Herewith a statement read by Dr Basil Brown on behalf of the heads of units of the PE Hospital Complex.
Delivered in Port Elizabeth at 16:00 on Monday, 25 June 2012.
JOINT STATEMENT BY THE HEADS OF UNITS OF THE PE HOSPITAL COMPLEX
We, the Clinical Heads of Units (CHUs) of specialist departments at Dora Nginza, Livingstone and Provincial hospitals – which together comprise the PE Hospital Complex (PEHC)- have, after due deliberation, decided to issue a public statement on the crisis affecting service delivery at all PEHC hospitals.
We are doing so because we feel that the Eastern Cape Department of Health (ECDOH) has proven itself to be incapable of dealing with the crisis
The crisis we face is essentially due to the fact that the ECDOH has placed a moratorium on the appointment of new junior and specialist doctors, while at the same time not renewing the contracts of doctors who have worked in our department s previously. Doctors who have left by attrition or resignation have not been replaced, despite there being willing qualified applicants. To compound matters further, the salaries of a number of doctors who have worked on a sessional basis have not been paid since January.
An equally serious situation affects the appointment of other vitally important health care workers, such as nurses and pharmacists.
The outcome of this is to exacerbate the impact of the understaffing situation already existing in certain departments, while creating a similar crisis in others. If matters do not improve, levels of service will continue to drop, and there is a strong possibility of widespread resignations by disillusioned doctors in the service.
This situation is already evident in the Casualty departments at Dora Nginza and Livingstone, where there are not enough doctors to run the units.
All our specialist departments are affected to a greater or lesser degree.
All attempts from our side to convince the ECDOH of the dire consequences of this policy have fallen on deaf ears. We have also written to the Premier of the Province, Mrs Noxolo Kiviet and to the National Minister of Health Dr Aaron Motsoaledi, appealing for them to intervene in the crisis – but to no avail.
Having exhausted all avenues open to us, to persuade the powers that be to reverse this moratorium on the filling of critical medical posts, we now feel obliged to make the general public aware of the dire situation the PEHC hospitals are in.
The CHU’s have jointly come to the conclusion that the only way in which we can deal with the serious staff shortage – which is beyond our control – is to curtail the services offered by our various departments.
We are hereby serving notice that, with effect from the 1 July, we will only be able to offer emergency services to patients. For example, as in the case of the surgical disciplines, no elective or cold surgery will be performed. In other words only emergency or life-No elective or cold surgery will be performed. In other words only emergency or life-saving surgery will be performed. In addition, all non-emergency referrals from district hospitals will be stopped, and the number of patients seen at our daily or weekly clinics will be limited.
We need to emphasise that our decision to implement these drastic measures has not been taken lightly, and is being resorted to out of sheer desperation, and the determination to maintain a professional level of service commensurate with our abilities.
The state of the units:
Department of Anaesthetics:
One quarter of the staff at the department – which serves all three hospitals – will have left by the end of June. No new staff have been appointed to fill the vacancies.
Elective services will be cut by 25% in order to free up the remaining anaesthetists to attend to emergency cases.
The rural outreach programme, which has helped reduce maternal deaths, has been halted until there are sufficient doctors to provide the service.
Department of Burns and Plastic Surgery:
Currently served by one full-time specialist. The post of on-site consultant for the Burns Unit, which comprises three wards and a high care facility, is currently vacant.
Two sessional consultants assist with theatre, clinics and on call duties in the department. The consultants have not been paid for their services.
The department has had to suspend all combined Ear, Nose and Throat (mainly oncological), surgery, as well as providing support for cleft palate patients, who often also suffer from hearing difficulties.
Department of Cardiology
The most experienced MO in my department, Dr R Kariem has resigned to take up a registrar’s post at Tygerberg hospital with effect from 1 July.
If she is not replaced, the following measures will be implemented from July 1:
Reduction in the number of patients seen in the cardiac clinic on a daily basis, and the number of in-patients
Acute cardiac problems, especially those seen after hours and over weekends at peripheral clinics and hospitals must be admitted to Livingston or Dora Nginza for stabilisation, and such patients will only be considered for admission after the case has been discussed with the Head of Department.
Ear, Nose and Throat Department:
The department has not had a full-time specialist since it was opened. Visits from East London specialists have stopped because their contracts have not been renewed.
