People queueing outside of Ngcobo Community Health Centre in Masonwabe township. The clinic has been without running water for 10 years. (Delwyn Verasamy)
It was only as she tried to run away to save herself that a former colleague of Sisipho Grootboom* discovered she was stuck.
Her patient’s family, who’d rushed him in, intoxicated and with a knife wound, had locked the main entrance, fearing that the attackers would try to get to him again.
But in doing so, they’d cut her off from the only other person on site — and the person who could help her most, the security guard.
It was 2022, and Grootboom, a professional nurse, worked at Ngcobo Community Health Centre in Masonwabe township, about 80km from Mthatha in the rural Eastern Cape.
Her nursing colleague hid in a side room and, somehow, the security guard, who’d heard the commotion, managed to find his way into the building and battle the aggressive patient down.
In 20 years of being a nurse, Grootboom says, she’s never experienced something like what happened to her colleague that night at her workplace.
She’s become used to dealing with unequipped and understaffed health facilities — and how to find ways around it to still serve her patients.
But fearing for their lives has never been part of her worries like it is in Ngcobo.
ON TOP OF THE WORLD: While officials point fingers at each other for the lack of piped water in Engcobo, claiming that it’s a challenge to supply high-lying areas, the community health centre suffers. (Delwyn Verasamy)
Many years, no change
For the past 30 years — ever since the first democratic elections in South Africa — the ANC has been in charge of the Eastern Cape’s affairs.
Yet, again, in this year’s elections, close to two-thirds of the Eastern Cape’s people voted for the ANC.
In June, the new Eastern Cape’s new Health MEC, Ntandokazi Capa — the chairperson of the ANC Women’s League in the province — was sworn in, replacing Nomakhosazana Meth, who is now a member of parliament in the National Assembly.
Capa, who has visited hospitals like Maclear Hospital in the Elundini local municipality area since her appointment, told the Daily Dispatch on Instagram she’s “ready to face [the Eastern Cape’s health] challenges”.
“When you’re a leader, you’re not supposed to cruise,” she said, “I understand the challenges of budget, infrastructure and [the difficulties] that come with being a rural province.
“I want people [in the province] who visit government health facilities to get good service.”
But will things really change?
No water, no service
Not feeling safe is only part of what led to the Ngcobo 24-hour community health centre, which has to serve about 3 000 people a month according to the facility’s manager, Ncandeka Sotyato, having to cut its operating hours in half.
About eight out of 10 people in this town live in poverty and rely on public health facilities.
The health centre, which is now only open from 7am to 7pm, and can therefore no longer attend to after-hours emergencies, is about 1.5km from the business centre of Ngcobo — a hub of activity where people go to work, shop or get transport.
This means there’s a constant thoroughfare of people — including patients coming to the clinic to collect chronic medication, get their children immunised, see a doctor, get an antenatal check-up or receive help for a medical emergency.
Community health centred like the one in Ngcobo are an important cog in the country’s primary healthcare machine in that they provide many routine and emergency services 24 hours a day and so can reduce the patient load on district hospitals, which are geared towards handling child health issues, reproductive health problems, more complex health matters and general surgeries.
But, to function well, a health centre needs proper infrastructure, including easy access to running water, something the Ngcobo community health centre hasn’t had for the past 10 years, says Grootboom.
The two buildings that make up the facility have no piped water, explains Sotyato. Instead, water is supplied from municipality-serviced water tanks outside. This means staff have to fetch water in plastic containers and carry them inside to do things such as flushing toilets, washing hands and cleaning.
A decades-long problem
During Capa’s visit to Maclear Hospital in June, she told the SABC that 24-hour clinics in the Eastern Cape are crucial for healthcare and need attention but that people can’t expect “a hospital every 20km” because there are serious budget constraints.
Like the Ngcobo Community Health Centre, Maclear Hospital faces security problems, with reports of patients being raped during admissions.
At facilities across the province, access to tap water and power supply are problematic.
Twenty years ago, a report by human rights organisation Section27, that looked into why healthcare delivery is so poor in the Eastern Cape, found that many facilities didn’t have a reliable supply of electricity and water; many were too small for the number of patients they had to serve and some were “literally falling apart”. This, they said, was the culmination of a systematic breakdown of health services over 15 years — which they said needed “urgent attention”.
“We call on the MEC for health to develop a plan with clear timeframes that includes components that address the items listed urgently to remedy the crisis in health in the Eastern Cape,” they wrote.
Almost 10 years on, almost nothing had changed.
