Source: Daily Maverick
By Estelle Ellis• 1 July 2020
Admitting that the province’s health system has been overwhelmed, Eastern Cape Premier Oscar Mabuyane asked the President on 30 June to deploy the South African Military Health Services to help. Gift of the Givers has also stepped in to assist the beleaguered province.
Humanitarian organisation Gift of the Givers has offered the Eastern Cape provincial government the use of two of its ambulances to supplement the fleet in Nelson Mandela Bay and have deployed another six nurses to assist with testing one of the province’s outbreak hotspots, with founder Dr Imtiaz Sooliman adding that they are engaging with authorities to see where they can help. This comes as the Department of Health admitted that several patients in Nelson Mandela Bay and East London were abandoned by healthcare workers who refused to work.
The Eastern Cape Department of Health has admitted that the few doctors and nurses who were working at the province’s maternity hospitals as huge numbers of healthcare workers stayed away, were in quarantine or were ill, were forced “to play God” and decide which patients to help.
The admission came as Premier Oscar Mabuyane asked President Cyril Ramaphosa on Tuesday, 30 June to deploy the South African Military Health Services of the South African National Defence Force in the province, saying that the health system has become “overwhelmed” by the pandemic.
Their admission comes as Gift of the Givers’ Sooliman said he believed that supporting and protecting health workers would be key to preventing a disaster in the province.
Mabuyane said 26,195 people in the province have tested positive for the coronavirus and so far 397 have died with the number of deaths increasing in six of the eight districts.
“The number of recoveries also continue to increase but are confounded by the rapid increase of cases which were reported since the beginning of June.
“As the community transmission rate increases, fatality cases also increase in our province. In the provincial government we have also lost our colleagues, brothers, sisters and friends to this virus and many of them worked in the frontline services providing essential services. They include 24 health workers who succumbed to this virus. We remain indebted to them and their families for their selfless sacrifices and unwavering commitment to their calling. We remain hopeful that the healthcare workers working in public and private healthcare centres who tested positive for coronavirus will recover from the virus soon …Without their dedication and commitment, we would be in a far worse situation.”
He said the Department of Health had to pay R2.5 billion in cumulative payments for legal claims and this money was diverted from its budget.
“This situation led to some payments to service providers being delayed as these funds were diverted to pay medico legal claims. As the provincial government we are implementing
“In order to sustain itself financially, the department has received R6.4-billion in additional funds to increase provision of healthcare. In the 2019/20 financial year for an example, R1.4-billion was additionally allocated to the department.
“All of us must work together to protect our health system from collapsing. This we must do so that the health system is capable of providing quality healthcare to the people of our province. We must prevent the infections by adhering to the regulations of the national lockdown.”
Sooliman announced on Tuesday that his organisation will also send six nurses to assist with testing in the Nelson Mandela Bay metro.
“Gift of the Givers has supported many facilities in the Eastern Cape with personal protective equipment and will be engaging the authorities to optimise additional support as best we can. We will be supplying huge quantities of PPE’S, having delivered supplies to Livingstone and Uitenhage Hospital last week. Immediately, we can assist Port Elizabeth with two of our ambulances to improve capacity.
“The key element that will ensure a successful response to the outbreak in the province is the availability, commitment and dedication of health care workers, be it doctors, nurses or general assistants.
“That commitment is greatly enhanced when healthcare workers understand that they are appreciated and their safety is paramount to health authorities. They are acutely aware of the increased risk to them and their families yet they are prepared to engage. That risk taking has to be reciprocated with total support from the authorities. This includes unrestricted and unlimited supply of quality personal protective equipment (PPE’s), hygiene and thorough, regular sanitation of affected health facilities, providing abundant back up staff for overworked personnel and sufficiently reducing call duty to prevent burnout.
“If this approach is utilised, most, if not all, healthcare workers will willingly stay on the front line. Without this step everything else will be a dismal failure,” Sooliman added.
He said point-of-care PCR Covid-19 testing machines on site can provide quick results and enable accurate triaging of patients. “Machines and kits are readily available for this purpose, and will substantially reduce turnover time and free beds much faster.”
