Doctors at the Helen Joseph Hospital (HJH) say they are on the frontline of another kind of “pandemic”: a crisis that threatens to collapse public health services in the Gauteng, especially at HJH, which they describe as being in dire straits and posing increasing risks to patients’ lives. But they also won’t give up without a fight for a hospital that was at one time a world-class facility.
They are urging doctors at state institutions to “not leave the public sector”, and to make their voices heard, while the public should “complain formally about the state of government hospitals”.
They have also asked that President Cyril Ramaphosa intervene and tackle the issue of the deteriorating public hospitals.
Adding to the doctors' woes was the deplorable conditions of on-call rooms, a City Press report, says, forcing many to opt to sleep in their cars while on call at state hospitals.
In a Daily Maverick report, Helen Joseph Hospital Dr *M said he never imagined he would say his hospital should close its doors or stop accepting patients. Never did *Dr O think she would cancel surgeries because an unmaintained roof has turned theatre floors into soggy swamps. And never did *Dr D imagine she would advise friends to emigrate if the government were left to manage the National Health Insurance (NHI).
The three doctors, based at Helen Joseph Hospital, are exhausted and frustrated, but refuse to be beaten down any further.
Over the past few weeks the three have separately contacted Maverick Citizen, raising the alarm that the public must wake up to mismanagement and incompetence they believe has sunk the hospital to the brink of dysfunction and collapse.
Dr M says she cannot stay silent as the government punts the line that “everything is okay” – it’s not.
She says that over the past few years the doctors have been asking for the HVAC (heating, ventilation, air-conditioning) system to be repaired and maintained. It’s not only for the comfort of ill patients, but because a lack of temperature control is potentially dangerous. There is a raised threat of infection, especially in theatres.
“We have to cancel surgeries, or reschedule them because the coolers don’t work properly, and already we are seeing patients returning to the hospital because of sepsis,” she says.
Doctors increasingly had to try to fix problems themselves – buying supplies, mopping floors and using scrubs and medical bins to collect water dripping into the buildings: “Recently some of the doctors suggested we club together to get the aircon fixed but management would not allow it. But when we raise our issues with senior management they have the same old excuse that it’s the responsibility of the Gauteng Department of Infrastructure & Development, not the Gauteng Department of Health.”
She says it is a similar situation with ongoing water interruptions and water shortages at the hospital. Already doctors like Dr M are bringing in water daily for himself and some of his patients. As angry and fed-up as he is, it’s still patient welfare to which he won’t turn a blind eye.
‘Hiding problems’
“Helen Joseph management has become obsolete and problems come from the top – from the Gauteng Health Department. They are now hiding problems behind city water problems, but the problems are much bigger and there are also other issues unrelated to water.
“We don’t get feedback as to what the problems are or why funding that is available is not being used to fix what needs fixing and doctors are left to MacGyver everything to keep working,” he says.
The doctor flags other problems and signs of deep rot and mismanagement – perhaps even misappropriation, he says. Doctors are told there is no linen but the laundry department continues to operate.
Doctors are being made to fill out road accident reports even though there is a Road Accident Fund doctor paid to do the job. There are also random repair jobs, like the replacement of unbroken light switches when more urgent problems need priority.
And there are problems of the autoclaves, used to sterilise surgical and other equipment, not working; equipment and services have not been paid for by the hospital, resulting in medicine shortages; access to the PACS (picture archiving and communication system) has been cancelled because subscriptions have not been paid.
It means X-rays have to be located and printed out. When they can’t be found, new ones must be ordered. The hospital has also had to install portable toilets because many indoor toilets no longer function.
“We need to blow the lid off this place. The situation at Helen Joseph should be a national crisis – but this dire issue is just not being discussed. The President has to speak out and have a family meeting to address this issue of our public hospitals,” he says.
Dr D said a few weeks ago a patient had to remain in theatre after surgery instead of being taken to ICU, because of a shortage of ICU beds. The patient had to be given post-op care in the theatre, creating a surgery bottleneck.
“We cannot pretend everything is fine. I remember a rep said to me that 10 years ago HJH’s theatres were on a par with those in the private sector, and now these theatres are putting patients’ lives at risk,” says Dr D.
Patients wait a month for emergency surgeries and elective procedures are constantly postponed, she says.
“Infections can set in and people could lose their limbs or even their lives.”
For Dr D, one of the biggest impacts of weakening service delivery at Helen Joseph Hospital is that patients are trusting doctors less and less – even blaming interns when surgeries are cancelled. She says there are even rumours circulating that patients should bribe doctors to get on to surgery lists.
They face hostility not just from patients but also senior clinical management who, she says, resort to intimidation and bullying as a management style when dealing with consultants.
“It makes you so despondent. If we do our jobs well then we can heal our patients, but we just don’t have the resources or the support from clinical managers and management to do our jobs,” she says.
The doctor adds that weekly departmental reports submitted to clinical managers never receive any acknowledgment, let alone feedback.
“There was an HOD who was asked how he is going to sort out a maintenance problem in the hospital, but it’s not his role. We also never see the CEO or senior management on the hospital floor, it should be their job, so they understand the day-to-day realities we face,” she says. “The doctors are willing to go the extra mile and are hard-working, but they can’t go on like this forever and it’s not why we trained to be doctors.”
