It’s the worst thing to happen – to anyone.
We meet Natasha Sibanda in Johannesburg’s bustling Central Business District. On the street, the cantankerous crowd has a life of its own, their colorful clothes distinct in the morning light as they move in unison like shoals of fish.
Adjacent to this street is a tiny one-bedroom apartment the size of a matchbox and in grimy grey.
As we enter, a pall of gloom. Sibanda, only 22, lost her husband Samuel four weeks ago in Zimbabwe, his country of birth. Their only son is a year old.
“My husband was 25 years old&#8230; We were in Zimbabwe visiting family when he suddenly fell ill. We went to the hospital where they gave us a list of all the items they needed in order to help him. We had to buy all of them [with] cash at a pharmacy before they could treat him,” she says, as a lone tear rolls down her cheek.
The items totaled a bill of $300, which they didn’t have. Her sister, working in South Africa, promised to send the money the following day.
“I pleaded with the hospital to help him while we looked for the money because we both lived in Zimbabwe and had no jobs but they said his condition wasn’t serious and we had to come back when we have money because the hospital didn’t have any of the medicines needed.”
Heartbroken and worried, Sibanda took her husband home.
The night was going to be long.
At about 2AM, Samuel started vomiting. She took him back to the hospital where he was declared dead on arrival.
“I’m still not sure what killed him but I’m hurting because doctors wanted to help him but couldn’t because they didn’t have medicines and now he is dead and my son has no father,” sobs Sibanda.
Her story is only one of many painful parallels in some of Africa’s developing economies with poor – and crippling – healthcare systems.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/healthcare-got-available-everybody/" target="_blank" rel="noopener">READ MORE: ‘Healthcare Has Got To Be Available To Everybody’</a>
“You don’t want to fall ill in Zimbabwe. It’s like a backyard garage where you bring all your car parts for your vehicle to be fixed. If you have no cash, you can’t be treated,” says Mthokozisi Khuphe, a former government nurse.
Khuphe worked for government for eight years before moving to the private sector and then migrating to work in Namibia.
“When I started, there was already a crisis. I remember there was a big strike and a lot of people resigned. We, the new junior staff, had to work on everything even though we were just starting out. I would have 120 to 150 patients in a day [who] I had to help by myself,” says Khuphe.
He says Zimbabwe’s healthcare system was and still is putting patients’ lives at risk.
“Many patients lost their lives. I remember sometimes there would be no syringes, and needles were in shortage. We would reuse them repeatedly on the same patient when in fact you are supposed to use one and dispose it off immediately&#8230; There was even a time the whole hospital had one ventilator&#8230; As a nurse, it is difficult to know what can help the patient but you don’t have the equipment and the patient dies.”
Zimbabwe is not alone. Africa’s public healthcare sector is in the intensive care unit.
Although the situation is not as terrible as in Zimbabwe, the World Bank and World Health Organisation issued a report on universal healthcare in the world in December, where South Africa received a score of 70 out of 100 for Universal Health Coverage. (The National Health Service (NHS) in the United Kingdom (UK) scored 90.)
The report stated that the poor quality of healthcare in the public sector was concerning.
Jasson Urbach, a director of the Free Market Foundation and head of its Health Policy Unit says the situation is dire. There are pervasive problems with the quality of healthcare in the public sector.
“The healthcare system is a sea of mediocrity in the government-run healthcare sector, punctuated by islands of excellence in the private healthcare sector. Currently all political will is aimed at implementing National Health Insurance (NHI) [free health for all] and nothing is being done to address the current issues of pervasive poor quality in the public sector,” he says.
According to Urbach, the NHS in the UK employs 1.3 million people to service 55 million UK residents, yet the entire South African civil service employs 1.3 million people.
“To think that South Africa can run a government administered Universal Health Coverage system such as the National Health Service is unrealistic.”
He says the poor quality of services in the public sector is the single greatest challenge in South African healthcare.
“If the quality is not addressed, 70 percent of public facilities will not qualify to contract with the NHI, if it gets implemented, which will collapse service provision in the healthcare system altogether. Poor quality is not the result of shortages of funding; it is the result of poor management,” he says.
It is true.
