Gauteng health system is heading for catastrophe

While officials remain entangled in bureaucratic knots, clinicians warn that the continued closure of the Charlotte Maxeke Johannesburg Academic Hospital risks a ‘humanitarian disaster’.

Gauteng clinicians are growing concerned at the worsening threat of an outright health crisis in the province as the closure of the Charlotte Maxeke Johannesburg Academic Hospital drags on. It has been more than two months since a fire gutted 40% of the hospital’s intensive care beds and destroyed R40 million worth of medical consumables.

The fire, which ripped through Africa’s second biggest hospital on 16 April, has left Gauteng 1 068 hospital beds short in the midst of a third wave of Covid-19 infections.

With more than 5 200 people currently hospitalised with Covid-19 in Gauteng, which is now registering more than 8 600 new daily cases, the South African Military Health Service has been brought in to ease pressure on the province’s buckling healthcare system.

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Daynia Ballot, the head of the University of the Witwatersrand’s School of Clinical Medicine, said that Gauteng’s healthcare system “cannot withstand the closure” of Charlotte Maxeke. The paediatrician described the results of the closure as a “catastrophe” that was “completely off the scale”, even in a provincial healthcare system that ordinarily operates under near-crisis conditions.

Ballot is one among a growing number of senior clinicians around the province raising the alarm.

Another, from Chris Hani Baragwanath Hospital, said there is “no other solution” than to reopen Charlotte Maxeke, which might “bring us back from the brink” of a “situation that borders on a humanitarian crisis”. At the time of publication, a petition started by Ballot to have the hospital reopened had over 25 000 signatures.

Managing the red tape

While three of the hospital’s five blocks, along with its oncology unit, are structurally safe, Department of Infrastructure Development and Property Management presentations suggest it will only be partially reopened by the end of July. Gauteng health member of the executive council Nomathemba Mokgethi gave no further clarity on the hospital’s reopening when it was added as a debate of urgent public importance at a sitting of Gauteng’s provincial legislature on 18 June, saying only it would happen “in due course”.

Charlotte Maxeke’s radiation oncology unit – the largest of its kind anywhere in the country – was scheduled to start admitting patients again on 5 June. It remains closed.

Some of the urgency and accountability regarding the reopening of Charlotte Maxeke appears to be getting lost in the bureaucratic knot that makes up the hospital’s management. While the City of Johannesburg is responsible for issuing the occupational health and safety certificates needed to reopen Charlotte Maxeke, the provincial Department of Infrastructure Development and Property Management owns the hospital and the Department of Health employs the staff who keep it running.

31 May 2018: Patients that would have gone to the Charlotte Maxeke Academic Hospital are redirected to already overstretched facilities in Gauteng as officials await compliance certification. (Photograph by Gallo Images/ Sowetan/ Mduduzi Ndzingi)

The City issued non-compliance reports in May relating to fire equipment, signage, detection and alarm, along with smoke control, water pressure and emergency lighting. But to date, the hospital has still not been issued with the requisite fire certificate and other occupational health and safety certification.

The City’s spokesperson, Mlimandlela Ndamase, said the municipality met with representatives of the Department of Infrastructure Development and Property Management on 11 June and “awaits signed documentation from the engineers of the department in order to consider [and] inspect the facility, and [then] issue occupational health and safety certificates”.

The Department of Infrastructure Development and Property Management is still not in possession of an up-to-date floor plan for the hospital, which is one of the reasons for the delay in issuing the fire certificate. The installation of fire doors is another. Bongiwe Gambu, who is the spokesperson for Tasneem Motara, the head of the department, said reduction of local manufacturing capacity because of the Covid-19 pandemic is part of the reason it is taking so long to acquire and install the doors.

Gambu said the department had acquired assistance from the Solidarity Fund to help speed up the procurement of fire doors and other equipment, products and systems with longer delivery times.

Bed shortages

In the meantime, it appears the Department of Infrastructure Development’s only plan to offset the devastating effects of the ongoing lack of hospital services has been to move patients to other facilities in the province.

But a senior clinician at Baragwanath has called the plan “ludicrous” and “impossible”. Trauma admissions at the already-stretched Baragwanath are up by 50%, as Charlotte Maxeke’s orthopedic, cardiology and ear, nose and throat patients are redirected there. In some units, stretchers have been set up in the spaces between intensive care beds. A fire also broke out in the early hours of 20 June at Baragwanath, although it appears to have been contained without interrupting clinical operations.

There is a dire lack of beds at the hospitals taking on Charlotte Maxeke’s patients. And what beds are made available fall short of the care that would be available at Charlotte Maxeke, which offers the most developed clinical services in Gauteng. Along with dedicated trauma and emergency medical units, the hospital boasts the largest medical oncology unit in Gauteng, one of the province’s two renal transplant units and its largest renal dialysis units, as well as the public sector’s only liver transplant unit.

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A trauma unit at one of the province’s hospitals was forced on 18 June to take on patients suffering medical emergencies like heart attacks, Covid-19, asthma and pneumonia, despite being unsure of how many new trauma cases would be added in the coming weekend.

The Department of Health repeatedly avoided questions about whether it is taking any extra steps to avert the crisis its clinicians have outlined. Regarding whether or not anything is being done to hold Charlotte Maxeke’s chief executive, Gladys Bogoshi, accountable for the ongoing closure, the department’s spokesperson, Kwara Kekana, said “investigations into the fire have not been concluded”.

The hospital was renamed in 2016 for the Witwatersrand’s leading reformer and welfare worker of the early 20th century. Among others, Charlotte Maxeke co-created the Bridgman Memorial Hospital for Black women, a model institution at the time where women received dignified treatment and access to some of Johannesburg’s best obstetricians and gynaecologists.

Maxeke’s legacy is sullied in the wake of the April fire. As waiting times for treatment steadily increase across the province, it might be “almost impossible to count the impact” of the continued closure of Charlotte Maxeke, according to Ballot.

There is no way to know what happens to patients after they are turned away from hospitals with no space to treat them, or how many babies might die in ambulances delayed by the confusion of what hospital has available services.

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