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Updated 10 October 2014

Gang warfare in state hospitals

Staff in South African state hospitals are routinely put at risk when at work, being exposed to theft, muggings, rape and even murder on a regular basis. Shaun Swingler investigates the dangers faced by our health workers.

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“One night the police brought in a patient who was only mildly injured – he needed a few stitches at most,” says Vanessa*, a doctor who was working at GF Jooste Hospital in Manenberg, Cape Town. “I was busy seeing someone who was having a heart attack, and somebody else had an epileptic fit, so I had my hands full.

Hospital surrounded

"I told the police that the man could wait – I had more pressing concerns. They said: 'No doc, you don’t understand – You have to see him NOW because the gang who attacked him want to finish him off. They’ve surrounded the hospital and they want to come in because they know that he’s here’.”

As this experience suggests, hospital staff are routinely put at risk when working in state facilities. They are exposed to theft, muggings, rape and even murder on a regular basis, and many interviewed for this article place the blame squarely on the shoulders of provincial health departments which “lack accountability” and have employed “incompetent” security companies to guard their hospitals.

Read: SA hospital shocker

"The stuff we see is really crazy and the people who are not in the system just have no idea,” says Vanessa. “Whenever there was an issue I never looked to the security to come help me,” she continues. “Once I was bitten and attacked by a patient. He just launched out of the bed at me and bit my arm and I screamed my head off. The security didn’t come and help me. My students came to help me. We eventually had to throttle him before he opened his mouth and let go of my arm.”

“To be fair there is quite a bit of security around,” says Oliver*, an intern doctor at the Pietermaritzburg Hospital Complex. “There’s a guard at the gate who checks what you’re bringing in and taking out, but the security is not great – it’s more of a presence than it is an actual functional thing, and it definitely varies from hospital to hospital.”

“Most of my experiences [in Pietermaritzburg] are petty theft,” he says. “A few weeks ago my phone got stolen from under my nose while I was writing notes for a patient. There’s an incident at least once a week where patients or their family steal things.”

Attacked and raped

There have been a number of high-profile security incidents in state hospitals recently. In September a nurse was attacked and raped at Helen Joseph hospital in Johannesburg, and in July a locum physician at Khayelitsha Hospital was murdered when he left the hospital to buy food during his shift. And most recently, in October at Chris Hani Baragwanath, a security guard was stabbed to death by another security guard after they got into an argument while on duty.

These incidents prompted outrage from the public and fear from the victims’ colleagues and others working in similar facilities. Security is often stepped up after such incidents; but, as some of the healthcare workers interviewed for this article argue, these interventions do not last for long.

Read: A day in the life of a rural doctor in SA

Security in South Africa’s clinics and hospitals is run at a provincial government level by the departments of health and community safety, with some smaller clinics run by local government. Security companies and their contracts therefore differ from hospital to hospital and from province to province. Risk assessments of the hospitals are conducted by the departments of health and community safety and after risks are identified a tender process is conducted with the successful security company’s contract usually lasting two to three years.

The training received by security guards differs by company; however, all security guards are graded on an A, B, C or D scale according to where they receive first aid, firefighting and fire arm training. Security working at psychiatric institutions receives training from a professional psychiatric nurse.

“Sometimes it’s quite shocking seeing what’s happening in hospitals here,” says Belinda*, a 1st year intern at the East London Hospital Complex.

Really anxious

“A patient chased me around casualty recently,” she says. “I was calling the security for help while he was chasing me around, and the sisters and the other staff just ran away – I think they went to get security but they just left me alone with the guy chasing me.”

“The security was out of earshot to the extent that it took them a while to come,” she continues. “Luckily it was fine but it could’ve just as easily not been fine. The next few times I had to go on call at night I got really anxious about it.”

“I feel threatened by some of our patients and I’m not the only one,” says Belinda. “I’ve taken to walking with a pepper spray in hand [when on call at night].”

“These hospitals are often in really dangerous places and they need to be because these places have poverty and crime and alcoholism and drug abuse and violence,” says Vanessa. “These are places where healthcare workers are needed the most. But how much accountability is the Department of Health taking to keep us safe? The accountability seems to lie in our hands and it shouldn’t be that way.”

Read: Hospital crisis: managers the solution

“I don’t personally think that we’re doing enough as far as improving security is concerned – but we’re working on it,” says Dr Terrence Carter, deputy director-general in the department’s National Tertiary Hospital Services and Human Resources. “We recognise that security is a concern and we’re spending a staggering amount of money on it. We’re implementing new security measures [such as improved access control and CCTV] … but it’s an unfortunate reality in South Africa that we have to spend so much money on security because it’s money we should be using for healthcare.”


Little faith in security

While a significant amount of money is spent on securing state hospitals (R135 million in the Western Cape alone last year, according to Western Cape Health MEC Theuns Botha) a number of healthcare workers have little faith in the people tasked with securing them.

“I don’t think the security is top notch at all,” says Heather*, a 1st year intern doctor at the East London Hospital Complex. “And in terms of how safe I feel, I try not to think about it too much – to live in a kind of oblivion and hope that everything will be okay. During the day when the hospitals are busy and are fully staffed you generally feel safer. I would say it’s more at night when you’re on call and the hospital’s a lot emptier.”



