KZN health growing challenges
Image: Dumisani Dube / File
Patients seeking to be admitted to Ngwelezane Tertiary Hospital could wait as long as five days for a bed, as the healthcare facility battles a severe shortage of beds.
The hospital issued a notice recently warning that it has been forced to transfer some patients to nearby hospitals to alleviate this pressure. On its website, the hospital states that Ngwelezane Hospital, a 516-bedded facility, is designated as a tertiary hospital for the King Cetshwayo, Zululand, and Umkhanyakude districts in the region.
It is the only hospital in the uMhlathuze sub-district functioning as a Level I, Level II, and Level III hospital. A Level I hospital provides general, first-level medical care with basic diagnostic and therapeutic services. A Level II trauma centre or regional hospital is an acute-care facility capable of providing definitive trauma care, offering 24/7 emergency services, general surgeons, and common specialist care. Level III hospitals are equipped to provide prompt assessment, resuscitation, and emergency surgery for injured patients.
The hospital said it receives referrals from 18 hospitals in Region IV for secondary and tertiary care.
A warning issued by the hospital recently stated that Ngwelezane Tertiary Hospital is facing a problem of bed shortages, which means that those who are ill could have to wait for five days. “We are concerned that this could lead to a situation where the quality of care offered to outpatients may decline, and hence we have taken a decision to transfer some of our patients to other nearby hospitals,” said the notice. It added that those in need of advanced care will be accommodated in the hospital. “We are doing this to reduce the pressure on the capacity of the hospital.”
Dr Sabelo Mthethwa of the MK Party and member of the Health Portfolio Committee said the situation at Ngwelezane Hospital reflects the broader crises faced by the Department of Health. He noted that the critical shortage of doctors and other key staff members is a major contributing factor to the challenges.
“In a normal situation, a patient would walk in, be treated, and be discharged quickly. However, because there is a shortage of key staff such as specialists, patients stay in hospital longer because the treatment is not administered quickly,” he said.
“It is also the failure to manage the department's budget properly that has led to issues with medication. If you do not have good quality medication, that contributes to patients staying longer in hospital because you cannot give them medication that they do not respond to. What then do you do?” Dr Mthethwa emphasised that the Department of Health is a very complicated department, and it requires someone who understands what the department does.
The chairperson of the Health Portfolio Committee, Dr Imran Keeka, stated that Ngwelezane Hospital is a tertiary facility providing very specialised services.
“It should not be a walk-in facility and must require a referral. However, during the committee’s engagement with the hospital last year, we found that given the large and rural receiving area of the hospital, many general walk-ins could not be avoided or denied.”
“While it was a compassionate compromise, this is now the result. Referral of patients to the level of care that is needed is not untoward. The facility must manage its bed space for what it is intended for — in this case, for specialised tertiary-level services. Notwithstanding, they are duty-bound to ensure that no life-threatening emergency is turned away.”
Dr Keeka added that referral pathways are strictly followed to minimise the impact on the most ill patients who must be serviced by the hospital.
“Once the regional services at Vryheid Hospital are fully operational, there will be mitigation on the impact. This is still underway.” In response to questions, Ngwelezane Tertiary Hospital in a statement said it remains fully operational, with its doors open to all patients requiring emergency and life-saving care. The statement said the hospital is mandated to provide highly specialised services, including orthopaedics, burns, and cardiology.
“The recent public communication regarding bed management was issued to address a challenge known as ‘bed-blocking’.”
This occurs when patients who are medically stable and no longer require the intensive, specialised care available at a tertiary level occupy beds that are critically needed for emergency referrals from district and regional hospitals.” It said the hospital is implementing standard clinical protocols to down-step or de-cant stable patients to district hospitals.
“This decision is based strictly on clinical judgement by the treating physician and ensures that patients are only transferred when they are medically fit for a lower level of care. This approach is not a refusal of service but a responsible management of resources to ensure that the sickest patients receive the specialised attention they require.” The hospital said it acknowledged that the initial communication may have caused public concern and apologised for any confusion.
“The Department of Health appreciates the public’s understanding and cooperation as we work to improve patient flow and ensure that Ngwelezane Tertiary Hospital fulfils its mandate of serving the sickest patients in the region.”
For more stories from The Mercury, click the link THE MERCURY