Nightmare at Manapo Hospital

QWA QWA, 20th SEPTEMBER 2016: Members of the Treatment Action Campaign (TAC) in Phuthaditjhaba report serious problems at Manapo Hospital that are putting people’s right to access healthcare in jeopardy. This follows last week’s strike by frustrated staff members including doctors, nurses, physiotherapists, porters, cleaners, and kitchen staff who report to be overburdened and to have not received pay for significant amounts of overtime since 2015.

On Sunday 18th September the Hospital was very quiet. The gates were open and no security checked as TAC members entered and exited the premises. There was no one around the facility or in the lower levels of the building.

Yesterday, life emerged in the Hospital. Visibly injured patients could be seen wandering the grounds in their pyjamas. After taking a rest on the grass, one young man with bandages across his face struggled to stand up and had to be assisted by two other patients to get onto his feet before limping back inside.

Portable toilets sit outside the Hospital. They remain from a water crisis the month prior. It is unclear whether the water shortages continue. A TAC member helped a man with crutches who struggled to climb up the metal steps to enter the toilet.

TAC members spoke to many patients entering and exiting the Hospital. Reports of long waiting times, a lack of nurses, doctors and other staff being stretched beyond their capacity, and medicines shortages were common. We list below a number of stories that were brought to our attention.

– Shortage of nurses / overburdened nurses:

·       One nurse confirmed the issues of the strike as a result of overburdened staff and no clear system of overtime that has lead to no payment. In the ward in which she works, two nurses work on each shift from 7h00 to 19h00, and then two more from 19h00 to 7h00. If someone is off sick the area manager has to come on duty, who remains on shift for a couple of hours before leaving again. After resigning in 2014, the MEC of Health pleaded with this nurse (and others) to return with the promise of better working conditions and pay. They returned after 6 months. However, the situation has not changed. To date they remain on probation which means not being absorbed as permanent staff members, lower pay and the requirements of doing regular assignments and examinations in order to be able to be absorbed in the system in the future.

·       After delivering her premature baby at home – at just 7 months – one woman was taken to Hospital by ambulance on 1st September. The nurses quickly attended to her when she was admitted. To date her baby remains in the ICU being monitored by nurses. She is only able to see her baby at 8h30, 11h30, 14h30 and 17h30 each day. The woman, together with three others, are staying in a ward together. There are no glass window panels in the windows. They are cold and have some of their own blankets for warmth. They had been wearing the same pyjamas for seven days and had just been given fresh ones that morning. When we met them outside the Hospital – in slippers, pyjamas and blankets – they were carrying plastic food packages as there is limited food on the ward, and when it comes it is served cold. There is limited water in the ward – not enough to wash themselves with. They clean the ward themselves as no cleaners have attended to the ward.

·       One woman reported to us that she had brought her 74 year-old father to the Hospital 2 weeks ago. He is suffering from kidney failure and blood clots on the kidneys. They arrived at 14h00 and were attended to at 18h00. Due to his condition her father has been given adult nappies to wear. However, the woman reports that each day she goes to the ward in order to change these nappies, as nurses say they just do not have time to do it. One night her father reported falling from his bed and having to get assistance from the other patients on the ward in order to get back into bed as no nurses were available to help him. Her father also suffers from high blood pressure and sugar diabetes. Since being admitted he has begun hallucinating and acting in an odd manner – something that had never happened on his medicines at home. She worries there is an issue with his treatment. Her father continually asks for her to bring food. If he is asleep and does not wake up at meal times, his food is taken away without him getting an opportunity to eat. This only worsens his existing conditions. During his stay he alleges that two patients on the ward robbed him. He reported this incident to the nurses who have yet to take up the matter.

·       One man reported that he had been struggling to breathe, potentially with asthma or another respiratory condition. He arrived at the Hospital on Saturday and had yet to be provided with any medication until yesterday when TAC members spoke to him. The only test that he had been given was an HIV test despite asking the doctor for an examination related to his respiratory condition.

– Shortage of doctors:

·       8 days prior a teenager had been admitted to the Hospital after being stabbed in the forehead. Nurses stitched his wound on the first day and he was given painkillers. They advised him to wait to see the doctor given the seriousness of the head injury. 7 days later and the doctor had not yet seen the patient. His father insisted his son be seen. At the time of our meeting with the patient he was due to be seen by the doctor although there had been no confirmation that this would indeed happen.

·       Another teenager had been stabbed in the upper chest 4 days earlier. On Friday night he came into casualty. He waited to be seen until Saturday. The nurses stitched his wound and gave him painkillers. He is now also still waiting to see a doctor.

