Port Elizabeth's Tertiary Care Reaches Crisis Point
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Izindaba Port Elizabeth’s tertiary care reaches crisis point district hospitals and clinics that rely on them exclusively for referral – with potentially fatal effects when inter-disciplinary care is required. When Dr Siva Pillay was shown the letters by Izindaba, he expressed the ‘utmost respect’ for ‘most’ of the specialists who were ‘fighting a genuine battle that needs to be fought’. However, he said, had they spoken to him, they would have learnt that he had smoothed out the human resource process ‘so that we can now fast-track appointments’, and that his recent intervention with national treasury had led to a resetting of his health budget to include the R1.5 billion in overdraft and unauthorised expenditure previously earmarked for immediate repayment. In terms of recent political manoeuvring, a provincial co-ordinating and monitoring team now vets all appointments and provincial treasury has taken over the PERSAL (personnel L - R: Dr Lungile Pepeta, Paediatric Chief at Dora Nginza Hospital, Dr Basil Brown, Cardiology Chief salary) function and, said Pillay: ‘They don’t at Port Elizabeth Provincial Hospital and Professor Sats Pillay, Head of Surgery at Livingstone Hospital, understand the urgency of it’.1 at their ‘rebel’ Port Elizabeth press conference on 26 June this year. Dual loyalties again to Almost across disciplines, health care in country-wide since. Eastern Cape Health the fore the Port Elizabeth Provincial Hospital Director General, Dr Siva Pillay, angered Professor Sats Pillay, Head of Surgery at Complex (PEPHC) has deteriorated at the bypassing of him and the direct Livingstone Hospital, who received warning so badly in the past six months that approach to Premier Noxolo Kieviet, told letters together with Dr Lungile Pepeta, short-staffed departmental heads are Izindaba the specialists had not used any Paediatric Chief at Dora Nginza Hospital unapologetically cutting back on vital of the regular avenues, including the public and Dr Basil Brown, Cardiology Chief at patient services to focus only on the very service commission, public service monitor, Port Elizabeth Provincial Hospital, said local sick and dying. the bargaining council or the labour court. management and head office failed to respond While conceding that their concerns to ‘repeated submissions and warnings’ about were ‘genuine, legitimate and serious’, he the collapse of basic services resulting in The confrontation has its roots said the picture painted was ‘not entirely sub-standard and unsafe care of patients. In in posts not filled over the past accurate’. The confrontation has its roots his formal response (demanded within 48 six months by a corruption- in posts not filled over the past six months hours) Pillay, a veteran surgeon, wrote that driven and dysfunctional by a corruption-riven and dysfunctional his actions were ‘based purely on frustration’. provincial health department provincial health department struggling to address a R2.5 billion budget shortfall. struggling to address a R2.5 Izindaba has in its possession urgent When Dr Siva Pillay was shown billion budget shortfall. letters to their superiors from the heads of the letters by Izindaba, he Emergency Medicine, Paediatrics, Neurology, expressed the ‘utmost respect’ for Ear Nose and Throat (ENT), Anaesthetics, ‘most’ of the specialists who were When they held a joint press conference Oncology, Urology, Surgery, Orthopaedics ‘fighting a genuine battle that to announce this on 26 June, Head Office and Ophthalmology, begging for vacant needs to be fought’. However, he at Bhisho responded by demanding reasons PEPHC posts to be filled and detailing said, had they spoken to him, from three of the most senior specialists as golden staffing opportunities missed through to why they had spoken to media without administrative inaction. More importantly, the they would have learnt that he following protocols, threatening possible chiefs outline how this is having a debilitating had smoothed out the human charges. A provincial health spokesman and far-reaching effect on service delivery, resource process ‘so that we can added colourfully: ‘They’ve acted as if doctor training and staff morale. The hospital now fast-track appointments’. the department is a banana department’. complex comprises Port Elizabeth Provincial, The strong response is unlikely to lead to Dora Nginza and Livingstone hospitals. any official hearings because of an almost Their incapacity is aggravating dysfunction ‘My unwavering stance is that the welfare unanimous professional and civic outcry at the already hard-pressed network of of my patients supersedes my obligation 720 September 2012, Vol. 102, No. 9 SAMJ Izindaba to obey the instructions of