Shut up and toe the line – the daily lot of a South African public health worker

“As a doctor, you … try to help and save as many [patients] as possible, but under no circumstances publicly speak out. That will be career suicide.”

These are the words of a dejected health worker recalling their ordeal with a public health system hellbent on covering up its failures. This health worker had written to the media as a student doctor to raise concerns with administrative issues in a public hospital. Their actions landed them in hot water, and they lived to regret that day.

More than 10 years later, that incident remains firmly in the health worker’s memory, a constant reminder of how they can never speak out unless they want to ruin their career.

This is the story of many public health workers. They have learnt to never speak publicly for fear of losing their jobs, intimidation, harassment and potentially getting killed. Yet, the public health sector continues on a downhill trend. Their silence comes at a high price.

We recently woke up to headlines about the Health Ombud’s report from a year-long investigation into allegations of patient neglect, an unsafe environment for both workers and patients and maladministration at the Rahima Moosa Mother & Child Hospital (RMMCH).

The findings of the health ombudsman corroborate new research by the Campaign for Free Expression (CFE), which found that authorities in public hospitals abused the law to cover up their incompetence. They cared more about protecting their image than they did about saving patients’ lives.

As a result, they abused their power to bully workers into silence. Health workers are afraid to speak out to address the challenges that they face in the workplace because authorities use the Public Service Rules and Regulations which restrict public workers from speaking with the media, to disproportionately discipline workers who do so.

The ombud’s report details chilling findings of the hospital management’s failure to run the facility efficiently, and both the provincial and national government’s “lack of care” to address issues that have been highlighted since as far back as 2017.  

“Quite simply, it appears that no one seems to care,” said the report. It adds, “the failure of leadership, management and governance resides at all levels – province, district and RMMCH itself.”

Ironically, this is the same hospital where a dedicated paediatrician, desperate to save the lives of children whose lives were at risk due to the lack of resources necessary for providing them with critical care, was disciplined for going public with his grievances.

Dr Tim De Maayer was suspended in June 2022 after he published an open letter decrying the deteriorating working conditions at Rahima Moosa hospital. According to De Maayer, the conditions made it difficult for him and his co-workers to execute their duties efficiently, contributing to the needless deaths of children.

“How do you manage to come to work every day, fail at your job of ensuring basic healthcare for the people you serve and still sleep at night?” De Maayer asked.

Instead of addressing the issues, the hospital management was more concerned with protecting the reputation of the institution (and theirs of course). They took action against him for bringing the Department of Health into disrepute. However, a public outcry forced them to overturn their decision, and they reinstated De Maayer within a few days.

CFE’s research includes an analysis of the application of the law in De Maayer’s case. It finds that the CEO of Rahima Moosa did not apply ethical reasoning in suspending De Maayer for his open letter. Ethical reasoning is recommended by the Ethical Code of Conduct for Health Professions which requires that when faced with a conflict of ethics in the workplace, one should always consider the effect of their actions on the public’s interest.

De Maayer either had to remain silent and watch children continue to die in breach of his moral obligation to save lives, or make a disclosure in the public’s interest, but in breach of the Public Service Rules and Regulations – which he did and for which he got victimised.

With recent developments around the release of the ombud’s report, CFE has received credible reports that there have been new efforts to silence De Maayer after he made a few comments in the media in response to the ombud’s report, leading him into cancelling a scheduled interview with eNCA.

The new Public Service Rules and Regulations as amended in 2016 encompass a Code of Conduct for public workers which specifies that employees may only communicate with the media with authority from the head of department.

Chapter 2, section 3.3 stipulates that a public service employee should use “appropriate channels” to air grievances or to direct representations. This means they must report the grievance to their immediate supervisor first. The supervisor is expected to escalate the matter if they fail to adequately address it. However, in many cases the challenge is that when such a procedure is followed grievances are not addressed.