How clinic closures disrupt health services in Port Elizabeth

The temporary closure of clinics in the Nelson Mandela Bay Metro whenever a staff member tests positive for Covid-19 has disrupted healthcare services at many of the clinics and at least two hospitals. This often means patients, mostly women, children and the elderly, are left stranded because they rarely have the means to go to a different clinic further away.

At times, visibly frail patients are advised to visit nearby clinics until their local facilities reopen. Often, it doesn’t end there. Some people seeking treatment and medication at nearby clinics are referred to yet another facility when the required medicine is not available or when patient numbers are too high.

Some people simply give up.

From pillar to post

Bongiswa Mbatsha from New Brighton visits the New Brighton Clinic for her antenatal check-ups. “The constant closure of clinics due to the Covid-19 pandemic is becoming a problem because sometimes, patients are being forced to leave without being treated,” she told Spotlight. 

“Patients are now sent from pillar to post to access healthcare, more especially when visiting alternative clinics such as Tshangana or Empilweni clinics. Nurses constantly refuse to assist patients from other facilities because they have a huge workload.”

This week, Health Minister Dr Zweli Mkhize was on a two-day visit to the Nelson Mandela Bay Metro where he inspected health facilities. It has been reported that obstetric services at hospitals such as Dora Nginza Hospital have huge backlogs due to the closure of clinics.

Thobeka Peter, a patient at Soweto-on-Sea Clinic, said she was turned away when she took her baby there for a routine vaccination in June 2020.

“Last month, I had an appointment for an immunisation injection for my four-week-old baby boy, but a security guard said the clinic was closed because one of the nurses had been infected with Covid-19,” she said. “I was not given an alternative date. I was concerned about the health of my son because immunisation is important at his age. We can’t afford to skip it.”

Spotlight previously reported that national immunisation rates for children under five years had dropped dramatically over the lockdown period, sparking fears of an outbreak of deadly infectious childhood diseases such as measles.

Safety risks

A nurse assistant at New Brighton Clinic, who asked not to be identified, said health workers were working under very dangerous conditions. “We are working under life-threatening conditions. Once a health worker is diagnosed with Covid-19, that influences the decision to close clinics,” she said.

“When a colleague has contracted the virus, we can’t risk working as we have to isolate ourselves and get tested. This is meant to protect the vulnerable members of the community. Safety of patients is of paramount importance and we take this decision with them in mind.”

She said people had to understand that health workers should be safe at all times. “Nurses or doctors coming into contact with those who’ve tested positive for Covid-19 will risk the lives of those we treat on a daily basis and are not positive.”

According to Nelson Mandela Bay Metro’s district manager for health, Darlene de Vos, 337 primary healthcare workers in the metro had tested positive for Covid-19 by 21 July 2020 and three staff members had died.

It starts with hygiene

De Vos painted a more positive picture of the situation and said the health facilities were improving.

“There is a glimmer of hope as clinics are operating far better than they were last month [June 2020]. The department could not afford to have health facilities shutting down even if our personnel tested positive for Covid-19. Clinic closures resulted from an unfortunate situation created by fear and anxiety, which caused panic among staff. Also, there were and still are some areas that lack enough knowledge among our own personnel, which we are vigorously trying to address,” said De Vos.

“When Covid-19 started, everybody was in a state of panic. Even in health facilities when there was one infection, the staff would close the facility and demand it to be decontaminated because they were scared,” said De Vos. “The health department has developed guidelines for cleaning and disinfecting of all facilities, as a way of dealing with this.”

De Vos said the health department had a cleaning protocol because every health facility had to deal with various infections daily. “Our normal standard cleaning procedures include disinfecting protocols that are as applicable to Covid-19 as there are for any other infectious condition. Also, the National Institute for Communicable Diseases has made it clear that it does not promote the spraying of facilities.”

During his visit to Livingstone Hospital this week, Mkhize slammed unhygienic conditions at health facilities as a result of poor management. “The question of quality of care starts with cleanliness,” he said.

“Anyone who walks into a hospital that is dirty gets even sicker. It’s a simple, basic issue. We need to focus on that. It’s a question of how the hospital is being managed.”

