial Legislature to address this crisis and to hold officials in the department of health accountable for the current mess in the province.

We will be loading a more detailed report as well as a number of photos of the things we saw and the people we met on our Parliament for People webpage. 

We decided to visit a public hospital, and more specifically, a hospital in the Free State for two main reasons: 

• We visited a public hospital against the background of the ANC government's proposed expensive and unwieldy National Health Insurance (NHI) scheme which the DA believes will do little to solve the real problems that exist on the ground and which can be easily addressed by taking a number of concrete action steps instead of overhauling the entire healthcare system;
• We visited a public hospital in the Free State because of the widely reported shortages of ARVs in the province at the beginning of the year and the four month moratorium placed by the provincial health department on new patients starting ARV treatment as well as halting non-emergency surgeries.

In an oral question session in the NA on the 2 September Deputy Minister of Health Dr Molefi Sefularo stated with regard to the health crisis in the Free State:  "our information is that we had such a problem towards the end of last year. The Minister at the time, Minister Hogan, did go to the Free State to personally investigate the matter, verified that that report was true and promptly went ahead to mobilise resources, financial and otherwise, to ensure that people were put back on treatment and that measures for sustaining the programme were put in place. If, indeed, the hon member is suggesting that there is a recurrence of the problem, we would be able to verify it by the end of this week, which is Friday, and we should be in a position to report to the House on our finding"

We therefore went to see for ourselves what the current situation was in the Free State, specifically Pelenomi hospital, and whether there was truth to Deputy Minister Sefularo's statements that these problems had been adequately addressed.

We visited a number of different sections and wards in the hospital and these are the most disturbing things we found:

• No running water: A number of the top floors in the hospital did not have running water, including the burns unit. Staff told us that this water problem had started as far back as May yet nothing had been done to address the situation. Nurses were filling containers with water to clean medical equipment and wash their patients. Instead of "showering" burn wounds, nurses were coming in direct contact with the wounds and the infection rate had increased dramatically as a result. We found a small child whose legs had been badly burnt and these wounds had become infected. He could not get skin grafts because of the infection and had been at the hospital for three weeks waiting for his wounds to heal. He was crying pitifully because he wanted to go home with his mother who was visiting him at the time (our webpage contains more details of the water crisis);
• No security at the hospital: Last year, as part of the cost cutting measures, the Free State health department had cut all security spending at public hospitals. It was clear that this funding had not been reinstituted at Pelonomi hospital. We walked straight through the front door of the trauma unit and there were no locks on the doors or security entrances in the hospital, nor any security guards. This posed a major threat to the safety of staff and patients (our webpage has photos of this lack of security)
• A shortage of hospital beds: Nurses in the ante-natal ward showed us the "floor-beds" (thin sponge mattresses) patients often had to use due to their being no empty beds available in the ward. We also found patients lying on stretchers that had been crammed in between the beds in the wards.
• Obsolete and inadequate medical equipment and facilities: The maternity ward only had three CTG machines while it required at least ten of these machines. There was only one theatre in the labour ward despite the fact that 60% of the approximately 350 births that took place in the hospital every month were caesarean births. The lack of theatres and doctors in the labour ward had resulted in foetal asphyxiations increasing by 30% at the hospital in recent months (there were 24 foetal asphyxiations during the previous month alone). Nurses in the burns unit told us that there had been two deaths in the past week alone because they did not have the necessary medical equipment needed to treat patients who had over 70% burns on their bodies and had damage to their respiratory systems. (Our webpage contains more details and photos of the lack of equipment as well as photos and details of inadequate filing system)
• Infrastructure that has not been repaired for years: Staff showed us a paraplegic toilet in the post-natal ward that had been out of order since 2004 despite staff complaining about the toilet to the department year after year. We also found two lifts that have not been working for five years. We were told that there had been instances where hospital operations had been cancelled because lifts weren't working in the building. (Visit our webpage for photos of the toilet and lifts and for more details on the infrastructure);
• A shortage of medicines: We visited both the ARV clinic's pharmacy and the main pharmacy in the hospital. Staff at the ARV pharmacy told us that when the province had run out of ARVs they had managed to get this medicine from the NGO USAid. They told us that they often ran out of other medicines and it was largely due to suppliers not wanting to supply the pharmacies in the province because the health department had failed to pay them. When the department did pay these suppliers these amounts usually went to paying off the large debt backlogs that had accumulated. They believed that the Free State health department under-budgeted when it came to ARV spending because it did not take into consideration patients had to take ARVs every month and also because they had greatly underestimated the amount of people actually on ARVs in the province. We asked the pharmacist at the main pharmacy to provide us with a list of the medicines that were currently out of stock. We found that there were close to 150 medicines that were currently out of stock. (This list has been uploaded onto our webpage and there are more details on what the pharmacy staff told us about these shortages).
• A severe shortage of hospital staff: There are a large number of vacancies across all the wards we visited. There is currently one doctor in the Heidedal ARV clinic who is meant to treat all 5000 patients currently receiving ARVs from the clinic. There is only one doctor in the labour ward who has to deal with approximately 350 births (60% are caesarean births) a month. There is a 40% vacancy rate at the burns unit, three pharmacists are expected to help the hundreds of patients visiting the hospital everyday (the optimal number is ten) and 14 staff members have resigned from the adult surgery ward in the last couple of months. Staff blamed the shocking conditions they had to work under, the long hours they were expected to work without being paid, and the occupation specific dispensation (OSD) system implemented by the department where certain staff working in certain "specialised" disciplines received higher salaries. Staff at the hospital believed that the system used to identify "specialised" disciplines was deeply flawed. The staff morale at the hospital was extremely low. These people come in day after day trying to provide their patients with proper healthcare without any assistance or recognition being provided by the provincial health department. (Our website contains mores details of these staff shortages);
• Patients at the hospital: We spoke to a number of patients in the packed pharmacy waiting room who told us they get to the hospital at seven o'clock in the morning hoping to receive their medication only to be turned away at the end of the day because the pharmacy was closing. We also met people who had been waiting for operations for over six months. (Visit our webpage to read about some of the stories we heard and about the people we met).

