Doctors have come out in support of an open letter by paediatrician Dr Tim De Maayer to the Department of Health, detailing how children are bearing the brunt of a failing public health system.
In his letter, released on 22 May, De Maayer referred to Rahima Moosa Mother & Child Hospital, where problems like loadshedding, water shortages and an overburdening of the system were affecting the lives of young patients, reports Daily Maverick.
De Maayer has been a respected member of the Rahima Moosa paediatrics department for more than a decade, says HoD Professor Ashraf Coovadia. Much of what De Maayer said echoes what other doctors in the department have been talking about for months.
Professor Haroon Saloojee, head of the community paediatrics division at Wits University, “wholeheartedly” agreed with De Maayer.
“He’s highlighted the problems at one hospital but… it’s a problem at many hospitals, not only (in) paediatrics, but in other departments as well,” he said.
The first priority should be addressing the issues at Rahima Moosa hospital, said Saloojee, as many of the problems De Maayer highlighted needed immediate attention. However, the bigger challenge would be ensuring that healthcare for children at hospitals in other settings improves.
There have been engagements between the Gauteng Department of Health and management at Rahima Moosa since the letter’s release, said De Maayer.
“I’ve been told the Office of the Presidency wants the CEO’s response to the article. So, I think it’s gone up quite high,” he said.
Tyrone Seale, acting spokesperson for the President, said: “We are aware of the issue, and… assisting the (Gauteng) province in dealing with multiple issues affecting the health sector.”
Issues of power
Chairperson of the Gauteng Health Portfolio Committee, Mauwane Phaladi-Digamela, said the acting deputy director-general (DDG) of the Gauteng Department of Health had assured the committee no children had died at the Rahima Moosa Mother & Child Hospital because of electricity or generator failures.
De Maayer had also described doctors treating children by cellphone torchlight, due to power failures, and referenced a case where a child’s incubator switched off because of loadshedding. “Our generators are unfortunately inadequately sized to supply the hospital,” he said.
Dr Freddy Kgongwana, acting deputy director-general of the Gauteng Department of Health, said: “We don’t have a report from the Rahima Moosa (Mother & Child Hospital) doctor which speaks to what the doctor’s stated allegations (are) in his letter.”
In his letter, however, De Maayer said the hospital’s issues had been raised with management repeatedly, including in “two reports on the critical state of the neonatal wards and obstetric services in 2016 and 2021, and a more recent letter on 11 April 2022”.
A system ‘intact’?
On 24 May, the Gauteng Department of Health released a statement saying that despite challenges within the health system, it “remains intact” and continued to service millions of patients annually.
Regarding Rahima Moosa Mother & Child Hospital, the department said the past decade had seen an increase in patient load with no increase in infrastructure development.
"The hospital has steadily increased intake from 10,000 deliveries to 16,000 deliveries per year, the second highest in the country.”
De Maayer’s letter further detailed how water cut-offs worsened sanitation and the spread of hospital-acquired infections in the neonatal ward.
Another factor placing pressure on neonatal wards in many Gauteng hospitals was the increase in admissions in recent years, said Saloojee. “As Dr De Maayer said, the result of that is overcrowded neonatal units, where infections are rife. That’s the biggest area needing attention and it’s not just (that) it needs staff, but it needs space. And with space, things like water.”
In its statement, the Department of Health said there was a functional infection control process at Rahima Moosa, adding that the recorded rate of hospital-acquired infections at the facility in the past year was, on average, 1.38%.
It added that the hospital has alternative measures for water supply challenges, including a borehole donated by Gift of the Givers, and water tanks from Johannesburg Water. However, these measures were not ideal as they sometimes failed to supply enough water.
“(The department) will liaise with …Infrastructure and Development to replace and reroute the old rusted pipes,” it said.
The Rahima Moosa facility has made a submission to the City of Johannesburg to be excluded from the load-shedding schedule to ensure minimal interruption to services, and is awaiting a response, said the department.
BusinessLIVE reports that other challenges include access to 24-hour laboratory services, for which the hospital relies on neighbouring Helen Joseph Hospital, and availability of essential supplies. These were compounded by the effects of the closure of Charlotte Maxeke Johannesburg Academic Hospital, where remedial work is progressing after a fire.
The department said the appointment of a stock controller has been finalised to assist in the management of essential supplies.
Regarding the issue of CT scans, the department agreed there was a breakdown of the 16-year-old machine in mid-February but there were “minimal delays as patients are referred and transported to nearby facilities, including the Nelson Mandela Children’s Hospital and Leratong Hospital”.
Immediate repairs to the machine were negated by the discovery of further faults. Parts from the condemned CT scanner at Charlotte Maxeke Hospital are being used to repair the one at Rahima Moosa, said the department.
Looking back
A contributor to the problems faced by Gauteng’s public health sector is the instability in the province’s Department of Health. In the past 18 months there had been four heads of department. The high turnover of MECs for Health in Gauteng is similarly problematic. Since 2006, there have been seven Health MECs – some of whom have been embroiled in corruption or mismanagement claims.
The role is currently held by Nomathemba Mokgethi. In a recent interview with GroundUp, she described the problems facing the Gauteng public health system as “pressure”, but not a “crisis”.
Open letter to Department of Health (Open access)
See more from MedicalBrief archives:
Viral video leads to investigations at Rahima Moosa Hospital
Maverick investigation: Mother and Child Hospital’s CEO denies any crisis
Water crisis continues to affect Johannesburg hospitals