An exclusive, weeks-long BBC investigation inside filthy hospitals in South Africa has exposed an extraordinary array of systemic failures showing how exhausted doctors and nurses are overwhelmed with Covid-19 patients and a health service near collapse.
With key staff on strike or sick with coronavirus in the Eastern Cape province, nurses are forced to act as cleaners, surgeons are washing their own hospital laundry and there are alarming reports of unborn babies dying in over-crowded and understaffed maternity wards.
As doctors, unions and management fight over scarce resources, one senior doctor described the situation as “an epic failure of a deeply corrupt system”, while another spoke of “institutional burn-out… a sense of chronic exploitation, the department of health essentially bankrupt, and a system on its knees with no strategic management”.
The revelations come just as South Africa – which held the coronavirus back for months with an early, tough, and economically devastating lockdown – now sees infection rates soar nationwide, prompting President Cyril Ramaphosa to warn that “the storm is upon us”.
Fear and fatigue
The health crisis, focused on the city of Port Elizabeth, raises fundamental questions about how those extra months were used, or wasted, by officials.
“There’s a huge amount of fear, and of mental and emotional fatigue. We were working with a skeleton staff even before Covid-19 and now we’re down another 30%,” said Dr John Black.
“Services are starting to crumble under the strain. Covid has opened up all the chronic cracks in the system. It’s creating a lot of conflict,” he said, confirming reports that patients had been “fighting for oxygen” supplies in a ward at Livingstone Hospital in Port Elizabeth.
Dr Black – one of only two infectious disease specialists in a province with a population of about seven million – was the only doctor in Port Elizabeth who agreed to talk to us on the record, but a dozen nurses and doctors spoke on condition of anonymity, fearing they would lose their jobs if they were identified.
Rats feeding on red waste
At Livingstone Hospital – designated as the main Covid-19 hospital in the district – doctors and nurses described scenes “like a war situation” with blood and waste on the floors, a lack of Personal Protective Equipment (PPE), oxygen shortages, a severe shortage of ambulances, no ventilation and patients sleeping “under newspaper”.
Rats have also been spotted feeding on dark red hospital waste pouring into an open drain.
“Doctors scrabbled to do the most urgent of surgeries, portering, scrubbing the floors, working with one or two remaining nursing staff. Matrons were washing linen,” one doctor wrote by email.
“Every day I come to work in fear,” said a senior nurse who had just finished her shift.
“The [infection] numbers are going up. Every day we’ve got chaos. There are a lot of pregnant women all over the wards,” said another nurse.
‘Mothers and babies dying’
Several doctors said staff had been left deeply traumatised by a recent episode where a maternity ward at Port Elizabeth’s Dora Nginza Hospital became so overwhelmed that several mothers and infants died.
“I was personally involved in the delivery of two dead infants and know there were more. This is very unusual. To have several mummies and babies dying in one week in one hospital is totally unheard of and unacceptable,” said one medic.
They were convinced the deaths were almost certainly the result of severe understaffing, which left many pregnant women waiting for days, sometimes lying in corridors, for urgent surgery.
Three other medical officials with knowledge of the relevant wards confirmed the reports of an unusual number of stillborn infants in recent weeks.
The sense of a deepening crisis has been compounded by a lack of proper management, which has seen departments turning on each other, and using Covid-19 as an “opportunity to air every grievance that ever happened”, according to one official.
Livingstone Hospital has been without a permanent chief executive officer or management team for a year and a half, after the last team was sacked for alleged corruption.
“We’ve been rudderless for some time now,” said Dr Black bemoaning the lack of “strong leadership” to stabilise escalating conflicts between different departments at the hospital, and, in particular, with local unions.
South Africa’s powerful unions have been extremely active in Port Elizabeth during the crisis. Laundry workers, cleaning staff, porters and some nurses have all – at various times – gone on strike.
The sudden, union-backed, closure of smaller clinics, in particular, has pushed more patients towards the city’s three big hospitals, quickly overloading them.
“We have seen unions shut down hospital after hospital. Each time one staff member or patient tests positive, all staff down tools. While all these union demands are being met, nothing happens… for up to two weeks,” one doctor complained.
‘We cannot risk nurses’ lives’
Union officials have vigorously defended their members’ actions.
“It’s not true at all that we’re exploiting the situation,” said Khaya Sodidi, provincial secretary of the nurses’ union, the Democratic Nurses Organisation of South Africa.
“Our nurses are overwhelmed, having to clean floors or cook because kitchen staff are not working. We cannot risk the lives or nurses. They’re human beings.”