S.Africa: Collapsing Hospital Infrastructure

Jan, African Crisis, July 8, 2008

A surprise visit to the overburdened maternity section of East London’s Frere Hospital has led to Nozizwe Madlala-Routledge, the deputy health minister, describing the situation as a “national emergency”.

The minister found acute shortages of staff and equipment, and situations in which nurses had to “play God”—deciding who would live and who would die.

The hospital was simply not equipped to save the lives of the increasing number of underweight newborn babies, the victims of Aids, poverty and drug abuse. Very small babies were sometimes regarded as stillborn, nurses admitted to the deputy health minister.

A distressed Madlala-Routledge said she saw Frere’s combination of problems as an example of a massive systemic crisis, which threatened a breakdown in the delivery of healthcare.

‘Certainly, with those kinds of babies referred to it, that hospital needs to be reviewed’

“It really shows what is a national emergency, in my view, particularly with infant mortality seen as an important human-development indicator,” she said.

South Africa’s human-development indicator has been declining continuously, and much of it is blamed on infant mortality, according to United Nations Development Programme sources.

The deputy minister’s unannounced two-hour visit to the hospital followed a report in East London’s Daily Dispatch this week, which suggested the problems at Frere had led to the deaths of hundreds of babies every year.

A total of 2 000 babies have been stillborn at Frere in the past 14 years and last year’s figures appeared to be the highest—a record 199. Maternal death rates are also increasing.

Hospital staff conceded in documents that “most” maternal deaths and stillbirths could have been avoided.

Most mothers with complicated pregnancies in the eastern part of the province are referred to the Frere’s maternity section.

The Sunday Independent accompanied the minister on her visit and observed nursing staff dashing from one tiny baby to the next. With only five incubators available on the ward, nurses said they were not equipped to save many of them.

In emergency theatres and a post-natal care unit for babies with problems, nurses spoke of major staff shortages—the number of senior nurses had decreased by more than 50 percent since the 1990s.

Since January, the maternity section at Frere has lost 15 key staff. It could take years for critical posts to be filled.

There was also a shortage of clerical staff and porters and, consequently, nurses were spending too much time on paperwork and on moving patients between units.

Internal documents reveal that senior management has known for years that the situation is out of control but has done little to address the crisis.

In the maternity section, nurses had only two instruments to measure high blood pressure, one of the key risk factors among pregnant South African women. It also had only two machines to monitor the heartbeats of babies during labour.

Frere is an academic hospital where nurses undergo basic training and this stretches human resources even further.

On most days, only two sisters are in charge of the emergency delivery ward, where about 10 Cesarean sections are done and most other births are accompanied by complications. One of the nurses has to supervise training while carrying out her duties.

Many recently graduated nurses are now appointed to senior posts because experienced nurses are no longer willing to work under the stressful conditions.

Madlala-Routledge reiterated her controversial stand that a rapid review of the healthcare system was urgently needed.

She made a similar appeal in an internal document earlier this year but got short shrift from her cabinet colleagues.

After her visit to Frere, Madlala-Routledge was adamant that the shortages were “acute” and the turnover “just too high”.

Of the nurses, she said: “They are totally overstretched. It has gone so far that it needs a real, comprehensive intervention.

“Certainly, with those kinds of babies referred to it, that hospital needs to be reviewed.

“The staff was burning out fast! I was humbled by their dedication and passion for the profession.

“What upset me was that they have to play God and make decisions, which must be very difficult for people who are healers.”

Madlala-Routledge said the crisis highlighted a need for a national investigation to go to the heart of planning, budgeting and allocating money.

“We really need to understand why people are dying. It warrants a rapid review [of the national health system].

“We need to understand exactly what money is being spent on, [and] whether the limited resources are deployed efficiently.”

Earlier this year her review plan was rejected by both the ANC and the government.

The treasury has since called for a systemic review of delivery in key social services, particularly health and education.

A confidential internal report on maternal deaths has already urged a serious intervention by the department.

On Friday, Manto Tshabalala-Msimang, the minister of health, announced substantial salary increases for the country’s overworked nurses.

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