According to inspection records published by the Office of Health Standards Compliance, a government agency in South Africa, hospitals and clinics in the government’s flagship NHI pilot program are failing to improve any faster than those in the rest of the country.
<a href="http://www.forbesafrica.com/uncategorized/2018/04/03/death-denial-fear-listeriosis-cost-south-africa/" target="_blank" rel="noopener">READ MORE: Death, Denial And Fear: What Listeriosis Cost South Africa</a>
Among the 1,427 facilities inspected, only 89 scored a pass mark of 70% or more. Facilities fell short on matters ranging from the availability of medicines to infection control.
“As an example, there are contracts with cleaning services in place in all public facilities, or cleaners are employed. If a facility is not considered clean, that is a management failure. Poor systems and processes lead to undue delays in treatment. Incompetent political managers at the provincial level, leads to incompetent appointments at hospital levels, which leads to failure of the system,” says Urbach.
Patients in South Africa’s public hospitals are dejected.
Results cited in the General Household Survey 2015 suggest healthcare received from the private sector is significantly preferred to that from the public sector, and states that users of private healthcare facilities seem to be more satisfied with those facilities than users of public healthcare facilities, across all provinces.
“Whereas 97.7 percent of users were satisfied with private facilities (91.9 percent were very satisfied), only 81.1 percent of users of public healthcare facilities were somewhat satisfied or very satisfied. Only 57.6 percent of individuals that used public healthcare facilities were very satisfied,” states the report.
According to Urbach, another problem is that the government does not have the same incentives as the private sector. It partly explains why there are poor healthcare outcomes in the public sector.
Dr Matthew Adams, a surgeon at one of the big public hospitals in South Africa, agrees with Urbach.
“Private hospitals pay two to three times more than government and they have better working conditions compared to us&#8230; essential machine breakdown and fixing them is delayed, and tenders to supply certain things are given to people who can’t deliver on time which always sets us back,” he says.
That’s not all.
Adams says hospitals are understaffed and they have to work long hours and there is misadministration by hospital management.
“[The] department says there is no more money for new doctors but not enough monitoring is done on how much is spent per patient and measures aren’t taken to see how we can save the hospital money&#8230; Hospitals are actually set up in a hierarchy, so that the first place a patient goes to is a clinic before a hospital for day-to-day assistance, but because of low quality, patients overlook lower level health centers to go to hospitals and doctors see cases they are not supposed to see adding to doctor frustration,” he says.
Frustration leads to doctors leaving the public sector for the private sector, or leaving the country altogether.
“The last time I saw statistics [about the number of doctors leaving] was in 2005 when the Health Professions Council of South Africa reported that despite the fact that medical schools produced approximately 19,500 graduates between 1990 and 2005, their records show only 9,304 new registrations during this period. This implies that a significant number of individuals, after graduating, instead of practising in South Africa, are leaving the country,” says Urbach.
Among the common reasons cited for the mass exodus of skilled healthcare personnel from the public sector are poor salaries, high workloads, poor work environments and few opportunities for advancement.
According to Liz Still, who compiles the annual Health Care in South Africa publication, the public sector does not have enough posts available to employ South Africa’s health professionals. For example, over the period 2002-2010, approximately 11,700 doctors graduated but only 4,403 posts were created in the public sector. In the field of dentistry, there were 2,140 graduates but only 248 public posts were concurrently created.
These conditions impact the quality of care.
According to various reports, last year, South Africa’s Health Minister, Aaron Motsoaledi, said more than 5‚500 medical negligence claims have been made against the health department since 2014. The number of claims grows every year. There were 1‚562 claims made in 2014/15‚ 1‚732 in 2015/16 and 1‚934 in 2016/17.
And it hurts the tax payer.
The department paid R391.32 million ($32.4 million) in medico-legal claims in 2014/15 alone and a whopping R730.87 million ($60.6 million) in 2015/16.
It is so bad that in 2016/17‚ the total value of claims rose to R1.2 billion ($99.5 million)‚ with Gauteng&#8217;s 521 claims accounting for almost half of this at R566 million ($47 million).
Romany Sutherland, an attorney at LLA INC. Law, says the majority of these cases are due to obstetric damages.
