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Zithulele Hospital in Mqanduli, a rural part of OR Tambo District in the Eastern Cape, is a 146-bed public health facility that serves about 130 000 people. (Black Star/Spotlight)
- Zithulele Hospital was one of South Africa's best-performing rural hospitals.
- That was until the appointment of a new CEO, which led to conflict with staff.
- Now, a senior doctor who worked at the hospital for close to a decade, has been instructed to report to the Nelson Mandela Academic Hospital.
In another twist in the ongoing Zithulele Hospital saga, one of its most senior doctors, family physician Nick Fine, has effectively been removed from the remote rural hospital in the Eastern Cape.
This was confirmed to Spotlight by Mkhululi Ndamase, the spokesperson for the Health MEC, Nomakhosazana Meth.
Fine's unexpected instruction follows a turbulent two years at Zithulele Hospital, sparked by the appointment of Nolubabalo Fatyela as the CEO. After a tense period of conflict between the CEO and hospital staff, clinical manager Ben Gaunt eventually accepted a transfer in mid-2022.
At the time, unhappy residents protested at the hospital in support of Gaunt. Daily Maverick has reported on those events in detail.
Similarly, nurses and other hospital staff last week protested at the hospital after Fine was asked to report to the Nelson Mandela Academic Hospital. The protesters petitioned the Eastern Cape Department of Health for Fine's return to Zithulele.
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"We demand Dr Nicholas Fine back with immediate effect. We demand [the] district manager to take back Mrs Fatyela [to] wherever, we don't need her anymore," reads a section of the petition seen by Spotlight.
Fine did not respond to messages from Spotlight, but he is understood to have taken leave and is away from the hospital. Fatyela also declined to respond to questions from Spotlight.
A community member, who asked not to be named for fear of reprisals, and who was one of the leaders of the protests at Zithulele in 2022, said there is discontent over the way Fatyela is managing the hospital.
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The community member said the district manager, Nomvume Ntshanga, arrived at the hospital on Tuesday, 28 May, when health workers protested.
"We listed our concerns in a petition which we gave her. She promised to come back on 12 June, so we are waiting for that day. She said Dr Fine can continue to work here until she comes with the answers on the 12th."
Spotlight was not at the hospital at the time of the protest, but we've seen footage and heard accounts from several sources.
'Not transferred'
Asked to respond to a range of questions, Ndamase said Fine originally applied to Nelson Mandela Academic Hospital, where he was employed before he was seconded to Zithulele.
Fine, therefore, he said "has not been transferred from Zithulele Hospital", but was "recalled by Nelson Mandela Academic Hospital", where he is responsible for mentoring and training students in family medicine.
"Whether or not Dr Fine will be seconded back to Zithulele is an internal departmental process. This is an employee and employer matter. But, for now, he has been recalled to his original post at Nelson Mandela Academic Hospital."
Ndamase added that none of the four formally recognised trade unions at Zithulele Hospital said they were aware of a recent protest by their members.
Spotlight attempted to speak to union leaders at the hospital, but none was willing to be interviewed.
An intermediary said they declined because "the matter is very sensitive and there is a friction between the labour unions inside the hospital".
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The petition to the department also complained about Fatyela's alleged accommodation in a luxury Mthatha hotel.
Responding to this, Ndamase said: "The department can confirm that Mrs Fatyela had to temporarily leave Zithulele Hospital because of safety reasons. The department cannot divulge its supply chain management process. The relevant stakeholders are aware of where the rental money is paid. We can also confirm that the rental money is not used for anyone's personal use, but for the upkeep of the facility."
Responding to the call in the petition for Fatyela to be replaced, Ndamase said:
The department has no reason to transfer the CEO as she has been carrying out her duties with utmost diligence even when her safety was under threat.
Ndamase confirmed the department planned to hold meetings about the impasse at Zithulele Hospital "within the first two weeks of June".
Meth is expected to become a Member of Parliament - and it is thus likely the province will, in the next two weeks or so, have a new Health MEC.
'Great cost'
Dr Karl le Roux, who worked at Zithulele for 16 years, said Fine's transfer would come at great cost to patients as well as the doctor and nursing teams.
Le Roux was himself embroiled in the dispute at Zithulele, in which Gaunt clashed with Fatyela.
He left the hospital soon after Gaunt and is now set to become a Member of Parliament, representing the DA, Spotlight reported last month.
It is thus possible that both Meth and Le Roux could serve on the Portfolio Committee of Health in the new Parliament.
READ MORE | From rural doctor to MP? 'I hope to continue to serve,' says Dr Karl le Roux
"Nick is hard working and compassionate. He has good relationships with people at the hospital. He's certainly at Zithulele because he wants to make a difference and help people, and is also really important for the supervision of the two family medicine registrars currently training at Zithulele," he said.
According to Le Roux, Fine is contracted as a registrar by Nelson Mandela Academic Hospital, but a part of his training was allocated to Zithulele.
"The agreement was, because there were no posts on the Zithulele establishment, Nelson Mandela were kind enough to appoint him and second him out, but it was part of the whole training process and part of it was that he was also supervising two of the family medicine registrars at Zithulele," he said.
From rural doctor to MP? “I hope to continue to serve”, says Dr Karl le Roux
After sixteen exhausting but rewarding years working in a remote Eastern Cape rural hospital, Dr Karl le Roux is now hoping for a seat in parliament on the @Our_DA's ticket. https://t.co/S7zxjrpLSk pic.twitter.com/MQLwfBodg3
Notwithstanding that the process was legal, Le Roux questioned who would initiate a request for Fine to be sent back to the hospital he was seconded from.
He suggested that the hospital CEO used a technicality to try and push Fine out.
Le Roux described the decision to move Fine out as being counter-intuitive.
"This latest action will really lower the morale of an already fragile team of doctors and nurses at Zithulele, which is why they've come out to protest."
He added:
But the worst part of it is the harm it does to the poor patients, and the way it destroys what was an excellent hospital that has been very difficult to build up over 17 years.
"If this continues, it will destroy the hospital. It is extraordinary that nurses and other hospital staff are protesting to support a white doctor and demanding for the CEO to go. That sort of thing is not done lightly," said Le Roux.
*This articlewas published by Spotlight – health journalism in the public interest. Sign up to the Spotlight newsletter.
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