The crisis in state health services in Nelson Mandela Bay was amplified today in a long and detailed statement endorsed by all 30 specialists in the PE Hospital Complex.
Their statement today comes in the wake of the announcement yesterday of the resignations of three heads of department who quit out of frustation at the state of affairs in state health institutions.
Read the full statement below.
12 December 2012
MEDIA STATEMENT ISSUED BY SPECIALISTS WORKING IN THE PORT ELIZABETH HEALTH COMPLEX HOSPITALS - statement endorsed by all 30 specialists.
Re: COLLAPSE OF TERTIARY HEALTH SERVICES
As concerned specialists we held a media conference in June this year in order to inform the public regarding the severe staff shortages in the PEHC. Although there was huge public outcry and support from various civil societies, it has not lead to any improvement in the situation.
If anything matters have deteriorated and the situation is unlikely to improve in the immediate future. Furthermore, recent developments have led to a further deterioration in the current staffing of our departments and a critical staffing shortage for all clinical departments can is anticipated as from 1 January 2013.
The PEHC has lost at least 47 doctors during 2012 while only a handful has been appointed. No advertisements have been published and no registrars have been appointed for 2013.
However, the most immediate reason for our decision to issue this statement has been the recently-announced resignations of the HODs of the following departments: Prof. SS Pillay of General Surgery, Dr C vd Walt of Plastic surgery and the Burns unit and Dr M Kent of the Urology department. These resignations are almost entirely due to the critical staff shortages which have been ongoing since the beginning of 2012, and which show no signs of improving in the New Year.
Furthermore, the functioning of two other departments, namely Neurosurgery and Cardiology, will be seriously affected by the non-renewal of the contracts of Dr I Copley and Dr B. Brown respectively.
In the absence of a commitment from the Eastern Cape Department Of Health (ECDOH) to do so, we feel obliged to inform the general public of the possible dire consequences of this turn of events.
We feel it our duty to inform the public that there are certain, essential tertiary services that cannot be rendered effectively and believe that the ECDOH, which has done very little to avert this crisis, must take full responsibility for the increased mortality and morbidity which will inevitably flow from this catastrophic situation.
All departments are affected. Some examples include the following:
Anaesthetics:
In January the department will have lost one third of its staff in the last year. As of January 01 the department will run emergency theatres until staff has been appointed and trained which is usually about six weeks. Rural outreach has been stopped and that will lead to an increase in maternal and baby fatalities. The teaching program which has trained 10 specialist anaesthetists is in tatters. Despite numerous applications no appointments have been made as no one appears to know where the blockage is .The situation is a disaster as without anaesthetists no surgery may be performed.
Burns Unit:
The number of doctors has decreased from five to one during the course of the year. This will effectively lead to the closure of the burns unit as a referral unit. Due to this, the Unit can now only accept referrals of patients with > 20% burn wounds (15% in children) when the doctor is on duty. Previously patients with lower percentages could be accepted e.g. > 5% in children. These patients will now have to be managed in non-specialist centres.
Cardiology:
Two out of three medical officers will have left by 31 December. If no replacements are appointed then the clinic and in-patient services will have to be severely curtailed.
Cardio-thoracic Surgery
In Cardio-thoracic surgery there are only two full-time specialists and one junior doctor, who is a registrar.
The situation in the Department at the moment is as follows:
1.Calls are shared equally between Consultants and the single Registrar.
2.Consultants do both Consultant calls as well as Medical Officer calls and this applies to after-hours calls.
3.We still have to see many patients in the Thoracic Clinic as we are the only Cardio-Thoracic Unit in the Province.
4.We only have one full-time Perfusionist and cardiac operations are cancelled when she is sick or on leave.
5.A number of candidates have applied for positions in the Department and could not be appointed due to financial problems: 1 Perfusionist, 1 Registrar, 1 Medical Officer.
As of next year, we will only be able to do what we can under the current staffing situation. It is unlikely the situation will improve and this will impact on patient care and mortality. The waiting list for open heart surgery is greater than six months and getting longer. It is well over a year for paediatric cardiac patients.
Ear nose and throat service:
There has been no full time ENTspecialist in the Port Elizabeth Hospital complex for nearly 10 years. The lack of supervision has forced junior doctors to work under extreme duress which has resulted in significant morbidity to some patients - this is verified by the newspaper headlines and public outcry a few years ago when a spate of children who underwent elective tonsillectomies suffered complications. A South African surgeon working in Australia was finally enticed to accept the post in Port Elizabeth and appointed from 1st July 2012. However, on arrival, he was told that 'the post has been frozen'. He left PE in utter dismay and decided to do into private practice in Cape Town.