“These are children who suffer brain injury as a result of complications during birth&#8230; South Africa has a 10 percent higher cerebral palsy rate than anywhere in the world and we don’t know why this might be&#8230; To me, as an attorney, it comes down to perhaps people not being trained properly. Nurses are not involving the obstetricians soon enough,” she says.
Cerebral palsy cases cost the government about R17 million ($1.4 million) on average per case.
“Each province deals with the issues differently. I’m in the Western Cape and here; we try and negotiate or mediate these cases as soon as possible so that reasonable pay-outs are made without undue delay. I believe the best way to go with the negligence cases is to take the initiative to open discussion with your opponent,” says Sutherland.
The problem is, some health departments don’t have any decision-makers who have settlement authority. It means all negligence cases have to go before a judge in the court of law before the department can pay out. It takes longer and costs the state more money.
“The litigation process is extremely expensive. The amounts you see reported in the media don’t include costs. It is a big worry because I haven’t gone to court in nine years because I like to negotiate cases and come to reasonable settlement and the Gauteng government doesn’t allow for that to happen,” she says.
According to Sutherland, some costs to take the case through trial can be four times the amount of settlement.
The amount of money that attorneys stand to make on such cases has caused a boom in the medical negligence industry.
“There are attorneys who are touting for clients and some even paying midwives up to R30,000 ($2,500) for a file. There are also some frivolous cases where the negligence did not cause damages&#8230; yet they carry on&#8230; If such cases are settled, it is not the touting attorney’s fault but the department that is not defending those cases properly,” she says.
The rise in lawsuits is also causing medical insurance for obstetricians to rise.
“An obstetrician is currently paying R1 million ($82,830) in insurance. I think the price has gone up by approximately R100,000 ($8,283) if not more every year for the past couple of years&#8230; This is also cause for some medical students to not consider this field because insurance is just too expensive.”
Back in Johannesburg, as we part with Sibanda, she tells us she wants to go back to school to study public healthcare administration so she can help the very hospitals that didn’t give her husband timely treatment. She wants to save lives.
If only government authorities sitting in their airconditioned offices and seeking treatment in plush private hospitals knew her pain and predicament.

Operating theatre in a cardiac surgery ward. Anesthetics.

Would You Seek Medical Care In Africa’s Public Sector?

December 25, 2017, was the worst Christmas for the Warmback family.
The festivities began two days before with the arrival of Keith and Glenda Warmback’s children from the US. There was food and celebration as the couple saw their one-year-old granddaughter for the first time.
“That evening, we went out and my wife had a chicken salad [from one of the fast food restaurants]. The following day my wife Glenda started having a tummy ache. She went to lie down for a while. She fell asleep and I woke her up around 5PM and she said she couldn’t get out of bed because she wasn’t feeling well and had a running tummy,” says Keith.
Keith says he was woken up by barking dogs, in their room where Glenda was asleep, at about midnight.
“I went to see what was going on and I found Glenda on the floor. She said she thought she had a stroke,” he recalls.
He bundled her up and rushed her to the nearest private hospital.
“The staff was disastrous… They were disinterested in my wife’s condition and three others who were there with similar symptoms,” says Keith.
According to Keith, it was just the beginning of a series of mistakes. Eventually, Glenda’s lungs collapsed and she died at 2AM on Christmas day. She was 61 years old; they had been married for 41 of those.
“The painful thing is the incompetence at the hospital,” says Keith.
<div id="attachment_35790" style="width: 310px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-35790" class="size-medium wp-image-35790" src="https://www.forbesafrica.com/wp-content/uploads/2018/04/keith-300x200.jpg" alt="" width="300" height="200" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/04/keith-300x200.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/keith-600x400.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/keith-768x512.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/keith-1024x683.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/keith.jpg 2048w" sizes="(max-width: 300px) 100vw, 300px" />Keith Warmback lost his wife Glenda to Listeriosis on the Christmas day of 2017. Photo by Motlabana Monnakgotla.</div>
Doctors sited natural causes as a cause of death. The problem is, just 20 days before, the health minister had announced a foodborne outbreak called listeriosis. According to Keith, Glenda had all the symptoms and blood tests indicated she had it but she was never treated for it.