This has resulted in:
- Indefinite postponement of pre-booked cases
- Cases booked for specialist opinion do not receive the necessary specialist attention
- Urgent paediatric cases which need specialist care have to be directed straight to Frere Hospital
There are only two full-time medical officers and one doctor doing two-hour sessions in the mornings to service the department. The post of an extra medical officer was frozen two years ago.
The Department is also operating out of unsatisfactory facilities, where the consulting cubicles do not have doors and there is no security for patients, staff and property.
Department of Haematology
The newly-commissioned wards for the Department of Haematology have not been taken into service due to a lack of staff. The Department has just three nurses.
Nurses were interviewed and short-listed, but no appointments have been made. The department also needs two more medical officers.
Patients with Acute Leukaemia are being treated in a general ward as the Eastern Cape can no longer send them to other provinces for treatment.
The lives of patients are being cut short because they cannot be given stem cell transplants due to the fact that the ultra-modern isolation wards in the new Aloe Igazi Haematology Ward are not yet operational.
Livingstone Hospital Emergency Unity
Only two medical officers are on duty over the weekend (Saturday and Sunday) instead of the six required. This is because the unit has only eight medical officers on staff at present.
The pressure on medical officers in casualty has increased due to:
- Closure of the acute surgical unit due to a staff shortage
- Fewer patients seen in outpatient facilities
- Failure of the Primary Health Care clinics to deliver basic health care
- Failure of the District Health system
Department of Neurology:
There is only one Neurology Consultant, assisted by a Registrar rotating from Internal Medicine. For the past two months they have been on call every other day and every other weekend. Teaching has come to a stand-still, as the two see the same number of patients as is handled by a team of three consultants and four registrars at other state institutions.
Where the Department had the opportunity to secure scarce skills for the province it failed to act, and the services of an electrophysioligist have been lost to another province.
Plans for setting up a stroke unit, contributing to the Paediatric Neurology Unit, and reaching out to other centres in the province have been put on hold.
Department of Ophthalmology:
At present it is fully staffed. However, the situation is expected to change as 33% of the junior staff are expected to leave over the next six months. The functioning of the department will be affected by curtailments in support service such as the Department of Anaesthetics.
Department of Paediatrics:
Five medical officers have left the department since the beginning of 2012. The posts have not been filled, despite there being applicants. A specialist who applied in April has subsequently taken up a post at Chris Hani-Baragwanath Academic Hospital.
From July 1, and until the situation improves, the department of Paediatrics will not be able to provide emergency services on a daily basis. Priority will be given to very sick patients, and outpatient services – including specialist clinic services which are run by both specialists and medical officers – will be reduced.
Department of Urology
The Urology Department will stop elective surgery as of 1 July. Thereafter we will only perform emergency and oncology cases.
As of the 1 August there will not be enough staff members to cover after hours services for roughly two weeks of the month. Thus there will be no after-hours cover during that time.
Department of Radiation Oncology
There is 1 consultant instead of 4, doing all after hour duties for the past six months and working excessively long days.
The daily clinics are excessively long and regularly overruns to 17h30.
There are long delays in commencing radiation due to staff constraints.
A newly qualified Radiation Oncologist who applied on 27 April for a position for 1 Aug 2012 has not yet been appointed. This is only the 3rd applicant in 12 years. The first went elsewhere after waiting for 2 months to be appointed, and the second left after 15 months.
Department of Psychiatry
Due to the failure to replace two medical officers, services to four clinics which were being provided as part of an outreach programme have been stopped due to staff shortages.
The Department has also had to stop a comprehensive Child & Adolescent Service Clinic which was servicing 50-60 patients a month from all over Cacadu and the Metro, the only one of its kind in the area.
This has left children with mental health problems without a service since then.
Department of Surgery
The Department has been working under conditions which are medico-legally indefensible and open the doctors to litigation and disciplinary action by the Health Professions Council of South Africa (HSPCA).
The department had 16 Medical Officers in January 2012, and is currently down to eight Medical Officers, five of whom cannot operate as the primary surgeon
The department has been forced to implement the following crisis management guidelines:
- On some days no emergency surgical service will be available after 17:00 due to the lack of staff
- The registrar training programme has ground to a halt
- All elective surgery has been cancelled from June 25, 2012
- No new patients will be seen or accepted in the Surgical Out Patients Department unless the referring doctor, hospital or clinic personally or telephonically discusses all referrals with the doctors on duty
- All doctors will work their required committed overtime hours
- The department will be unable to assist with the daily GIT Endoscopy lists
For more information, contact: Ed Richardson: 083 656 9757
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Contact: 041 582 3750/ 083 656 9757
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