According to De Vos, her department was training cleaning staff, including nursing staff, on Covid-19 cleaning protocols and teaching them about occupational health safety measures. She said this training would help when the metro reached its Covid-19 peak.

“We are very concerned about the peak period. Our staff are going to be infected, but that doesn’t mean that the facilities must be closed. Instead, we should be ready when the peak comes,” she said. 

Heavy burdens

Morgan Breakfast from Motherwell is one of the patients who was referred to other facilities. “I have been turned away a couple of times at Motherwell Community Health Centre where I was supposed to have surgical sutures removed and collect medication. We don’t have a clinic at NU29 in Motherwell. We rely on a mobile clinic, but it doesn’t have my medication. It costs me R26 to travel to the clinic and back. It is a heavy burden because I’m unemployed. When I don’t have bus fare, it takes me nearly one hour to walk to the clinic. It is very painful to walk such a long distance.”

Nqaba Nkanjeni, a TB patient at Thanduxolo Clinic in NU10, Motherwell, said: “The situation is made worse by non-availability of people who monitor queues at health facilities because people are not observing physical distancing,” he said. 

“I suspect that our nurses are using Covid-19 as a scapegoat because services were poor at our clinic long before Covid-19. Nurses only take a minimal number of elderly and frail people. Some patients are being forced to leave without being treated,” said Nkanjeni.

A nurse working at Kwazakhele Clinic, who preferred not to be identified, said their clinic was one of a few in the metro that had not yet closed since the start of lockdown. “When neighbouring clinics are affected by Covid-19, we see an influx of patients. Bear in mind we have our own long queues because we normally don’t explain to our patients about the alternative [way] of collecting their medication. We fear that it will make it difficult for us to track them. We only give them two months’ supply so that we are able to monitor their progress.” 

The action plans

According to De Vos, there is never a situation where all clinics are closed at the same time. “We have put measures in place in an attempt to meet our patients’ needs during those closures. For example, when Motherwell Community Health Centre was closed, arrangements were made for pregnant women who needed to give birth to be taken to Kwazakhele Clinic and trauma cases to Dora Nginza Hospital.

“When our facilities were closed, we instructed nurses from those facilities to follow their patients to neighbouring clinics. This means nurses must move with their patients to the nearest facility in order to relieve pressure on that clinic that already has its own client base.”

De Vos admitted that this measure was not always successful, because staff sometimes refused to work at other facilities. “We have dealt with staff members who have refused to relocate with patients and had to invoke labour legislation.”

De Vos said they planned to notify and educate people to not start queueing at clinics early in the morning, because they only open at 8am.

“We are looking at putting systems in place to provide a delivery service to the homes of people on chronic medication so that they don’t have to come to clinics and put themselves at risk. We are getting assistance from community health workers. We don’t have transport for patients and most of our clinics are less than 5km apart,” De Vos explained.

She said more stable patients were encouraged to enrol in the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme to reduce travel time and costs by collecting medication from a wide range of safe and convenient medicine pick-up points. “The CCMDD programme is well established in the metro. There are currently 26,426 patients already registered and more than 40 collecting points.”

Dr Mthandeki Xamlashe, head of medical services in the province, agreed on the importance of patients taking advantage of the programme to reduce the number of patients flocking to clinics.

“The virus is expected to peak in the province and it is now at a stage where it is not only affecting us, but it is infecting us,” he said.

“We had problems at our clinics that are constantly closed due to Covid-19 cases. Patients can go to their nearest clinics to collect chronic medication because patients’ information is centrally stored,” he said.

Xamlashe said the CCDMM programme also had contingency plans for when an independent pharmacist gets sick and has to close for days or weeks. “All the clinics in the province have a uniform package. If a patient cannot access medication [or care] from their local clinic, they can go to a nearby clinic. We do sometimes experience connectivity challenges in remote areas, but those cases are now manageable,” he said.

Neither Xamlashe nor De Vos would say how many clinics had had to close temporarily during lockdown. As of 16 July 2020, the city had recorded 14,655 confirmed cases and 240 confirmed Covid-19 deaths. DM/MC 

This article was produced by Spotlight – health journalism in the public interest. Sign up for our newsletter.