In South Africa’s rural Eastern Cape province, one doctor’s 14-hour fight to save a dying toddler has sparked a national campaign to fix a healthcare system that many say was broken long ago.
Dr. Dingeman Rijken will always remember baby Ikho. Now, following the infant’s death at the hands of a failing health system, a national campaign will ensure others don’t forget him either.
On 15 August, Ikho* celebrated his first birthday. Five days later, the chubby toddler died in an Eastern Cape hospital after being failed on multiple levels by the provincial health system.
His death has become a rallying point for a range of organisations, which will be marching to Bisho on Friday under the banner of the Eastern Cape Health Crisis Action Coalition, to demand that the province urgently addresses the healthcare crisis.
Ikho was admitted to Holycross Hospital in Flagstaff early on 19 August with a severe chest infection and battling to breathe. His doctor, Dingeman Rijken, would spend the next 14 hours in a desperate scramble to save the child.
‘There was a moment when I checked the oxygen flow and I realised that we had run out. Ikho’s mom noticed at the same time – she just stared at me.’
But when Rijken reached for basic equipment, it was out of stock. When he looked to management for help, he found apathy. When he needed oxygen to keep Ikho alive, he had to forage the hospital’s forgotten corners for near-empty canisters until he was left with nothing. When he tried to get Ikho transferred to a better-equipped hospital, the ambulance took hours to arrive.
Rijken remembers standing over Ikho, and catching his mother eye, as the two watched the hospital’s last bottle of oxygen, which was helping her only child to breathe, run out.
“There was a moment when I checked the oxygen flow and I realised that we had run out,” Rijken says. “Ikho’s mom noticed at the same time – she just stared at me.”
“I was standing there, looking at this child that was busy dying and unable to do anything,” he remembers. “I felt utterly powerless, this was so stupid.”
Before Ikho died, he suffered multiple seizures due to a lack of oxygen so severe that they would have left him severely brain damaged if he had lived, Rijken says.
Nurses in the rural province carry a patient load twice the national average
Ikho is not the first child to die from preventable causes at the hospital, which only orders oxygen when the supply has been completely exhausted, Rijken alleges in a new report by the Treatment Action Campaign and Section27 on the state of Eastern Cape’s health services.
The report paints a picture of almost complete dysfunction in the province, including a lack of basic services, massive staff shortages, crumbling infrastructure and financial mismanagement that conspire to create a public health emergency.
Health facilities across the province are running with half the doctors they need or less, leading to some facilities like the Mount Frere and Cecilia Makiwane hospitals to close their operating theatres, according to the South African Medical Association (SAMA). Others have stopped performing Caesarean sections, conducting physiotherapy and rehabilitation outreach, or supporting nurse-initiated antiretroviral therapy.
Nurses carry a patient load more than twice the national average while the doctors who continue to battle poor conditions – like other health workers – often go unpaid, according to the report.
Just last week, SAMA announced that doctors in the province had not been being paid correctly for the past five years and that the province owed them millions in back pay.
The province experiences regular shortages of medicines like antiretroviral medicine basic vaccines. Ambulances are non-existent while the waiting time for access to crutches and wheelchairs is almost two years.
In the 18 months between January 2009 and June 2010, health officials and their accomplices had robbed the department of R800-million, according to a Special Investigations Unit investigation into corruption.
The province is a hotspot for newborn deaths
Eastern Cape children are paying the highest price for the collapse in care. The province has the highest death rate for newborn babies and the majority of districts in the Eastern Cape recorded higher-than-average death rates of children under the age of five, according to the report.
OR Tambo district, the birthplace of former President Nelson Mandela, has the highest death rates of children below the age of 5 in the country. A recent study found that almost half of all three-year-olds in the district had gone without basic childhood immunisations.
When Ikho died, Rijken compiled an incident report. He was suspended and told to leave the home he shared with his pregnant wife on the Holycross grounds immediately.
While district health documents link his suspension to allegedly graphic training materials Rijken developed to help train traditional nurses on safe medical male circumcision, he argues the suspension is directly related to his whistle blowing over baby Ikho’s case and others.
“I spoke out to the media,” he says. “My wife and I, we believe that has had a role to play.”
Rijken has resigned from the hospital, but district health officials have allegedly threatened to re-instate his suspension should he take up another post anywhere within South Africa. He is contesting the dismissal.
Complex health budget crisis likely to be affecting other provinces
Former Head of Health Shiva Pillay also acted as a whistleblower and instituted a large-scale campaign against corruption. He recently left the department but not before threats were made to himself and his family.
According to the Rural Health Advocacy Project’s Daygan Eager, corruption is just one reason behind the Eastern Cape’s complex budget crisis.
The province has received only incremental adjustments to historically low funding levels – leaving its health services chronically funded, says Eager, but cautions that’s only half the story.
“National Treasury has said itself that they are willing to give the province additional funds, if it can improve its management,” Eager told Health-e. “That hasn’t happened.”
“The Auditor General reports come in year in and year out with poor audit outcomes,” he adds. “That includes finding fruitless, wasteful or irregular expenditure as well as overspending and failure to account for spending. “
Baby Ikho’s death and the stories of others in the report have prompted a coalition of civil society actors, including the nursing union the Democratic Nursing Organisation to launch a campaign in Ikho’s name to fix the province’s health system.
However, Eager says that other provinces including Limpopo and Mpumalanga may be facing similar crises with far less media attention.
“Treasury says it can’t invest in health departments until they show they can spend it,” he says. “Provincial departments of health haven’t developed strategies to develop the capacity to spend or define a minimum package of care.”
“Meanwhile, budgets continue to be based on what provinces can spend rather than what is needed – it becomes a Catch 22 that results in massive underfunding.” – Health-e News Service.
*Full name withheld to protect the patient’s identity. This article first appeared on September 11, 2013 in Health-e News.