·       The Mohau Clinic at Manapo Hospital is a specialist ARV clinic. If people living with HIV face complications related to their ARV treatment regimens they are referred to the clinic for specialist care. Often they are reacting to their treatment and need urgent attention. The doctor previously employed in Mohau Clinic left in May 2016. The position remains vacant. Reports to TAC members show people being sent back from Mohau Clinic to local clinics as care is not available. Hospital management state that they are waiting for the position to be filled through Right to Care.

– Patients being turned away:

·       One woman had arrived at 8h00 at the Hospital. Her hand lay close to her chest in bandages and a sling she had put on herself at home. The night prior she had hurt her hand and now in severe pain believed it to be broken. After attempting to register at the Reception she was told to return to her local clinic for a referral letter. No one attended to her. She was not even given a panado. The hand at this stage was extremely painful and swollen. As an unemployed woman the R40 return taxi fare was already leaving her out of pocket. She was unable to afford to additionally go to the clinic to obtain a referral and then to return again to the Hospital. TAC is concerned if she returns for an x-ray given the reports of a limited number of x-rays taking place due to the lack of radiologists.

·       A woman explained how her daughter had previously gone to the Hospital suffering from shortness of breath. The staff told her that they were unable to help as she had previously been treated at Elizabeth Ross Hospital. She was not provided with help.

·       One man had been sent away after making his way to the Hospital for an appointment as no doctor was available yesterday. He was asked to return on 19th October.

·       One elderly woman reported attended the Hospital with problems with her eyes. Having been brought to Hospital with an ambulance she remained waiting to be seen for several hours. More than five hours later she left without being seen in order to be taken home in the ambulance.

– Shortage of cleaners and poor working conditions:

·       Volunteer cleaners work in the outside grounds of the Hospital. They work 7h30 to 15h30 from Monday to Friday. They are given a R700 stipend per month. They are supposed to work in the grounds of the Hospital only, however a shortage of cleaners within the Hospital means that often they are asked to clean inside, they specifically reference the Psychiatric Ward. They allege that there are 24 vacant full time cleaner positions. 

– Management response:

·       TAC Free State Chairperson and TAC Advocacy & Campaign Manager met with the Hospital CEO on Monday 19th September. The CEO stated that 18 nurse positions had been recently filled. She hoped to fill a further 10 professional nurse positions by the end of October 2016 to cover those nurses who left at end of August 2016. She denied that people are sent away without being attended to and the extent of the shortage of doctors.

We reiterate that we have no faith in the provincial department to address this emergency adequately or rapidly. We demand urgent intervention by President Jacob Zuma and Premier Ace Magashule to fix the Free State health system, to fill vacant positions, to pay people for outstanding overtime, and to fire a criminal Health MEC given his clear lack of concern or ability to deal with the ongoing and emerging challenges in the provinces.

TAC has written to President Jacob Zuma requesting an urgent meeting to bring to his attention the increasingly serious crisis in the public healthcare system in a number of provinces – including Free State, Mpumalanga, Limpopo, Eastern Cape and Gauteng. Free State Premier Ace Magashule has requested a meeting with TAC on 22nd September to discuss possible solutions to this crisis. We await formal confirmation of this meeting.

If urgent action is not taken to turnaround this crisis, we will be forced to yet again embark on a campaign of civil disobedience in order to save the lives of those reliant on the failing public healthcare system.  

Issued by:
Anele Yawa | General Secretary | TAC | 079 328 1215


·       Last week staff at Manapo Hospital in Phuthaditjhaba, Qwa Qwa were on strike. All emergencies were being redirected to the already overcrowded Dihlabeng Hospital in Bethlehem, more than 50 kilometers away. Reports suggest the strike was in response to staff including doctors, nurses, physiotherapists, porters, security staff, cleaners, kitchen staff etc. receiving no pay for significant amounts of overtime since 2015.

·       Recently the MEC of Health Dr Benny Malakoane made a public statement that he would cut overtime by a third – yet ongoing tensions suggest this matter has not yet been resolved. Multiple doctors in the Free State have worked more than 80hrs overtime per month (Group 4 overtime) this year. Yet due to the fact they did not get approval they received no compensation. Unions met with the Hospital COO Dr Mzangwa last week at which time no resolutions had been made. See full statement issued last week:

·       TAC has previously alerted the Deputy President, in his capacity as head of the South African National AIDS Council, to the crisis in the Free State. We have on more than one occasion alerted the Minister of Health. We have also alerted the leadership of the ANC to the situation. Yet, after years of engagement the situation in the Free State is only getting worse. See the full timeline of the Free State health crisis here:

·       Premier Ace Magashule last week has requested the list of the #BopheloHouse94 – the 94 community healthcare workers who were arrested outside Bophelo House for taking part in a peaceful night vigil. The Premier claims to be pushing for these CHWs to be reinstated by October 2016.

·       TAC and SECTION27’s fact finding mission in the province continues this week. 

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