An open letter from 73 doctors in the North West on the ongoing health crisis in the province

Currently there is a crisis in the provision of health care in the North West Province. This is a result of action taken by various groups who are angered by chronically unresolved issues which resulted in violence and closure of health care facilities.

The crisis that began in the health sector has rapidly spread including calls for the resignation of the Premier. Some of the violence has led to opportunistic attacks on innocent individuals and private businesses particularly foreign owned. These issues have gone beyond health care issues.

Issues that have ignited the crisis include:

• Alleged corruption
• Freezing of posts despite resignations/retirements.
• Shortages of skilled personnel and support staff within the sector.
• PMDS challenges that are unresolved.
• Non-payment of service providers resulting in shortages of medications, surgical sundries, interruption and lack of telephones and poor internet access.
• Demands for resignation of HOD who has been implicated in alleged corrupt activities
• Outsourcing of services by department.

Actions taken by striking employees include:

• Main medical store closure such that institutions are unable to procure medication and surgical sundries. This resulted in shortages of medications and surgical sundries compromising patient care.
• Closure of clinics/hospitals particularly Lehurutshe/Zeerust, Mahikeng and surrounding areas-These communities cannot access preventative, obstetric, both acute and chronic surgical/medical care. Ironically these actions are committed by individuals, some of whom are likely to have access to private health care via medical aids and are unlikely to be personally affected by their action.
• Intimidation of caregivers by striking individuals who were threatened and intimidated with physical violence and forced to leave patients unattended.
• Issues beyond health care which include demands for resignation of Premier of the NWP complicating resolution of crises in health.

These actions lead to the compromise of all aspects of health provision and patient care with associated increases in illness profile and death of patients:

• Suboptimal management of pregnancies resulting in poor outcomes.
• Surgical emergencies not timeously attended to, particularly trauma, burns and motor vehicle accidents.
• Risks for patients suffering from tuberculosis and development of multidrug resistant TB –  thus risking the community at large.
• Risks for patients with HIV and development of Multi drug resistant HIV making treatment more complicated and costly in an already expensive health care service sector.
• Chronic diseases not appropriately treated causing complications like strokes, heart failure and diabetic emergencies leading to poor outcomes including death.
• Many psychiatric patients not treated, which may make Esidimeni numbers look insignificant.

Who is affected?

• Poor/ homeless.
• Disadvantaged.
• Disabled/vulnerable.
• Those with lack of access to private care.
• Those with chronic illnesses that include HIV, TB, Hypertension, diabetes, psychiatric disorders, etc.

As caregivers, we have been silent for too long. We have taken an oath to “do no harm” and in our silence, we have contributed to harm. This cannot go on as we are concerned about methods used which include closure of health care facilities that affect the health of our society. Of note provision of health care is an entrenched Constitutional right in South Africa.

The grievances of the striking employees are valid and supported, however the modus operandi is condemned, particularly the shutting down of health service provision.

We urge the following:

1. The immediate reopening of health care facilities including main medical stores.
2. Government, all political parties, labour movements, civil society groupings, faith based organisations, health care worker movements and the community in general become more vocal about rejecting corruption with denunciation of current methods used by striking workers.
3. National Department of Health to ensure that both patients and care givers are supported and provided security when seeking and delivering services.
4. That immediate and urgent negotiations be held on issues that precipitated this crisis and all attempts be made to ensure adequate service delivery including unfreezing of posts, employing adequate number of qualified staff, payment of outstanding bills to food suppliers, Telkom, NHLS, pharmaceuticals and other issues are addressed.
5. Currently and in the future action taken by striking employees does not affect communities already dispossessed and disadvantaged — and government together with communities actively prevent closure of essential services with any strike action.
6. Medical equipment together with diagnostic services including radiological, laboratory and specialist services be made available to appropriate levels of care.
7. Insourcing of core services be addressed
8. Proactive steps to be taken by government and its relevant departments to avoid such situations in future.

This document is a result of our commitment to serving patients and their communities, noting that the denial of health care is unconstitutional. Hopefully the issues that precipitated this crisis are resolved immediately without further harm to our patients.

Doctors who support this letter and request urgent action be taken include:

D Leburu, E Variava, M Dikhing, B Luke, A Calver, A Daude, A Mallier, T Makotsvana, C Das, O Mekgoe, S Gerber, A Thaivalappil, E Verster, C Chiwara, I Sebogodi, T Rangaka, NC Ngene, S Nair, M Dikgang, M Nong, T Ledibane, GD Kegakilwe, S De Villiers, H Ferreira, P Naran, D J Lamptrecht, N Sabet, W Urban, S Mosam, N Mfuta, P Sharma, SP Dlamini, P Kyei, H Van Niekerk, S Makhate, I Motala, P Mentoro, PM Ntila, KN Masuku,OS Leburu, R Minty, JK Mentor, LF Keogotsitse, S Masala, SLK PItso, KC Tsele, O Mahloko, M Mokhajoa, TS Bogatsu, Z Esterhuizen,IO Kingsley, KN Holonga, NS Maitin, JMM Shakung, LC Nthutang, R Moorad, N Mphothulo, BP Moncho, I Wana, V Titus, D Sauer, L Khatle, H Huan, ZS Lubiki,T Swiel, L Marapo, C Lion-Cachet, P Juggernath, Manwana, D Masudubele, K Pillay, C Wu, TNC April