As the full horror of the conditions at the Rahima Moosa Mother and Child Hospital (RMMCH) unfolded with the release of a damning report, and healthcare workers' first-hand accounts of the dysfunctionality at the institution, doctors there fear an increase in deaths with high-risk infections on the rise, writes MedicalBrief.
Among the issues raised as contributing to the crisis (in addition to budget constraints and overcrowding) were a drastic shortage of nurses, an influx of foreign nationals and obstretic doctors booking more elective Caesarians than could be accommodated.
The report by Health Ombud Professor Malegapuru Makgoba on the RMMCH in Coronationville, Johannesburg, painted a shocking picture of a facility crippled by dysfunction and failure: broken toilets, pregnant patients left to give birth while lying in filth on the floor. No heating, no blood bank, no laboratory service, no ICU, and a broken CAT scan machine.
Staff were being mugged at work, cars were being stolen, and the CEO was often absent. The description conjured up scenes from a horror movie, notes a TimesLIVE editorial.
To add insult to injury, paediatric gastroenterologist Dr Tim de Maayer, who blew the whistle on the appalling conditions and claimed in an open letter that “hospital-acquired infections spread like wildfire”, was suspended for speaking out.
Makgoba also revealed that over the years, the issue of a serious nursing shortage at the hospital was repeatedly raised with the Gauteng Health Department.
He said the hospital had relied on “agency nurses” to address needs due to the longstanding nursing staff shortage, reports News24, and that the Health Department had failed expectant mothers by not taking reasonable legislative and other means within its available resources to achieve the realisation of the right to access healthcare services.
“The issue of overcrowding is a longstanding challenge,” he added. “It poses a high risk of disease outbreak and infection transmission not only to healthcare users but also to personnel and visitors. In the case of RMMCH, this risk would include neonates, who are at greater risk.”
Frew Benson, a doctor at RMMCH, estimated that more than 40% of patients admitted were foreign nationals, and that the hospital was still operating under the auspices of the 1996 Service Plan and could not deal with the number of patients.
Dr Nomathemba Mokgethi, a member of the Gauteng legislature and a former Health MEC, said the issue of foreign nationals was the leading cause of overcrowding at Gauteng hospitals.
She said overcrowding at RMMCH was worsened on 1 April 2022 when Chris Hani Baragwanath Hospital and Charlotte Maxeke Johannesburg Academic Hospital diverted patients there.
Dr Nomonde Nolutshungu, head of the Gauteng Department of Health, blamed foreign nationals for putting pressure on hospitals, as they were not catered for in the budget.
Makgoba’s investigation found that there had never been a documented Divert Policy at RMMCH, and despite several requests during the investigative period, no document had been submitted to the ombud.
Dr Thomas Kleyenstuber, head of anaesthetics at RMMCH, said the hospital’s overcrowding issue was compounded by the cancellation of elective Caesarean section (C/S) cases to accommodate emergency C/S ones.
Kleyenstuber said the obstetric doctors had booked more elective Caesarean procedures than the hospital could accommodate.
This was corroborated by the prenatal ward supervisor, who indicated that “doctors admit patients knowing very well that there are no vacant beds”, the ombud said.
De Maayer told Daily Maverick it “remains to be seen” whether Makgoba’s recommendations in the report will be implemented.
He said what was happening to patients was “criminal”.
“The last weekend I worked, we had blood tests that were done on Friday afternoon and did not reach the laboratory until Monday. That is three days that we are treating a child without any idea what the blood results are. It’s ridiculous! They’ve been talking for many many years about a 24-hour lab but it never materialised,” he said.
De Maayer was one of the 34 people interviewed by the health ombud and his team, and said the report’s findings were accurate when it came to the recommendations.
“But I am worried they’re not going to materialise. After the story last year … lots of things were talked about and planned – and absolutely nothing has happened.
“The infrastructure is still crumbling, we’ve had no change in our staffing complement despite punting for this for many years, and the staff morale is low.”
He said if things did not turn around, there was a possibility of losing their specialists in the next five years.
Also under fire is a nurse who now faces disciplinary action after making her own concoction of medical steriliser to prepare patients for abdominal surgeries during August and September 2022 when the hospital ran out of Povidone-iodine and SteriPrep solutions.
Theatre department operational manager Sister Thembela Goduka was told the hospital’s chief executive, Dr Nozuko Precious Mkabayi, had instructed them to borrow stock from other health facilities.
But the nurse diluted Steriscrub and water to make her own concoction, which she then used in theatre to clean patients’ skin before surgical procedures, reports News24.
“A total of eleven patients who were operated on developed sepsis and had to be taken back to theatre for ‘relook’ procedures,” Makgoba said.
He recommended the Health Department institute a disciplinary inquiry against the nurse.
On the issue of former CEO Dr Nozuko Mkabayi, the report showed she was appointed three weeks after reporting to the regulator that she had been admitted to a psychiatric hospital for a long-standing mental condition, according to the Sunday Times.
Annexures attached to the report show she spent just 182 days at work since being appointed in January 2021, missing 98 days with no reason.
When asked by the Gauteng legislature in August last year to confirm how many days she had been at work since her appointment, she claimed a total of 346 days, but an affidavit from the hospital’s HR manager revealed that her office had booked out her file and never returned it, so this could not be verified.
According to documents, she had e-mailed a “self-declaration” to the Health Professions Council of South Africa (HPCSA) in December 2020, saying she had been admitted to a psychiatric unit for a condition she had lived with for 21 years. She had had “multiple psychosocial issues; hence the relapse”. The council logged the report but offered no record of having done anything further.
