KZN hospital is in ‘toxic meltdown’
Experienced doctors and nurses at a rural hospital in Kwazulu-natal are quitting over strained relations with the facility’s new medical manager and chief executive
Emmaus Hospital, near Winterton in Kwazulunatal, has become the country’s second rural healthcare facility headed for clinical-staff breakdown after doctors’ relations with hospital management turned poisonous, allegedly compromising healthcare.
So far, three clinical stalwarts have resigned, another three are considering leaving, and the nine community service (commserve) doctors say they are deeply disillusioned after being attracted there by colleagues thriving in what, until two years ago, was a “tight-knit” 20-doctor team. Several experienced nurses have also quit.
The pattern of alleged authoritarian hospital management and nurses appointed as chief executives (with provincial political backing) is similar to that at the award-winning Zithulele Hospital near Mthatha in Eastern Cape, as previously reported by the Mail & Guardian.
On 21 July, police fired rubber bullets and teargas at protestors supporting doctors at the hospital, who had been targeted by the new chief executive who was accused of arbitrarily moving patients to clinics.
Attempts at outside mediation between the chief executive and senior clinicians, who had revolutionised care at Zithulele, failed and they resigned. The two married doctor couples had attracted likeminded colleagues, plus several local NGOS, over 15 and 17 years of service, respectively, complementing and supporting local healthcare delivery.
At Emmaus Hospital, matters allegedly took a turn for the worse after the new medical manager Adeolu Apelehin and chief executive Ndileka Mzizi assumed their posts in 2020 and 2019, respectively. Within a short while, they began clashing with junior and senior clinicians, against several of whom they have since brought disciplinary charges.
One junior doctor transferred out last year after the working environment became “unbearably toxic”.
“Anyone who stood up to them became an immediate target, culminating in disciplinary action, with accusations of racism regularly thrown in for good measure. The commserves initially felt we’d lured them there under false pretences because it used to be the exact opposite, with an environment in which people learnt and thrived,” the junior doctor said.
A former colleague concurred, saying Apelehin, who left abruptly to work in Canada in May, allegedly had “a predilection for publicly shaming doctors on our internal Whatsapp group by making disparaging remarks about them”.
The junior doctor and former colleague allege he was unavailable to help junior doctors with patients and “uncontactable” by nursing staff responding to emergencies.
They said he often labelled anyone who opposed him as racist, including a black doctor who sided with his white colleagues.
When the senior clinical manager, with 15 years’ service at Emmaus, confronted him on these and other issues, he allegedly began targeting her, “trying to work her out”.
Among the unpopular changes Apelehin made was assigning doctors on call specifically to casualty, wards or theatre, allowing far less room for “teamwork and flexibility”, which affected patient care and resulted in an uneven doctor workload.
“If any doctor chose to follow these new rules, it immediately created collegial workload tensions,” she said.
One clinical manager who recently resigned was singled out by an ally of Apelehin for “lying” and being fraudulent about his HIV diploma (which he’d chosen not to register with the Health Professions Council of SA) despite having the papers to prove it.
Apelehin’s successor, acting medical manager Mampho Machaoa, a family physician, joined the hospital well before Apelehin left and, according to some in the Emmaus doctor cohort, allegedly closed ranks with him and Mzizi, ironically a known on-site corruption buster.
The doctors alleged that Mzizi picked up the “victimisation” baton, prompting a disciplinary hearing that led to the senior clinical manager being demoted to medical officer and suspended on charges of misconduct for undermining her, plus overtime irregularities involving paying peers to stand in for her.
This is a widespread practice among rural doctors, often overlooked by more benign management in the interests of workload flexibility and service delivery.
The medical manager is appealing the ruling. Although she has resigned and intends going into private practice, colleagues say she is determined to clear her name.
The junior doctor and former colleague, who asked to remain anonymous to avoid victimisation, said one disillusioned clinical manager, Michael John Acres, left in July after seven years at Emmaus. Medical officer Kulekani Mabaso left in September last year after five years at Emmaus, while four long-term medical officers were considering leaving, because of the toxic working environment and adversarial management style. Insiders confirmed this.
“Another former commserve who stayed on at Emmaus from 2018, married and bought a house locally, is now being targeted with arbitrary
claims of patient negligence, despite having an excellent clinical reputation among her colleagues,” they said.
The junior doctor said the climate of fear was so entrenched that few doctors still working there would speak out for fear of retribution.
She said she wrote to the district health manager and the Kwazulunatal department of health head office “on more than one occasion” detailing her experiences last year and reflecting on the ongoing situation but had not received a response.
The former colleague said the clinical managers who left “were the ones who developed strong relationships with our referral centres and advocated for patient care”. The other medical officers who wanted to leave also initially planned to stay at the facility long term, serving the community, she added.
“The attitude of management was, ‘people come and go, it doesn’t matter because they’re replaceable’ — which may be true but is also harmful because they’re losing those who really care about the community and district medicine. It’s much like what happened at Zithulele. It seems to us that management hasn’t considered that a district hospital is successful
‘He completely eroded her capacity as manager, her authority, reputation and personal pride in what she could do’
when the staff are invested in it and the community in a strong and longterm way,” she said.
The former colleague said the community service cohort was unanimous in supporting the doctor facing negligence charges, having told her they were disheartened and found it “absurd”. They described her as one of the hardest-working doctors at the hospital. “The entire team is 100% behind her,” she added.
A management ally and one of the complainants against the “rebellious” more senior doctors recently put in notice that he was leaving, the doctors said.
One added, “He’s leaving just like Apelehin did, having further messed up the hospital environment with no accountability. They try to create this racist narrative that deflects attention from their own shortcomings.”
Another doctor described Apelehin’s clashes with the senior clinical manager as “gaslighting”.
“Over time, he completely eroded her capacity as manager, her authority, reputation and personal pride in what she could do. He’d write scathing e-mails and copy the CEO, contaminating minds against her, even asking how her salary could be higher than his. He was convinced there was a parallel organisation at the hospital conspiring against him.”
The M&G learnt the demoted clinical manager has taken mental health leave and is consulting a psychiatrist. This is also what happened with Ben Gaunt, the clinical manager at Zithulele Hospital, after his protracted clash with his chief executive.
Like Zithulele Hospital, an exter
nal investigator was brought in to look into management allegations in October last year but was unable to make any conclusive findings.
Previous and current doctors at Emmaus said, until recently, it had attracted high-quality doctors with a strong vocational and work ethic who “put roots down”, buying homes locally and starting families.
“It’s tricky staffing a rural hospital, you need an element of flexibility because there are no strong financial or academic incentives, so there must be give and take.
“Work doesn’t always fit with the prescribed hours. Sometimes allowing those who’ve been on overnight call to go home at 8am instead of working till 1pm makes all the difference. Moving here was a life choice, putting kids in boarding school, finding a house, all that,” one added.
Apelehin read the list of the claims about him but said he was “not at liberty to discuss human resourcerelated matters out of respect for my colleagues and the KZN department of health”, referring the M&G to hospital management and the provincial department of health. Mzizi referred the M&G to “head office”.
Health department spokesperson Mdu Ncalane said it was an internal labour relations matter and he could not comment, except to say there had been no negative effects on the running of the hospital or its clinics.
“Staff ought to be aware of all labour relations channels to be followed when grievances arise, so they can be dealt with in line with established standard procedures.”
Machaoa declined to comment.