Why Mount Frere’s babies die

Early in 2007, a whistleblower contacted local journalists with alarming stories of a surge of infant deaths in Frere Hospital, the main public health facility in East London in South Africa. The source said stillbirth rates and deaths of babies under the age of one month had long been high but were getting worse. Newspapers had carried some stories about conditions at the hospital, but local health department officials, and staff working at the hospital, would rarely respond to reporters’ questions, or, if they did, would outright deny that there was anything amiss. A team of journalists from the Daily Dispatch, East London’s longestablished city newspaper, backed by its editor, believing it was unlikely that any officials connected to these deaths would ever talk on the record, decided to go undercover to find out what was really going on at the Frere maternity ward in particular. Justifying their use of hidden cameras and recorders due to the urgent and compelling public interest, a small team – Brett Horner, Chandre Prince and Ntando Makhubu – with the support of editor Phylicia Opphelt and deputy editor Andrew Trench worked on the investigation for three months before they published their first story.

What they discovered horrified them and their readers. Between 1994 and 2007, more than 2000 infants had died in Frere Hospital and it was clear that many of these deaths were preventable. Given the political sensitivities of what was still regarded as a ‘transition’ from the apartheid-era health system to a democratic one, including the rapid deracialising of a previously segregated hospital system, the investigative team knew they had to be right on every single fact. Starting with the initial breaking story, ‘Why Frere’s babies die’ on 12 July 2007, and continuing with a series of investigative pieces over the next few weeks, the reporting revealed how those terrible conditions had been allowed to develop in the Frere Hospital and its smaller feeder hospitals and clinics. A common thread was the failure to control infections through basic hygiene measures in maternity wards and in the hospital more generally, but inadequate staffing levels, incompetence and lack of equipment all played a role too.

Front-line staff were not always directly to blame – there were substantial staff shortages and a large number of unfilled posts, causing a great deal of stress, burnout and low morale among nurses in particular – but it became clear there was also a good deal of negligence. The journalists were determined to share the broader health context in their stories, acknowledging the social determinants of the situation the hospital found itself in, including the impact of the AIDS epidemic and the high levels of poverty in the area. The stories were carefully researched, well written, poignant and emotionally wrenching. Responses were always sought from those implicated and detailed lists of questions were sent to the health department and hospital managers, but these were rarely answered with more than disavowals. The story also elicited strong denials from the highest office in in the land. Then president, Thabo Mbeki, castigated the reporting in the strongest terms and went as far as to fire one of his ministers, Nozizwe Madlala-Routledge, then deputy minister of health, who had responded by saying that what was happening at Frere Hospital (and other hospitals in the Eastern Cape) was indeed a ‘national emergency’.

The minister of health at the time, the notoriously inept Manto Tshabalala- Msimang, also responded initially with furious denials. Her national health department took out paid ads in newspapers in an attempt to refute the allegations. A long-time AIDS denialist, Minister Tshabalala-Msimang had, with President Mbeki, effectively delayed the provision of live-saving antiretroviral medication to millions of South Africans. The story marked something of a turning point in the struggle for a more responsive healthcare system under the ANC government. A year later, President Thabo Mbeki was recalled as president after an internal coup within the ANC. His AIDS denialism might have played a small part in his recall. Minister Tshabalala-Msimang was removed from her post at the same time and replaced by Barbara Hogan, who declared, on her first day of office, that the era of AIDS denialism was over.

Despite the denials that anything was wrong at Frere Hospital, equipment maintenance budgets were soon doubled and then doubled again, and extra nurses and doctors were hired. But the department of health in the province still moved harshly against one of the original whistleblowers: Dr Nokuzola Ntshona was found guilty on charges of ‘speaking out’ about Frere Hospital maternity deaths and summarily dismissed. The same pattern – of refusing to allow media to investigate properly nor permitting health officials to talk to the media, and the seeking out and punishing of whistle-blowers – continues to the present day. This has led, in part, to the Life Esidimeni Crisis in Guateng province where 1,700 mental health patients were moved from a long-standing service provider, without proper checks of the new facilities they were being moved to, and 150 of these patients died.

