In the front yard of a small brick house a toddler ambles unsteadily, following a neat cement pathway around the side of the house in Thabong township outside Welkom.
He stops abruptly at the back door, through which he views 75-year-old Louisa Mokwakwe stirring her pot. The toddler and his two siblings depend on their gogo for most things. But Mokwakwe is uncertain about for how long she will be able to continue doing this. The answer is there, she knows. But she has taken countless taxi trips to get the answer and it's always just out of her reach.
Despite her age, Mokwakwe is proudly self-sufficient and healthy – "except for high blood pressure, which I take treatment for", she says with a smile, moving from the stove to the tiny adjacent room where she sits on one of three couches arranged around an old-fashioned box-shaped television.
But, she explains, this might change soon. Almost a year ago, a Pap smear test at her local clinic returned with "abnormal" results and she was immediately referred to Bongani Regional Hospital for a more specialised test to see whether she had cervical cancer, precancerous lesions or another reproductive health problem.
But when she arrived for her appointment at the hospital in May she was turned away because, as nurses told her, the specialist doctor – a gynaecologist – was not available to perform the procedure, called a colposcopy.
Mokwakwe returned many times last year, spending R18 on minibus taxi fare for each trip, in the hope that the problem would be resolved. She survives on a state pension of R1 400 a month, which also supports her three grandchildren and their unemployed mother.
Another 316 local women are anxiously waiting along with her – they're all on the procedure's waiting list at the hospital.
According to a 2015 study in the Southern African Journal of Gynaecological Oncology, about 8 000 South African women are diagnosed with cervical cancer each year. It is the leading cause of cancer-related deaths and disproportionately affects black women.
Women over the age of 50 are at a higher risk of developing the disease, which is treatable if caught early by screens such as Pap smears and colposcopies. The study notes that the high death rate is largely owed to "poor access to medical facilities … and the late presentation of cervical cancer".
According to the Treatment Action Campaign, Bongani hospital's chief executive officer, Jabulile Mngomezulu, promised that colposcopies would be resumed at the facility by the third week of January.
In December last year, Mokwakwe was happy to receive a call from the hospital to schedule a new date for her colposcopy – January 21, the day before Free State health MEC Benny Malakoane was set to lead a media tour of Bongani.
Malakoane has achieved notoriety among health activists for repeatedly denying that the province's health system is dysfunctional and on the point of "collapse".
But on January 21, after arriving for her appointment, Mokwakwe was again sent home with "excuses" instead of answers.
"I'm very worried because I don't know if I have cancer," she says. The toddler rests his head on her lap while she strokes his head distractedly. "There is nowhere else to go for this, so I don't know what more I can do. But maybe the MEC's visit will change that."
Worried: Louisa Mokwakwe has been waiting for almost a year for specialised cancer tests at the Bongani Hospital.
By 6am the following morning, the Bongani nursing hall is packed to capacity with patients, activists, health workers and the media equipment of the public broadcaster. Rows of plastic chairs are flanked by guards in bright yellow reflector vests, and uniformed police stand at the back.
The hospital made headlines in October last year when five babies died there in the space of a week. In the same month, the Health Systems Trust revealed that the province had lost a quarter of its public sector doctors in a year.
But today Malakoane, his officials and Mngomezulu will be briefing the restless crowd about the work being done to improve service delivery at the hospital and in the province, including hiring staff and making sure equipment and drugs are accessible.
According to Malakoane, his department has embarked on a province-wide project, termed Operation Hlasela, to ensure "critical service delivery is reaching people on the ground".
"We have extended the hours of clinics across the province, increasing the number of 24-hour facilities so that working people aren't disadvantaged," he announces.
Microphones are given to people in the crowd as their hands shoot up. As the officials field their questions, the mood in the hall starts to change.
An angry woman asks about the colposcopy procedures. Mngomezulu responds: "Staff shortages have temporarily halted the process because doctors have resigned to further their studies. But we are doing our level best to address the backlog. We have appointed a new specialist and 25 additional nurses will start at Bongani on February 1."
Another woman inquires about a piece of equipment that has reportedly been broken since early last year – she has been told it is necessary to remove her painful gallstones.
Mngomezulu says she is not aware of the situation but will investigate.
Health MEC Benny Malakoane tours Bongani Hospital in Welkom.
The heated session is cut short because of time constraints.
Malakoane walks to a brigade of ambulances and an emergency services helicopter, which are on display outside of the hospital.
"As an experienced healthcare provider myself, as the leader of the department of health in the province, I wasn't shocked today," he explains in front of the helicopter.
"When you gather people they will tell you about their individual experiences, which aren't necessarily systemic. Health is an emotive issue."
A group of staff members from the hospital watches from a distance as the MEC speeds away in a black Audi A8 for the next stop on his tour.
A nurse clicks her tongue. "I never knew we had an emergency services helicopter. It's the first time I have seen it," she says. "There are all kinds of things happening here today because of the MEC's visit."
She waves a hand in the direction of the hospital. "All of a sudden there is toilet paper and soap in the bathrooms. A week ago there was nothing."
