Sfx’€¦ (People speaking in ward)

KHOPOTSO: Sister Catherine Monamodi, sister-in-charge of ward 11 ‘€“ a female ward at Rustenburg Provincial Hospital – has been in this particular unit for two years. Her ward capacity can admit up to 30 patients. But, she says, due to increased morbidity, there is a massive demand for the beds.

SISTER CATHERINE MONAMODI: We’€™ll be having 30 patients in the morning, but whilst we have those patients we’€™ll receive a phone (call) from Casualty, OPD that ‘€˜please we want seven beds, we want six beds’€™. Once a patient is discharged or is transferred, already, that bed has got a patient.

KHOPOTSO: As a result, says Monamodi, patients are discharged quicker than they should be so as to free up bed-space. Patients in wards and out-patients are visibly sick. Emaciated people walk around the hospital. Subdued coughs come from skinny bodies underneath the covers in the wards.

SISTER CATHERINE MONAMODI: It’€™s mostly pneumonia, TB’€¦ You know because of this mine; because of the HIV most of our patients are very sick. They take a long time to recover because you’€™ll think the patient is just admitted for pneumonia, but you find that that it’€™s not just pneumonia. There’€™s a lot of things.              

KHOPOTSO: The average length of stay in Rustenburg Hospital’€™s medical wards is seven days. But the recent addition of a step-down ward has brought some relief as sick patients can still remain in hospital to receive medical attention.

SISTER CATHERINE MONAMODI: At least with step-down, most of them we don’€™t discharge them when it’€™s due. We send them to step-down for rehabilitation. Step-down is a ward which came to relieve the situation in the acute ward. It’€™s like a sub-acute ward. So, patients, when they are better but they are not fit to can go back home we send them to step-down ward.

KHOPOTSO: Sighing heavily, Monamodi expresses how staff feels the pinch due to the increasing load of patients that need care.

SISTER CATHERINE MONAMODI: (She sighs) We’€™ve got a serious problem of staff. Like, in a medical ward one patient will be sick. You have to turn this patient. You have to feed this patient. You have to help this patient to walk to the bath or to push her with a chair to the toilet – such basic things. We need nurses who can render that. But you’€™ll find in a day like today we’€™ve got two assistant nurses, one enrolled nurse and two professional nurses, including the sister-in-charge. In the afternoon, it’€™s even worse. It will be two assistant nurses, one enrolled nurse and one professional nurse with 30 very sick patients who need to be attended for total basic care.              

KHOPOTSO: In the management block of the hospital, CEO Mampeta Bolokoe, acknowledges that there is extreme shortage in the hospital. For instance, the HIV Wellness Clinic, has a vacancy rate of 50%. The situation is not likely to change soon as the hospital has placed a moratorium on new posts due to over-spending by R10 million.

MAMPETA BOLOKOE: The R10 million over-expenditure of filling posts that we have actually over-spent in this particular financial year (2005 ‘€“ 2006) is related more importantly to the number of posts that we created and were never funded in subsequent years ‘€“ about R5.8 million of scarce skills, of ward secretaries ‘€“ which were actually created as a result of a conditional grant. Then from there we are not able to include them in the equitable share and sustain them over time. And now they are there as an over-head.

KHOPOTSO: A positive spin-off of the over-expenditure, however, has seen an investment in more doctors.

MAMPETA BOLOKOE: The other reason is that because we have not been able to attract doctors for a long time in the past years, for the first time there were doctors who wanted to be retained’€¦ So, when medical doctors became available we then had to create extra 10 posts for doctors. That over-expenditure also came because there were allowances, there was over-time.

Sfx’€¦ (People in a ward)

KHOPOTSO: Back in ward 11, Sister Monamodi says despite the chronic shortage of nursing staff, the rising number of patients due to AIDS-related conditions and low pay, health workers at Rustenburg Provincial Hospital have been generally upbeat since the new CEO took over three years ago. The boost in morale has come from a few small gestures.                    

SISTER CATHERINE MONAMODI: Even if you can see the environment ‘€“ there’€™s been a change even in the structuring of some wards. There’€™s been painting. You know, that thing also boosts us. When you walk around wards like this you feel that you are recognised because there’€™s been this renovation going on within the hospital, within wards, even the staff morale, such things’€¦ She has made an impact’€¦ You know, as nurses we spend most of our time in this setting compared to other professionals. You’€™ll be working from 07h00 to 07h00 in the evening’€¦ So, it’€™s very important for us to be happy where we are.