The delays in reopening Charlotte Maxeke Johannesburg Academic Hospital in Gauteng could have consequences more dire than the Life Esidimeni scandal. This is the view of human rights and social justice activist Mark Heywood.
At least 144 people died when Gauteng’s Department of Health haphazardly moved patients from Life Esidimeni facilities that were ill-equipped to nurse people with mental health issues. There are still patients from Life Esidimeni who cannot be found and whose families are looking for them. The department has no information on their whereabouts.
“[If] you close a hospital, people disappear,” said Heywood. “[If they died], you don’t know why they died. You can’t actually say they died because they were getting care and are no longer getting care, or they died because they spent years coming to Charlotte Maxeke and when this hospital was closed, they didn’t know where to go and stopped seeking healthcare.”
It’s been almost a year since a fire gutted a portion of the hospital, with damage estimated to be around R40 million. Some of the damaged sections, including casualty, the cardiothoracic ICU and specialist psychiatric ward, are yet to reopen owing to various delays in refurbishing them. What began as a week-long closure has since escalated to a desperate situation that is likely already deadly, and many calls have been made to reopen the entire hospital urgently.
“If there was real political will they could fix this hospital in a couple of months at the outset,” said Heywood. “The sad thing is that we don’t actually know the extent of the damage, 11 months later.”
With about 1 000 beds, Charlotte Maxeke is one of the biggest hospitals in the country. The job of treating its patients is now split between Helen Joseph and Chris Hani Baragwanath hospitals, which are buckling under the pressure. Thabo Masebe, acting director general in the premier’s office, said these institutions would get more funding to cope with the extra burden.
Stationing security guards in different parts of Charlotte Maxeke during the construction that has taken place did not stop the recent theft of copper pipes, more than 500m of electrical cable and distribution boards. It has resulted in another potential delay in reopening casualty, through which most people are admitted to the hospital. It was due to reopen on 14 March.
Masebe said contractors working in the casualty section had sent a report after the theft. “They completed their work at the end of February, but when they wanted to connect the electricity to test all their systems, they couldn’t do it because of the [stolen] cables,” he said.
Last year, copper pipes worth R30 million were reportedly stolen.
Neglectful and cruel
Having joined a picket outside the hospital on 4 March, Daynia Ballot, head of the University of the Witwatersrand’s school of clinical medicine, said the hospital is mostly used by vulnerable patients who cannot go elsewhere and do not have the luxury of private healthcare. They also cannot get some of its specialist services at other hospitals in Gauteng.
“There aren’t enough beds, there aren’t enough special services, there aren’t enough emergency wards, and so having the hospital closed means that patients suffer and die. The burden on other hospitals is terrible, so this translates to not only patients dying because they can’t get care, but also suffering when they need care because they have to sit in emergency rooms for days on end waiting for beds,” said Ballot.
Sasha Stevenson, the head of health at public interest law centre Section27, slammed the provincial government’s handling of the crisis. Referring to the closure of the specialist psychiatric ward, she said: “I don’t think the premier even realises that there’s both a chronic and an acute mental health crisis in this province, and there’s just no real leadership on fixing it.
“There are still only a few places in the province where people can go to live if they need chronic psychiatric mental healthcare, and there’s no beds for the most part. So it remains this area of real neglect. We hear … a lot of emphasis on how important mental health is, but we are not seeing the government putting their money where their mouths are or really dedicating themselves [to it].”
At Helen Joseph Hospital alone, said Stevenson, there are 40 psychiatric patients who don’t have beds. Many patients using mental healthcare services at other hospitals are without medication and beds as well, posing a risk to themselves and those around them.
Just a month ago, Solomon Stix Morewa Memorial Hospital in Selby, Johannesburg, which treats patients with mental health issues, was due to be shut down. Experience has shown it may have been a fatal move for its patients, and Stevenson said there are allegations that their families were not contacted and kept informed. After many concerns were raised, the closure did not go ahead.
“The people are going to stay in the facility in the medium term, but long-term plans remain unclear, so that’s a real worry for us,” she said. “We want to make the government see that contracting for chronic care for mental health users isn’t the same as other contracts. It requires long-term, consistent services. You can’t just move people around, so that’s what we need to get across to the Gauteng Department of Health.”
In February, a report from the Special Investigating Unit (SIU) implicated a dozen senior officials in the Gauteng departments of infrastructure development and health, who were reportedly suspended. Allegations of corruption, a failure to deliver on time and overpricing concerns led Gauteng’s premier, David Makhura, to issue a proclamation transferring responsibility for the refurbishment of Charlotte Maxeke from the department of infrastructure development to the national Department of Health, which appointed the Development Bank of Southern Africa as the implementation agent.
It has been a month since the suspension and the officials have still not been charged, which means they cannot be named. Gauteng government spokesperson Vuyo Mhaga was unreachable and the names could not be confirmed.
“This is the problem,” said Heywood. “People get suspended and they sit [at home] and nothing happens. We have a terrible problem in the provincial health department. We lack skilled and honest people. So many people have been corrupted, and a lot of people have been driven out because those people who don’t go along with the corruption get scared or they get alienated.”
The oncology unit at Charlotte Maxeke was reopened in June 2021 after its radiation department was shut down because of fire damage. Gcinashe Nqabeni, an advocacy officer at non-profit organisation the Cancer Alliance, said cancer patients are dying while waiting for treatment as there’s a backlog of over 2 000 people needing it.
“It’s quite difficult for cancer patients because a lot of their cancers are progressing while they are waiting for radiation, or they pass away as they are waiting. Although the oncology unit has been opened, the issue of the waiting list and lack of staff and proper equipment remains,” she said.
Nqabeni said the shutdown of a health facility has a ripple effect and contributes to societal stress. “Jobs are affected. If people are ill, they can’t work. If they can’t work, they can’t earn money, so there is an economic impact. The staff is also impacted in terms of job satisfaction and being overworked,” she said.
According to Mark Human, a member of the South African Medical Association’s board of directors, morale is low among Charlotte Maxeke staff, who are also still dealing with the anxieties around Covid-19. He said Gauteng is witnessing the systematic demise of one of its flagship hospitals, and the continuous looting in healthcare provincially and nationally must stop.
“We should not be deluded into thinking this [calamity] was due to a fire – that was merely the trigger. This was due to chronic maladministration and gross negligence in terms of maintenance that’s been going on for well over a decade now,” Human said.