At least, national infant mortality rates have fallen since the Frere story: under-five mortality rate had declined from 77.2 deaths per 1,000 live births in 2002 to 45.1 deaths per 1,000 live births in 2015. The Daily Dispatch team responsible for the series of stories of baby deaths at Frere hospital won the 2007 Taco Kuiper Award for Investigative Journalism. The judges wrote: ‘The paper uncovered every aspect of the story, from the highly technical to the human interest; to get to the evidence, they had to use imagination, creativity and some unusual methodology; it had an enormous impact on the country as a whole; and, when facing pressure and criticism, their story held up well, leading to major positive results for the ordinary people they were writing about.’ Noting that the story started from just a single source, the judges in 2007 praised the editors for encouraging reporters to dig deeper: ‘Great stories often involve taking a single case and building it into a larger picture which lays out the context, examines the cause and points fingers at the culprits – and therefore has maximum impact. This is what the Daily Dispatch did. It is a testament to the power and value of the best kind of journalism …’

Why Frere’s babies die Brett Horner, Chandre Prince & Ntando Makhubu, Daily Dispatch,
12 July 2007

Hundreds of newborns are dying every year at Frere Hospital’s overburdened maternity section – and the institution’s own records reveal the scale of negligence behind many of the deaths. A Daily Dispatch investigation has found that the situation is so bad that a cleaner delivered a baby in front of shocked students. Exhausted staff are stretched so thin they must abandon the nursery at night to assist doctors in theatre. Mothers are also victims of negligence. A swab was left inside of a patient after a Caesarean-section while another’s placenta was removed a full 24 hours after she gave birth. The Dispatch team spent nearly two months walking the maternity wards with hidden cameras, attending the mass burial of dead babies and interviewing medical staff and heartbroken mothers. Reporters even staffed the Frere mortuary for an afternoon, answering the phone and dispatching porters to collect bodies. Internal documents show that senior management knew the situation was out of control for years, but did little to address the crisis … Two thousand babies were stillborn in the past 14 years at Frere, according to the abortions and stillbirths book in the labour ward.

Last year’s figures appear to be the highest on record, when at least 199 babies were stillborn. Frere’s official baby mortality rate exceeds provincial and national figures as contained in an unpublished report by a unit of the Medical Research Council. Worse is that hospital staff concede in documents that ‘most’ maternal deaths and stillbirths ‘are avoidable due to care’. References are also made to the worrying increase in the number of maternal and neo-natal deaths from 2005 to 2006. The pattern of death is illustrated at the Haven Hills Cemetery where batches of up to 45 babies in tiny white coffins are buried in mass pauper funerals every month. Two weeks ago, 43 babies were buried. The burial included two tots who died in October 2004 and another in December 2005. Their bodies had remained in maternity’s cold storage for years …

Renata Coetzee went to Frere in labour, but was turned away by an intern who, she said, confessed he could not read the CTG machine, which monitors the foetal heartbeat and other vital signs. An hour later, Coetzee’s baby was stillborn … Other moms complained of sitting on wooden benches in prolonged labour, wearing blood-soaked clothes and being left unattended during and after birth. Some mothers blamed insufficient vital equipment for babies dying. A maternity nurse concurred: ‘You feel so helpless as deaths could have been avoided if there was enough equipment.’ Again, the hospital’s own documents points to crippling shortages of staff and equipment, like CTGs and oxygen points. The situation has become so critical that a long-serving cleaner is known to have delivered babies and dispensed medication. ‘I once saw a cleaner doing a delivery …’ said a student nurse, a claim corroborated by a veteran of Frere’s maternity wards. Soon after the Dispatch investigation began and emergency inventory was ordered of all equipment and staff needed in the maternity section. ‘Frere does not have even half the number of required staff, leaving those available exhausted and burnt out …’ said a former Frere midwife. Another nurse said staff shortages often forced them to leave the nursery unattended to assist with theatre duties.

