Minister of Health on Woman who gave Birth at Park Station; Mentally Ill Patients care services; KZN Department of Health

Meeting report

The Chairperson welcomed delegates from Department of Health (DoH) in KwaZulu-Natal (KZN) Province and said she was glad that the Minister for Health had honoured the invitation of the Portfolio Committee (PC) to clarify the issues concerning the woman who gave birth at Park Station in the Johannesburg CBD. She hoped that the situation was not as bad as portrayed by the media.

Address by Minister of Health

The Minister for Health, Dr Aaron Motsoaledi said he woke up on 5 June to news concerning an asylum seeker from Democratic Republic of Congo (DRC) that was allegedly turned away from three hospitals because of her asylum status. She was said to have gone to Tshwane District Hospital but the authorities at the hospital told her they had no bed for her and that she waited in the hospital’s entrance for hours. She was then driven to Steve Biko Hospital, where she was also denied medical care and intended to go to a Johannesburg hospital where her brother’s wife, also a Congolese asylum seeker, had given birth to a baby. However, the baby could not wait any longer and the woman delivered her baby at Park Station. On delivery, the woman and her baby had been taken to Charlotte Maxeke Academic Hospital, where they were again turned away, but she was finally accepted at Hillbrow. He had the impression that the reporter intended a maximum reputational damage and almost succeeded in creating an impression that the health sector of South Africa was evil and xenophobic. However, this was not the case when he investigated the matter.

On receiving the news, he was shocked and called Steve Biko Academic Hospital, being a hospital that he uses and was familiar with. The administration department of Steve Biko Academic hospital said they could not find the patient’s record because they had commenced investigation before the Minister called. There was no record that the woman visited Steve Biko Academic Hospital even after checking through the CCTV camera recordings. The Member of Executive Council (MEC) for Health in Gauteng had already started an investigation on the case, had the woman’s phone number and was able to schedule a meeting with her. The MEC met the woman at Steve Biko Academic hospital where the baby was treated for Jaundice. When asked about her previous visit to Steve Biko Academic hospital. She said she had never been to Steve Biko Academic Hospital before the referral. After the baby was born, mother and child were taken to Charlotte Maxeke Academic Hospital where the baby was examined by an advanced midwife and kept in an incubator for a while to keep warm, then sent to Hillbrow Hospital for six hours of observation. The labour wards of teaching hospitals are basic and it was alright for the Patient to be stepped down to a lower hospital for observation but this was also misunderstood and counted as another denial. He granted an interview with Radio 702 and another interview by the journalist that wrote the story. However, instead of receiving an apology and the publication of the right story, there was another publication which said the husband of the patient, who speaks English as a second language, had misspoken by saying that he went to Steve Biko Academic hospital. South African Hospitals did not have problems with serving foreigners because even undocumented foreigners had enjoyed the services of the health sector in South Africa.

In addition, the Minister said he watched the CCTV recordings for seven hours and was able to determine that the woman was in Tshwane hospital for 40minutes. She met with a rude nurse and decided to go to a hospital in Johannesburg where she had delivered three years before, and unfortunately gave birth in Park Station. No one deserved to give birth in the train station and gave statistics of foreigners who had given birth in South African hospitals. The statistics showed that more than 3,500 babies were delivered at the Charlotte Maxeke Hospital, Parktown, Johannesburg, in Gauteng since January and about 46% were delivered by foreigners. In addition, foreigners that delivered in Tshwane district hospital were about 35% in the last few months and Limpopo delivered about 49% Zimbabwean women between July and March 2017. According to records, most hospitals across South Africa had also delivered babies from foreigners in the past few months. He admitted that it was a case of a rude nurse, South Africa health sector was not in the habit of turning away foreigners because it was stipulated by the Constitution that ‘nobody may be refused emergency medical treatment’. Nurses and doctors in South Africa should be praised and the rude attitude of one nurse should not be used as a measure for the entire health sector. There had been reports on bad attitude of health workers in the past.

Discussion

The Chairperson said everyone should understand why the Minister was angry about the report, as health patients was an emotional subject and hoped the journalists present in the meeting would write exactly what was said at the meeting.

Ms C Ndaba (ANC) said the Minister must not be afraid to fight for the truth. She had worked as a clerk and as a nurse and was sure that the story was not true. The Minister must take the journalist head on and ensure that the paper apologises because the publication was unethical and not acceptable.

Mr T Nkonzo (ANC) said the Minister and the staff of South African hospitals must be praised for the good work done for citizens and foreigners in South Africa. He advised the Minister to act and do more findings on the subject. He also appealed to the media to tell the correct story about the day’s briefing.