my employer He said the PEPHC had just over 240 for the entire PEPHC after one who had as I am committed to the ethics and doctors to service about 1 100 ‘viable’ patient travelled from Frere Hospital in East London morality of my profession and conscience,’ beds, but emphasised that this included some went unpaid for seven months and stopped he said. In a flood of letters to their 90 interns and 20 community service officers coming. A replacement identified and given superiors from 20 to 22 June this year, the (Comserves) undergoing training. ‘Nearly all appointment papers for 1 July was told the departmental chiefs complain about how the Comserves are being taken out and put post was frozen after he arrived for work. disgruntled applicants, many of them ideal into the countryside (district hospitals and Once the controversy broke, a briefing for posts, take jobs elsewhere after waiting clinics). We have to deal with all the resulting by Sats Pillay and his colleagues of the for months to hear from head office in complications as they struggle on mostly provincial parliamentary health portfolio Bhisho. Pepeta (at Dora Nginza Hospital) unsupervised,’ he added. ‘The authorities’ committee and various community leaders writes that he lost five medical officers assertion that we have too many doctors resulted in ‘wide eyes and dropped jaws’, Sats from January to July this year yet has seen in the complex is thus wrong,’ he added. Pillay added. ‘The administration obviously no replacements, while a specialist who His DG, Siva Pillay, immediately took issue, does not have any concept of what a tertiary applied in April (without reply) had since saying there were actually 312 doctors plus 41 service or teaching hospital is or what taken up a post at Chris Hani Baragwanath sessional doctors for 1 300 beds in the three staffing levels should be – we have single- Hospital in Gauteng. Pepeta baldly states PE hospitals. He juxtaposed this with the 97 consultant departments as exemplified by under the cross-heading Resolution: ‘A s doctors for the surrounding Cacadu region Urology, Paediatric Surgery, Plastic Surgery, from July 1st (2012), our department will (the sprawling mainly rural area west of Port Oncology, Neurosurgery, Nephrology not be able to provide after hour services Elizabeth) which had 17 (district) hospitals and Medicine. Neurosurgery is one of the (emergency services) on certain days. and 1 600 beds, explaining: ‘We have a target busiest sub-specialty departments and is Outpatient services, including specialist to fill the positions at district hospitals first. being run by a retired specialist with help clinic services, will be reduced as priority Yes, PEPHC is short-staffed but they’ve been from a Johannesburg-based consultant who will be given to very sick inpatients.’ in worse situations and it’s not as grave as operates here once a week – and who has not they present it. They must re-orientate their been paid for the past six months. business. There are even less doctors in East Dr Gerda Wahl, Head of Neurology at the London (than in PE) – for more beds!’ PE Provincial Hospital, is the last consultant Dr Sats Pillay (no relation), said the much- standing in her department. She’s supported touted and heavily equipped acute ‘trauma by a registrar rotating from Internal Medicine unit’ in his department, set up for the Fifa and writes to her superior that she’s been on World Cup and subsequently converted into call every other day and every other weekend an ‘acute surgical unit’ – the first of its kind for the past two months. ‘What’s more is that in the country – had deteriorated into a I do not have time to teach these registrars ‘glorified casualty unit since they took all and feel that the training does not fulfil the the staff away in January’. Again, Siva Pillay standards set by the HPCSA for registrars. labelled this ‘a misrepresentation’. ‘They The two of us see the same number of patients could have formed a team and converted it at my neurology clinic as what is seen at other into a training school for trauma specialists, state institutions by between three consultants thus qualifying for a national treasury and four other registrars. Honestly, you can in-service training grant, but they messed it see the strain we are under to help our up, creating a problem,’ he countered. patients. I basically do the job of an intern, medical officer and consultant.’ Wahl says the academic programme has collapsed and Patients were waiting for up regular meetings with Internal Medicine, to a month to have a fractured Neurosurgery, Radiology and Psychiatry have ankle fixed, a year for a had to give way to service delivery. Clinics prostate operation or elective lasted too long to attend any meeting and paediatric surgery while no intern training was non-existent.