On Thursday 5 March, Health Minister Dr Zweli Mkhize announced South Africa’s first confirmed case of the novel coronavirus.
A week later, on the morning of Friday 13 March, a Durban hostel resident – we’ll call him Mpilo – arose, then collapsed to the floor. His legs were not working. He had previously experienced lower back pain but no other symptoms. By late afternoon, sufficient funds were raised to put fuel in a vehicle to take him to hospital. An ambulance would have taken too long, or maybe not arrived at all.
Analysis: Public health system fails its first coronavirus test
Those who follow our work know that as a rule we don’t lend our pages to opinion writers and activists. Investigative journalism is premised on factual inquiry, which is best served by detachment.
But rules are there to be broken. Passionate immersion can open the floodgates of information. If that information is passed on to readers in full acknowledgment of the heart on the writer’s sleeve, society may be richer for it.
One writer who has bridged the gap between activist and investigative rapporteur is Vanessa Burger, whose urgent account of one patient’s experience of the public health system in KZN we reproduce.
Vanessa is best known for her tireless efforts on behalf of victims of the violence at Glebelands Hostel in Umlazi, Durban – not least by exposing the complicity of police and public officials in it.
Now, she tells the harrowing story of a hostel dweller, whom she calls “Mpilo” to protect his privacy. As the novel coronavirus hit our shores, Mpilo fell ill, probably with spinal tuberculosis, paralysing him from the waist down. To confirm the diagnosis and offer treatment, doctors needed to send him for an MRI scan.
But in Durban’s creaky public health system none was available – seemingly because one hospital which still had a working machine was being set aside for the expected tide of Covid-19 emergencies. And so Mpilo is to be discharged – “so I can die with my family” he suspects – even though he was told he might get his turn with the MRI machine as an outpatient in some months, or next year.
If he returns to the crowded hostel room he shares with his family, Mpilo puts them at risk too. TB kills tens of thousands in SA each year – many times Covid-19’s current world toll. But don’t get this wrong.
Yes, Mpilo’s story is one of an individual who probably can be saved given proper care, and of bureaucrats apparently so fixated on the impending deluge that they care not for a man already going under.
But it is also a canary in the coalmine of our readiness for Covid-19.
For if the system is already so undersupplied and overburdened that it cannot spare one man a bed and a scan, how will it cope when hundreds and thousands of critical Covid-19 patients really start rolling in, gasping for the care and machines that will let them breathe another day.
*Stefaans Brümmer, amaBhungane managing partner.
Mpilo, who has been unemployed since 2015, is reliant on state health care. His friends took him to Addington Hospital in central Durban where he was put in wheelchair and a catheter fitted. At around 3am the next day he saw a doctor.
Blood tests and x-rays were done and he was finally admitted just before 8am on Saturday 14 March. He had eaten nothing since Thursday, was in pain and scared to death, not knowing what was wrong with him and if he would ever walk again.
Mpilo subsequently developed intermittent breathing problems and was put on oxygen. He also complained of stomach pains, that the weakness had spread to his arms and hands, and that his feet had begun to swell. He was now paralysed from the waist down.
A preliminary diagnosis suggested a rare autoimmune disease that may cause paralysis, but this was abandoned. Mpilo was however assured that as soon as a bed became available he would be transferred to Inkosi Albert Luthuli Central Hospital so that an MRI scan could be done to establish conclusively what was causing his condition.
Addington’s own MRI scanner was not working, he was told. Once at Inkosi Albert Luthuli, he could also receive any specialised treatment that might be necessary.
On Sunday 15 March, President Cyril Ramaphosa declared a national state of disaster in response to the coronavirus pandemic. The number of confirmed cases had risen to 61.
While doctors were discussing his condition the following day, Mpilo heard one of them say: “If he does not receive treatment within 72 hours he may never walk again.” He was however told he would be sent to see a neurologist at Inkosi Albert Luthuli.
According to Mpilo, the neurologist was unable to tell him much; only that the problem was “in his spine” and that further x-rays and the MRI scan were needed for diagnosis. He was warned there “could be delays.”
