On Monday morning, a group of more than 50 health workers, including senior doctors and heads of department, held a short, dignified picket outside the accident and emergency entrance of the 600-bed Helen Joseph Hospital in Johannesburg.

The picket was organised to highlight the adverse impact that the continued closure of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) is having on the quality of health services at Helen Joseph Hospital and on the morale and safety of people who work there.

A doctor displays a poster at the Helen Joseph Hospital picket on Monday, 14 March 2022. (Photo: Shiraaz Mohamed)

Over the weekend, pressure had mounted on the organisers not to hold the picket, with threats of disciplinary action against those who participated. However, according to one of the organisers, “Head office arrived just before the protest and overruled the CEO and told her to allow the picket to proceed.” They need not have worried. The protest organisers were at pains to ensure that services were not disrupted by the picket, pointing out in their memorandum that:

“All Critical Care Areas will remain manned at ALL times to ensure that all Emergency Care will be provided. No patient’s care will suffer as the result of this picket. Indeed, the aim of the picket is to improve the quality of care that can be provided to patients.”

The memorandum (published in full below) was handed over to Basani Baloyi, the deputy director-general of corporate services, who promised to draw it to the attention of the MEC and head of the Gauteng Department of Health (GDoH), but said nothing else to reassure protesters.

A doctor’s poster calls for the reopening of the Charlotte Maxeke hospital. (Photo: Shiraaz Mohamed)

Apart from the reopening of CMJAH, the protesters demanded that “In the interim, Helen Joseph Hospital be provided with the following resources by the Gauteng Department of Health to be able to service its community with the dignity that they deserve:

1. Equitable distribution of staff from CMJAH for the provision of emergency, trauma and psychiatric services at HJH for the patient load previously handled from their drainage area.
2. Provision of resources/ budget to compensate for patients that would have been treated at CMJAH to allow adequate patient care to continue
3. Other facilities within the CMJAH cluster area (such as Hillbrow CHC/South Rand/Edenvale Hospital) and/or additional facilities to assist in managing the burden of psychiatric patients.
4. Replacement of Covid staff who have left because of burnout so as to keep the emergency services going at HJH’s emergency department (ED).
5. A fire safety evaluation of HJH comparable to that of CMJAH.”

Dr Relebohile Ncha, the CEO of the hospital, was present but did not address her staff. Later, in response to questions, she told Maverick Citizen that “I can’t respond to the raised questions”, which she requested be forwarded to the head office instead.

Doctors’ protest posters at the Helen Joseph Hospital picket in Johannesburg on Monday, 14 March 2022. (Photo: Shiraaz Mohamed)

By contrast, the desperation of the staff at Ncha’s hospital was evident in the hand-drawn placards they carried. One asked pertinently “DOH, What if Our Patients were Your Family?” Another appealed: “Hear our cry, Open CMJAH now #StateofDisaster”; another, “I Google searched CMJAH It said NO LONGER EXISTS”.

Dr Pat Saffy, head of the HJH’s Emergency Medicine Department, spoke about the terrible conditions in the hospital’s overcrowded psychiatric ward, talking of “patients sleeping in corridors, with no showers and water,” and of “assaults by psychotic patients on healthcare workers”.  “It makes your heart cry,” she said, mentioning doctors in tears after bearing the brunt of the anger and frustration of patients and their families.

The picket was timed to coincide with a promise that the reopening of the casualty department at CMJAH would take place on Monday, 14 March. As feared though, it has still not happened. Instead, on Monday the department issued a media statement (available here) offering an update on the remedial work and setting out five measures (said to be under way) to get the Accident and Emergency Unit section ready for handover.

However, no date as to when these will be complete was provided.

