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Successes and failures in the world’s largest hospital

Miracles performed here but there are no toilet seats and they leak.

JOHANNESBURG – Having commended Netcare’s Olivedale Clinic on Moneyweb last month, I took an unauthorised walk around Chris Hani Baragwanath Hospital to note the contrast.

We have all heard horror stories about State hospitals – doctors and nurses abandoning patients to go on strike, equipment being broken, stolen and even deliberately sabotaged, power outages, patients waiting days in queues, being ignored or even worse, abused.

My curiosity was piqued by the unhappy experience of my daughter’s helper, Happiness. She was treated roughly at the Helen Joseph Hospital, when she went into premature labour six months ago. The baby was stillborn in my daughter’s car.

“You have killed your baby” the doctor scolded his hapless patient, “and I am going to report you and you will go to jail”.

It was a groundless and empty threat. Happiness was admitted for one night. My daughter needed to give her a cellphone so that she could call her to fetch her on discharge. The staff refused to let my daughter give her the phone. Happiness was discharged or dumped outside early the next morning. She was given no pills to dry up her milk. Her breasts became agonisingly engorged and she developed a massive infection, which was cured by antibiotics from a private clinic.

To be fair, two of our helpers had far better experiences at the Krugersdorp Hospital, where two babies were safely delivered. Hilda, who had terminal cancer and died last week, was compassionately handled by the hospice at Krugersdorp. So even in the government sector, there is care and concern.

I had to see for myself, so simply strode around Chris Hani Baragwanath with a notebook in hand. 

Let’s state the positives first. The Chris Hani Baragwanath hospital sprawls over 173 acres, has 3 200 beds and 6 760 staff, which makes it the largest hospital in the world.

Tens of thousands of people are cured from all manner of disease and injury every year. Thousands of babies make their entrance to the world here. The trauma unit handles thousands of cases a month, many of them life and death matters. Patients come from all over SA but also from Mozambique, Zimbabwe and treatment is pretty well free.

A young doctor friend, who has worked here for more than ten years, says the hospital is a lot better equipped today than it was. Indeed, a lot of its technology is extremely advanced. There is a new radiology unit and a new casualty outpatients section. Companies such as Johnson & Johnson sponsor units such as the burn clinic. There is an advanced hand unit and serious HIV/Aids research happens here. The advanced cardiology unit is also sponsored.

“If you are seriously sick or injured, you won’t do better than at Baragwanath”, he said, “but if you’re not so bad, you could battle for attention.”

There are serious management deficiencies, however. There are frequent power outages causing cancellation of operations. Autoclaves often do not work. There are occasional shortages of antibiotics. Linen is still stolen wholesale.  Nurses come in and out as if through a revolving door.

Those in the college went on strike because of perceived unfairness in marking their exams. Bara called a media conference recently to report that some staff are deliberately sabotaging equipment such as bulk oxygen supply, generators in the maternity wards and laundry machines. That was in spite of 135 security guards and CCTV all over the place.

Baragwanath started life as a military hospital during the second world war. Some of the original bungalows are still being used and some really are squalid – stinky toilets and all. But there are modern sections that look just as good as the Olivedale.

Bara is to receive a R170m makeover. The number of beds will be reduced to 1 200. In the future then, it will look more like a First World hospital.

Students of the Wits Medical School have trained here since the war. They have been exposed to a bewildering diversity of complaints and graduate with rich experience. The relationship with the medical school has been beneficial for both parties. Really advanced work takes place here.

Bara is right up there in trauma treatment, cardiology, orthopaedic surgery, neurosurgery, urology, cardiovascular, radiology, ophthalmology, oncology and even nuclear medicine.

Virtually all the specialists and senior doctors hold positions in the private sector as well. This is mutually beneficial. The State gets top doctors at a rather derisory rate but these doctors can supplement their income.

My young friend, now a specialist, enjoyed fellowships in two First World countries but has come back “because this is home and we are needed here”. The contrast between the spotless, sterile hospitals overseas and Bara, where 1km from the hospital sewage can be seen running into a stream, is stark.  

One can only be glad that the first step in introducing the National Health Insurance Scheme will be to upgrade public hospitals. The most vital steps there will be to bring in decent management and to step up medical and nursing training radically.

Baragwanath has the worst communications team in the country. They sat on my questions for three weeks before telling me on Thursday that they couldn’t answer any of them. They didn’t call me. I had to call them.

Fortunately Fidel Hadebe of the Department of Health was more efficient and responded the same day. There were Bara-specific questions he could not answer.

He commented: “Chris Hani Baragwanath has been designated as one of the central hospitals in the country, playing a very important and strategic role in the training of doctors.

“My understanding is that the plan to re-build the facility entails having a wing attached to the hospital to deal with minor ailments, which, at present lead to congestion. The hospital of this stature needs to deal with serious cases and to teach.

“The R170m recently announced by the minister is a stop gap measure aimed at dealing with the immediate pressing challenges facing the facility. These include electricity generation and revamping the nurses’ quarters. Over the years the hospital has expanded but the electricity supply has not matched growth.

“The challenges facing CHB are not too different from those of any other facility: long queues, ageing infrastructure and of course issues of supply management which are managed at provincial offices. Gradually, these are the things that the health Minister is working on addressing together with the MECs.

“Cleanliness remains a problem. Infection Control and Prevention is one of the six standards that are enforceable in our hospitals, the others being long queues, patient safety and security, drug availability and staff attitude.

“In our view, it is simply NOT acceptable that a hospital doesn’t have toilet paper or soap. It’s a No, No, No. Once you allow this to happen, you are exposing yourself to serious infection problems. The minister always says car dealerships are much cleaner than some of our health facilities! It’s a fact.

“People will steal anything. They steal toilet seats, coat hangers in toilets, mirrors, toilet paper in some instances even window panes. This is not a health problem – it’s a social problem if you asked me. We see it all the time even outside of hospital environment. It’s a serious social illness.”

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