No major ENT surgery can now be performed in PE; emergencies have to be transferred to East London. There is a long waiting list for surgery, with patients not given dates, because it is unclear when the situation will be resolved.
Family Medicine:
The Casualty in Dora Nginza was closed the weekend of the 1st and 2nd December due to shortage of Medical Officers (8 at the beginning of the year to 4 now).
The Casualty may be closed again by the weekend 15th and 16th if the Hospital board withdraws from paying sessional doctors we struggle to get to work for us.
For the weekend of the 29th and 30th no sessional doctors available and with only one Medical Officer, the place is likely to be closed down.
If things remain this way by January,2013 the Casualty might operate during the week and alternate weekends.
General Surgery/ Acute Surgical Unit:
Following resignations and delays in appointments (leading to non-appointments), there is now no more dedicated staff in the Acute Surgical Unit and the Unit has ceased to exist (loss of 60% of non-intern staff between July 2011-July2012). Trauma cases are now seen by the same team who deals with general surgical emergencies. This has caused a 30 % drop in emergency surgery and a 10 % increase in the mortality has been documented for 2012.The public needs to take cognisance of the fact that there is now a waiting list for non-emergency surgery of over 450 cases and over 80 paediatric surgery cases.
Further to this, junior doctors in the Department of Surgery have instituted legal proceedings against the Livingstone hospital management alleging unfair labour practice. Seven out of eight medical officers have indicated that they will be resigning at the end of the year and no new applications or appointments have been forthcoming.
A crisis management plan has been drawn up by the department and the following will apply from January 2013:
1.No referrals will be automatically accepted from outlying hospitals and clinics. ALL
referrals must be discussed personally or telephonically with the Consultant on duty
2.No referrals will be accepted from Nursing Staff - all referrals must be from Medical
Practitioners to Medical Specialists
3.Surgical Out-patient Clinics (SOPD) will be severely curtailed and no walk-in patients will be accepted. With projected staffing levels, only 10 new patients may be booked per day.
4.All patients requiring surgery will have their operations prioritised as Emergency, Urgent or Elective. Patients requiring elective surgery will be dealt with on a first come basis - the current waiting list for elective surgery reflects nearly 500 patients
Haematology Unit
The Eastern Cape DOH has boasted extensively in the media with the opening of this Unit- however it is standing unused because no nurses could be appointed to staff it. No further stem cell transplants could be performed.
Intensive Care Unit:
As the situation stands currently, there will be no junior staff in ICU for January. Unless appointments and transfers are confirmed in the next few days, the adult Department of Critical Care will have to close on the second of January.
Medicine:
As a result of severe staff shortages and with effect from January 2013 the following measures will be put in place:
1.The physician on call will only see emergency referrals from outlying hospitals and clinics. All referrals must be discussed with the consultant on duty.
2.No patients will be accepted unless referred by the appropriate level 1 hospital. No referrals from general practitioners or nursing staff will be directly accepted.
3.Patients for CT scans will have to be accompanied by the referring doctor to give contrast.
4.Medical outpatients (MOPD) will close down. Patients admitted in hospital will have follow up dates at MOPD.
5.Patients on medication that require scripts from specialists will get 6 monthly scripts with detailed plans.
6.All non emergency outpatient cases will have to be booked with the consultant on call and seen at their discretion. No specific new patient bookings will be made by booking office.
Neurosurgery:
Following the resignation of one of the two neurosurgeons, there are now 60 patients with neuro-spinal conditions waiting for surgery. Many of these patients are in pain. At least three cases of brain aneurysms are awaiting surgery. Referral centres outside the province have their own waiting lists and largely unable to accommodate these cases. There is a risk of brain bleeding in delaying this kind of surgery.
There are only two junior doctors in this Department and one is leaving at the end of this year. As it is, they also do 24 hour emergency call s for general surgery, leaving the ward patients on theatre days in the hands of one intern.
