Secrecy and poor planning putting healthcare professionals and patients at risk 

Unconfirmed reports of at least 65 positive Covid-19 cases among healthcare professionals at the Leratong Hospital on Gauteng’s West Rand has sparked concern over government’s apparent lack of contingency plans to account for increasing cases among doctors and nurses countrywide.

According to a Whatsapp group message from one unit head at the hospital to her staff, which The Citizen has seen, four doctors and three nurses in the casualty department had tested positive for the virus by this past weekend.

The internal medicine department had seven positive doctors and 18 nurses, pediatrics had one doctor and four nurses, three doctors and two nurses in general surgery, one ophthalmologist, two psychiatrists, two psychologists and six nurses in the psychiatric department, and one doctor and two radiologists in the radiology department.

Six National Health Laboratory Services staff members working at the hospital also apparently tested positive.

There have been reports in both private and public institutions of a lack of PPE and N95 masks, a lack of testing and self-quarantining, and deliberate misinformation campaigns.

After numerous attempts to get through to Leratong’s staff infection control centre proved fruitless, one matron in charge of infection control among patients at the hospital did reveal to The Citizen that despite educating people about Covid-19, “every morning you teach until you can’t anymore”.

“You teach them one thing over and over again.”

The matron’s dismay is unfortunately not an isolated case, and it is not helped by the fact that staff in several departments reportedly being told by management to reuse the same N95 masks for at least five days before they will be supplied with a new one.

Conditions even before Covid-19 were trying at best, but according to South African Medical Association (SAMA) board chairperson Dr Angelique Coetzee, Covid-19 has begun to expose the compounding issues plaguing the healthcare sector.

Dumped Covid-19 test kits found in the Eastern Cape. Picture: Facebook

“Patients’ families usually call out medical institutions, but because of lockdown, there is no more whistleblowing. We don’t have enough information on the issues at hospitals, and doctors will not easily complain, for fear of being discriminated against. You can’t trust anyone. You ask the authorities and they’ll tell you everything is fine,” Coetzee said.

The lack of information, and fear of intimidation when speaking out, was also confirmed by South African Emergency Personnel’s Union (SAEPU) President, Mpho Mpogeng.

Mpogeng said that at the start of lockdown, most union representatives were not permitted to travel and represent their members, creating an opportunity for management to abuse them.

“We are not here to play the blame game, but it’s true that some losses were caused by management, who are just instructing and intimidating workers.”

Mpogeng explained that if a paramedic refuses to respond to a patient, it will result in dismissal. However, paramedics, who are often the first to interact with Covid-19 positive patients, are not being given the correct PPE and N95 masks to respond to patients safely.

“They have to choose between their families and their own wellbeing. And the repercussions are now bearing fruit, with members dying.”

According to Mpogeng, a number of paramedics have died of Covid-19, but in some areas, when an emergency worker tests positive for the virus, management has reportedly prevented them from disclosing their status. This puts paramedics’ lives, and the lives of their families, at risk.

“Results are being hidden deliberately, and we receive complaints from members saying they didn’t know about the results. We need to be truthful.

“I called it, I said we are not ready for dealing with Covid-19, but I was accused of provoking management. They say our workers are lazy, and are using Covid-19 as an excuse to stay home. We say they are there to work, but please respect them and provide them with proper equipment,” he appealed.

Mpogeng added that management and government are hiding the truth so that they can keep business operating as usual.

“This is not a normal situation, and people will panic, but we need to know the truth.”

According to Mpogeng, the problem is poor planning.

At the opening of a field hospital in Port Elizabeth, the health minister said there were now more than 27,000 beds for COVID-19 patients across the country. AFP/Michael SHEEHAN

He suggests that in order to mitigate the amount of deaths among emergency personnel, one ambulance should be allocated to deal strictly with Covid-19 patients. In this way, he explained that certain people could be assigned to deal with Covid-19 patents, which would mitigate mask and PPE shortages, and prevent further risk of infection when patients that are not Covid-19 positive travel in the same ambulance that was used to ferry positive patients to hospital.

The SAEPU’s misinformation concerns were echoed by SAMA, with Coetzee saying there was no contingency plan when it comes to increased cases among doctors and nurses.

“What is communicated from the CEOs of hospitals up to provincial and national level is not what is happening on the ground,” she revealed, adding that SAMA has received complaints that many nursing staff members are either on strike or not at work, which has put further pressure on doctors.

This lack of information, or misinformation, hampers SAMA’s efforts to provide assistance to facilities in need, Coetzee explained.

“We are in quite a deep mess. The infrastructure is not in place. Lockdown was supposed to give us time to prepare ourselves.”

National Health Department spokesperson Popo Maja reiterated the concerns of more critical medical staff contracting Covid-19. Maja said it is suspected that healthcare professionals “get infected outside their workspaces.

“We suspect that they lower their guard when they are taking a break or are in public spaces.” 

However, he said the Department is addressing this, “because it is worrisome indeed.” 

The issue of a lack of N95 masks also comes down to a lack of information, with many masks not being used properly.

“If you wear N95 masks at an incorrect level, you are wasting it. If you take out waste and abuse and give it to the right people, the shortage would be less.”

She said that poor mask quality and purchasing masks from unknown suppliers has also created a massive backlog.

Coetzee admitted that at first, the medical community was convinced that ventilators were necessary to deal with Covid-19 patients. However, it has since been revealed that high-flow nasal oxygen is more effective. But without certain infrastructure already available at hospitals, this cannot be applied across the board.

She said the virus was expected to be around for the next three years, with countries that have recovered now reporting recurring infections. This means that struggling health facilities, notably most public hospitals in Johannesburg and the far East Rand, could be even worse off than they are now.

Dr Eric Goemare (R), and Nompumelelo Mantangana, a doctor and nurse with Doctors Without Borders (MSF), look at the progress being made in setting up a field hospital being set up in a sports hall in Khayelitsha, near Cape Town, on May 22, 2020. Both Goemare and Mantangana have experience in dealing with the AIDS epidemic of the early 2000’s in this area. This field hospital is being set up with the support of Doctors Without Borders (MSF) as part of South Africa’s fight against the COVID-19 coronavirus pandemic. (Photo by RODGER BOSCH / AFP)

“We are worried about the quality of care. All patients, public or private, are the same, and it’s the patients with a good chance of survival that get preference – not those with medical aid. Getting a bed does not depend on who you are or how rich you are or how advanced your medical aid scheme is. It’s very difficult, but that’s the reality,” Coetzee said.

The first step to improving the healthcare sector was to try and find out what is going on behind the scenes, Coetzee said. As such, SAMA has committed to looking into an anonymous whistleblowing initiative, in which medical professionals can privately send proof of mismanagement. This would mitigate fears of intimidation, and give SAMA irrefutable proof of corruption and poor governance within a medical facility.

“No whistleblowing means information must come from the inside, but getting into a hospital to conduct an investigation puts those people at risk too. You are putting yourself in harm’s way just to get information, and if it’s a struggling facility, you could get Covid-19 and other hospital-resistant bacterial infections,” she explained.

“We need to sort this out, and we’ve just tried to come up with a plan to mitigate risks as much as possible, while also exposing poor governance at hospitals that have been there since before Covid-19.”

SAMA hopes the platform would expose all the issues that have been raised for many years, but ignored.

– nicas@citizen.co.za

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