Mpilo was duly returned to Addington for further x-rays. These were however delayed because Mpilo was in an upper floor ward and he was told that the lifts weren’t working.
Urgent emails were dispatched to the hospital’s chief executive. By late afternoon both lifts were working and Mpilo was x-rayed.
Again he questioned doctors about his supposed transferal. His condition was clearly deteriorating. He had been in hospital for a week but received no clear diagnosis, no treatment and worst of all, almost no information.
A little later, doctors told him they would “treat what they can see for now”, emphasizing that they could only provide a definitive diagnosis and begin specific treatment once the MRI scan had been done, which they hoped could be arranged later that day.
Mpilo waited patiently, but by late afternoon, instead of being taken to Inkosi Albert Luthuli for the scan, he was given four tablets.
“Eish, I’m worried, they are giving me TB medication but no one has told me if I’ve got TB,” wrote Mpilo in a panicked WhatsApp message.
“The nurse says it’s written in my file. But I asked the doctors this morning what is wrong with me and they said they need to do the scan first. This medication is really messing me up, I feel terrible, I can’t eat, and they say that the treatment is 6 months. It’s going to hit me hard. If it’s TB the least they could do is tell me before giving me the medication. I don’t understand what’s going on.”
Some time later it seems Mpilo finally managed to establish that spinal TB was suspected but could only be confirmed by the MRI scan. He was told the medication was a precautionary, interim measure, until he could be transferred to Inkosi Albert Luthuli. It would protect him and others from infection in the event he did indeed have TB.
More than a week after his admission, on 21 March, Human Rights Day, a doctor informed Mpilo that the health minister had issued instructions that Inkosi Albert Luthuli was only to make space available for Covid-19 related emergencies.
Mpilo’s case, it seems, was not deemed an emergency. He would therefore not be transferred, neither would he get the scan for which diagnosis and subsequent specialised treatment was critically needed.
An independent TB specialist, whose opinion was sought, said the medication would perhaps “buy him some time”, until he could have the scan.
In a statement later that day, Mkhize announced that 240 cases of Covid-19 had been confirmed of which 27 were in KwaZulu-Natal. Patients who tested positive were being hospitalised purely for assessment, he assured South Africa. None were in intensive care or critical and there had been no fatalities yet.
Scarce hospital space was to be reserved, it appeared, for Covid-19 patients, while other serious and – if left untreated – potentially fatal or disabling cases, such as Mpilo’s, were to be denied the medical care critical for their survival and recovery.
According to the World Health Organisation’s (WHO) 2019 global TB report, in South Africa alone, 301 000 people fell ill from TB in 2018 while 64 000 (21%) died. Of the 10 million global TB sufferers, 1.5-million died (15%) during the same period.
By comparison, a situation report by the European Centre for Disease Prevention and Control on the same day as the minister’s statement recorded 271 364 Covid-19 cases globally of which 11 252 had proved fatal (4.2%).
TB remains the top infectious disease killer worldwide and South Africa is in the eight countries with the highest prevalence rate. The WHO report also stressed the importance of speedy diagnosis and treatment in curbing the spread of this deadly disease.
At his hostel, Mpilo shares a room with his family, including his young son. He is in close daily contact with dozens of other hostel residents and recently visited his rural parental home. If TB is indeed the cause of his condition, then all those close to him need to be tested and treated immediately if found to have contracted the disease. The longer his diagnosis is delayed, the more people could be potentially at risk.
The coronavirus pandemic is shining a harsh light into the gaping chasm between South Africa’s haves and have-nots; those who enjoy human rights and those who still don’t. In an SAFM interview last week, Mthembiseni Thusi, spokesperson for Ubunye bamaHostela, KZN’s hostel dwellers association, highlighted the dangers presented to- and by- hostel communities’ unhygienic living conditions in light of the Covid-19 pandemic.
Social distancing, he pointed out, was a fantasy when up to 30 people are forced to share one tiny room. Across Durban an estimated 250 000 hostel dwellers still endure inhumane living conditions more than 25 years after the fall of apartheid.
