3 April 2020
Chairperson of the South African Medical Association Angelique Coetzee has written a strongly worded open letter to the Limpopo MEC for Health Phophi Ramathuba. This follows two doctors who work at Mmametlhake Hospital in Mpumalanga, but who live in Modimolle, Limpopo, testing positive for Covid-19 and being forced by the Limpopo government to spend their isolation period in a Limpopo multi-drug resistant tuberculosis hospital.
The letter speaks for itself so we republish it below in full. We have sent requests for comment to both MEC Ramathuba and Minister of Health Zweli Mkhize. This article will be updated if we receive a response.
Dear Dr Ramathuba
RE: Forced isolation in the Modimolle MDR-TB Hospital for two doctors tested positive for COVID-19 in Limpopo
I refer to the matter involving Drs Taryn Williams and Claire Olivier. The doctors work at Mmametlhake Hospital in Mpumalanga but reside in Modimolle, Limpopo.
As you are aware the doctors were diagnosed with COVID-19 on Sunday, 29 March at a private hospital in Bela Bela. The doctors are asymptomatic, and have, in their own words, “been in strict self-isolation at our home” since testing positive.
Since becoming aware of their status, they have been contacted by yourself, and were visited by EMS personnel on Monday, 30 March, who performed physical checks, including checking on their vitals, which were both in range. No indication was given that the self-isolation approach by the doctors – which is a prescribed course of action once being treated positive for coronavirus – was unsatisfactory or inapt.
However, on Tuesday 31 March EMS personnel again arrived at the doctors’ house informing them they need to be moved to the MDR-TB Hospital in Modimolle, Limpopo, a move both doctors have resisted.
Their resistance to a proposed relocation is based on two pillars: firstly, they believe – as we do – that the strict-self isolation approach is, for now, the most effective course of action for them to follow, and, secondly, that moving them will place them in an environment which may, in fact, further aggravate their conditions while they are still clinically stable.
The resulting court action you embarked on to force these doctors into a provincial facility, and the manner in which these doctors have been treated by yourself and certain healthcare staff of the province, is most unsettling.
According to the doctors, you informed them that the spread of COVID-19 in Limpopo was not due to local spread, and that all cases were by people of high socio-economic status who had travelled outside the province. You informed them that they had brought the virus to the people of Limpopo, and that they should have stayed where they were at the time, despite their explanation that they work in Mpumalanga but live in Limpopo.
Further to this, you informed the doctors that since they don’t work for the Limpopo provincial Health Department, they should go back to where they are employed. They were further told they can self-isolate anywhere they want, just not in Limpopo.
This approach is distressing for a number of reasons.
To suggest the virus is somehow linked to economic status is misleading and ignores the vast body of available evidence which indicates, quite clearly, that it is indiscriminate in who it infects. This approach also politicises the spread of coronavirus at a time when the exact opposite approach is required.
The approach to the two doctors – healthcare workers who put their lives at risk at this time to care for others – also stigmatises the disease by implying the relevant, widely endorsed, and proven method of self-isolation is inappropriate. The message is that despite the worldwide acceptance of the practice, self-isolation is not viable in Limpopo.
What is of greatest concern, however, is that your approach seemingly negates that of national government which is calling for strict self-isolation instead of hospitalisation, particularly of those who are asymptomatic. At a time when beds, equipment, PPE, medicines, and human resources are at a premium, surely those who can self-isolate within the parameters should be allowed to do so?
We are disappointed in the approach you and the Limpopo Department of Health have taken regarding these two doctors; we believe it to be heavy-handed, unfair, and contrary to the provisions which national government has stipulated. We further believe that you are politicising the events for political gain, a truly troubling development.
Importantly, the approach you have embarked on will, undoubtedly, have unintended consequences going forward for many, many other healthcare workers in the country. Given the iron-fisted manner in which these doctors have been treated, would it come as a surprise if other doctors either refuse to be tested, or, worse, refuse to disclose their status? It may be that doctors seek other ways not to work (such as taking leave of absence for two weeks) instead of reporting for duty. Given the severe shortage of medical personnel this will cripple efforts to deal effectively with the pandemic.
I would like to strongly urge you to reconsider your approach to Drs Williams and Olivier, to rescind the court order to have them relocated, and to allow them to continue to self-isolate as they have done since Sunday. SAMA believes, as do I, that this is the correct approach. They should be given the space to recover in their home, and to be tested at the end of their self-imposed quarantine period. Once this is done, a future course of action can be considered.
In addition to writing to you, I will also be speaking to the Minister of Health, Dr Mkhize, with a view to him intervening to resolve this matter.
Dr Angelique Coetzee
Chairperson of SAMA