It is evident from out visit that the recent statements made by the Deputy Minister Dr Sefularo are far from the truth. Pelenomi hospital is currently in a state of crisis and we believe that this crisis extends to all the other public hospitals and clinics in the province. There is also strong possibility that the Free State will once again run out of ARVs which will also result in a large number of deaths (it is estimated that during the previous four month moratorium 30 people died everyday).

While the national and Free State department of health has claimed that these ARV shortages, and also the shortage of other medicines and medical equipment, are purely due to a lack of money this is difficult to believe and accept when the Free State Provincial Cabinet has recently spent R11-million on buying new Mercedes Benz's and spent R7-million on a function celebrating the opening of the Free State legislature in June (the provincial government spent a further R49-million on the Manguang African Cultural Festival last year).

The DA believes that the present health crisis in the Free State province is a result of under-budgeting, the poor prioritisation of resources, wastage, poor management and lastly the human resources brain drain due to the lack of training of new health professionals and the mistreatment of current professionals.

The ANC's proposed NHI scheme will not solve any of these problems.

Immediate action needs to be taken at Pelenomi hospital and in the Free State health sector as a whole to firstly, prevent a reoccurrence of the ARV shortage that occurred at the beginning of the year and secondly, to ensure that these hospitals and clinics are adequately equipped with staff, medicines and medical equipment to ensure patients receive the proper healthcare they so rightly deserve.

The DA will therefore be taking a number of action steps in Parliament and in the Provincial Legislature including:

• Holding Deputy Minister Dr Sefularo to the statement he made in the National Assembly by requesting that he report to the House on the current situation in the Free State;
• Posing a number of parliamentary questions to the National Health Minister Dr Aaron Motsoaledi on the crisis in the Free State including whether he will launch an official enquiry in the province, whether he will take action against the management in the Free State health department and whether he will consider placing this department under the administration of his national department;
• We also request that both the national department and the Free State department appears before the portfolio committee on health to account for the current situation in the province;
• We will pose a number of questions in the Free State legislature specifically on the problems we found at Pelenomi hospital, including the water supply shortages;
• We will also request that the Free State Minister of Health Sisi Mabe and the CEO of Pelenomi hospital Mr Tsibolane appears before the portfolio committee of health in the legislature to account for the current problems at the Pelenomi hospital and in the province as a whole;
• We will also request that both portfolio committees in Parliament and in the Free State legislature conduct oversight visits to Pelenomi hospital and other hospitals and clinics in the Free State;
• We will also conduct a follow-up visit in twelve months time to see whether any improvements have been made to the current situation at Pelonomi hospital.

We will provide continuous feedback on the replies received to our parliamentary and provincial legislature questions, on the outcomes of the portfolio committee meetings and visits as well as what we find during our follow-up visit.

Statement issued by Democratic Alliance parliamentary leader, Athol Trollip, and DA shadow minister of health, Mike Waters, September 17 2009

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