The shock resignation of a highly experienced staff member from Cecilia Makiwane’s psychiatric unit, and a warning by the Democratic Nurses Association (Denosa) that staff shortages in Eastern Cape hospitals are putting both staff and patients at risk, have again thrown a spotlight on the crisis in mental healthcare in the province.
The revelations come as a case in which a former psychiatric patient is seeking compensation for an alleged assault in hospital was postponed in the East London Regional Court last week.
On 26 March, South African Society of Psychiatrists (SASOP) President Bernard Janse van Rensburg told Grocott’s Mail that a professional staff member had recently resigned from CM’s psychiatric unit.
Grocott’s Mail confidentially spoke to the staff member about the reasons for their resignation after 13 years of service at the institution. The former CM staff member expressed similar concerns to that of former Tower psychiatrist, Dr Kiran Sukeri, whose claims, as reported in Rapport 4 March, concern the overall management of Tower Psychiatric Hospital in Fort Beaufort, as well as alleged substandard and inhumane patient care.
“Management asked me to stay, but I said ‘no’, because things won’t change,” the former CM staff member told Grocott’s Mail. After 13 years of fighting for change and improvement, the former staff member said, they could no longer cope.
“Nothing has changed”, they emphasised.
“I love the work that I do. Leaving was very hard.”
The source said the ward conditions at CM were not suitable for psychiatric patients. The two wards had previously been used as medical wards.
The psychiatric wards at Cecilia Makiwane were divided into male and female sections, the former staff member said. Both wards were completely closed, and each housed 25 acute patients of varying ages, histories and diagnoses under one roof.
There were no open wards and recreation space was dismal, the former staff member said – a claim that appears to be backed up by images independently provided to Grocott’s Mail.
“They are not designed for psych patients,” the former staff member said, describing the patients as “difficult, acute, [and]aggressive”. Both wards were closed, with round-the-clock nurses and security.
SASOP said the issues currently faced by Tower Psychiatric Hospital in Fort Beaufort were not isolated. The East London facility showed similar problems, SASOP said.
SASOP continues to urge for the examination of the entire Eastern Cape psychiatric care referral system. This concern has also been presented to the Health Ombud.
16 June 2017 revolt
On 16 June 2017 there was a “revolt” in the male ward, which was reported in regional media. The former staff member said patients had turned on each other as well as staff, including nurses and security guards. The South African Police Service (SAPS) was called to defuse the violent situation.
“There was no barrier,” the former staff member emphasised, because it was an “ordinary medical ward”. They further commented that acute wards typically have a barrier for the protection of nurses and staff.
The revolt caused severe damage to the ward, and the majority of patients were immediately transferred to other institutions, including Tower, the former staff member said.
The incident had been highly traumatic for both staff and patients.
The Superintendent General had visited the hospital less than week after the incident, but nothing had come as a result, the source said.
They added that hospital management had not adequately addressed staff concerns after the traumatic incident and ward nurses had embarked on industrial action on 21 July 2017 in protest against the dangerous working conditions.
Patients were transferred again, as there had been no capacity to care for them, the former staff member said.
On 9 April Grocott’s Mail spoke to Khaya Sodidi, provincial Secretary of the Democratic Nurses’ Organisation of South Africa (Denosa) who says staff shortages in Eastern Cape hospitals are putting both staff and patients at risk.
“Staff are working in an unsafe environment in hospitals and clinics,” he said.
Nurses working at the three local psychiatric facilities – Tower, Fort England and Cecilia Makiwane – received danger allowances, Sodidi said. This was because they worked with patients who were unpredictable.
“For the past few years, nurses have been asking for an increase in that danger allowance or, alternatively, an increased staff complement.”
There was a shortage of staff in those institutions, Sodidi said.
“For example, a unit that is supposed to be manned by three nurses – you’ll find there is only one there.”
That one nurse is sitting with patients who are unpredictable. They are surrounded by unpredictable people. Some staff are scared to even go to work at a particular ward because they’re scared of being attacked by patients.
Since the incident in June 2017, CM’s psychiatric unit now only takes “16 to 18 patients” per ward, as they do not have the staff capacity to manage another crisis, stated the former staff member.
This specifically affected adolescent and geriatric patients, as the ward conditions were too unsafe, the former staff member said.
“Doctors and nurses bear the brunt. We feel as we are letting down a community.”
New psychiatric hospital?
In 2012, the Eastern Cape Province commissioned a new psychiatric hospital for Cecilia Makiwane to be built in 2015.
“We were promised this stand-alone hospital,” the former staff member said. “I don’t know what happened, maybe it was too much money.”
They added that the issue of poor mental healthcare facilities was a province-wide problem.
The problems at CM are at an “institutional level, even at national level”, they said.
There is big discrimination against psychiatric patients.
Regarding the ward conditions, the former staff member stated that “the patients are in pyjamas 24/7” and there is a television in each ward. They described highly medicated patients sitting in pyjamas in front of a television, calling it “counter-rehabilitation”.
Because there is no open ward for patients to progress to, there was a “massive revolving door syndrome at Cecilia Makiwane”, in that patients came back because they had not received proper treatment.
“It’s about considering what is the risk to the patient,” they said.
They added that there is an overall failure by the “trained staff” to understand psychiatric conditions. For example weapons were commonly found on patients as security guards did not understand how to search psychiatric patients, they said.
“Basic things are not done”, they said, which impacted “general safety”.
A grim future
The former staff member plans to leave the province, as they believe the working conditions are not suitable or healthy. “It’s the despondency that’s now among us,” they commented with regard to professionals who have left institutions.
With Eastern Cape facilities continuing to suffer from staff shortages, overall patient care would continue to be put at risk, they said.
The staff member’s resignation, and Denosa’s comments on staff and patient safety, come as a former patient alleges that poor ward conditions in 2013 contributed to their being violently assaulted by a fellow patient in the East London hospital at that time. In the civil claim, the former patient says they lost many teeth and were left permanently disfigured and traumatised.
The MEC for the Department of Health is named as the respondent.
At the start of proceedings on 6 April, the defence immediately called for a postponement, on the basis their expert witness was not able to attend the hearing. The MEC’s legal counsel argued that the specialist, a psychiatrist from Durban, was necessary in order to determine if the former patient was mentally capable of understanding the litigation process. The matter was postponed to August 2018.
Grocott’s Mail has approached the Provincial and National Department of Health and other bodies for comment and further information and will continue to report on this provincial crisis.
On 18 April, Eastern Cape Department of Health Spokesperson, Sizwe Kupelo, was requested to comment on concerns expressed by the former CM staff member, but has not responded at this time.
- Additional reporting by Sue Maclennan
*This story has been re-edited as of 3 June 2018, the original story was published online on 18 April 2018.