The industrial unrest in the mines is still big news here. The headlines are dominated by claim and counter claim and some very high profile politicians are wriggling uncomfortably in the spotlight. One minute everything is resolved and the miners are all going back to work and the next there has been some new development (usually involving further violence) and they are back to square one. The families of the 34 miners shot by the police at the Marikana mine were offered financial help to attend the hearings. This was then withdrawn but now a contribution to the costs is back on the table. There are allegations of the police arresting and torturing miners who might be called as witnesses of the police killings. The enquiry into the shootings of striking miners has begun although the major focus appears unexpectedly to be on the three policemen who were also killed and ensuring that everything possible is done to bring their killers to justice. Weighty comments are being made about lawless armed strikers. The part of the investigation which concerns why the police felt authorised to shoot the miners seems to be taking a back seat. One slowly emerging connection is that Cyril Ramaphosa (who is being nurtured by Zuma as a possible successor) was quoted before the killings as saying that the strikes ‘are plainly dastardly criminal acts and must be characterised as such’, adding that the response to them must be by ‘commensurate’ or ‘concomitant’ action (depending on which article you read). Ramaphosa is a very wealthy businessman apart from being a very big wheel in the ANC from his high profile activities during the struggle against apartheid. The finger is being pointed at him as sanctioning from within the ANC the excessive response of the police. Why should someone with such an active Trade Unionist history have such a bias against the ‘working class’ miners? Could it be anything to do with his company holding a 9% stake in Lonmin, the owners of the Marikana mine and him sitting on the Lonmin Board?

There is much else of this ilk if one has the stomach to wade through it. It strikes me again that George Orwell would have felt prophetically vindicated with the situation here, and Tom Sharpe, if he could find the energy to write about the post-apartheid era as well and as prolifically as he did about the apartheid era, would find no less fertile material for his penetrating satire.

By contrast another strike has generated virtually no publicity. It seems not to have been in any of the media. There are no queues of journalists jostling for unique ‘angles’ and churning out copy with every trivial new development. Friends elsewhere in South Africa are completely unaware of it and yet it has almost certainly killed many more people than died at Marikana. There will be no judicial enquiry when it is over and none of the relatives of those who have died will be in any position to take action against the perpetrators for the loss of their loved ones, let alone receive financial support to do so.

In the UK when the nursing profession have in the past even mentioned industrial action it has excited polar responses of sympathy and censure. Nowadays the Royal College of Nursing in the UK has a ‘no strike’ policy. This is for the very reason that a stoppage by these pivotal individuals most affects those least able to help themselves. Lives would be at risk.

No such concerns cloud the brows of the nurses at Mthatha hospital – or to give it its full name The Nelson Mandela Academic Hospital – who have been on strike now for 5 weeks. In this time they have comprehensively crippled the hospital and have wreaked havoc on all of the smaller hospitals, including Zithulele, for whom NMAH is the major referral centre.

This strike is also over pay. One grievance is that the nurses’ night allowance money was not paid. This was because the hospital authorities noted that the pay claims being submitted for night duty payments included the names of people who were on leave at the time; perhaps a reasonable concern and worth investigating. Subsequently this same group of staff at what is widely known as the worst performing hospital in the Eastern Cape continued to strike because of the hospital withholding their performance related pay (sic). They are still out and there is little sign that a return to work is imminent.

Time and space (and a limited lifespan) prevent me from detailing what a disgrace and a disaster the normal level of treatment at this hospital is usually like. It is telling that, unlike other hospitals in the Eastern Cape, they don’t use the standard audit tools to assess their own performance. There are a few good conscientious people among the medical staff (and probably among other groups there too) but the overall standard is below what I would inflict on my worst enemy.

They have radiology services which we don’t; at present not only is the ultrasound machine at Zithulele on indefinite strike but the X ray machine has broken. Sometimes our patients’ management is critically dependent on a scan. More often than not the hapless patient pays for transport for the two hour drive to go to Mthatha only to be turned away at the door (and this is when they aren’t on strike).

A few other choice examples of their standard of ‘care’ out of very many:-

A patient coughing up life threatening amounts of blood is referred there for an opinion and treatment and sent back to us the same day because the doctors there say they could not make an assessment without a chest x ray. The machine to do this five minute investigation is an integral part of workings of the chest medicine clinic to which they went.

A patient with a plastic tube draining inflammatory fluid from their abdomen (which was needed because it was collecting in huge quantities) comes back to us after a request for a scan and a medical opinion with a note saying that ‘the colostomy is functioning well, no further action’. It would be funny if it wasn’t so tragic.

One man whose feet needed amputating, because of gangrene caused by long standing disease of his arteries, eventually went to the surgical team there after over a month of requests, debate, argument, persuasion and pleading. Conventionally a leg amputation is performed just above the knee or just below it as this makes fitting artificial limbs easiest and gives the best hope for being able to walk again. In the operation it is important to remove more bone and muscle than skin so you have a large flap of skin which you sew over the end of the stump to cover it and allow it to heal over. Leaving bone and muscle exposed means it will just get infected and never heal. I apologise to those with weak stomachs for the appended picture showing the handiwork of the Mthatha team in pioneering a novel operation – the ‘above ankle’ amputation, which cannot heal.

With the onset of the strike Mthatha has now gone from merely dangerously incompetent to simply awful. Today we tried to send a newborn baby there because her blood oxygen level was extremely low for no obvious reason and we suspected a congenital heart defect. The (very good) paediatrician there advised us, nearly in tears, that it would be the worst thing possible to do as he was acting as doctor, porter, nurse and clerk and that babies were dying all around him. The baby died on her way to a more distant, but much better, hospital; one which would normally not accept referrals from so far away.

Nobody would dispute the right to protest in a legitimate way for a living wage. Few people here are well paid and the average black wage is about one fifth that of the average white. Ironically though some of the best paid staff are government employees, including nursing staff. So to add to the obscenity of the ‘caring profession’ abandoning the helpless, we have some of the best paid workers in the most secure jobs going on strike from a job (which some of us naively think of as a vocation) and causing direct harm to those much worse off than themselves.

Like people in other countries who work for governments, however badly they perform these nurses are generally almost unsackable. As occurs elsewhere (including the UK), the contortions that must be gone through to prove that an employee is not competent at their job are Byzantine and exhausting and often make the effort so out of proportion to the benefit of a successful result that it is just not worth the candle. However these nurses are on unofficial strike so the authorities would be completely within their rights to dismiss the lot of them.

We will never know how many peoples’ lives have been damaged irretrievably and how many have died because of this action. No administrator would dare attempt to quantify it and no politician would risk professional suicide by being implicated as a part of a government which passively sanctions such appalling malpractice. Whatever the death toll is eventually it will dwarf that at Marikana.

It may be very convenient for a government to have a high profile industrial dispute on its hands occupying the headlines, especially one which has an undercurrent of the privileged white company owner and the poor underpaid black. Admittedly the political fallout is probably not quite what they expected in Pretoria. What is not comfortable for these same politicians is for the general public to hear that nurses are behaving abominably; the well paid inflicting discomfort, danger and death on those who need them most. Nor is it attractive to them for the generally dire predicament of the state run health services in Mthatha to be made public. Call me paranoid but the complete lack of publicity about a situation that verges on genocide does not seem to me to be an accident.

How not to amputate