Hos­pi­tals, courts face back­log headache

Thou­sands of surg­eries de­ferred by Covid-19

Weekend Argus (Saturday Edition) - - FRONT PAGE - CHELSEA GEACH chelsea.geach@inl.co.za

IN­FEC­TIONS may have fallen, but South Africa is wak­ing up with a Covid-19 han­gover as pub­lic fa­cil­i­ties face the gar­gan­tuan task of catch­ing up on all the ser­vices that were shut down or lim­ited dur­ing lock­down.

At the Cape’s two big­gest hos­pi­tals, there is cur­rently a back­log of over 7 500 surg­eries, while across the coun­try’s courts there was a back­log of nearly 50 000 crim­i­nal cases at the end of last month.

At the be­gin­ning of this month, nearly 21 000 peo­ple coun­try­wide were re­prot­edly await­ing ap­proval from Sassa for dis­abil­ity grants which had not ac­cepted new ap­pli­ca­tions since the be­gin­ning of lock­down.

When the coun­try plunged into lock­down, health ser­vices at hos­pi­tals’ ca­pac­ity was dras­ti­cally re­duced in or­der to pri­ori­tise space, re­sources and staff for Covid-19 pa­tients, and to limit other pa­tients from be­ing ex­posed to the virus in hospi­tal.

As a re­sult, Groote Schuur Hospi­tal is now fac­ing a back­log of 4 142 surg­eries, Tyger­berg Hospi­tal has a back­log of 3 500, and 370 at Red Cross War Me­mo­rial Chil­dren’s Hospi­tal.

Pro­fes­sor Elmin Steyn, head of surgery at Tyger­berg Hospi­tal, said there were thou­sands of pa­tients they would have seen in the past seven months who had their surg­eries de­ferred – many of whom have died as a re­sult, or whose dis­eases have pro­gressed be­yond the help of surgery.

“Only the im­me­di­ately life-threat­en­ing cases were op­er­ated. Many of the de­ferred pa­tients have al­ready re­turned with pro­gres­sion of dis­ease lead­ing to life-threat­en­ing sit­u­a­tions. Many will have died out­side of this hospi­tal, or will have a wors­ened prog­no­sis or poor out­come due to de­layed surgery.”

Steyn added that es­ti­mat­ing how long it will take to catch up all the post­poned cases is prac­ti­cally im­pos­si­ble.

“Catch-up is im­pos­si­ble to calculate, as many of those con­di­tions have evolved – some are now in­op­er­a­ble, there­fore catch-up is ir­rel­e­vant. For the sur­vivors, we are al­ways try­ing to catch up, and the wait­ing lists re­main long.”

Spokesper­son for the na­tional Depart­ment of Health, Popo Maja, said the back­log could be seen coun­try­wide, but ex­act num­bers for other prov­inces were not im­me­di­ately avail­able.

“There is a back­log of non­emer­gency surgery across the coun­try in both the pri­vate and pub­lic health sec­tors. This trend is also ap­par­ent glob­ally,” Maja said.

“All of the aca­demic hos­pi­tals have opened the­atres to bat­tle this back­log.”

At Barag­wanath Hospi­tal in Gaut­eng a to­tal of 7 541 surg­eries were re­port­edly post­poned, in­clud­ing a high num­ber of oph­thal­mol­ogy, or­thopaedic and pae­di­atric surg­eries.

In a re­cent is­sue of the SA Med­i­cal Jour­nal, an ar­ti­cle that Steyn contribute­d to found that 84 of 85 sur­veyed hos­pi­tals can­celled or re­duced non-cancer elec­tive op­er­a­tions. A quar­ter of hos­pi­tals only con­tin­ued with symp­to­matic cancer op­er­a­tions, and 3.5% can­celled all cancer op­er­a­tions.

Two hos­pi­tals stopped all emer­gency op­er­a­tions, and 87% can­celled or re­duced new out­pa­tient vis­its.

The ar­ti­cle con­cluded: “Hospi­tal sur­gi­cal de-es­ca­la­tion in re­sponse to Covid19 has greatly re­duced ac­cess to sur­gi­cal care in South Africa, which could re­sult in a back­log of sur­gi­cal needs and an ex­cess of mor­bid­ity and mor­tal­ity.”

In the coun­try’s courts, the back­log of crim­i­nal cases is now “a mat­ter of se­ri­ous con­cern”, ac­cord­ing to the Depart­ment of Justice and Con­sti­tu­tional Devel­op­ment.

By the end of Au­gust, there was a back­log of 6 8171 cases at the high, re­gional and district courts – an in­crease of nearly 29 000 added to the al­ready large back­log be­fore lock­down. By the end of Septem­ber, the back­log had de­creased slightly to 49 160.

A case is con­sid­ered to be “back­logged” if it is still open six months af­ter first ap­pear­ance at a district court, or nine months at re­gional court.

Spokesper­son for the depart­ment Steve Mahlangu said the courts had not been spared the ef­fects of Covid-19.

“Not only has Covid-19 in­ter­rupted the op­er­a­tions of de­part­ments, it has re­quired the rapid and mas­sive re­de­ploy­ment of re­sources,” said Mahlangu.

“In ad­di­tion, the ab­sence and ro­ta­tion of staff and other court role-play­ers, as well as court clo­sures due to de­con­tam­i­na­tion ef­forts, have all had an im­pact on back­logs and court op­er­a­tions.”

Mahlangu was not able to pro­vide de­tails of the types of cases and charges, but said that they in­clude se­ri­ous cases such as fraud and cor­rup­tion which are dealt with at re­gional courts.

A Court Op­ti­mi­sa­tion Com­mit­tee has been set up in or­der to over­see the back­log as well as ef­fi­cient func­tion­ing of the courts in the time of Covid-19.

“Catch- up is al­most im­pos­si­ble to calculate...


IAN LANDS­BERG African News Agency (ANA)

TYGER­BERG Hospi­tal has thou­sands of pa­tients who were in need of surgery since the start of lock­down, but had to be de­ferred due to Covid-19 re­stric­tions. |

HENK KRUGER African News Agency (ANA)

MISS South Africa 2020 top 10 fi­nal­ists Natasha Jou­bert and Karishma Ramdev en­joy the view from Ta­ble Moun­tain yesterday, ahead of the 62nd edi­tion of the pageant, which will be held next Satur­day at the Ta­ble Bay Ho­tel. |

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