The HPCSA did tell the ombud that it had previously investigated Mkabayi in 2017 but found no evidence that she was too impaired to do her job. Then, in March 2021, just three months into her stint as CEO, the regulator received new information about her and launched a fresh inquiry.
As a result of this inquiry, the council told Mkabayi in December last year that it planned to suspend her from practising as a doctor.
Makgoba recommended she face a disciplinary hearing but did not recommend her dismissal.
The report also included that:
• A grievance from 55 staff in the neonatal ward in June 2021 said the ward was hopelessly overcrowded with up to 80 patients and only 35 beds;
• Staff complained of a shortage of equipment and that broken machines were not replaced;
• Patients with Covid were not isolated and three newborns with Covid-positive mothers were mixed in with other babies in the paediatric ICU;
• Another ward was not properly heated, nurses were not allowed to wear jerseys and babies were cold with too few blankets;
• Between 30 and 50 patients were being admitted daily to a nine-bed labour ward and a 10-bed labour admissions ward;
• The hospital switchboard broke down in June 2021 and was only fixed in March 2022; and
• The hospital’s generator was not powerful enough and was out of action for a full week last July. Doctors had to intubate patients by the light of their cellphone torches.
Another complaint about the shortage of nurses said that while the hospital had 1 412 staff, there were 350 vacancies, a “crisis that will lead to deaths if it is not resolved”.
A report by senior doctors said outbreaks of multidrug-resistant organisms had tripled, and a dangerous fungal infection – Candida auris – had emerged. Reasons included overcrowding, high patient-to-nurse ratios, poor hygiene because of a lack of sanitiser and broken towel dispensers, pipe bursts, no running water, flooding and failure to isolate babies with infections.
“The mortality rate is increasing and preventable causes of death like asphyxia and sepsis are rising,” the doctors said.
A BusinessLIVE editorial said the release of the shock report into the harrowing conditions confronting pregnant women and babies at the hospital “came as no surprise to anyone who has had the misfortune to rely on public health services in Gauteng”.
In many cases, hospitals continue to operate due only to the dedication and hard work of the doctors and nurses who work in untenable situations, yet have not forgotten their Hippocratic oath to uphold professional ethical standards.
The report is yet another reminder that Gauteng’s state health system is facing collapse, with a long list of health and criminal crises that have made headlines, said the editorial.
“While there are undoubtedly many hard-working and committed doctors and nurses providing excellent care, the vast majority of the 16m people who depend on the province’s public health facilities face a callous, uncaring and degrading system.
“The report has painted a picture of a once-proud institution so poorly managed that pregnant women are now forced to sleep on the floor, raw sewage runs between buildings and wards are left unheated. While patients endure these terrible conditions, senior management luxuriates in newly renovated offices.
“Read between the lines and it is clear the place is rotten to the core.”
The editorial added that given that two previous investigation reports into the hospital were shelved, there was little hope that Makgoba’s recommendations would result in anything more than cosmetic changes.
The stock response from the government when presented with this catastrophic state of affairs is that there is not enough money in the health budget.
“And therefore, the argument goes, the financing reforms proposed under National Health Insurance (NHI) will fix it all. That is naive at best, and dishonest at worst.
“No health budget is ever enough. No budget is so small that the most basic items required to run a hospital cannot be purchased. This is not an underfunding problem and NHI is not going to fix the corruption and indifference running through the veins of the Gauteng Health Department.”
The list of evidence and notorious headlines is long: the Life Esidimeni tragedy in 2016, when 144 people at state psychiatric facilities died of starvation and neglect after 1 500 patients were relocated to cheaper care centres, many of which were not registered and unequipped. No official has faced criminal charges for this.
At Tembisa Hospital, the Special Investigating Unit confirmed in December that a probe had found maladministration and possible fraud and corruption related to the supply chain management process. It identified R1bn in payments to criminal syndicates.
At Charlotte Maxeke Johannesburg Academic Hospital, two years after arsonists gutted a large portion of it, police are none the wiser as to who started the blaze.
While parts of the hospital have reopened, copper piping worth more than R3m was stolen from above an operating theatre, disrupting surgeries.
Soon afterwards staff in the ICU and the emergency department refused to work overtime because they had not been paid for it since last year.
At Helen Joseph Hospital, two nurses have been stabbed while on duty this year, and doctors have had to cancel surgeries due to leaking ceilings, broken aircons and other infrastructure and resources problems.
At Diepkloof’s Chris Hani Baragwanath, the third largest hospital in the world, crippling lawsuits are the order of the day, with provincial health confirming in December that the hospital’s maternity unit was facing claims worth almost R1bn.
And just last month, a leaked video showed rain pouring through the roof at Steve Biko Academic Hospital in Pretoria.
To subject citizens to this level of health care (or rather lack of it) is not only barbaric but also clearly unconstitutional and criminal.
“Public health in Gauteng has collapsed. It is time to stop wasting energy on NHI and fix the rot. For that, President Cyril Ramaphosa needs to make good on his promises to stamp out corruption and clean up Gauteng.”
Sunday Times PressReader article – CEO’s missing months at chaotic maternity hospital (Open access)
Business LIVE article – EDITORIAL: Stop wasting energy on NHI and fix the rot (Restricted access)
See more from MedicalBrief archives:
Callous disregard at ‘dirty’, ‘filthy’, ‘unsafe’ Rahima Moosa – Ombud
Floundering Rahima Moosa Hospital ‘needs to admit it has a crisis’
Maverick investigation: Mother and Child Hospital’s CEO denies any crisis