A public protector report of 2021 found that, at four district or provincial hospitals here, buildings were run down; services like water and electricity were lacking; facilities were understaffed and equipment was either old or non-existent, meaning that even basic tasks like washing laundry couldn’t be done on the premises.
In a further report last year, which looked into the state of health services, basic education and infrastructure development in villages across the Eastern Cape, the independent watchdog found that many government buildings, including clinics, didn’t have a proper water supply, pipes were damaged, roofs were leaking and toilet facilities were inadequate.
The blame for this lack of maintenance was laid at the feet of the provincial public works department, which should — but has failed to — inspect public facilities every five years and do the necessary maintenance so that they can deliver proper services.
In 20 years, Grootboom hasn’t seen change.
“When we complain about water, we’re told to speak to the district. Then we’re told to speak to public works. We go back and forth but we still end up with no water. If you’re not on the ground, it’s impossible to understand our challenges.”
Blame games
It’s here where the blame shifting starts.
According to law, municipalities — either at the town or district level — are responsible for providing services like collecting rubbish and supplying electricity and water to people living in that area.
In the Chris Hani district, under which Ngcobo falls, only 20% of households have running water inside.
In the Engcobo subdistrict, things are even worse — only about 7% of households can turn on a tap inside their home for water.
Ngcobo’s mayor Siyabulela Zangqa says that the council is “not a water service provider like the district municipality [is]” and therefore he is not notified about water delivery issues.
Yet the district’s mayor, Lusanda Sizani, told Bhekisisa that water infrastructure “is the responsibility of [the] public works [department]” — which, at the lowest level, is a provincial governance structure.
Moreover, Bulelwa Ganyaza, the spokesperson for the district municipality, claims that because funds for building or upgrading systems for things like water supply (and which comes from the municipal infrastructure grants handed out by the co-operative governance department) have dropped, “some projects [in the Engcobo area] have been delayed since 2012, affecting the provision of water and sanitation services to the town and informal settlements”.
In the 2023 financial year, about half of the roughly R328 million available for water and sanitation projects in the Chris Hani district was set aside specifically for water supply infrastructure.
TANKED: Staff at the Ngcobo community health centre claim that they’ve not had continuous running water for about 10 years and must rely on municipal water tanks. (Delwyn Verasamy)
Clamping down on crime — not
While officials are passing the buck, it’s the people of this community who lose out.
The situation at the clinic mirrors the collapse of other local government structures in the area. For example, crime is rampant here. ISS Crime Hub statistics show that crimes in categories that include murder, theft, assault and sexual offences have, over the past 10 years, close to doubled in Ngcobo.
The police, though, deny that they’ve not got a handle on crime here.
Spokesperson for the South African Police Service in the Eastern Cape, Priscilla Naidu, told Bhekisisa that “police conduct frequent operations in the area” and cites, as an example of their success, that in one such a clampdown in March, “three suspects [in a community of about 155 000 people] were arrested for possession of an unlicensed firearm, drug dealing and selling liquor without a licence”.
They also started a 15-member community patrol group in March, she adds.
But Zangqa says he’s seen how crime has affected services, like the health centre. Crime in the area close to the health centre “got to the point where it started affecting the clinic”, he says.
“The nearby tavern, which is open 24 hours a day, is a problem. The people who drink there at night cause chaos.”
And the lack of proper municipal services makes it worse.
RUNNING ON EMPTY: The attack in 2022 was the final straw for staff at the community health centre who have been complaining about poor water supply and security for years. (Delwyn Verasamy)
Stalemate
The incident in which the night-shift nurse was attacked in 2022 was the final straw for the staff at the centre. The nurses reported the attack to their union, who in turn, wrote a letter to the Eastern Cape health department, Grootboom told Bhekisisa. In the letter, the union put forward their concerns about safety issues and the conditions at the health centre under which staff have to work.
In response to Bhekisisa’s enquiry about the implications of the issues at the health centre, the health department’s spokesperson, Mkhululi Ndamase, says that when healthcare workers are too traumatised or afraid to work, it “impacts negatively on service delivery and communities end up suffering”.
And that’s indeed the case.
Says Grootboom: “At night, it’s very scary to go out and fetch water from the tank since the safety in this area is so poor. [The security guards] don’t have guns and there are only two of them, so I’m not sure how they will protect us if there are multiple attackers.”
The department and unions are still in talks, Ndamase says, and “we are hopeful that a lasting solution will be found and the labour matter resolved.”
Until this stalemate breaks, the health centre remains closed after 7pm.
*Not her real name
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.