On the topic of social distancing and hand washing, a few days earlier another hostel leader had reported that at Prince Mshiyeni Hospital in Umlazi, most taps were without water, there was no soap and no toilet paper. He also said the grounds were full of hawkers selling food to patients and visitors. “It’s like a market,” he said.
According to constitutional law expert Pierre de Vos, “regulations issued in terms of the declaration of a national disaster must comply with the provisions of the Bill of Rights and a court can declare specific regulations unconstitutional if they impose limitations on rights in a manner not justified by the limitation clause”. This would include the right to health care and access to information, especially about one’s medical condition.
Even in the event of the declaration of a state of emergency, de Vos emphasized that certain rights cannot be suspended, such as the right to life, human dignity and freedom from discrimination on certain grounds. It would seem inconceivable, that, although medical discrimination is not listed in the constitution, a court would uphold a decision to deny a patient critically needed medical diagnosis and treatment on the basis that he was not suffering from a specific virus.
Spinal TB is apparently very difficult to diagnose and requires a variety of tests of which an MRI scan is critical. More complex and supportive treatment is needed than for pulmonary TB. Sometimes surgery is necessary to remove and repair damaged areas of the spine. Cold abscesses can develop which need to be drained to prevent infection. Physiotherapy will be needed. But it can be treated, and 76% of TB patients recover.
The first step however requires diagnosis. Mpilo still does not know if he has TB. Will he be required to wait until the coronavirus has run its course in South Africa to find out? How many people in other hospitals are facing the same uncertainty?
On Sunday it was reported that KZN’s private hospitals would make beds available, free of charge, should there be a large-scale outbreak of Covid-19 in the province. Although timely, this does not go far enough. All patients with critical illnesses should enjoy the same right to good quality and prompt health care, especially those in very deprived circumstances and who may have serious contagious diseases.
On Monday this week, a doctor told Mpilo that the situation was “now out of their hands”. Although Mpilo could have the MRI scan at Inkosi Albert Luthuli as an outpatient, due to the significant strain on the crumbling public health system, he was told he would have to wait months, even “until next year”, for a booking.
Later that day, Ramaphosa announced that from Thursday 26 March, the country would be entering a nationwide lockdown to slow the spread of Covid-19.
On Tuesday, Mpilo was provided with a wheelchair and told he would never walk again. He was told he would soon be sent home and could then stop taking the TB medication. He would receive training how to change his own catheter. When he asked if he did indeed have spinal TB, the doctor confirmed they did not know.
The MRI scan (maybe in a year’s time) was needed for conclusive diagnosis. Conventional understanding dictates that once TB medication is started the course must be completed to prevent the disease developing into multi-drug-resistant TB.
Side effects from the TB medication mean Mpilo cannot cope with solid food. He has not been placed on a drip and has had no nourishment since Sunday. He has received no counseling, no emotional support and no information about how he is supposed to cope with his condition after he is discharged.
His rural family is certainly not equipped to deal with a disabled relative while his room at the hostel is on an upper floor.
Although demands currently placed by Covid-19 on the public health system are extreme, it would appear highly unethical to deny proper treatment – even diagnosis – to other seriously ill patients, especially those who may have TB – and even worse, to send them home to the rural areas where there is little access to clean water and health care is all but non-existent, or back to an overcrowded hostel.
And how many other Mpilo’s are being subjected to the same?
“It seems my condition is not serious. They can’t tell me what’s wrong or give me proper treatment because I’m not suffering from coronavirus. So they are sending me home as soon as possible – even today – so I can die with my family,” said Mpilo.
He added that some staff had suggested that Addington might be turned into a dedicated Covid-19-only facility within two weeks. “And the lifts aren’t working again,” Mpilo reported.
Vanessa Burger is an independent community activist who has worked extensively in hostels and is involved in trying to help Mpilo (not his real name), who has consented to this article being written. Burger can be emailed on firstname.lastname@example.org.
Associates of Burger have written to both hospitals but received no reply. AmaBhungane invites comment from the hospitals and the health ministry. We did not seek comment in advance due to the urgency of the matter.