On Thursday 5 March, Health Minister Dr Zweli Mkhize announced South Africa\u2019s first confirmed case of the novel coronavirus.<\/p>\n
A week later, on the morning of Friday 13 March, a Durban hostel resident \u2013 we\u2019ll call him Mpilo \u2013 arose, then collapsed to the floor. His legs were not working. He had previously experienced lower back pain but no other symptoms. By late afternoon, sufficient funds were raised to put fuel in a vehicle to take him to hospital. An ambulance would have taken too long, or maybe not arrived at all.<\/p>\n
Those who follow our work know that as a rule we don\u2019t lend our pages to opinion writers and activists. Investigative journalism is premised on factual inquiry, which is best served by detachment.<\/p>\n
But rules are there to be broken. Passionate immersion can open the floodgates of information. If that information is passed on to readers in full acknowledgment of the heart on the writer\u2019s sleeve, society may be richer for it.<\/p>\n
One writer who has bridged the gap between activist and investigative rapporteur is Vanessa Burger, whose urgent account of one patient\u2019s experience of the public health system in KZN we reproduce.<\/p>\n
Vanessa is best known for her tireless efforts on behalf of victims of the violence at Glebelands<\/a> Hostel in Umlazi, Durban \u2013 not least by exposing the complicity of police and public officials in it.<\/p>\n Now, she tells the harrowing story of a hostel dweller, whom she calls \u201cMpilo\u201d to protect his privacy. As the novel coronavirus hit our shores, Mpilo fell ill, probably with spinal tuberculosis, paralysing him from the waist down. To confirm the diagnosis and offer treatment, doctors needed to send him for an MRI scan.<\/p>\n But in Durban\u2019s creaky public health system none was available \u2013 seemingly because one hospital which still had a working machine was being set aside for the expected tide of Covid-19 emergencies. And so Mpilo is to be discharged \u2013 \u201cso I can die with my family\u201d he suspects \u2013 even though he was told he might get his turn with the MRI machine as an outpatient in some months, or next year.<\/p>\n If he returns to the crowded hostel room he shares with his family, Mpilo puts them at risk too. TB kills tens of thousands in SA each year \u2013 many times Covid-19\u2019s current world toll. But don\u2019t get this wrong.<\/p>\n Yes, Mpilo\u2019s story is one of an individual who probably can be saved given proper care, and of bureaucrats apparently so fixated on the impending deluge that they care not for a man already going under.<\/p>\n But it is also a canary in the coalmine of our readiness for Covid-19.<\/p>\n For if the system is already so undersupplied and overburdened that it cannot spare one man a bed and a scan, how will it cope when hundreds and thousands of critical Covid-19 patients really start rolling in, gasping for the care and machines that will let them breathe another day. Mpilo, who has been unemployed since 2015, is reliant on state health care. His friends took him to Addington Hospital in central Durban where he was put in wheelchair and a catheter fitted. At around 3am the next day he saw a doctor.<\/p>\n Blood tests and x-rays were done and he was finally admitted just before 8am on Saturday 14 March. He had eaten nothing since Thursday, was in pain and scared to death, not knowing what was wrong with him and if he would ever walk again.<\/p>\n Mpilo subsequently developed intermittent breathing problems and was put on oxygen. He also complained of stomach pains, that the weakness had spread to his arms and hands, and that his feet had begun to swell. He was now paralysed from the waist down.<\/p>\n A preliminary diagnosis suggested a rare autoimmune disease that may cause paralysis, but this was abandoned. Mpilo was however assured that as soon as a bed became available he would be transferred to Inkosi Albert Luthuli Central Hospital so that an MRI scan could be done to establish conclusively what was causing his condition.<\/p>\n Addington\u2019s own MRI scanner was not working, he was told. Once at Inkosi Albert Luthuli, he could also receive any specialised treatment that might be necessary.<\/p>\n On Sunday 15 March, President Cyril Ramaphosa declared a national state of disaster in response to the coronavirus pandemic. The number of confirmed cases had risen to 61.<\/p>\n While doctors were discussing his condition the following day, Mpilo heard one of them say: \u201cIf he does not receive treatment within 72 hours he may never walk again.\u201d He was however told he would be sent to see a neurologist at Inkosi Albert Luthuli.<\/p>\n According to Mpilo, the neurologist was unable to tell him much; only that the problem was \u201cin his spine\u201d and that further x-rays and the MRI scan were needed for diagnosis. He was warned there \u201ccould be delays.\u201d<\/p>\n Mpilo was duly returned to Addington for further x-rays. These were however delayed because Mpilo was in an upper floor ward and he was told that the lifts weren\u2019t working.<\/p>\n Urgent emails were dispatched to the hospital\u2019s chief executive. By late afternoon both lifts were working and Mpilo was x-rayed.<\/p>\n Again he questioned doctors about his supposed transferal. His condition was clearly deteriorating. He had been in hospital for a week but received no clear diagnosis, no treatment and worst of all, almost no information.<\/p>\n A little later, doctors told him they would \u201ctreat what they can see for now\u201d, emphasizing that they could only provide a definitive diagnosis and begin specific treatment once the MRI scan had been done, which they hoped could be arranged later that day.<\/p>\n Mpilo waited patiently, but by late afternoon, instead of being taken to Inkosi Albert Luthuli for the scan, he was given four tablets.<\/p>\n \u201cEish, I\u2019m worried, they are giving me TB medication but no one has told me if I\u2019ve got TB,\u201d wrote Mpilo in a panicked WhatsApp message.