A mother’s pain Brett Horner, Chandre Prince and Ntando Makhubu, Daily
Dispatch, 13 July 2007

Baby Liano King. Born May 22, 2007. Died May 22, 2007. Buried July 3, 2007. At his graveside in the Haven Hills Cemetery, his mother Murichia King bowed her head and allowed herself to grieve. Hers was a subdued grief, a silent grief. Her eyes filled with tears, but she had her composure as Pastor Charles Gallagher intoned a blessing that should have been cause for uncontrollable emotion. ‘Lord God, ever caring and gentle,’ said Pastor Gallagher, ‘we commit to your love this little baby who would have brought so much joy to the lives of his parents and many others King was mourning the death of her first child, who was stillborn at Frere Hospital’s maternity unit – a death she solely blames on the hospital’s ‘negligent’ staff …

A week before Baby Liano’s funeral, on June 27, 43 other babies were interred in a mass pauper burial at Haven Hills … Cemetery documentation revealed that 35 of the 43 babies were stillborns from Frere Hospital, while the other eight died between either a day or four days after birth. However, all their death certificates stipulate the cause of death as ‘stillborn’. A stand-out feature of these deaths is that nearly all of them occurred over the course of this year, from January 29 to June 12. But most shocking of all was the discovery by the Dispatch of three babies who had been forgotten in the maternity unit’s cold storage for years. Two of the babies were stillborn in October 2004 and the other in December 2005. The death certificates of two clearly show an attempt to change the date of death to this year. But a copy of a hospital stillborn register in the possession of the Dispatch confirms that the babies died years ago. Also, 18 out of the 43 babies who were buried did not appear in the same register …

HRC and health council join Frere fray Brett Horner, Chandre Prince and Ntando Makhubu, Daily
Dispatch, 14 July 2007

As the public outcry over baby deaths at Frere Hospital continued to grow yesterday, the Health Professions Council of South Africa (HPCSA) and South African Human Rights Commission (SAHRC) vowed to find the culprits and prosecute them. This follows an in-depth investigation by the Daily Dispatch that revealed at least 2000 babies were stillborn at the hospital in 14 years – many of these avoidable and the problem was getting worse. HPCSA head of legal services advocate Tshepo Boikanyo yesterday said a team would be descending on the hospital without warning to investigate. ‘We don’t want Frere to know when we’re coming … documents go missing if they know this. In terms of regulations, if we find any cases of misconduct, we go directly and prosecute individuals,’ he said. Internal documents obtained by the Dispatch acknowledged that lack of staff, equipment and general negligence were key factors to increased maternal and baby mortality rates. The HPCSA is the statutory body for investigating malpractice complaints against all health professionals. Boikanyo said their objectives were more about holding health professionals to account than the hospital as an institution. But he warned ‘we won’t do this thing subtly’.

The SAHRC’s chairperson, Jody Kollapen, said he would formally write to the council to offer their services in any investigation. ‘This is clearly a matter of human rights because babies are dying. We will either monitor, share, assist or become part of any investigation process,’ he pledged. Kollapen contacted the Dispatch after the newspaper’s story on the Frere baby deaths was debated on SAFM’s After 8 Debate with host Jeremy Maggs yesterday morning … Thirza Clarke, a former nurse at Frere, called in to say the crisis warranted the closure of the hospital and immediate evacuation of babies … Speaking on behalf of the national Health Department, Professor Ronald Green-Thompson said the hospital had ‘ruthlessly and robustly’ employed nurses over the past few months. Maggs quipped: ‘You would need a brigade of nurses to address this issue.’ Green-Thompson said that Health Minister Manto Tshabalala-Msimang had spoken to provincial Health MEC Nomsa Jaula on Thursday about the reports. ‘The matter will be addressed in whatever way,’ he said.