Ms L James (DA) commended the Chairperson for a quick connection with the Minister to explain. The Committee did not take it kindly when the report was aired in the news. People from other parts of Africa were making money from the South Africa hospitals by taking hospitals to court for one reason or the other. The Minister should investigate the issue further. It was unfair for the health sector staff be labelled as xenophobic despite working short staffed. She appreciated the Minister and the MEC for prompt investigation and action, and supported the move to make the journalist apologise so that it would be publicised.

Dr P Maesela (ANC) said the Minister should give a press statement to make the true story come to fore and make the journalist and paper apologise and also correct the story.

Ms C Ndaba said she believed there was a syndicate of foreign nationals that comes to South Africa to deliver babies, she requested that it should be investigated.

The Minister said he did not believe there was a syndicate; rather people came from neighbouring countries to have babies in South Africa because of financial hardship. Most of these women were victims of bad leadership in their countries and should not become victimised in South Africa by denying them healthcare. The story was written by an America intern who has since returned to her country.

Dr Maesela said although the journalist had returned to her country, the newspaper company should be held responsible.

The Minister said Parliament did not have jurisdiction over the media. The journalist called and he had given all information as requested and expected a follow up apology but instead of an apology the journalist said the husband of the patient had misspoken because English was his second language. The Department is dealing with a negative attitude towards patients as a whole and not towards foreigners. The DoH is investigating the behaviour of the nurse in question although it should not be seen as the general attitude of healthcare workers in South Africa.

The Chairperson said the matter presents the ruling party, African National Congress (ANC) as being xenophobic and also puts the nation in a bad light across the world. She pleaded with media houses to be responsible and factual in their reporting. Bad attitude of staff had been a challenge in the sector and in the public service and a whole. Private hospitals were not excluded from the problem of bad attitude of nurses towards the patients; the bad attitude of nurses is not towards foreigners alone but the general public. She said the Committee would follow up on the result of the investigation about the alleged rude nurse.

The Minister said he had instructed the CEO, who also is a foreigner, to follow due procedure in dealing with the issue of the alleged rude nurse. Awareness about the attitude of staff brought about the creation of the office of Ombudsman on health.

The Chairperson thanked the Minister for his presentation. She called on the Department of Health (DoH) KwaZulu-Natal to make its presentation and encouraged DoH to highlight its challenges because when the Committee Members go on oversight they would expect that what would be found on the ground would align with what will be said by the team. Mental health was a big challenge especially among the youth and the aged.

Status of Mental Health Services in KwaZulu-Natal

Dr Sibongiseni Dhlomo, Member of Executive Council (MEC), Health KZN, said the DoH was guided by the Mental Health Care Act (MHCA) 17 of 2002 and was under obligation to look after people with mental illnesses. The service platform was divided into three; primary, secondary and tertiary. The hospital platform of specialised services is comprised of seven specialised mental health hospitals and the mental health services are provided within regional hospitals. 72 hour assessments are conducted within district hospital which reserves 5% of their total number of beds for mental healthcare.

The Non-Governmental Organisations (NGOs) are a part of the mental health care services at the community level, they provide step-own care and act as referral gateways into health and discharge between hospital, families, SAPS and families. The treatment of a mentally ill person depends on the category in which the illness falls. It can be acute, chronic or step-down. There were 25 NGOs involved in mental healthcare in KZN which were funded by the DoH. The criteria used to assess NGO selections in KwaZulu-Natal were physical structure, care processes, medication, therapeutic programmes and administration of medication, human resources, monitoring and evaluation (regular check by the Mental Health Coordinators) and the renewal of licenses.

Some of the gaps identified within the KZN models were shortage of psychiatrists and also psychiatrists in the public sector; old dilapidated building not fit to provide mental healthcare, limited budget and prioritisation against the disease; lack of community based services and increase in substance abuse, were mentioned as challenges facing the delivery of a qualitative mental health in KZN. The DoH had taken some remedial actions such as revising the mental health strategy and costing, lobbying for more budgets to support mental health, working with universities to increase training, encouraging active participation of family members to support patients, and educating the public about the dangers and prevention of substance use among others. He also included information about oncology and mentioned that, certain strategies had been put in place to support early detection of cancer. The strategy had put an increased demand on the resources of the DoH. Oncologists were not available at Inkosi Albert Luthuli Central hospital but were available at Gray’s hospital. Hence the oncologists in Gray’s hospital had been scheduled to visit Inkosi Albert Luthuli hospital. There are 25 private oncologists that had agreed to help with offline planning. The Department was currently awaiting work clearance for a foreign oncologist that had just being employed by the DoH. Oncologists always left the public sector for the private sector and the DoH is in acute shortage of full time oncologists.

