What’s on at hospital zoo?

The biggest problem with the NHI is not that it’s unaffordable, but the systemic rot that Makgoba’s report uncovers.

B usiness Day reports that President Cyril Ramaphosa appeared “sombre” at the ANC lekgotla last weekend. That’s more serious than what eNCA pegged as his “rather sombre” bearing during his Christmas Eve speech.

Whatever the state of Ramaphosa’s psyche at the lekgotla, the president made an interesting admission. He confessed that the National Health Service (NHI) that is supposed to replace the private healthcare sector by 2026 might not happen at the scale and speed intended, for economic reasons.

This will come as an unpleasant surprise to Health Minister Zweli Mkhize, who says the NHI is “non-negotiable” and would be implemented “irrespective of the country’s economic situation”.

But whatever our ambitions for an NHI, the SA public has during this pandemic shown an admirably finely-honed survival instinct, doing everything possible to avoid falling into the clutches of the “caring” state hospitals.

Conditions in most of them are hellish. Social media reveals corpses left lying on the floor; patients weeping with terror and frustration; and bathrooms awash with blood, vomit, faeces and urine.

And, as health ombud Dr Malegapuru Makgoba reported this week, there’s the starvation of patients. The report traces the demise of Covid-19 patient Shonisani Lethole at Tembisa Hospital in June last year. As the report makes clear, this one death, in a supposedly exemplary teaching hospital, is emblematic of everything wrong with the public health sector.

First, Lethole died because of the grossly “negligent, callous and uncaring” actions of Tembisa staff. Second, the hospital, from the CEO down to nurse aides, kitchen staff and a mortuary porter, obfuscated, lied and destroyed evidence to hide their failures. Third, we know what happened to Lethole was not because of professional oversight and quality control, but because it became an embarrassing cause célèbre.

Makgoba found Lethole’s tweeted claims of poor care and indifferent staff to be “credible and truthful”. By the time of Lethole’s death, he had not been given food for more than four days.

Only three days after admission did staff carry out a clinical assessment of Lethole. Vital blood tests were “not seen, reviewed, interpreted or repeated and acted upon timeously by the senior doctors”. He was left without oxygen at critical junctures and when he was dying, no attempt was made at resuscitation.

The biggest problem with the NHI is not that it’s unaffordable, but the systemic rot that Makgoba’s report uncovers. The failings of training, administration, management and – let’s face it – morality and basic humanity, which are endemic to the public sector, would turn an NHI into a Frankenstein.

Makgoba recommends that Gauteng health urgently conducts an independent “fit for purpose” assessment of Tembisa’s leadership and management. He also recommends disciplinary action by the province against the hospital CEO, Dr Lekopane Mogaladi, nine other medical doctors, five nurses and at least five support staff. They should also face further disciplinary sanctions by the Health Professions Council and the SA Nursing Council.

Don’t hold your breath. It’s going on six years since Makgoba investigated the deaths of at least 143 people – also by starvation and neglect – in the Esidemeni scandal. There, too, he identified systemic failures and recommended disciplinary action against administrators and doctors. Nothing happened.

Speaking off the cuff, Makgoba said that Tembisa is “like a zoo of people supposed to look after patients”. That sums it up with probably more candour than he intended.

Sombre Cyril will be suitably shocked.