<a href="http://www.forbesafrica.com/focus/2017/05/01/rat-race-silent-killer/" target="_blank" rel="noopener">READ MORE: The Rat Race Against The silent Killer</a>
At the time of going to press, Glenda was one of 183 South Africans who had died from this disease since January 2017; 978 had been infected. It is the world’s worst outbreak of listeriosis, according to the World Health Organization (WHO).
“Listeriosis is the name of a disease that people develop when they eat food that is contaminated with the bacterium called listeria,” says Dr Juno Thomas, head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD).
According to Thomas, this bacterium is found worldwide. It can be in soil, water and even faeces in many animals.
“Once in the environment, it is very difficult to get rid of because it attaches to things very easily. Once it attaches itself in an environment, it produces a layer of a sticky sugary slime that sticks onto the surfaces and makes it difficult to remove and resistant to disinfectants,” says Thomas.
According to Health Minister Aaron Motsoaledi, South African hospitals saw and treated an average of 60 to 80 patients affected by listeria between 2013 and 2016 with no problems.
Then, in July last year, doctors started seeing more cases of newborn babies born with listeria.
<div id="attachment_35791" style="width: 310px" class="wp-caption alignright"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-35791" class="size-medium wp-image-35791" src="https://www.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife-300x200.jpg" alt="" width="300" height="200" srcset="https://cms.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife-300x200.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife-600x400.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife-768x512.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife-1024x683.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2018/04/Kieth-wife.jpg 2048w" sizes="(max-width: 300px) 100vw, 300px" />Keith looks at an image of his wife (right), Glenda Warmback. Photo by Motlabana Monnakgotla.</div>
It was a cause for concern. They informed the NICD. A search, led by Thomas, began. On November 29, they found that at the time, 557 people had been infected.
“A team from the NIDC interviewed 109 patients to obtain details about foods they had eaten in the month before falling ill. Eighty five percent of the people reported eating ready-to-eat (RTE) processed meat products, of which polony was the most common, followed by viennas/sausages and then other ‘cold meats’,” says Motsoaledi.
Sixty percent of cases were reported in Gauteng, 13% in the Western Cape and 7% in KwaZulu-Natal.
“We think it affected Gauteng the most because of consumer behavior. Things like sausages, polony and viennas are staple street and household foods in Gauteng because they are affordable and quick to prepare. The economy of Gauteng also plays a factor. There are many more people who can afford to buy these items than other provinces,” says Thomas.
Even armed with this information, the source of the outbreak remained unknown.
<h2>Symptoms of Listeriosis:</h2>
<ul>
<li>Fever</li>
<li>Diarrhoea</li>
<li>Vomiting</li>
</ul>
“When you have an outbreak like this you have no idea where it comes from. We also had not seen many cases of listeriosis in the country, meaning it wasn’t a big health priority compared to all the other issues we have to deal with. For example, we saw 30,000 cases of malaria last year, rabies is a big concern, TB and many others were more severe,” says Thomas.
With hard work and vigilance, the outbreak was traced from Soweto.
Nine crèche kids under the age of five got ill and were admitted to the Chris Hani Baragwanath Hospital. Tests revealed that they had been infected. A team went to the crèche the very day and found kids had eaten polony manufactured by Enterprise Foods, owned by Tiger Brands.
“We then visited the Enterprise Foods factory in Polokwane that makes this brand. We took over 28 samples and they tested positive for the outbreak strain. The conclusion from this is that the source of the present outbreak can be confirmed to be the Enterprise Food production facility in Polokwane,” she says.
On Sunday March 4, Motsoaledi ordered a safety recall of all products from Tiger Brands.
<a href="http://www.forbesafrica.com/focus/2016/09/01/deadly-75-billion-business/" target="_blank" rel="noopener">READ MORE: A Deadly $75-Billion Business</a>
After Motsoaledi’s announcement, Tiger Brands shares fell more than 10% when the market opened on Monday.
“It is devastating for me that our business is linked to this outbreak&#8230; we detected low levels of listeria in our products on the 14th of February. We took immediate precautionary measures which included immediately halting production of the affected product, quarantining all affected product within our distribution center and withdrawing all affected products manufactured on that day,” says Tiger Brand CEO Lawrence MacDougall at a press briefing the next day.
MacDougall, however, controversially denied any responsibility for the deaths.
