Hospitals, courts face backlog headache, Newsline

Cape Town – Infections may have fallen, but South Africa is waking up with a Covid-19 hangover as public facilities face the gargantuan task of catching up on all the services that were shut down or limited during lockdown.

At the Cape’s two biggest hospitals, there is currently a backlog of over 7 500 surgeries, while across the country’s courts there was a backlog of nearly 50 000 criminal cases at the end of last month.

At the beginning of this month, nearly 21000 people countrywide were reprotedly awaiting approval from Sassa for disability grants which had not accepted new applications since the beginning of lockdown.

When the country plunged into lockdown, health services at hospitals’ capacity was drastically reduced in order to prioritise space, resources and staff for Covid-19 patients, and to limit other patients from being exposed to the virus in hospital.

As a result, Groote Schuur Hospital is now facing a backlog of 4142 surgeries, Tygerberg Hospital has a backlog of 3500, and 370 at Red Cross War Memorial Children’s Hospital.

Professor Elmin Steyn, head of surgery at Tygerberg Hospital, said there were thousands of patients they would have seen in the past seven months who had their surgeries deferred – many of whom have died as a result, or whose diseases have progressed beyond the help of surgery.

“Only the immediately life-threatening cases were operated. Many of the deferred patients have already returned with progression of disease leading to life-threatening situations. Many will have died outside of this hospital, or will have a worsened prognosis or poor outcome due to delayed surgery.”

Steyn added that estimating how long it will take to catch up all the postponed cases is practically impossible.

“Catch-up is impossible to calculate, as many of those conditions have evolved – some are now inoperable, therefore catch-up is irrelevant. For the survivors, we are always trying to catch up, and the waiting lists remain long.”

Spokesperson for the national Department of Health, Popo Maja, said the backlog could be seen countrywide, but exact numbers for other provinces were not immediately available.

“There is a backlog of non- emergency surgery across the country in both the private and public health sectors. This trend is also apparent globally,” Maja said.

“All of the academic hospitals have opened theatres to battle this backlog.”

At Baragwanath Hospital in Gauteng a total of 7541 surgeries were reportedly postponed, including a high number of ophthalmology, orthopaedic and paediatric surgeries.

In a recent issue of the SA Medical Journal, an article that Steyn contributed to found that 84 of 85 surveyed hospitals cancelled or reduced non-cancer elective operations. A quarter of hospitals only continued with symptomatic cancer operations, and 3.5% cancelled all cancer operations.

Two hospitals stopped all emergency operations, and 87% cancelled or reduced new out- patient visits.

The article concluded: “Hospital surgical de-escalation in response to Covid-19 has greatly reduced access to surgical care in South Africa, which could result in a backlog of surgical needs and an excess of morbidity and mortality.”

In the country’s courts, the backlog of criminal cases is now “a matter of serious concern”, according to the Department of Justice and Constitutional Development.

By the end of August, there was a backlog of 68171 cases at the high, regional and district courts – an increase of nearly 29000 added to the already large backlog before lockdown. By the end of September, the backlog had decreased slightly to 49160.

A case is considered to be “backlogged” if it is still open six months after first appearance at a district court, or nine months at regional court.

Spokesperson for the department Steve Mahlangu said the courts had not been spared the effects of Covid-19.

“Not only has Covid-19 interrupted the operations of departments, it has required the rapid and massive redeployment of resources,” said Mahlangu.

“In addition, the absence and rotation of staff and other court role-players, as well as court closures due to decontamination efforts, have all had an impact on backlogs and court operations.”

Mahlangu was not able to provide details of the types of cases and charges, but said that they include serious cases such as fraud and corruption which are dealt with at regional courts.

A Court Optimisation Committee has been set up in order to oversee the backlog as well as efficient functioning of the courts in the time of Covid-19.