Mr W Maphanga (ANC) welcomed the presentation and asked if there were a quality check on the NGOs, and observed that there is poor alignment between the NGOs and the Department.

Ms Ndaba asked the team to state why oncologists preferred the private sector. She asked the team to confirm if it was related to the pay package hence she advised the DoH to motivate for better doctors’ pay package if the pay package in the private sector was higher than the public sector.

Ms James welcomed the presentation but noted that it lacked content. There was no information on the number of beds, number of mentally ill persons per district, if budget was allocated to mental healthcare, if NGOs were capacitated continuously to ensure that they abided with the framework, how many vacant posts are available, how many out-patient and in-patient facilities are available. She asked for clarity on why oncologists moved from public to private hospitals.

Dr Maesela said the Mental Health Act of 2002 needed to be amended to regulate the relationship between the NGOs and the Department. The act must be looked into so as to bring it in consonance with the current need of the Department. He asked who was responsible for issuing licenses to the NGOs and how many licenses are allowed to be approved. He asked the team to state what led NGOs to take over the burden of taking care of the mentally ill patients. He also asked the team to state if there was a workable plan to take care of registrars in healthcare and the reason why oncologist left the public health sector to the private health sector.

Ms Ndaba asked the team to state the relationship between the DoH, traditional healers and traditional leaders.

The Chairperson agreed with Ms James that the presentation was too general and did not equip the Committee with sufficient information. She asked the DoH to state the relationship it had with Department of Correctional Services. In addition, she asked the team to state the most prevalent mental disorder and what awareness programmes were carried out in the community. She asked the team to explain how it recruited mental health professionals and state its relationship with the Department of social development (DSD) . Furthermore, she asked the team to clarify how the rate of unemployment contributed to mental health and asked if the DoH had a functional mental health review board.

Dr Dhlomo apologised for the incompleteness of the report and promised to use the template that the Committee wanted for its next presentation. The delegates had noted all that the Members had said and will supply the needed information.
Each district had its own mental health review board. The board had a tenor of five years and the members of the board were elected. The mental hospitals at Townhill, Fort Napier, Umugeni, King Dinuzulu Ekuhlengeni, Madadeni, and Umzimkulu had 280, 370,459,120,965,250 and 130 beds respectively. There was an annual joint inspection by both the DSD and DoH, and the licensing was done by both Departments. There are also outpatients for mental health patients. First the patients are treated for acute attention and then put on outpatient treatment. The review of strategy is necessary, the gap had been noted and the DoH was working towards a review.

One of the reasons that oncologists were leaving was that there are no strict rules guiding the return of doctors to the public sector after training, especially postgraduate training. Although commitment to work with the government for certain years after training was always on paper but there was no enforcement of the agreement. This gives rise to a situation where doctors resign from the public service immediately after completing their postgraduate studies, though sponsored by the government. They go to the private sector where they get better remunerations. Secondly delay in repairing hospital equipment results to frustration and may be responsible for doctors leaving the public sector. Equipment breakdown might also lead to work overload on other facilities, another reason why doctors leave the public sector but this can be solved by provision of more equipment.

Dr Thembeka Khanyile, Acting Deputy Director General, Clinical Support, DoH, KZN, said there were awareness programmes at facility level and some also at district level. There had been one on depression and another on mental health care.

The Chairperson said the Committee would send a template to the DoH on the format that the report was expected to follow and indicated that the DoH did not answer the question on their relationship with the Department of Correctional Services.

Ms Ndaba said her questions on the relationship of the Department with traditional rulers and healers were not answered as well.

Dr Dhlomo said there was no specific programme with traditional rulers or traditional healers but there was a good relationship between the DoH and the traditional rulers while reaching out to the communities. The traditional healers have been enlightened concerning certain diseases and their symptoms, such that when they observe symptoms that were similar to those highlighted the patients were referred to the hospital.

The Chairperson asked if traditional healers were empowered to persuade patients to take treatment given to them by the hospitals, especially in the area of mental health. There was a need to empower traditional healers because traditional healers were major stakeholders in healthcare.
The Department had to come back to address all the concerns highlighted by Committee Members. She thanked the team for the information provided on Oncology. It will be good if the country can produce its own equipment. Although there are challenges of human resources and procurement good works are being done in all the provinces.

The meeting was adjourned.