For now, Dr D is determined to carry on fighting and her call is for the public and doctors to lay formal complaints at the hospital.
“I’ve decided to do this even though I have the quality assurance people complaining about it because it’s extra paperwork and they try to scare me off with the extra admin, but I’m not going to stop. I’m also encouraging all doctors to not leave the public sector and for the public also to make the effort to complain formally, because we need to have records of what’s going wrong.
“The public must demand better. And we need people who run this hospital to be fit to do the job – not people who have been demoted and moved around from province to province just so they can keep a job. If they can’t do the job they must go.
“I know the doctors don’t feel as if they can’t go on much longer; but we must fight on – because our patients are dying.”
Hospital response
CEO of Helen Joseph Hospital Dr Relebohile Ncha responded to Maverick Citizen via Gauteng Health Department communications. She says the hospital is “not collapsing” but its problems stem from being a 50-year-old building with “ailing infrastructure”, including leaking roofs. Work on the roofs would begin once a contractor was appointed, while work on the HVAC system had already begun.
Ncha calls this a “recent challenge”, but acknowledges that it has delayed operation.
“However, claims that there has been an increase in surgical complications due to suboptimal theatre conditions are inaccurate as the current data do not indicate an increase in that regard.”
As for the hiccups in radiology, she says the PACS system for X-rays is being upgraded but is “waiting for the finalisations from the provincial structures”. She adds: “We are currently printing X-rays for clinicians, therefore no data are lost and no files are lost.”
She also maintains that there is no shortage of ICU beds, as the facility has 14 of these.
On the issue of communication to staff, Ncha says: “The hospital has always been transparent with sharing of information.
Challenges are discussed at executive level and decisions taken and communicated to staff via their managers as well as on a public platform at the hospital.”
But she adds: “It is not procedural to allow staff to fix items while there are departments responsible for fixing those items.”
And while doctors continue to ask for their identities to be protected, Ncha says there is no intimidation or prevention of any staff member from speaking up, but she says matters should be resolved through internal processes. She confirms there are tensions between clinical managers and consultants but that this “has received attention from the (department) and is being addressed”.
Meanwhile, the SA Medical Association Trade Union says doctors who work in under-resourced public hospitals often prefer to sleep in their cars rather than in appalling conditions in on-call rooms as they work around the clock to save people’s lives, according to a report in City Press.
An on-call room is allocated to doctors to rest while waiting to be on hospital duty, but SA Medical Association Trade Union national task team co-ordinator Dr Cedric Sihlangu said the state of these rooms in various government hospitals was deplorable.
"Many doctors, especially junior doctors, medical officers and trainee doctors, out up with inhumane conditions at work when on call, covering overtime and when doing night shift,” he said.
Some doctors, he added, had no choice but to sleep in their cars during their shifts because of inhabitable on-call rooms.
“These rooms go for months without cleaning, often with dirty and smelly linen. Hospital management simply turns a blind eye and there is no inclination (on management’s part) to improve the working conditions. These doctors are often bullied and intimidated.”
Doctors who spoke to City Press on condition of anonymity complained about the working conditions.
A doctor working at Charlotte Maxeke Johannesburg Academic Hospital said only three on-call rooms are functional out of the six in a certain department.
“The one call room is used for storage and it is too hot inside. The second call room has no bathroom and it doesn’t lock. The third’s lights don’t switch off. The fourth doesn’t have a toilet seat. None of the call room showers is functional.”
Additionally, the on-call rooms were not properly cleaned and doctors are expected to sleep on mattress on the floor.
“There’s a communal microwave and fridge. However, they are both very dirty. There is no kettle and we often have to ask the nurses if we can use theirs.”
A doctor at Livingstone Hospital in the Eastern Cape said there were no on-call rooms in the hospital, only tea rooms.
“(The hospital has) no call rooms for emergency department staff. There are sofas in the tea room for naps. I usually prefer to sleep in my car.”
Gauteng Health head of communications Motalatale Modiba said that Charlotte Maxeke hospital has 15 on-call rooms. He added that of the hospital’s total budget, “10% is for maintenance for the entire hospital, not specifically for call rooms”.
“Chris Hani Baragwanath Academic Hospital currently has no challenges with on-call rooms for doctors. They have been recently renovated and equipped with all the necessities, including beds. They are also regularly cleaned. The doctors’ quarters were also recently renovated.”
Doctor and health activist Joash Naidoo said on-call rooms were heavily burdened by budget constraints and lack of resources.
“Most of the resources are spent on ensuring healthcare service delivery is achieved. These call room facilities are often neglected. Many colleagues work extended shifts and then end up using poorly capacitated call rooms or even sleeping in empty ward beds or their cars,” Naidoo said.
City Press – doctors sleep in cars to avoid dirty linen, mattresses
See more from MedicalBrief archives:
Water supply problems compound issues at Helen Joseph Hospital
Charlotte Maxeke debacle places ‘enormous load’ on Helen Joseph Hospital
The long, slow collapse of South Africa’s top hospitals
Gauteng hospitals deteriorate further after damning PP report
Dysfunctional provincial health departments make a mockery of the ‘capable state’