Part two of a two-part series on how corruption is killing people in the province’s health system
In November 53-year-old Colleen Swigelaar died of Covid-19, and with a broken heart. Days earlier, as the illness was taking hold in her own body, she had witnessed her sister Antoinette die. Swigelaar was convinced that she had carried the virus home from her job as a casualty nurse at Livingstone Hospital, the Eastern Cape’s flagship health facility in Port Elizabeth, to infect her sister. In her last moments, she was riddled with guilt.
This emotion was at odds with the dignity and pride that Swigelaar brought to her work as a 14-year stalwart at Livingstone. By all accounts, she embodied the selflessness with which many health workers in the troubled Eastern Cape health sector rose to the challenge of treating Covid-19 patients.
“Colleen was always patient-orientated. The dignity of the patient always came first,” says Sania Jordaan, her nephew, who took inspiration from his aunt to train as a nurse. Today he works at Christiaan Barnard Memorial Hospital in Cape Town.
During the first wave of the pandemic, Colleen and Sania developed the habit of checking in with one another daily. “She would not complain about things, but she was anxious about things that were not there — shortages of PPE [personal protective equipment], oxygen, ventilation equipment. It was heartbreaking and frustrating … When you are faced with situations where you do not have enough to do your daily job, it just breaks you, I think. The higher-ups could see that here were people that put their lives on the line … “.
Sania falls silent when asked to reflect about the “higher ups” in the provincial and national health system who are accused of enriching themselves through corruption in the procurement of PPE.
“For those we do not have words,” he says. Then he refocuses on Colleen’s memory.
“I have told myself that she gave her life for life, and to remember the good in that.”
Overpricing, unfair processes and fraud
Across South Africa, the plight of poorly-equipped health workers working in close quarters with Covid-19 patients has been juxtaposed with allegations of large scale corruption in the government’s procurement of the PPE — something the World Health Organisation’s head Tedros Adhanom Gebreyesus has described as tantamount to “murder”.
Late last year the Eastern Cape government — and the province’s health department in particular — emerged as a flashpoint for law enforcement agencies probing these allegations. In a briefing to Parliament’s Standing Committee on Public Accounts (SCOPA) in October, the Special Investigations Unit’s (SIU) head Andy Mothibi confirmed that the nearly R2 billion in PPE contracts under investigation in the Eastern Cape was second only to the value of contracts being probed in Gauteng. Of these contracts, the SIU has confirmed to us that it is investigating 175 PPE and other emergency Covid-19 procurement contracts, totalling R620 million, to the province’s health department alone.
Across government departments, the Auditor-General’s first report on a special audit of Covid-19 relief spending found “clear signs of overpricing, unfair processes, potential fraud and supply chain management legislation being sidestepped” — especially with regard to the procurement of PPE.
“This has shocked everyone,” said Advocate Shamila Batohi, National Director of Public Prosecutions, reflecting on the scale of the alleged graft across the country. Batohi was speaking at a Health Sector Anti-Corruption Forum webinar in December where law enforcement agencies gave feedback on progress on their probes of government’s Covid-19 relief spending.
“Given what South Africa has just come out of in the past ten years or so with regard to corruption in this country. When Covid hit us… with people putting their hands into the relief fund cookie jar (it) was just unbelievable. We were on a trajectory to rebuild, to deal with pre-covid corruption. And then Covid hit us… “
How well the SIU’s investigations will uncover the extent of the corruption, recoup the money lost and refer implicated officials for disciplinary or criminal prosecution remains to be seen. As of early this year, the SIU has only brought ten Covid procurement cases from around South Africa before the Special Tribunal. None of these related to PPE contracts in the Eastern Cape health department.
A second Auditor-General report, published in December, has also flagged irregularities within the Eastern Cape health department’s Covid-related procurement and contract management. For instance, it identified payments to the tune of R6,1 million made for quotations which made little or no mention of the goods that were to be delivered.
The Auditor-General found that such stocks of PPE as were available were being mismanaged. Audits of storage and medical facilities suggested that stock management systems at bulk storage facilities were in disarray. The Auditor-General found “poor storage” practices at five of the six facilities that were audited. Stock-outs or low stock levels meant healthcare facilities were not provided with the PPE requested. This led to rationing, leading healthcare facilities to “borrow, share or exchange PPE among themselves” and sometimes leading health workers to purchase PPE directly from suppliers.
And where PPE was delivered, the Auditor-General found, it sometimes did not “did not meet the minimum required standards and/or specifications”. For instance, some isolation gowns delivered to healthcare “were too short, tore easily or had a bad odour”.
The deadly toll of Covid-19 in the Eastern Cape
For health workers in South Africa, there is no doubt of the link between corruption in PPE contracts, PPE stock-outs at the facilities where they work, and increased risk and loss of life among their ranks.
“This is not only about Covidpreneurs lining their pockets with ill-gotten gains but about frontline workers who are getting infected on a daily basis… Families are losing breadwinners because of the insatiable demand for money by Covidpreneurs,” responded Nehawu to the Auditor-General’s first set of findings in September.
Nowhere in South Africa has the risk of infection and death faced by health workers been more apparent than in the Eastern Cape.
Health Minister Zweli Mkhize said in November that 9,117 of the province’s health workers had contracted the virus. Ninety-four had “died in hospital”. Both figures were higher than in any of the country’s other eight provinces. Also in November, the Eastern Cape health department published figures which indicated that the death toll among health workers — at 143 — may be even higher than indicated by the minister’s report.
During the early days of lockdown, says Mthandwa Zitha, a nurse and NEHAWU chair at the Holy Cross Hospital in Flagstaff in the rural Eastern Cape, he often spent a whole week wearing one builders’ dust mask. At the time, alcohol-based hand sanitiser was completely unavailable at the hospital, he says.
“But, they know that their cousins and their brothers are ones that are supposed to provide PPE… they collude somewhere and have a meeting and discuss that there is a tender for ten million, so it is your time to get that tender. We were requesting protective clothing, but there was no clear direction who was supposed to provide us with this… we are feeling angry, but we do not know who we can direct our anger to… Our lives are at risk. There is nobody who is taking care of us.”
The Eastern Cape Health Department did not respond to our queries.
Produced for GroundUp by Viewfinder and West Cape News.