Daily Maverick
columnist and Western Cape Premier Helen Zille’s articles (I’m often not sure
which role comes first) is always food for thought and a chuckle. While her army of supporters agree with what
she says with fulsome praise, I often find her self-righteousness and
know-it-all hubris – her Delphic-like pronouncements – nauseating, to say the
least.
When Daily
Maverick still had comments, I regularly criticised her centrist, DA navel-gazing
arguments and opinions, e.g., her oft-stated view that auditor-general audits
of government are hindering service delivery (and here). When I said she was misinformed, she replied I didn’t “understand”
government audits (I was once a contracted AG auditor, and said so). On a different occasion, she said I was always
“insulting and personal” when I pointed out inconsistencies.
It’s a pity they
discontinued comments (but soon to be reinstated, they promise) because I’d
have robustly responded to her article about her administration’s efforts to prevent a Life Esidimeni-type
situation, which I do here.
While I’ve little
doubt that, bar political boasting and one-upmanship (to the ANC), she means
what she says in this case because it’s at the forefront of the public’s mind,
Life Esidimeni is symptomatic of a wider problem within the public health
system including the Western Cape. The allegedly well-run and well-resourced
province is not isolated from the national malaise. Naturally, Zille focuses on what she’s doing on one aspect only. But what of
the little reported cases elsewhere, not necessarily in mental health, where
the system is either failing or has serious problems?
In one article Zille boasted of compliments she’s
received for province’s health service – “I hear affirming accounts
of the quality of our public health service, from middle class and wealthy
families too”. Predictably, she focuses only on nice
things but ignores the bad.
In 2012 the then
head of Eerste River Hospital’s trauma unit Dr Errol Visser was fired after he
reported poor conditions where “patients slept on the floor”, after the department failed to address
matters. The then head of the Western
Cape Health Department, Prof. Craig Househam, claimed he was fired because he
was improperly hired. But the CCMA vindicated Visser saying his dismissal was
“substantively and procedurally unfair”.
At the time, the
department’s spokesperson complained Cape Argus, which broke the story and
obtained patient and unnamed staff corroboration, was conducting a vindictive “campaign”
and Visser’s allegations were untrue. In
an exchange of emails I had with her, she was initially combative and dismissive,
but conceded there were problems when I persisted with questions they couldn’t
answer, e.g., why the area manager and departmental oversight system (see here where Zille writes of problems in the education department) – the
kind Zille speaks of now – failed then, and I’m sure before and since.
So, what Zille
says now about improving healthcare systems must be taken with a degree of
scepticism.
As I commented (reprinted
below with minor edits) to this article by Mark Sonderup, associate professor at UCT Medical School and
Groote Schuur Hospital, Life Esidimeni is relevant beyond the treatment of the
mentally ill. It’s indicative of broader problems in the
public health service
throughout the country. The denials, lies, evasion, and negligence of the
Gauteng Government’s and the Health Department’s politicians, bureaucrats and doctors is not singular to that province, but
across the country, including in supposedly well-resourced and well-run Western
Cape.
But
we don’t hear of those cases and the media doesn’t report on them. Except for
activists and families who knew, the public only heard about Esidimeni, and the
outrage went into overdrive, after over 140 people died. Why not after the
first person?
While
many patients receive reasonable treatment in the public health system, many do
not. Often, at best, even tertiary care is like a fast food restaurant. At
worst, patients go there to die. That includes Western Cape hospitals like
Groote Schuur.
Five
months ago I went to Groote Schuur’s emergency room after a frightening and
severe episode. After 18 hours, during which tests were done, the senior doctor
deduced my condition, dismissing the junior doctor’s suggestion of a
specialist consult, i.e., her diagnosis wasn’t confirmed. But the condition
persisted. Last month I went to a private specialist who said GSH’s doctors
“assumed” the diagnosis, i.e., they didn’t conduct a proper examination and
diagnose the underlying, at times almost debilitating, chronic condition. It
requires ongoing management with a (private) specialist and my GP.
That’s
what I mean by the public health system’s fast food-type medical care –
hurried, slap-dash, indifferent, unapologetic, impolite, lacking finesse and no
attempt to treat deep, underlying causes. Rather, their attitude is “fix ‘em up
and get them out of here – get the beds turned over as quickly as possible”.