The nursing students' residence next to the hospital wasn't part of the media tour. Inside, there is no toilet paper or soap, and the showers are filled with mud.
The taps are leaking and toilets are broken. A nursing student is eager to sneak us in. "We are supposed to be promoting health, but we ourselves are not living in a healthy environment," he says.
The student accommodation study room, attached to Bongani Hospital, is locked and filled with broken furniture.
At the hospital, a woman from the administration department asks: "How can things get better when our [chief executive] is never around to sign leave forms or attend to anything? She is away for three weeks at a time and the backlog of forms pile [up] on her desk."
Mngomezulu's office denied the allegations, saying she only left the hospital to attend official health meetings in Bloemfontein, which never lasted longer than a day.
In the doorway of the entrance to the hospital, about 50m away from where the provincial health department's helicopter shines bright yellow in the sun, a cleaner – dressed in patient's scrubs because he hasn't received his uniform – shakes his head. "Things are not getting better. They didn't get better after the premier's visit last year and they won't now, after the MEC's. This is a stunt to get publicity for the ANC ahead of the upcoming municipal elections."
Back in Thabong, Mokwakwe is considering using money she can hardly spare to go to a private hospital.
"If I don't do this, who will know if I have cancer now – if I have a few years or months left?" she asks.
Less than 10km from Bongani hospital, in the private Mediclinic Welkom hospital, Nozimanga Pitso arrives at 6pm for her 12-hour shift as a nurse in the maternity ward.
She is also the aunt of 21-year-old woman who died at Bongani hospital last May after the hospital took five days to remove a dead fetus. Pitso was told her niece died in the intensive care unit – but her official cause of death remains unexplained.
"I have approached lawyers to help get answers and, when I went to Bongani to get the medical file requested by the legal team, they charged me R490. This was last year August and I still haven't seen the file."
Pitso, who has twin daughters, is thankful that her grandchildren were born in the private hospital she works at and didn't have to "suffer" the same fate as her niece.
"Bongani is a slaughterhouse," she says, and walks down the pristine corridor as the doors of the maternity ward close behind her.
Patients wait in the admissions area at Bongani Hospital in Welkom.
In March last year, Bhekisisa published an exposé on the dismal state of the Dihlabeng Regional Hospital in Bethlehem. At the time, it had almost no permanent leadership – most managers were in acting positions, including the chief executive, nursing manager, head of administration and clinical manager. The hospital also had less than half the medical officers it needed.
The consequences of the understaffing and lack of administration were drastic, with patients who needed colostomy bags to collect their stools having to use supermarket bags instead.
One woman's husband died after Dihlabeng ran out of stock of the antibiotics he needed. All the hospital's lifts were broken and, because no porters were available, she had to hire four men from a burial service to carry his body from the fourth floor of the hospital to a hearse on the ground floor, amid the "stench of rotten, wet bodily fluids".
But Dihlabeng's situation has since improved considerably.
Within two weeks of the publication of Bhekisisa's investigation, four different teams visited the hospital – a national health department team, a presidential team, an Office of Health Standards Compliance team and Free State Premier Ace Magashule and his team, who met the hospital's executive committee.
All vacant positions were advertised and in July, a chief executive was appointed. A head of nursing was employed in August, a clinical manager in October, and in November a head of administration was appointed. According to Free State health department spokesperson Mondli Mvambi, four additional medical officers, two sessional doctors, a gynaecologist, a paediatrician, six additional nurses, a pharmacist and pharmacist's assistant, and 10 nursing assistants have also been hired.
The national health department has allocated a budget of R25 million to Dihlabeng for new equipment and a contractor has been appointed to maintain the hospital's lifts. New lifts are on their way from overseas.
Doctors at the hospital have confirmed that "there have been huge changes" at Dihlabeng. "Shortly after your newspaper story was published, we received colostomy bags, ECG machines, new beds and mattresses, and emergency trollies with resuscitation equipment. We now have a consultant doctor in each hospital department; we have a total of 12 doctors on staff now and I hear we're getting more soon," one doctor said.
But Dihlabeng was not part of provincial health MEC Benny Malakoane's media tour last week. According to Mark Heywood from social justice organisation Section27, the fact that doctors at the hospital have implicated Malakoane in the preferential treatment of patients to whom he is connected could be the reason.
In July 2014 Bhekisisa published a story in which doctors alleged that Malakoane instructed staff to create an additional intensive care unit bed for a branch secretary of the ANC, while other patients with better prognoses of survival had to be turned away. As a result of the allegations, a corruption case was opened against Malakoane, which, according to Heywood, is now at "a sensitive stage".
But Malakoane said he prefers to visit district and not regional hospitals, to show improvements in primary healthcare, also known as level-one care. Ironically, Bongani Hospital, to which Bhekisisa accompanied him on his media tour last Friday, is a regional hospital.
At Dihlabeng, one health worker was clear: "Since that media circus, everyone but Malakoane has been to Dihlabeng. He must be scared of us." – Mia Malan & Amy Green
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