“There is no direct link with the deaths to our products that we are aware of at this point. Nothing&#8230; All of our tests and results indicate that we kept a very high standard of quality protocols within those sites. The expectations going forward is that those standards are significantly increased if there is going to be a zero detection of listeria going forward,” he says.
Motsoaledi argues that there is proof the ST6 strain was found at their facilities.
“The fact remains that we have had an outbreak of listeria, we informed them [Tiger Brands], in terms of fair administrative justice, that we got the results and we were going public with them. I don’t think they did enough to make sure their produce is safe for consumption by the public. I believe the best way is for this to be a civil case rather than a government case,” says Motsoaledi.
Renowned corruption buster and private forensic investigator Paul O&#8217;Sullivan agrees. He is filing criminal charges against the board of Tiger Brands and has called upon them to step aside pending the outcome of the investigations.
O&#8217;Sullivan has teamed up with human rights lawyer Richard Spoor to bring charges.
“What is particularly shocking is that Tiger Brands, in its most recent annual report, placed product quality as number nine on the list of risks facing the company, when it should have been be at number one. We cannot think of a greater risk to the sustainability of any food company, than that of killing off your customers through recklessness or gross negligence. We are 100% certain that it will rank top of the list in next year’s annual report.”
What O&#8217;Sullivan finds completely unacceptable is that Tiger Brands is still in denial.
“On the one hand they close and deep-clean all the affected facilities, on the other hand they deny culpability and say they will meet each civil claim on its own merits, thereby indicating they will make it a long-haul for the litigants,” he says.
Gareth Lloyd-Jones, Chief Commercial Officer at hygiene and sanitation service provider Ecowize, however says government is to blame. He argues there should be a surveillance system that protects consumers.
“This type of rigorous investigation has been going on for the past couple of months, which is admirable, relevant and necessary and should have been part of a more robust routine surveillance and monitoring process in terms of food safety and legislation requirements,” he says.
According to retail analyst Syd Vianello, this can tarnish a brand that has spent decades trying to live up to high standards.
“How long is it going to take [Enterprise Foods] to convince consumers that the Enterprise brand is good for purchase again? We are talking about the value of the brand and the protection of the brand equity, insurance won’t even cover you for those kinds of losses. These can carry on for a very long time,” he says.
There is also a rub-off effect.
Ronald Dube, a manager at a supermarket in Johannesburg, says people have been returning all cold meats regardless of brand.
“People are afraid and have been returning all sorts of meat. We have also noted that sales of processed foods have gone down, no matter the brand,” he says.
Many people have also thrown away their cold meats but, according to Dr Johan Schoonraad, waste expert and group tactical specialist at EnviroServ Waste Management, there are only two options for disposing of listeria infected food waste – incineration or treatment and landfill disposal.
“The scale of the problem is too big for the incineration industry to deal with in any sort of reasonable timeframe, which leaves waste management companies with the option to do treatment and disposal to landfill,” he says.
Schoonraad says treatment can take many routes. You could sterilize the food waste, heating it and ensuring the material internally gets to 100 degrees which would kill the bacteria.
“If this was done, we could then landfill it without further treatment being required before disposal,” he says.
The other option is to chemically treat it prior to disposal.
According to Schoonraad, the problem is municipal landfills often have poor access control. The risk here, he says, is that the informal sector could enter and scavenge food material, which is then sold or eaten and could spread the disease.
“However, licensed hazardous waste sites have strict access control with no scavenging allowed at these facilities,” he says.
Nevertheless, South Africa remains in fear of this deadly disease.
<h2>Who is mostly at risk:</h2>
<ul>
<li>Pregnant women</li>
<li>Neonates (first 28 days of life)</li>
<li>Very young infants</li>
<li>Elderly persons &gt;65 years of age</li>
<li>Anyone with a weakened immune system (due to HIV infection, cancer, diabetes, kidney disease, liver disease, people with transplants and those on immunosuppressive therapy such as oral corticosteroids, chemotherapy, or antiTNF therapy for auto-immune disease)</li>
</ul>

Tag: Illness

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Would You Seek Medical Care In Africa’s Public Sector?

Death, Denial And Fear: What Listeriosis Cost South Africa