In
July 2017 my mother died at Groote Schuur Hospital of “unnatural causes”. Similar
to Esidimeni, there was stonewalling, denials and evasions up the chain from
the treating department’s director, to hospital chief executive, to the head of
the health department Dr Beth Engelbrecht and finally, Helen Zille (her lauded health
MEC, Dr Nomafrench Mbombo, was silent during all this). Engelbrecht and Zille promised
to investigate but then cancelled their “independent” investigations for
spurious reasons.
Before
this dead-end, after they initially refused to give us a written report, the
hospital’s chief executive’s superficial investigation and one-page report was
aimed more at absolving the treating doctors and hospital than fully addressing
the real – not imagined, as they tried to get us to think; according to their
insulting insinuation, we weren’t “objective” – lapses in care.
This
week, in a scenario like from the film Three Billboards outside Ebbing, Missouri, I wrote to the Director of Public
Prosecutions of Cape Town, Adv. Rodney de Kock, to ask why, after almost nine
months, there has been no inquest or arrests. Like the film, the black comedy
of official – hospital, health department, ministerial, police and
prosecutorial – ineptitude and indifference is real.
The
scary anecdotes I’ve heard about Cape Town’s public hospitals, particularly,
Groote Schuur, show problems are not isolated, or only to “badly run”
provinces. We’re just not hearing about them because the individual tragic
stories are not deemed topical and newsworthy. And even when they sometimes
make a blip in the media, they’re immediately forgotten, replaced by the next
hot but superficial news item.
In
the South African Health Review 2016 survey, under the section “public
health users satisfied with the service” for 2014 (p297), an overall indicator
of the effectiveness and efficiency of the service from users’ perspective, the
Western Cape scored third lowest with 52.8%, just above Gauteng (51.8%), and beaten
by the Eastern Cape (62.1%) and Limpopo (68.0%), for example. The national average was 57.1%.
While
in some indicators it scores higher than other provinces, in others,
lower. This refutes the commonly held
view that health and other services in the Western Cape, and specifically under
Zille’s administration, are better. It’s
why, taking into account the Eerste River Hospital experience, her claim
Esidimeni or other public health-related tragedies cannot and will not be repeated
in the province is false at worst and overoptimistic at best.
In
this article Zille unequivocally stated “in
the Western Cape, we have prevented the problem of precariousness by seeking
the best available fit at the top (provincial ministers and their departmental
heads)”. In another she wrote that including in her administration there
is “the inevitable tendency in bureaucracies for officials either to actively
protect one another or at least to give each other the benefit of the doubt,
especially when their union endorses slogans such as ‘an injury to one is an
injury to all’”.
This is the facile and specious, and contradictory, bluster I
mentioned at the beginning that often imbues Zille’s writings. She speaks without self-irony of government
including her administration’s employees’ “inevitable tendency to actively
protect one another” but claims the best available ethical and professional fit in staff appointments. She says problems occur lower down the management
chain, i.e., she conveniently isolates the executive from their failures, which
generally, Gauteng’s politicians and managers did in the Esidimeni case.
This is the solipsistic, arrogant and unsympathetic attitude that
contributed to Esidimeni, Eerste River Hospital, my mother’s and many other
cases – of complaints of poor and negligent care throughout the public service falling
on deaf ears. Complaints are shunted
from pillar to post, and in the end investigations, sometimes after being
promised, denied for made-up reasons – in our case, by the head of health
department and Zille herself.
With impunity they violate and repudiate the spirit and letter of
the National Health Act, which inter alia speaks of “protecting, respecting, promoting
and fulfilling the [constitutional] rights” of healthcare
users and that providers are obliged to investigate complaints, and the Promotion
of Administrative Justice Act. And be damned the National Patients’ Rights Charter and Batho
Pele.
While retired Justice Dikgang
Moseneke’s findings was a red-letter day for the victims, families and Gauteng
Health Department, the hope it will make a difference to the overall quality
of healthcare in
the country is going to be short-lived, weighed down by usual official
indifference and lies about real change.
The
justice those families obtained is uncommon, and then only because of the
severity of the case – 140 dead. While
one death for no reason is already one too many, it simply doesn’t register in
the official mind. As Zille said, their (politicians
and bureaucrats) priority is to protect themselves, never mind if it’s at the
cost to the healthcare (and public service) user’s constitutionally protected
physical and psychological integrity.
Politicians should not be raking over the ghosts of Esidimeni’s
dead in order to make political capital, and many sanctimoniously are. As for Zille’s article, she frequently writes
and speaks with a conviction and sincerity she doesn’t hold in private, away
from the media spotlight. I doubt we should read too into much what she says now.
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