<\/p>\n \u201cThe nurse says it\u2019s written in my file. But I asked the doctors this morning what is wrong with me and they said they need to do the scan first. This medication is really messing me up, I feel terrible, I can\u2019t eat, and they say that the treatment is 6 months. It\u2019s going to hit me hard. If it\u2019s TB the least they could do is tell me before giving me the medication. I don\u2019t understand what\u2019s going on.\u201d<\/p>\n Some time later it seems Mpilo finally managed to establish that spinal TB was suspected but could only be confirmed by the MRI scan. He was told the medication was a precautionary, interim measure, until he could be transferred to Inkosi Albert Luthuli. It would protect him and others from infection in the event he did indeed have TB.<\/p>\n More than a week after his admission, on 21 March, Human Rights Day, a doctor informed Mpilo that the health minister had issued instructions that Inkosi Albert Luthuli was only to make space available for Covid-19 related emergencies.<\/p>\n Mpilo\u2019s case, it seems, was not deemed an emergency. He would therefore not be transferred, neither would he get the scan for which diagnosis and subsequent specialised treatment was critically needed.<\/p>\n An independent TB specialist, whose opinion was sought, said the medication would perhaps \u201cbuy him some time\u201d, until he could have the scan.<\/p>\n In a statement later that day, Mkhize announced that 240 cases of Covid-19 had been confirmed of which 27 were in KwaZulu-Natal. Patients who tested positive were being hospitalised purely for assessment, he assured South Africa. None were in intensive care or critical and there had been no fatalities yet.<\/p>\n Scarce hospital space was to be reserved, it appeared, for Covid-19 patients, while other serious and \u2013 if left untreated \u2013 potentially fatal or disabling cases, such as Mpilo\u2019s, were to be denied the medical care critical for their survival and recovery.<\/p>\n According to the World Health Organisation\u2019s (WHO) 2019 global TB report<\/a>, in South Africa alone, 301 000 people fell ill from TB in 2018 while 64 000 (21%) died. Of the 10 million global TB sufferers, 1.5-million died (15%) during the same period.<\/p>\n By comparison, a situation report<\/a> by the European Centre for Disease Prevention and Control on the same day as the minister\u2019s statement recorded 271 364 Covid-19 cases globally of which 11 252 had proved fatal (4.2%).<\/p>\n TB remains the top infectious disease killer worldwide and South Africa is in the eight countries with the highest prevalence rate. The WHO report also stressed the importance of speedy diagnosis and treatment in curbing the spread of this deadly disease.<\/p>\n At his hostel, Mpilo shares a room with his family, including his young son. He is in close daily contact with dozens of other hostel residents and recently visited his rural parental home. If TB is indeed the cause of his condition, then all those close to him need to be tested and treated immediately if found to have contracted the disease. The longer his diagnosis is delayed, the more people could be potentially at risk.<\/p>\n The coronavirus pandemic is shining a harsh light into the gaping chasm between South Africa\u2019s haves and have-nots; those who enjoy human rights and those who still don\u2019t. In an SAFM<\/em> interview<\/a> last week, Mthembiseni Thusi, spokesperson for Ubunye bamaHostela, KZN\u2019s hostel dwellers association, highlighted the dangers presented to- and by- hostel communities\u2019 unhygienic living conditions in light of the Covid-19 pandemic.<\/p>\n Social distancing, he pointed out, was a fantasy when up to 30 people are forced to share one tiny room. Across Durban an estimated 250 000 hostel dwellers still endure inhumane living conditions more than 25 years after the fall of apartheid.<\/p>\n On the topic of social distancing and hand washing, a few days earlier another hostel leader had reported that at Prince Mshiyeni Hospital in Umlazi, most taps were without water, there was no soap and no toilet paper. He also said the grounds were full of hawkers selling food to patients and visitors. \u201cIt\u2019s like a market,\u201d he said.<\/p>\n According<\/a> to constitutional law expert Pierre de Vos, \u201cregulations issued in terms of the declaration of a national disaster must comply with the provisions of the Bill of Rights and a court can declare specific regulations unconstitutional if they impose limitations on rights in a manner not justified by the limitation clause\u201d. This would include the right to health care and access to information, especially about one\u2019s medical condition.<\/p>\n Even in the event of the declaration of a state of emergency, de Vos emphasized that certain rights cannot be suspended, such as the right to life, human dignity and freedom from discrimination on certain grounds. It would seem inconceivable, that, although medical discrimination is not listed in the constitution, a court would uphold a decision to deny a patient critically needed medical diagnosis and treatment on the basis that he was not suffering from a specific virus.<\/p>\n Spinal TB is apparently very difficult to diagnose and requires a variety of tests of which an MRI scan is critical. More complex and supportive treatment is needed than for pulmonary TB. Sometimes surgery is necessary to remove and repair damaged areas of the spine. Cold abscesses can develop which need to be drained to prevent infection. Physiotherapy will be needed. But it can be treated, and 76% of TB patients recover.<\/p>\n The first step however requires diagnosis. Mpilo still does not know if he has TB. Will he be required to wait until the coronavirus has run its course in South Africa to find out? How many people in other hospitals are facing the same uncertainty?<\/p>\n
\n*Stefaans Br\u00fcmmer, amaBhungane managing partner<\/em>.<\/p>\n