Dr GEORGE ABRAHAM: It’€™s two ways: Number 1, our number of patients with HIV-related diseases have increased. Number 2, we have been losing staff on a regular basis due to HIV.

KHOPOTSO: The 784-bed Natalspruit Hospital is struggling to hold on to staff. Many leave because they want to work overseas or in the private sector. But a significant number are dying of AIDS.

Dr GEORGE ABRAHAM: I don’€™t have statistics, but you’€™ll find that on a monthly basis we lose 1 ‘€“ 2 people because of this HIV problem.

KHOPOTSO: That’€™s a candid admission by Dr George Abraham, acting senior clinical manager of the facility. Over the 12 years that he’€™s worked at the hospital, he has learnt that healthcare workers at Natalspruit are no different from the community that they serve nor are they any different from the rest of the South African population.

NURSE: Sorry, sorry, sorry, sorry’€¦

KHOPOTSO: That’€™s a nurse wheeling a patient out of ward 16, a 38-bed male medical ward. Mrs Rosinah Serote, the motherly head of nursing services at Natalspruit Hospital, whispers to me.

ROSINAH SEROTE: You see? There’€™s already a death ‘€“ this one’€¦

KHOPOTSO: Visibly stressed, the sister in charge of the ward, Nombulelo Mabhija, writes into a file and fumbles to find her wrist-watch.

SISTER NOMBULELO MABHIJA: Hmm’€¦ Let’€™s ust quickly write the time now.

KHOPOTSO: It’€™s 12h55. What does the time signify?

SISTER NOMBUELO MABHIJA: The time of death.

KHOPOTSO: Mrs Serote looks over Mabhija’€™s shoulder to view the deceased man’€™s file.

ROSINAH SEROTE: It’€™s AIDS-related’€¦ That is how it is.

KHOPOTSO: This is the first death for the day in ward 16. At times, I’€™m told, they have up to five deaths per day. More than 80% of patients admitted to Natalspruit Hospital’€™s medical wards are AIDS-related. Patients often seek medical care when they are already seriously ill – like the man who had just died. Sister Mabhija feels the stress of working in this ward.

SISTER NOMBULELO MABHIJA: It does overwhelm us because, really, they are sick. They need to be cared for all the time. They are totally dependent upon us because most of them can hardly walk. They can hardly feed themselves. They can hardly wash themselves, so we have to wash them. We have to take care of them full-time.

KHOPOTSO: The hospital, in Katlehong on the East Rand, used to be a battle zone between the ANC and IFP before the 1994 elections. Now it has a different battle to deal with, says Dr George Abraham.

DR GEORGE ABRAHAM: In the early ‘€˜90s we used to have a lot of gun-shots and all those things. Those things have come down. But now we are overwhelmed by medical patients. For example, we used to admit between 10 ‘€“ 15 medical patients on a daily basis before. Now that number has gone up to between 40 and 50 patients per day. And most of these patients have to do with HIV-related complications.

KHOPOTSO: The surroundings of the hospital bear testimony to the poverty that engulfs the area. It’€™s also somewhat typical of a big hospital in a township environment. An informal market trades just outside the entrance, then just on the other side of the road is a mushrooming informal settlement and a busy taxi-rank.

Mrs Serote has spent five years working at the hospital. Over this time, she has seen the capacity of the 784-bed hospital shrink in comparison to the demand for beds. As a result, the hospital has had to make some adjustments to cope.  

ROSINAH SEROTE: Because of the pressure of these HIV-related patients we had to remove one paediatric ward and make it a step-down. And we had to take one female orthopaedic and make it a female medical ward. Yes, they are full in such a way that they over-flow into other wards, disciplines. For instance, at the present moment we do have patients in the Gynae and Obstets that are medical. We’€™ve got patients who are medical, who are mostly HIV-related, into Spinal. That’€™s what we have done. They are all scattered around the hospital because we don’€™t want to be seen as saying we have chased people away, we say we don’€™t have beds.

KHOPOTSO: The Gauteng Department of Health is building a hospital in nearby Vosloorus to help shift the pressure from Natalspruit. The new facility will open in three years’€™ time. But Mrs Serote is concerned that the stop-gap measures management has instituted might not be sufficient.

ROSINAH SEROTE: It’€™ll mean we will turn patients out and say: ‘€œWe don’€™t have any beds within this 784-bedded wards that we have been authorised with’€.