Tom London has set off a wave of outrage over his posts about his horrific experience at Helen Joseph, a state hospital. Those who want accountability should be immensely grateful to Tom for his video posts on the crumbling hospital, a body left for hours on a ward causing a swarm of flies, and the uncaring attitude of doctors.
But it is unlikely to be a wake-up call or a turning point for Gauteng’s health-care system or the national one. Lack of accountability means that there is a familiar chain of events that brings about lots of noise but no improvement.
London’s account should be enough to blow away the plans for National Health Insurance: the ANC’s vision for state control of medicine in the country. After all, London certainly reinforced what we know already, that the state cannot run hospitals at levels that are even close to being fit for purpose.
But the health minister, Aaron Motsoaledi, has illogically insisted that there is no reason to improve the state health system before the government embarks on plans for its health-care nirvana.
London’s experience at the Helen Joseph hospital was like many of the experiences of those who rely on state service delivery. It is much of the reason why the ANC only received 40 percent of the vote on May 29th. And that is why Batho Pele, the civil service’s commitment to courtesy and service, and indeed the much-admired concept of Ubuntu (concern for others) are largely meaningless in the public sector.
After a disaster, a tragedy or a revelation that is deeply embarrassing, ANC officials get into crisis management mode and visit those impacted, but nothing really gets done to change the root cause.
The assassination of the whistle-blower Babita Deokaran, who was the acting chief finance director of the Gauteng health department, did not bring about a clean-out in the department. Her killers have still to be found, and there have yet to be prosecutions for the allegedly corrupt spending of about R1 billion at Tembisa Hospital.
We have yet to see any prosecutions over the Life Esidimeni affair in which 144 patients died of starvation and neglect in the province’s psychiatric patient care system. All we really see after these incidents is attempts at reputational damage control.
Meant to show
The ANC’s Gauteng Premier, Panyaza Lesufi, and the province’s MEC for health and wellness, Nomantu Nkomo-Ralehoko, rushed to visit London in the private Morningside Clinic to which he had been transferred from Helen Joseph with the help of donors. The visit was meant to show their sympathy and concern for crisis management.
What these visits do is help ANC officials improve their sense of self-worth by showing that they are in charge.
In London’s case, the health MEC offered to expedite his move to a state hospital should he require an operation. It turns out he will be transferred back to a state hospital and might need the MEC’s intervention. In a well-functioning system he would not require such high-level intervention. But that’s often what ANC MECs like doing, as it is meant to show deep concern.
This concern for London and other patients would have been far better-placed, had the ANC-run provincial health departments been better and had clean audits. The only provincial health department that consistently receives a clean audit is that in the Western Cape. It also is the best-performing on infant and maternal mortality, key indicators which bear a close relationship to overall performance.
While larger budgets would be desirable, South Africa’s problem in health and education is that we get a terrible bang for our buck. There is poor management, corruption and wastage and a failure to ensure that providers are paid on time, and that state bodies pay market-related prices.
Profound inertia
It is not overwhelmingly a matter of more resources, it is a matter of getting things done within the available budgets. State institutions in this country display a profound inertia that just cannot appear to be broken.
The quality of the senior officials also matters. Jack Bloom, the long-serving DA shadow MEC, asks what sort of change can be expected when the newly appointed head of the Gauteng Health Department, Arnold Lesiba Malotana, is currently being investigated by the government’s Special Investigation Unit for corruption and inefficiency, and for allegedly sharing an R8 million bribe with two officials.
Last year, short of a billion rand was allocated by the province’s Treasury for outsourcing radiation oncology services. According to the Daily Maverick as of early July this year, this money had still not been spent.
Helen Joseph hospital has been in a state of disrepair and without a CEO for years. A long-promised upgrade has yet to happen, and from London’s account, leadership and authority have broken down at the hospital.
What pushed London to post on Facebook was not so much the matter of his own care at the hospital, but rather to inform people about the sheer state of disrepair of the ward, the facilities and the bathrooms, and the lack of service. The body of a patient, who died within clear view of London, was not removed from the ward for hours. During that time there were swarms of flies in the ward.
Was this due to overstretched staff and low morale, or really about lack of authority at the hospital due to poor leadership and accountability?
London says the doctors were offhand and abrupt toward patients. Doctors talked among themselves about their bonuses and the best restaurants in the area, all while a patient screamed out in pain. The doctors appeared self-absorbed and not wanting to communicate.
How low have things gone, when the Dean of the Wits medical school feels compelled to send out a reminder to staff and students to treat patients with “dignity, compassion and respect”? Helen Joseph is the teaching hospital for the University of the Witwatersrand Faculty of Health Sciences. The way to ensure that the doctors you train are caring is to ensure that they have a record of working on a voluntary basis in various care roles. Something is clearly amiss in our medical schools today.
Highly worthy
Tom London might not change things much, but what he has done is highly worthy. He has done a lot for the country by merely pushing for greater accountability. He should continue and expand the campaign.
It is not only the politicians, the state and hospital managers he has tried to call to account, but also the doctors. I have heard of accounts of centres of excellence and caring doctors in the health service, but all should still feel accountable to patients. Because they often do not want their judgments to be questioned, doctors can lapse into arrogance. Although patients have rights, these are difficult to exercise. Patients are scared and often simply do not have the words to question doctors.
Tom, you have pushed to change this and deserve immense credit from all of us.
[Image: Screenshot from X post on Tom London’s interview by Kaya 959, having relocated to a private hospital https://www.kaya959.co.za/lineup/point-of-view/tom-london-moved-to-private-facility-after-tirade-against-helen-joseph/]
The views of the writer are not necessarily the views of the Daily Friend or the IRR.
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