More uproar at Zithulele Hospital as senior doctor is moved

5 Jun 2024

A senior doctor who worked at Zithulele Hospital in the Eastern Cape for close to a decade has been instructed to report to the Nelson Mandela Academic Hospital in Mthatha. Some Zithulele hospital staff and residents protested against the move.

In another twist in the ongoing Zithulele Hospital saga, one of its most senior doctors, family physician Nick Fine, has effectively been removed from the remote rural hospital in the Eastern Cape.

This was confirmed to Spotlight by Mkhululi Ndamase, spokesperson for health MEC Nomakhosazana Meth.

Fine’s unexpected instruction follows a turbulent two years at Zithulele Hospital sparked by the appointment of Nolubabalo Fatyela as the CEO. After a tense period of conflict between the CEO and hospital staff, clinical manager Ben Gaunt eventually accepted a transfer in mid-2022. At the time, unhappy residents protested at the hospital in support of Gaunt. Daily Maverick has reported on those events in detail.

Similarly, nurses and other hospital staff protested last week at the hospital after Fine was asked to report to the Nelson Mandela Academic Hospital. The protesters petitioned the Eastern Cape health department for Fine’s return to Zithulele. “We demand Dr Nicholas Fine back with immediate effect; We demand [the] district manager to take back Mrs Fatyela [to] wherever, we don’t need her anymore,” reads a section of the petition seen by Spotlight.

Fine did not respond to messages from Spotlight, but he is understood to have taken leave and is away from the hospital. Fatyela also declined to respond to questions from Spotlight.

A resident, who asked not to be named for fear of reprisals and who was one of the leaders of the protests at Zithulele in 2022, said there is discontent over the way Fatyela is managing the hospital.

The resident said the district manager, Nomvume Ntshanga, arrived at the hospital on Tuesday, 28 May when health workers protested. “We listed our concerns in a petition which we gave her. She promised to come back on the 12th June so we are waiting for that day. She said Dr Fine can continue to work here until she comes with the answers on the 12th.”

Spotlight was not at the hospital at the time of the protest, but we’ve seen footage and heard accounts from several sources.

‘Not transferred’

Asked to respond to a range of questions, Ndamase said Fine originally applied to Nelson Mandela Academic Hospital where he had been employed before he was seconded to Zithulele.

Fine, therefore, he said “has not been transferred from Zithulele Hospital” but was “recalled by Nelson Mandela Academic Hospital” where he is responsible for mentoring and training students in family medicine.

“Whether or not Dr Fine will be seconded back to Zithulele is an internal departmental process. This is an employee and employer matter. But for now he has been recalled to his original post at Nelson Mandela Academic Hospital.”

Ndamase added that none of the four formally recognised trade unions at Zithulele Hospital said it was aware of a recent protest by its members.

Spotlight tried to speak to union leaders at the hospital, but none was willing to be interviewed. An intermediary said they declined because “the matter is very sensitive and there is a friction between the labour unions inside the hospital”.

The petition to the department also complained about Fatyela’s alleged accommodation in a luxury Mthatha hotel. Responding to this, Ndamase said: “The department can confirm that Mrs Fatyela had to temporarily leave Zithulele Hospital because of safety reasons. The department cannot divulge its supply chain management process. The relevant stakeholders are aware of where the rental money is paid. We can also confirm that the rental money is not used for anyone’s personal use but for the upkeep of the facility.”

Responding to the call in the petition for Fatyela to be replaced, Ndamase said: “The department has no reason to transfer the CEO as she has been carrying out her duties with utmost diligence even when her safety was under threat.”

Ndamase confirmed that the department plans to hold meetings about the impasse at Zithulele Hospital “within the first two weeks of June”.

MEC Meth is expected to become a member of Parliament and it is therefore likely that the province will in the next two weeks or so also have a new health MEC.

‘Great cost’

Dr Karl le Roux, who worked at Zithulele for 16 years, said Fine’s transfer would come at great cost to the patients and the doctor and nursing team.

Le Roux was himself embroiled in the dispute at Zithulele in which Gaunt clashed with Fatyela. He left the hospital soon after Gaunt did and is now set to become a member of Parliament representing the DA, Spotlight reported last month. It is thus possible that both Meth and Le Roux could serve on the portfolio committee for health in the new Parliament.

“Nick is hard working and compassionate. He has good relationships with people at the hospital. He’s certainly at Zithulele because he wants to make a difference and help people, and is also really important for the supervision of the two family medicine registrars currently training at Zithulele,” he says.

According to Le Roux, Fine is contracted as a registrar by Nelson Mandela Academic Hospital but as part of his training was allocated to Zithulele.

“The agreement was because there were no posts on the Zithulele establishment, Nelson Mandela were kind enough to appoint him and second him out, but it was part of the whole training process and part of it was that he was also supervising two of the family medicine registrars at Zithulele,” he says.

Notwithstanding that the process is legal, Le Roux questions who would initiate a request for Fine to be sent back to the hospital he’s been seconded from. He suggests that the hospital CEO used a technicality to try to push Fine out.

Le Roux described the decision to move Fine out as counterintuitive. “This latest action will really lower the morale of an already fragile team of doctors and nurses at Zithulele, which is why they’ve come out to protest.

“But the worst part of it is the harm it does to the poor patients, and the way it destroys what was an excellent hospital that has been very difficult to build up over 17 years.

“If this continues, it will destroy the hospital. It is extraordinary that nurses and other hospital staff are protesting to support a white doctor and demanding for the CEO to go. That sort of thing is not done lightly,” says Le Roux. DM

This article was published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.

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‘Not transferred’

‘Great cost’