In June 2023, as former Health Ombudsman Professor Malegapuru Makgoba concluded his seven year tenure, he delivered a scathing assessment of Gauteng, South Africa’s economic powerhouse and most densely populated province. 

“You have your best province run by Mickey Mouse. What can you expect? A service that is in shambles.”

Gauteng, geographically the smallest, is home to a quarter of the country’s population. Over 15 million lives are intertwined with the province’s economic, social, and health systems. But within this bustling core lies a medical landscape in disarray, a narrative of deteriorated public health facilities, dire  medicine shortages, broken medical equipment, staff shortages and a high patient load.

Overburdened staff grappling with relentless patient demand shared their grievances with Health-e News. 

From the Levai Mbatha Community Health Centre in Sedibeng, where a nurse lamented, “Coming to work is a nightmare”; to Dr. George Mukhari Academic Hospital in Ga-Rankuwa where overworked staff endure abusive treatment from desperate patients, the strains on the system are palpable.

Rahima Moosa Mother and Child Hospital in Coronationville epitomises the struggle, where nurses juggle patient care with fetching water from trucks and face the wrath of overcrowding and infrastructure failures that endanger newborns’ lives. Meanwhile, at Charlotte Maxeke Johannesburg Academic Hospital, the scars of a devastating fire in 2021 still linger, exposing deeper wounds of neglect and inefficiency.

Levai Mbatha Community Health Centre 

Levai Mbatha Community Health Centre in Sedibeng, south of Johannesburg, is one of the 36 centres that provide 24 hour service in Gauteng. It provides basic primary medical care to over 220,000 residents. It also provides maternity services, emergency care, and casualty. But the facility experiences medicine shortages, lack of equipment and water outages. A professional  nurse, who asked not to be named, shares his story. 

“Growing up in the dusty streets of Evaton in Sebokeng, I have always wanted to be a nurse. I fell in love with the white uniform nurses  proudly wore to work. When I started working as a nurse 10 years ago, things were a little bit better. We did not experience a lot of challenges at our workplace. These days coming to work is a nightmare because we are failed by the system.

“For the first three months this year we did not have panado. We serve the poor of the poorest community who survive on government grants [so they can’t afford to buy their own medication]. In some cases we are forced to stabilise children and send them home even though their condition is not 100% because there is shortage of medication. As a community health centre that is supposed to be operating like a mini hospital. But  we don’t have an X-ray department and patients need to travel 30 km to Sedibeng Hospital  for X-rays and then return to us.

“In January, the Gauteng health department  brought in new blood pressure machines but they also have a problem as we can not check the oxygen saturation. Our facility manager wrote a complaint to the district but nothing has happened.

“For the past two weeks we have been experiencing a shortage of water. We have to buy drinking water and we are worried about our patients. Some patients are not so understanding and they take their frustrations on us. On top of that we have been using expired sanitisers but what can we say it is business as usual.” 

Dr George Mukhari Academic Hospital

At the opposite end of the province in Ga-Rankuwa, north of Pretoria is Dr George Mukhari Academic Hospital. It is a teaching hospital for Sefako Makgatho Health Science University. It serves a catchment population of about 1.7 million people which includes Bojanala district in the North West and as well as parts of Limpopo. 

Here staff say they have no choice but to work long hours. A 28-year-old nurse working as a patient incident register shares her story. 

“We are overworked because of a shortage of staff members. This often results in us being verbally abused by patients who have to wait longer to be assisted. Most of the hospital equipment is not in good standard which impacts the delivering of quality healthcare services.”

Rahima Moosa Mother and Child Hospital

Rahima Moosa in Coronationville in Johannesburg is South Africa’s only mother and child hospital. The hospital delivers about 15,000 babies a year –  the second highest number of babies in the country after Chris Hani Baragwanath Hospital. The many problems in the hospital such as overcrowding and mismanagement have made news headlines in recent years and were even investigated by the health ombudsman.  We speak to a 30-year-old nurse. 

“We have to leave our work and go out to collect water from the trucks. If we are not busy collecting water, we are dealing with water leakages in the wards. That time patients are busy calling us all sorts of names because they have to wait longer for services. 

“The hospital, which caters for pregnant women, has got only 10 cubicles for new born babies with two sets of monitors. Sometimes you will find that only one monitor is working. The issue of loadshedding is a challenge as the generators take time to pick up. That is a danger for premature babies as during those couple of minutes they don’t get enough oxygen which can lead to brain damage. At the end of the day, they blame nurses for hospital negligence.” 

Charlotte Maxeke Academic Hospital

Not far from Rahima Moosa is Charlotte Maxeke Johannesburg Academic Hospital which sees about 70,000 patients a month. This facility has been dogged by a myriad of challenges including a fire that broke out in 2021. The fire saw the evacuation of over 800 patients who were quickly transported to other hospitals in the province. It destroyed an estimated R40 million worth of medical stock and personal protective equipment.

 A 27-year-old doctor shares his experience. 

“Some patients have to wait on the hospital benches for an available bed. That situation can be so frustrating for the patients. Some hospital medical machines are not in good standard and have not been serviced for years. We often get patients complaining about the rudeness of nurses but no one says anything about our working conditions.” 

Tembisa Provincial Tertiary Hospital

Tembisa Provincial Tertiary Hospital in Ekurhuleni made news when Babita Deokaran, a senior manager at the Gauteng health department, was killed outside her home after blowing the whistle about fraudulent transactions at the hospital. These included the purchase of  100 office chairs, skinny jeans or art and craft supplies to the tune of half a million rand.

A 30-year-old doctor shares her story.  

“We are short staffed and the hospital does not have enough beds. Most of the time patients feel neglected and they take their frustrations out on us. There is nothing we can do with the crumbling state of the hospital. At times we run out of essential chronic medications for high blood pressure and epilepsy. We serve people from disadvantaged backgrounds who cannot afford to get the medication at a chemist.” 

‘Hospitals slowly falling apart’

Provincial Secretary of Health and Allied Workers Indaba Trade Union (HAITU) and nurse, Samke Phiri says public health services in the whole province are in shambles. 

“Our government institutions are unable to provide quality healthcare services to our communities. There is a lack of maintenance for infrastructure to an extent that the structures are health hazards to individuals working there as well as patients using government healthcare services.

“This results in hospitals slowly falling apart. It is disturbing that the department returned R2.7 billion to the Treasury. When the budget is released we always complain about it being too small, it’s mysterious how we manage to underspend with so many challenges. How do you return so much money when our hospitals are falling apart?  

“We run out of petty things like needles. Clinics sometimes run out of panado or at times serious essential chronic medication. Some of our community members cannot afford to buy medicine from the chemist as they are poor. Some of the beds are old and others damaged as they have not been replaced in a long time.

“Our facilities are short staffed which is why there is a lot of absenteeism. People are no longer willing to work overtime  as Gauteng health announced that it would withdraw the delegation to approve overtime applications for the upcoming 2024\25 financial year. As a result it takes time for the department to pay us, instead they will complain about budget constraints. We are also tired as health workers, I mean there are limits to what the body can take.” 

A media enquiry on the state of health in the province was sent to the department. A response will be added once received. – Health-e News