Vanessa is equally critical of the security.

“When I was at Mitchells Plain District Hospital they found computers were being stolen and it was the security guards who were stealing the computers,” she says. “These are the guys who are hired to keep you safe but nobody trusts them.”

“I was working really late one night walking from the emergency centre to the laboratory at the back of the hospital,” says Vanessa, “and the security guard could clearly see I was a doctor, I had my stethoscope around my neck, and he started cat-calling me. I was like, are you fucking serious?”

Crisis control

The final straw for Vanessa was when she was attacked in her car at a notorious set of traffic lights outside Mitchells Plain District Hospital earlier this year. “A guy jumped into my car at the robots with a stone. He didn’t just grab and run, he was inside my car, pulling me, looking for stuff to steal. Luckily he just grabbed my bag and he left. I was the fifth staff member that had happened to at those robots in the preceding four months.”

“I kept saying I was fine, I just went into crisis control because that’s what we do. I just wanted to fix the car, sleep it off and go back to work the next day. My husband forced me to see a counsellor after the attack and I subsequently stayed at home for two weeks after that.”

During her counselling, Vanessa left her job.

Read: Choosing your hospital 

“I never thought that I would do anything like that,” she says, “I’ve always really enjoyed seeing patients in state facilities because I enjoy the work – it’s challenging, you feel like you are making a difference. But there just comes a time when [the department] sees you as replaceable and that makes us feel like we were not valued and cared for.”

“The lack of support in terms of physical and mental wellbeing of the staff definitely takes its toll and I think it’s a massive factor for people leaving to go overseas or into private,” says Vanessa. “It’s unsafe where we work.”

Vanessa left the Department of Health and now works as a locum. For Belinda, her experiences have made her think twice about staying in the state health sector.

'I have to get out of here'

“I was always incredibly idealistic about doing rural medicine and staying in South Africa and I used to get upset when people said they wanted to work in private or go overseas. And now I feel like I’ve been pushed to a place where I can understand why people form those views. I come home sometimes and I say: ‘I have to get out of here’.”

This migration of skills into the private sector and overseas is particularly worrying when one looks at the most recent employment figures in the state health sector. According to 2010 Department of Health figures, 56% of doctor and nurse posts in the state sector were vacant. That’s 14 351 doctors and 44 780 nurses that are missing from the public sector.

Read: Doctors worry about hospital staff shortages

Dr Carter doesn’t believe that safety concerns are resulting in doctors leaving.

“If doctors say that there is a concern about safety in our institutions I would agree with that,” he says, “but in more than fifteen years as a hospital manager I have never heard of doctors leaving the system as a result of a lack of security because they felt unsafe.”

Popo Maja, the national health department’s head of communications agrees: “Seldom has [a lack of security] been cited as the main reason why [healthcare workers] opt to go [to] the private sector or abroad. Many of them cite remuneration and other social factors such as the education of their children and being closer [to] amenities.”

A threatening environment

Dr Carter continues: “Often the people that use our trauma units have been involved in violent incidents where sometimes those violent incidents spill over into the hospital … and some of our patients tend to be over-exuberant in terms of their levels of physical activity. It becomes a difficult, threatening environment for a young doctor to work in – but that’s the nature of the work we do.”

Recently, Sandra* and her daughter visited a friend at Tygerberg Hospital on a Sunday night. After being let through security, she and her daughter had to walk through the emergency ward to reach her friend. They saw blood on the floors and walls and dozens of what she described as “gangsters” shouting and demanding special treatment for a friend of theirs who had been “knifed”.



Sandra’s friend described to her how, at night, the wards are locked so that patients cannot move around. This, she said, keeps perpetrators in their wards, and protects the innocent. Nevertheless, as Sandra’s friend said, “the tsotsis bang on the doors and walls and shout for them to open the doors.”

One hospital which has had consistently good safety reviews from those interviewed is Red Cross War Memorial Children’s Hospital in Cape Town.

Even so, according to the Western Cape Department of Health, there have been a number of security incidents reported; however, they are predominantly reports of theft and vandalism, and occasional reports of staff members requiring after hours escorts and psychiatric patients requiring restraint.

Maximum protection

Red Cross Hospital is one of 656 health facilities in the province which are visited by 14.8 million people. This, the provincial health department argues, is a large contingent to secure and they emphasise that “our primary task is healthcare and not policing or security. Our focus is to provide the maximum protection to our staff and patients, without making access to our facilities difficult.”

“You don’t feel safe,” says Belinda. “I suppose it’s to be expected if you’ve chosen to work here. But it would be great if there were more security measures in place to ensure people accompanied you; that there was enough security around, and they were within eyesight and earshot; and that we had adequate call room facilities within the hospitals that didn’t put you into risk when you tried to get there. Those things could definitely make a difference.”

“Sadly, things have to crash before anything is done,” says Vanessa, “and no matter how often the people tell you what you need to do to prevent the train smash, nothing gets done until it actually happens. You have to let things fail before there’s any change – and that’s the wrong way to do things.”

Read more:

Hospital crisis: managers the solution
Free State hospitals in trouble
Gauteng hospitals face billions in legal claims

*Not their real names. All healthcare workers spoke on condition of anonymity.

 
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