Obstetrics and Gynaecology:
There are only 3 specialist consultants for the Nelson Mandela and Cacadu districts. Three medical officers have left. As a result the gynaecological outpatient clinic and the ante-natal clinic can only see 20 patients each daily. Another consequence of this is that as from 19 December there will be no after-hours cover in the department. There will also not be any doctors to do ward rounds and to discharge patients over weekends. The perinatal and maternal mortality has increased and will continue to increase under these circumstances.
Ophthalmology:
Due to a loss of junior doctors and possible curtailed anaesthetic services the following eye services will be affected:
1.Possible cancelation/postponement of Outreach cataract projects to the district.
2.All screening projects including retinopathy of Prematurity and diabetic eye disease screening may be hampered.
3.Possible delay or cancellation of vitreo-retinal surgery and other routine eye surgery requiring general anaesthesia.
Orthopaedic surgery:
There has been a decrease in available theatre time to perform operations (due to theatre staff shortages). Surgical waiting times for some "major" traumatic injuries such as broken hips, broken legs etc. can be up to two weeks, "minor" traumatic injuries (e.g. broken ankles, broken forearms) can be up to four weeks. The service to provide 'major" non-emergency surgery such as hip replacements, knee replacements, etc., is grinding to a halt.
Most patients with "minor" non-emergency conditions such as shoulder rotator cuff pathology, shoulder instability, knee cartilage or meniscal pathology, carpel tunnel syndrome, bunions etc. cannot be helped at all. Most non-emergency paediatric patients that require surgery have to be referred to Cape Town.
Paediatrics:
As from January 2013 the department will be 6 Medical Officers short. This means the last 11 days of January will have no Medical Officer cover if we maintain two Medical Officers on-per-call system.
Alternatively, the department will have one Medical Officer on-call. The six-bedded Neonatal ICU will be closed and three beds will be reserved for new-borns in PICU, thus reducing the number of PICU beds to 3. The number of beds in the Premature (Prem) Unit will be reduced to 40. No Prem referrals will be accepted from surrounding district hospitals (Humansdorp, Settlers, Port Alfred, etc.). Only referrals from MOU's will be accepted.
The shocking mortality statistics set about below tell their own story!
The Perinatal Mortality Rate has risen for the month of October to a soaring 165.8, neonatal mortality rate 132.8 per 1000. The under one year old mortality rate for October was 199 per 1000, whilst the under-five was 164 per 1000!!!! Earlier requests for Paediatric and Neonatal High Care beds, and an increase in the number of NICU and PICU beds were unsuccessful. Shortage of staff forces us to rather cut the number of these beds as indicated above.
Perinatal Mortality Rates (Per Thousand)
2010 62.4
2011 63.9
October 2012 165.8
Neonatal Mortality Rates (Per Thousand)
2010 33.5
2011 33.5
October 2012 132.8
Under 1yr Mortality Rates
2010 52
2011 55
October 2012 199
Under 5yr Mortality Rates
2010 39
2011 72
October 2012 164
The waiting numbers for congenital heart surgery now sit at about 100, with dates in early December 2013!
Psychiatry:
From mid-March 2012 the Mental Health Unit has been operating minus 2 doctors. Per month around 50 vulnerable children, with serious mental health problems, are now left without a service.
In addition, outreach to four clinics in the Nelson Mandela Metro has had to be stopped. This has meant that 38 895 psychiatric patients serviced by the clinics have been deprived of early and specialist intervention to help manage their conditions in the community. This clearly will have a long term impact on successful outpatient management of all the affected patients and will ultimately affect admission rates.
Lastly, there are only two middle tier doctors for providing psychiatric on-call services after hours. This means each doctor is always either on call or post call, a situation which can easily lead to mistakes associated with such a demanding stressful schedule. Recently the doctor on-call had to deal with nine admissions after hours.
Radiation Oncology:
As the result of inadequate numbers of staff to deal with the workload, services will have to be curtailed as follows:
1.Longer intervals for follow-up visits.
2.New referrals which presently are seen within 7 working days will be placed on waiting lists.
3.Outreach visits to Grahamstown and Humansdorp will be stopped.
4.The waiting list for radiation remains at 40-60 patients- some up to three months.
Urology:
Due to resignations and non-appointment of interested applicants, there are now days where there is NO urologist on call at all. The current staff cannot take leave without completely collapsing the service. The last remaining medical officer will probably resign if additional medical officers are not appointed from 1 January.
As matters stand at the moment there is a one year waiting list for non-urgent surgery, and a one year waiting list for OPD appointments.
