Medical staff in Limpopo say the province’s health system is on the verge of collapse due to the strain foreigners are putting on it.
“We have raised this issue with the last two health ministers,” said Dr Michael Ndwambi, senior clinical manager at Thohoyandou’s Tshilidzini Hospital. “We are overrun by foreign patients and barely have the budget needed to care for our South African ones.”
The Sunday Times visited several hospitals in Limpopo this week. It found highly frustrated and demoralised staff who are battling to give patients the care they need.
Ntovhedzeni Ligege, the CEO of Messina Hospital in Musina — the closest South African hospital to the Zimbabwe border — is worried.
“Primary health care is free in our country and we do not turn sick people away. But what if people from neighbouring countries are abusing our constitutionally guaranteed access to primary care in ever-increasing numbers?” he asked.
“We are supposed to have 32 doctors. At the moment we have 19. So we are already struggling under our caseload. The constant influx of patients from other countries is exacerbating an already crisis situation. And it is destroying our budget.”
Ligege said outrage at health MEC Phophi Ramathuba, who took out her frustration on a Zimbabwean patient in a video that went viral this week, ignored the fundamental problem.
“We help everybody and turn nobody away, but we have to start facing realities when it comes to the issues of overcrowding and underfunding,” he said. “Most of our foreign patients come to us without a referral. Everything in their home countries has collapsed and they come to us in desperation. We have a perfect storm forming here.”
At Tshilidzini, the Sunday Times spoke to a 22-year-old Zimbabwean who recently gave birth to her second child at the hospital.
She has no form of identification and the hospital is waiting for guidance from the social development department before she can leave. Medical staff suspect she slipped into SA when she was already in labour.
“I had no choice but to come,” she said while breastfeeding her baby.
In Zimbabwe everything is broken or gone. Our hospitals have no medicine, no food, no pills and not even blankets. In South Africa they have everything I need to safely birth my child.
— Patient at Tshilidzini Hospital
“In Zimbabwe everything is broken or gone. Our hospitals have no medicine, no food, no pills and not even blankets. In South Africa they have everything I need to safely birth my child. I don’t care what happens now, my baby is safe and alive.”
In the Messina Hospital maternity ward, a 24-year-old mother from Harare is sitting next to her newborn boy, who is fast asleep in an incubator.
“This is my second child. After the birth of the first one I realised if I wanted to give birth safely I must come to South Africa. In Zim the doctor will write you a script, but when you go to the pharmacy they have no medicine.”
Ligege said it was not unusual for pregnant women to cross the border when their labour pains had already started, give birth in his hospital and then return to their home country.
“Under the [National] Health Act we are not allowed to turn someone away if they are experiencing an emergency,” he said. “We help them, but the numbers are starting to become overwhelming.”
Ligege said that between August 1 and Thursday this week the maternity ward had treated 242 women, and only 80 of them had been South Africans.
“We have a high-risk clinic for mothers whom we expect will have complications during birth. This week the clinic had 83 patients; 61 of them were foreigners.
“You must imagine yourself in the shoes of these mothers. Some of them travel from as far as Harare, Bulawayo and even countries like Zambia. Their medical situation at home is mostly unbearable and a complete failure. In South Africa they have a fighting chance,” he said.
“We are talking about heavily pregnant women who can’t cross the border at the official border posts so they pay R500 to cross the Zambezi river — full of crocodiles and hippos.”
Ligege said the oncology department was also under pressure.
“Patients who arrive in very advanced stages are a massive problem. Ideally you would have a haemoglobin level of 11 or higher in your blood. Some of these patients come in and they are below five. We must give them blood transfusions and an account like that can easily run to R40,000 in three days. Then the patient just folds his arms and says he can’t pay.
“We serve on average between 1,500 and 2,500 patients per month. About 35% to 45% of them are foreigners. Most of them do not pay. I have to haggle and make deals so the hospital can at least sometimes get something back.”
