Around 40 staff and students from the University of the Witwatersrand’s faculty of health sciences took part in a socially distanced picket outside the Charlotte Maxeke Johannesburg Academic Hospital in Parktown, Johannesburg, on Thursday 24 June. The picketers, dressed in academic gowns and standing at least 2m apart, called for the hospital to reopen, 69 days after a fire forced its shutdown.
The picket came on the same day that Gauteng Premier David Makhura acknowledged that the hospital’s closure “has had a severe impact on our health system”. Makhura went on to say that the “terrible delay” in reopening the province’s most developed clinical hospital was “completely unacceptable” and that further delays “will cause severe risk”.
That verdict was roundly shared by senior doctors at the picket.
Johnny Mahlangu, a member of the deanery and the head of the university’s pathology school, warned that the continued closure of Charlotte Maxeke risked what he called a “cascading effect” of hospital collapse in the province. The radiation oncology patients who have been redirected from Charlotte Maxeke to Steve Biko Academic Hospital in Pretoria, for instance, are jeopardising a cancer unit already perilously close to its limits.
Charlotte and the tsunami
Charlotte Maxeke’s capacity has been removed from Gauteng’s precarious health equation at the same time that a devastating third wave of Covid-19 infections has been added to it.
The 10 086 new infections recorded in Gauteng on 23 June – a new record for daily cases – accounted for two in every three new infections in South Africa. On the same day, 37% of Covid-19 tests in the province were coming back positive. The numbers came three days after Gauteng member of the executive council for health Nomathemba Mokgethi said: “Our system might be under pressure, but we still have the will and enough capacity to cope with the demand.”
In a presentation by Makhura’s advisory committee on Covid-19, Bruce Mellado from the Wits school of physics, who called the province’s case numbers and test positivity rate “very worrying”, said implementation of alert levels two and three had shown no impact yet in the province, which remained on track for a “worst-case scenario”.
Gauteng’s excess deaths, which were 80% higher than expected for the week ending 19 June, also appear to be on a dramatic rise. Excess deaths in Johannesburg were nearly double what was expected in the same week.
More than a hospital
In the midst of this crisis, the capacity at Charlotte Maxeke goes beyond the hospital’s much-reported 1 068 beds. It provides the most sophisticated clinical treatment in the province and handled the most Covid-19 cases during the first two waves of infection.
But in the wake of the fire, the City of Johannesburg has still not issued the hospital with the requisite occupational health and safety certificates. It says it is waiting for the Gauteng Department of Infrastructure Development and Property Management to complete the required work at Charlotte Maxeke before it can do so.
Nevertheless, Makhura said the province had taken the decision “to give a go-ahead to the hospital management to reopen the parts of the hospital that have not been structurally affected by the fire”. He said the hospital would start readmitting oncology patients on 28 June, and that the reopening of four of the hospital’s five blocks “will be immediate”.
Responding to Makhura’s announcement, Martin Smith, who heads the university’s department of surgery, said “this is no longer a time for statements, it is a time for actions. And until they arrive, it’s understandable that doctors remain suspicious.”
Smith said clinicians would soon be penning an open letter to President Cyril Ramaphosa, detailing the dire effects of the hospital’s closure on patients and medical students.