“Gift of the Givers has implemented this at Chris Hani Baragwanath Hospital (in Gauteng). The medical personnel are raving about its success,” Sooliman said.
“Pulse oximeters are the next frontline devices required. They can detect levels of oxygen saturation and a decision can be made for early oxygen intervention which, in most cases, is life saving. We have delivered 300 of these devices and another 300 are expected soon. Oxygen intervention requires adequate numbers of in-patient beds, high flow oxygen machines (which for now have a far higher success rate then ventilators), and auxiliary staff trained to monitor these machines.
“Medical students and paramedics could easily be trained to play that role in this situation. Additional beds could be purchased and set up in existing hospitals, within the building itself. In the worse-case scenario, tents could be introduced, however, the winter cold is a hugely limiting factor.
“Gift of the Givers already have 25 high-flow oxygen machines and 50 more on order.”
Sooliman added that healthcare workers taking care of non-Covid-19 patients do require the same level of acknowledgement ensuring that linen, disposable items, necessary medication, hygiene and sanitation, back-up staff, are all in place. “Once anxiety is allayed, functionality will improve significantly.”
In cases where there is a shortage of ambulances, these could be loaned from health facilities that are not in the “hot spot” and have had no real challenge.
“If these challenges are adequately addressed then there is no reason for the crisis we are witnessing at various health facilities. We need to be decisive and immediate in our implementation,” Sooliman said.
Eastern Cape Health Department spokesperson, Sizwe Kupelo said that they will now start to report any healthcare worker who stays away from work without good cause for abandoning their patients.
“Health professionals who have abandoned patients at maternity wards at Dora Nginza Hospital in Port Elizabeth and Frere Hospital in East London, are also condemned. No matter the grievances, abandoning patients can never be condoned. This placed expecting mothers and their unborn babies in grave danger. One doctor each at the respective wards at the two hospitals were left having to play God as they were left on their own.
“While their grievances are being addressed including deploying more staff to ease the pressure on them, abandoning patients is unacceptable as health professionals have taken oaths.
“The Eastern Cape Department of Health will speak to the national department regarding urgently finalising the regulation around closure of health facilities and will also be reporting the abandoning of patients to relevant professionals councils.”
The policy Kupelo refers to is the rule being enforced by unions that workers are allowed to stay away from workspaces where colleagues worked who tested positive for the virus. This has led to the shutdown of many clinics and hospital wards in the two metros that are the hotspots for coronavirus infections in the Eastern Cape at the moment.
Mabuyane said the provincial Department of Health would provide additional nurses and general staff for Uitenhage Provincial Hospital and Motherwell Day Hospital’s maternity services.
“The provincial department is acutely aware of the impact of staff who test positive and in response to this challenge, the provincial Department of Health has published an advert aimed at recruiting doctors and nurses,” he added.
A demure MEC for Health, Sindiswa Gomba, in a short speech during the provincial joint operations committee’s update said the condition of our hospitals was not designed to stand the force of Covid-19.
She said as many hospitals were not able to provide oxygen to patients struggling to breathe, they have asked for urgent construction work to be done to increase the number of facilities where patients can receive this therapy.
“While we all understand that Covid has come to find us in this situation – but it has not taken away the work we have done,” she added.
Gomba thanked many donors of personal protective equipment
“We have deployed senior staff to districts to strengthen the district health systems. We have deployed 7,000 people that can deal with Covid-19,” she said.
The superintendent-general of the Eastern Cape Department of Health, Thobile Mbengashe, said their latest models show that they will need 10,000 hospital beds and 3,000 ICU beds at the height of the peak.
“What we have done up to now is to design and plan … We are building eight additional field hospitals. We are re-engineering other hospitals – the way we are approaching this we will have sufficient capacity,” he said.
“We are in danger with the number of ICU beds. But we have a better system now to understand what must be done and that we must get oxygen early to our patients,” he said.
“No country can adequately prepare. There was not much we could do to prevent it,” Mbengashe said. DM/MC