Patients in financial difficulty must fill in a debt acknowledgment form. “Many foreigners give a South African address, but if we later look for them there they have disappeared,” Ligege said.
“More than half of our foreign patients disappear without paying. That is not financially sustainable.”
Ligege showed the Sunday Times what he said was a typical patient account, for an initial amount of R5,350. This figure had been scratched out by hand, and below it was written R3,745. This amount was also scratched out. Handwritten at the bottom of the page was the final charge: R2,500.
“This shows you the path. They get a bill, they say they don’t have money. I make an offer and they say what they can pay. Even that doesn’t always work, because people disappear.”
Another bill was for R62,946. “From this account we recovered nothing and the patient disappeared back over the border,” Ligege said.
This shows you the path. They get a bill, they say they don’t have money. I make an offer and they say what they can pay. Even that doesn’t always work, because people disappear
— Ntovhedzeni Ligege, CEO of Messina Hospital
“We have people who are involved in motor vehicle accidents. They come in and we treat them. Later our own rehabilitation people say the patient needs a wheelchair. One wheelchair costs R3,000. I have been at this hospital since 2015. In these seven years I have never even heard of a wheelchair coming back.”
He said Messina Hospital is one of eight in the Vhembe district, which has a population of 1.4-million to 1.5-million.
“For many of these people we are the last resort. They only cross the border and come to us when all their other options have been exhausted.
“People will often first try traditional healers and only when that doesn’t work come to us. This complicates matters even further. Because they wait so long, most patients come to us in a very advanced state and that means more resources, more attention. All of this affects our budget and staff morale,” Ligege said.
“Social media is killing us. We have a rural health initiative under which we fight to lessen the surgical backlog in the more rural areas. We advertise on social media ahead of time where the next one will take place. People in neighbouring countries see that and see it as an opportunity.”
A senior doctor in at Messina Hospital, who did not want to be named, said the pressure was immense.
“We have patients who are involved in vehicle accidents in Zimbabwe. They are taken to the hospital there, but sign a refusal of treatment and discharge themselves. Then they cross the border and come to us with their fractures,” he said.
In the Messina general ward, a 47-year-old woman from Zimbabwe was being treated for HIV and TB. “I started feeling sick here in South Africa. I survive by selling fruit. I will pay my account. Even if I have to come pay something every time I sell some fruit.”
At Tshilidzini Hospital, nurse manager and acting CEO Cindy Baloyi said the facility, with about 530 beds, was often stretched to capacity. This week 383 were occupied.
“If more patients come in, some of them will end up sleeping on the floor,” she said.
“We have had stabbings in our queue when South Africans get angry because most of the people in front of them are foreign,” she said.
“We have massive problems trying to collect payment. People supply wrong names and addresses and have no passports, but if they come to us in an emergency we are constitutionally mandated to provide care.
As we speak a Zimbabwean man is in our operating theatre receiving an orthopaedic implant worth R70,000. We will probably lose that money
— Cindy Baloyi, acting CEO Tshilidzini Hospital
“As we speak a Zimbabwean man is in our operating theatre receiving an orthopaedic implant worth R70,000. We will probably lose that money,” Baloyi said.
Dr Ndwambi said that in June Tshilidzini Hospital conducted a rural health initiative focused on orthopaedic surgery. “We helped 388 patients as part of our efforts to curb the surgical backlog.
Of those operations, 34 were for orthopaedic implants. Of the 34 patients, 20 were foreigners.”
He said the hospital spent on average R1m a month on implants, many of them for foreign patients.
“When people in Zimbabwe read online that we are planning a rural outreach, they physically discharge themselves and cross the border.
“The story of the weekend in Bela-Bela is angled the wrong way. It should not be about Dr Pophi berating the foreign patient but rather focus on the 495 people from all over who were helped with surgical procedures. Why are we not celebrating what Dr Pophi and our colleagues accomplished?” Ndwambi asked.
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