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Johannesburg - On August 15, 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 Bhisho on Friday under the banner of the Eastern Cape Health Crisis Action Coalition, to demand that the province urgently address the healthcare crisis.
Ikho was admitted to Holy Cross Hospital in Flagstaff early on August 19 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.
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’s 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 who was busy dying and unable to do anything. 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.
Ikho is not the first child to die from preventable causes at the hospital, which only orders oxygen when the supply has been exhausted, Rijken alleges in a new report by the Treatment Action Campaign and Section 27 on the state of Eastern Cape’s health services.
The report paints a picture of dysfunction in the province, including a lack of basic services, staff shortages, crumbling infrastructure and financial mismanagement that conspire to create a public healthcare emergency.
Healthcare facilities across the province are operating 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.
Last week, SAMA said doctors in the Eastern Cape had not been paid correctly for the past five years and that they were owed millions in backpay.
The province experiences regular shortages of medicines like antiretrovirals and 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 robbed the department of R800 million, according to a Special Investigating Unit investigation into corruption.
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.
The OR Tambo district has the highest death rates of children below the age of five in the country. A recent study found 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 immediately leave the home he shared with his pregnant wife on the Holy Cross grounds.
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 that the suspension is directly related to his whistleblowing over baby Ikho’s case and others. “I spoke out to the media,” he says. “My wife and I believe that has had a role to play.”
Rijken has resigned from the hospital, but district health officials have allegedly threatened to reinstate his suspension if he takes up another post anywhere within South Africa. He is contesting the dismissal.
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 he cautions that’s only half the story.
“The Treasury has said itself that it is willing to give the province additional funds, if it can improve its management. That hasn’t happened. The Auditor General reports come in year in and year out with poor audit outcomes. 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 Democratic Nursing Organisation of SA, to launch a campaign in Ikho’s name to fix the province’s health system.
However, Eager says other provinces, including Limpopo and Mpumalanga, may be facing similar crises with far less media attention.
“The 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.”
The provincial and national health departments have accepted a copy of the report, and the authors of the report have met with Minister of Health Aaron Motsoaledi about its contents.
Health-e News Service