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Trauma head at Bara pilots ICU through stormy waters

Professor Rudo Mathivha, who heads the trauma unit at Chris Hani Baragwanath Academic Hospital, Soweto, is an extraordinary woman, who despite the headaches involved in running the ICU at Africa’s largest hospital step, never falters, writes Biénne Huisman in Spotlight.

Mathivha became director of Baragwanath’s ICU in July 1999, holding her own in a white male-dominated space. Through a pioneering critical care training fellowship, she paved the way in this subspecialty for other women of colour.

Two years ago, her work on SA’s Ministerial Advisory Committee on Covid-19, where she represented clinicians and critical care, along with her lifetime of critical care work in resource-constrained settings, and her research into non-conventional respiratory support, anti-microbials, and paediatric care, earned her a Forbes Woman Africa 2021 award for academic excellence.

“I was the first black African female to train in critical care medicine and to head an ICU at an academic institution in South Africa,” she says. “My aim was to transform the landscape. I’m satisfied that I’ve summited that mountain. I’m on the way down to the valley below.”

Dressed in navy blue scrubs bearing the words “Critical Care Consultant”, she looks fresh and alert, having arrived at the hospital at 6.30am, her starting time of her average working day, which usually stretches up until 5pm or 6pm. Her phone, she says, is always open.

Crisis management

Mathivha relays a devastating incident two months back where an intruder cut pipes supplying oxygen to 26 patients in the ICU. An investigation is ongoing into what appears to have been sabotage, raising questions about security at Bara.

“How can a person get into a plant room and simply target the pipe that supplies oxygen to an intensive care unit?” she asks. “Whoever they are, knew which pipe they were cutting.”

Due to the quick reaction from Mathivha and her staff, there was no loss of life.

“When I took over as head of department, I put in a policy to always have oxygen cylinders at each bedside. We have life-sustaining equipment that immediately senses when there’s an oxygen supply interruption. So, that warning came early and we were able to switch the patients to cylinder oxygen.”

The patients had to be quickly moved to another area being used as a Covid ICU, which was fortunately empty.

“When you move critically ill patients, they become destabilised and you have to be very careful. So it took three to four healthcare workers to move one patient at a time. And then we had the challenge of infrastructure. We have two elevators we use to get patients in and out of the ICU, and one wasn’t working – another chronic problem – so it took us close to four hours to move these patients,” she says.

‘Trained to help’

About the emotional impact of heading the ICU – which serves an immediate catchment population of 1.5m people in Soweto – Mathivha says she is trained to help suffering people, and does not allow suffering to distract her.

Some 70% of admissions at Baragwanath are emergencies, with injuries often linked to poverty and social ills, including around 160 gunshot victims per month. According to a 2022 government estimate, Bara has around 3 200 beds and 6 760 staff.

“I am primed to correct the suffering,” says Mathivha. “It is not pleasant to watch somebody when their body is going through changes because of stress, either an infection or trauma or burns, and it can’t function properly. But I take comfort in the sense that I have the knowledge to try to correct the abnormality going on. So over time, I, have learned to focus on correcting the pathophysiology… not about me, it’s about the patient I’m helping.”

At Bara, as at many other public health facilities, staff shortages carry a constant threat of burnout for existing employees. But Mathivha says she has learned not to take this stress home.

“In the beginning, I used to call my late mom and dad saying, ‘Oh, it was such a hectic day. I am so tired.’ And my father would say, ‘What are you? A doctor, here to help your patients. So get on with it, no time to throw a pity party.’

“So that is my approach. That doesn’t mean I’m inhuman and I do not feel. I feel, and sometimes when I lose a patient, I will counsel the family and find a little corner and cry. Or sometimes I will cry with the family. I don’t see any shame in that because I think it’s part of me expressing my humanity. Because another human has died, where we couldn’t overcome what was ailing that body.”

She adds, wryly, that maintaining infrastructure did not form part of her curriculum at medical school.

An old hospital

“This is an old hospital, built during World War 2 as a convalescent military hospital for British troops,” she says. “It was then handed over to the South African Government in 1948 as a civilian hospital, mainly for black patients. And it has basically remained that way since. The wards are barrack-style, Florence Nightingale-structured.”

While the old hospital’s walls are sturdy, the interiors are poorly maintained, often with leaking roofs.

“When things break down,” she says, “it takes forever to be fixed. And even then, it’s shoddy work. Cheap materials are used. Two weeks later, it breaks again and you have to get another contractor to redo the work. The roofs leak when it’s raining. So this is not a comfortable environment for patients. What’s frustrating is it’s something that you talk about every time with management.

“And their hands are tied because the budget to maintain the infrastructure lies with the Department of Infrastructure Development, and we have to wait for them…”

‘The Professor of Everything’

One of seven siblings, Mathivha credits her mother and father for inciting her lust for learning. Her father was a professor in Linguistics and African Languages at the University of Limpopo (back then, the University of the North). “We called him the Professor of Everything,” she recalls. “He taught us to study and be curious way beyond our fields.”

Her father put his own seven children through school, as well as the five children of his brothers who had died, while studying towards his PhD. Mathivha’s mother resumed her own studies at the age of 55.

Mathivha tells Spotlight she is Jewish of African descent. Growing up in a university residential village outside Polokwane during apartheid, being baptised and attending church was mandatory. But her parents told the children, “On Sundays, dress up nicely, go to church. Just sit there and close your mind. Let it go in one ear, and out the other. On Shabbat is when our prayers matter, guided by readings from the Torah.”

Mathivha is a member of the Lemba tribe, who through oral tradition recalls their migration from the ancient Jewish kingdom of Judea, eventually settling in Southern Africa in 50 AD. Today the Lemba has an estimated 250 000 members.

Mathivha, who has a son and two grandsons, completed a medical degree from the University of Natal in 1982, followed by a paediatric residency at Baragwanath and a fellowship in paediatric critical care at Duke University Medical Centre in the United States.

Among other positions, she served as vice-president of the Critical Care Society of Southern Africa. In 2018, she earned the South African Medical Association’s Medical Specialist Outstanding Achievement Award.

A keen encourager of women and girls in science, a self-deprecating Mathivha told local radio programme Womanity: “Every single girl child has it in them. We (women) raise other human beings, we give birth to other human beings, we run families, we are custodians of cultural practices. So science, that should be a piece of cake…”

 

Spotlight article – Face to face: “It’s not about me, it’s about the patient that I’m helping”, says head of trauma at Bara (Creative Commons Licence)

 

See more from MedicalBrief archives:

 

Cable theft rife at state hospitals because of security failures

 

Bara thefts ‘deliberate sabotage’, says Health Department

 

Bara Hospital surgery crisis as waiting list balloons to more than 11 000

 

The long, slow collapse of South Africa’s top hospitals

 

 

 

 

 

 

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