Doctor Pat Saffy reads from a copy of a memorandum handed to the CEO of the Helen Joseph Hospital in Johannesburg as picketing hospital staff look on. (Photo: Shiraaz Mohamed)

Significantly, in its statement, the GDoH confirmed claims being made by our sources at CMJAH that there is what appears to be deliberate sabotage to delay the reopening. We have reported on this previously, but last week Maverick Citizen was again told of “another thing sabotaged. Mysterious cable being cut. Internet fibre cut in Block One.”

Belatedly acknowledging the problem, the GDoH reported that “security has been beefed up with restrictions to the affected areas”. However, there are suspicions among hospital workers that the vandalism and theft may be coming from within the government, possibly by would-be contractors who had expected lucrative contracts from the repairs. Our source alleges that: “The interfloors is managed by DID [Department of Infrastructure and Development]. All contractors get access to interfloors via DID. DID still have not handed over access control to CMJAH.  DID also have access to video surveillance and no one oversees them.”

The security of the hospital and the issue of the Gauteng DID were both issues that had been raised with the acting director-general in the Premier’s Office, Thabo Masebe, on a picket held on 4 March. Masebe had promised a detailed written response “within 48 hours.” Ten days later the response remains elusive.  DM/MC

MEMORANDUM

Attention: Helen Joseph Hospital Management and Community,

Urgent Communication from Helen Joseph Hospital Frontline Staff

Topic: Picket for urgent re-opening of Charlotte Maxeke Hospital Emergency and Psychiatric services

…

Frontline staff are disheartened at the continued postponement of emergency, trauma and psychiatric services. Multiple dates have been promised, but 11 months on, emergency and psychiatric services remain shut, leaving the most vulnerable literally out in the cold.  Overstretched staff and limited resources at Helen Joseph Hospital leave these vulnerable patients at risk of inadequate care and without the dedicated health services which they desperately need. The impact is felt not only by patients, but also by their families and by frontline staff across all areas of functioning – cleaners, porters, security, allied professionals, nurses and doctors alike.

Families express their frustration and at times are hostile towards staff due to increased waiting times.  Frontline workers remain burnt out and frustrated.  The frontline staff bear the brunt of patient aggression and dissatisfaction, the ongoing pandemic, and the immense load of patients previously serviced by CMJAH.

In the past 11 months, the emergency department has consistently scored within the “dangerously overcrowded” range using the National Emergency Department Overcrowding Score (NEDOCS).

The expectation that an already overstretched 600-bed hospital has had to take on the primary load of a 1,000-bed hospital’s patients without adequate contingency planning is unrealistic and in 11 months Gauteng Department of Health (GDOH) has not come up with effective plans to help HJH manage the load. Morale is low as we feel unheard and unsupported by GDOH in the efforts to reopen CMJAH.

The purpose of this picket:

1. Highlight the ongoing severe burden that the continued closure of CMJAH places on HJH and surrounding facilities.
2. Demand a confirmed date from the Gauteng Department of Health that will be honoured for the reopening of all emergency, trauma and psychiatric services.
3. In the interim, Helen Joseph Hospital should be provided with the following resources by the Gauteng Department of Health to be able to service its community with the dignity that they deserve:

a. Equitable distribution of staff from CMJAH for the provision of emergency, trauma and psychiatric services at HJH for the patient load previously handled from their drainage area.

b. Provision of resources/budget to compensate for patients that would have been treated at CMJAH to allow adequate patient care to continue

c. Other facilities within the CMJAH cluster area (such as Hillbrow CHC/South Rand/Edenvale Hospital) and/or additional facilities to assist in managing the burden of psychiatric patients.

d. Replacement of Covid staff who have left because of burnout so as to keep the emergency services going at HJH’s emergency department (ED).

e. A fire safety evaluation of HJH comparable to that of CMJAH.

The picket will be entirely peaceful.

All Critical Care Areas will remain manned at ALL times to ensure that all Emergency Care will be provided. No patient’s care will suffer as the result of this picket. Indeed, the aim of the picket is to improve the quality of care that can be provided to patients.

Yours sincerely, Helen Joseph Frontline Workers DM/MC