Finding a painkiller for Gauteng’s hospitals
Almost two years after Gauteng?s Commission of Inquiry into Hospital Care Practices, the provincial Department of Health has been working to implement some of the commission’s recommendations — aimed at ultimately improving hospital services. But senior specialists at the province?s two largest hospitals believe that little has changed. In fact they believe certain things are worse. Is this a fair assessment or have things changed, even though progress may be slow. Anso Thom spoke to those at the coal face?
Article 1 of a three part series
On June 21 1999, when Professor Ken Huddle, sat down to address a packed media conference at Chris Hani Baragwanath Hospital in Soweto, he believed that what he was about to say would change things. In fact, Huddle and his colleagues from the surrounding hospitals, believed that if Government did not listen to their concerns, the consequences would be serious, even life threatening.
In a nutshell, the professors felt that the frozen posts at Chris Hani Baragwanath, Johannesburg, Helen Joseph and Coronation hospitals would lead to most services being curtailed and in some instances even closed.
At the crux of the matter was the fact that budgets had been cut and were simply inadequate to meet the demands of an ever-increasing patient load at the hospitals. Equipment needed to be repaired or replaced, hospitals were losing highly qualified medical and support staff and the nursing situation was critical.
Understandably, this had led to a low morale among staff.
In short, the province?s hospitals were sick and in desperate need of an injection. But the “drugs” needed to be carefully selected.
“I don?t think we?ve made much progress since 1999. In fact certain things have got worse,” says Huddle, who heads internal medicine at the hospital and chairs the medical advisory committee. Two issues are at the core of this, according to Huddle – nursing and the AIDS epidemic.
“Everyone bashes the nurses and there is no question that nursing services are in desperate need of an overhaul. It used to be a sought after profession, but sadly it is no longer seen in that light.
“You cannot run a hospital without them, but we are running 30% under what out staff complement should be. They are leaving for greener pastures,” says Huddle, adding that many nurses are trying their best.
“We need to take nurses back to caring for patients, but they end up filling in form after form.”
Huddle also believes that the AIDS crisis was not being recognised by Government.
“The medical and paediatric wards are overrun with AIDS patients and we just have to cope.
“The nurses struggle. You must remember that these patients are desperately ill and this is putting enormous pressure on the staff as well.”
Huddle says they are unable to keep long term patients as they simply do not have the resources. He does not understand why there is still no step-down palliative care facility available to these patients.
“We did identify a place that could offer us 40 beds at R160 per patient per day (in comparison to R800 at the hospital). They are able to offer hospice care until the patient dies or is re-incorporated into the community, but the Gauteng health department said it had to come out of our budget.
“I can understand that the province is locked into budget constraints, but then they need to go to national government and lobby for more money or overseas funding.”
Huddle says that, unlike in 1999, the medical staff complement is reasonable with no critical shortages. Most of the staff are fairly committed and that the hospital still managed to attract elective students from the big, first world hospitals. “It?s a vocation, the perks are not overwhelming,” Huddle remarked cynically.
Commenting on the Patients? Charter, Huddle says the current situation at the hospital made a mockery of the document.
“We can?t meet the requirements and demands of the charter as things stand now. There are too many limitations and staff has been very unhappy about having to display the charter.
But despite all the doom and gloom Huddle says he did not regret setting foot at “Bara” 25 years ago. “It is nice to offer something to people who have nothing, but it is a pity that doctors have been forced to fulfill a gatekeeping function.
“I?ve loved working here. Despite all these constraints we have helped hundreds of thousands of patients, but it could be so much better. I don?t see why we should settle for mediocrity and below.” – www.health-e.org.za