Healthcare workers struggle to cope in Mpumalanga, where a spike in Covid-19 infections and a shortage of beds in public and private hospitals have put clinic and hospital staff under immense pressure.
Like those in other provinces trying to manage the second wave of the pandemic, healthcare workers are battling fatigue, a dearth of staff – many have died of the virus or are in quarantine – inadequate personal protective equipment (PPE) and financial woes brought on by a freeze on salary increases in 2019 and a lack of danger pay.
According to nursing unions and healthcare personnel, the workers hardest hit by Covid-19 are nurses and other essential support staff in the frontline healthcare sector, especially in clinics. “They say I must wear an apron and a mask, but I don’t know if the patients I am attending are positive or negative,” says one of the nurses at Beatty Clinic in Emalahleni. “When you transfer them to the hospital, they test positive. As the first contact person, was I protected?”
Unlike workers in hospitals who are somewhat resourced with protective gear, most nurses and support staff in clinics do not have proper PPE, despite attending patients with unknown Covid-19 results.
At Beatty Clinic, the nurse explains that they see between 150 and 200 patients a day. There are seven nurses at the clinic. Two are on leave and one is dedicated to attending patients with Covid-19 symptoms. “We see around 15 people per day … with Covid-19 symptoms,” explains the nurse.
Three auxiliary nurses are responsible for checking vital signs such as blood pressure and temperature. Currently, one of them is on leave. Auxiliary nurses are often only given non-medical masks and sometimes disposable aprons and face shields.
The nurse adds, “[Recently], there were 11 patients presenting with Covid-19 signs, and last week, it was more than nine. We are not safe in Mpumalanga, and people are dying. What makes us a hotspot are the mines. People come from different parts of the country and most of them are working in the mines.”
Support staff at risk
Covid-19 infections are rampant among cleaners and administrators, who are also essential staff in the healthcare sector but are often forgotten. “In a clinic set-up, cleaners are only given masks, yet in hospitals they receive full PPE. We need PPE that [is] worn at the hospital to be given to cleaners, admin staff and auxiliary and professional nurses, as we are highly exposed,” explains the nurse.
About 3km from Beatty Clinic is the Witbank Provincial Hospital, which admits patients from at least 14 hospitals around Mpumalanga, mainly from the Gert Sibande and Nkangala districts. At one of the hospital’s wards, a senior staff member concurs with the nurse at Beatty Clinic that healthcare personnel and support staff in clinics face precarious working conditions.
“We deal with the same patients, but the standards are not the same. Especially at primary care they lack a lot of PPE. Cleaners are the most affected people. Even from the president you can hear he says doctors and nurses, but frontline workers are more than this. We don’t think of the food service staff, the porters and more … Many porters and cleaners … have died.”
The senior staff member has lost count of the workers who have either been infected with the virus or have died from it. “So many, many, many, many and some of them are in quarantine. These people have children, and they are our mothers and fathers.”
Covid-19 admission rates spike
Staff at the Witbank Provincial Hospital are relatively well equipped with personal protective gear compared to clinics, but they are still battling to manage the influx of patients. “[The] Covid-19 wards are full. We are scared but we are used to it. It is like [being] a soldier who is at war,” explains the senior staff member. “[Recently], we had a meeting as workers to explain why our government does not take care [of] us. They keep saying we are heroes, but there is nothing to show for it. The government has failed us.
“Clinics are no longer referring patients to the hospital. Instead, patients just come presenting with the symptoms … This thing of staff [shortages] is killing us. More than 10 staff [members] a week go to quarantine. There was a time around January when doctors were in quarantine and we had to ask just any doctor to assist. We are really experiencing the second wave,” says the staff member.
The Mpumalanga secretary of the Democratic Nursing Organisation of South Africa (Denosa), Mzwandile Shongwe, says they are losing many colleagues to Covid-19 and need somehow to fill the vacant positions. “We want the government to absorb nurses and doctors. We have a lot of healthcare workers [who] are not employed and the government must ensure that those people come back. This issue with [the Treasury] that there is no money, that is not our baby,” says Shongwe.
He adds that the shortage of PPE is a result of corruption. “At Rob Ferreira Hospital there were dust masks that were procured, and our comrades … rejected this. Why would you procure a dust mask for medical use? This is because of corruption. When people want to do corruption, they ignore all the measures. We want people to be arrested. From where I am sitting, we’ve seen the Hawks arresting [people], but we haven’t yet moved to a stage where we’d be convinced that the government is dealing with the issue [properly].”
Shongwe says that salary increases frozen since 2019 and no danger pay for frontline workers are clear signs that “our government is losing [its] grip [on prioritising] people. They prioritise profit more than people. … Why would the [Treasury] say there is no money to increase salaries? … If the government cared for the people, would they have failed?”
A staff member stationed at the casualty ward in Witbank Provincial Hospital says: “We have a lot of problems here.” Though the ward has oxygen points, there is no one to operate the machines. On 31 December 2020, staff at the ward tested 13 patients, of whom 12 were positive. On 1 January 2021, they tested nine, all of whom were positive. On 2 January, they tested 26 patients, with 21 being positive. A communique was sent via WhatsApp to staff members at casualty on 12 January saying all leave was “cancelled with an immediate effect”.
The staff member says: “Yesterday I was heartbroken. There is an old lady who was sent by Impungwe Hospital. She’s around 65 years old. When I checked her, she was cold. Her husband died at 2am and had Covid-19 symptoms. This thing is tough, especially this new variant! Now I am confused. I don’t know what corona is or what we are dealing with. I just don’t understand.”
Shuttered public health facilities
In Ehlanzeni District, which comprises Bushbuckridge, City of Mbombela, Nkomazi and Thaba Chweu, hospitals are at breaking point. Bonginkosi Mkhonza, a nurse at Barberton Hospital and the chairperson of Denosa in the district, says the second wave has stretched the health sector. “Our colleagues are testing positive every day and we are scared as there will be facilities that will have to close down.”
Mkhonza explains that at least three clinics in the Mbombela area – Eziweni, Gujwa and Thekwane – almost shut down after there was no water. The problem was resolved when the labour movement intervened. At another clinic in the area, Sand River, staff members were testing positive one after the other. The Shabalala Clinic in Hazyview was closed about two weeks ago after staff members tested positive and no proper fumigating procedures followed, says Mkhonza.
“Steve Biko Hospital … was named … one of the readiest hospitals. Are we calling that … ready when oxygens points are in the parking lots? If yes, then all of us are not ready and we will all die,” says Mkhonza. “[At] Barberton, Rob Ferreira, Themba Hospital and many more we’ve got ward units where nurses are sick. Covid-19 finds us as we are already struggling due to shortages of staff.”
Denosa treasurer at Ehlanzeni District, Sibusiso Shabangu, who is also a nurse at Barberton Hospital, says more than a third of healthcare workers in Mpumalanga have either contracted the virus or have died from it. “The situation we are facing is very difficult. We’d appreciate it if the community understands that as nurses, we are exhausted, sick and have burnout. Nurses are dying,” says Shabangu.
The Mpumalanga health department failed to respond to questions after numerous attempts to get their comment.
Update, 21 January 2021: After the publication of this story, the department of health in the province went to numerous facilities to hand out the PPEs that healthcare workers have complained that they don’t have.