While taps run dry, generators malfunction and health workers despair, Gauteng children’s hospital CEO denies a crisis
Rahima Moosa Mother and Child Hospital is the only dedicated mother and child public hospital in South Africa. It has 350 beds and delivers 16,000 babies a year — on average, 44 a day.
Like the Charlotte Maxeke Johannesburg Academic Hospital down the road, it takes its name from a Struggle stalwart. Sadly though, like Charlotte Maxeke, one would imagine that its namesake, Rahima Moosa, would be turning in her grave if she was aware of the conditions at the hospital.
Twelve months ago, Maverick Citizen paid a visit to Rahima Moosa Mother and Child Hospital (RMMCH) after being alerted to the concerns of doctors and patients. We reported on the effects of water shortages on care and the suboptimal conditions. Partly as a result, Gift of the Givers dug a borehole to pump water into the hospital.
A year later, it seems conditions have only become worse.
Doctors call it a “crisis”, but in response to questions this week the hospital’s CEO, Dr Nozuko Mkabayi, stated categorically that the hospital is not in crisis.
Mkabayi said that while the hospital experiences periodic drug stockouts and equipment shortages, “Patients’ lives are not in danger and there is enough essential equipment. The hospital equipment committee is functional in ensuring adequate equipment needs for patient care.”
When drugs run out, “there is always alternative medication prescribed and supplied”.
The CEO seems not to be concerned about the withdrawal of 144 posts that were provided to the hospital to help it manage the Covid-19 pandemic. Although the Gauteng Department of Health has allowed its tertiary hospitals to retain their Covid posts, this has not extended to RMMCH.
In a joint statement issued on 22 March, the MEC and minister of health stated that they, “would have loved to retain all temporary Covid-19 appointed staff; however, the current grant provided by the Gauteng Provincial Treasury to pay for compensation of temporary employees is inadequate…”
(I will return to this later in the article.)
But while the CEO denies there is a crisis, healthcare workers and patients at RMMCH tell a different story. They say they seem to work in almost permanent “crisis” conditions”, that “things have always been tough, but now they seem to be spiralling downwards”.
Last weekend there was no water again.
At the time, a staff member told us that “a few wards had water for a while”, but even this dried up.
He says: “The implications are huge. Hospital-acquired infection outbreaks were already ongoing before this. Now nurses and doctors can’t even wash hands between patients. Toilets are unable to flush and with so many sharing a few toilets, you can imagine the results.”
This mirrors the conditions of a year ago.
Earlier this month, there were electricity cuts. On one day, when RMMCH was without any power for more than two hours, according to doctors: “Ventilators failed because there was no compressed air. Others delivered 100% oxygen, a recipe for blindness in vulnerable premature babies.
“High-flow circuits providing respiratory support to the sickest children failed, premature neonates’ incubators’ heating and ventilation systems failed, vital parameter monitors failed, simple lighting to enable intravenous cannulation (never mind resuscitation) of children, failed…”
This was not a once-off.
Health workers say: “The generator has been failing during many bouts of load shedding for the past uncountable years.” Although the new generators installed a few years ago appeared to improve the situation for a while, in the last few weeks these failures have led to total power outages for protracted periods.
The CEO and the Gauteng Department of Health (GDoH) admit there are challenges with sewage infrastructure. They explain this is “due to the age of the hospital” (79 years) and say: “We are working closely with the Department of Infrastructure Development [GDID] and Gauteng Department of Health to address the challenges. We are also engaging external stakeholders in engineering.”
However, on Thursday, GDID spokesperson Bongiwe Gambu said that the GDID “had not received any brief for refurbishment from Health in the past five years” and that there is no record of recent capital expenditure on the hospital. She said she was “not aware of a brief from the client department to do any work at the hospital” and advised that the GDoH should be contacted for further information about the detail of its plans.
The claim that infrastructure is getting attention does not tally with the experience of workers in the hospital, who confirm there has been no visible attention to infrastructure. “The phones don’t even work,” they say, and: “A free WiFi system for the whole hospital that was installed several years ago has never been brought to life.”
But electricity and water outages are sadly not the only crisis facing this hospital. The computerised tomography (CT) scan, an essential piece of medical equipment that provides more detailed information than plain X-rays do, was not working for five weeks, alleges one doctor.
Maverick Citizen heard complaints from a range of people who work at the hospital. The impression we got is of doctors at the end of their tether, suffering emotional strain and tortured by an invidious situation where they lose children’s lives for reasons that are beyond their control.
They told us: “For years, clinicians have been documenting shortages of essential equipment, overcrowding in the wards (combined with a lack of water to wash hands) and subsequent outbreaks of deadly hospital-acquired infections, frequent interruptions of power and water supplies, staff shortages, unreliable and interrupted laboratory support, and the list goes on…
“Crumbling infrastructure, lack of maintenance, and maladministration conspire to hamstring healthcare providers in providing care for society’s most vulnerable.”
144 Covid posts cut
Doctors seem particularly despairing (this is not an exaggeration) that the Gauteng Department of Health has recently cut “Covid-post” funding to the hospital.
“This should be seen as a clear kick in the teeth to the hospital that delivers 16,000 babies every year, with an Intensive Care Unit of barely six beds,” said one.
This withdrawal of Covid support occurs as the hospital goes into a fifth wave of the coronavirus and RMMCH and Helen Joseph continue to bear the brunt following the fire at Charlotte Maxeke Johannesburg Academic Hospital, despite its partial reopening.
Professor Shabir Madhi, the dean of the Faculty of Health Sciences at Wits University, explains it this way: “Although RMMCH is used by the University of Witwatersrand for teaching and training of undergraduate and postgraduate students (registrars who are specialising), neither of these have been earmarked as part of the tertiary academic hospital complexes. Such designation is done by NDoH [National Department of Health], in conjunction with the provincial health authorities.”
These hospitals are designated as district hospitals. This is despite the type of care they provide being more complex and advanced than district hospitals that don’t have the same academic linkage to Wits. As a result, they are not allocated the same sort of budget, especially with regard to staff-patient ratios, compared, for example, with Charlotte Maxeke (which itself has a more favourable staff-patient ratio than Chris Hani Baragwanath).
“The lower staff-patient ratio at the academic hospitals is partly related to more complexity in the cases being managed at such facilities, but also because there are specific grants provided to the province which are meant to be earmarked for staff to use 30% of their time for academic activities of teaching, training, research and university activities.”
The grants Madhi refers to are the National Tertiary Services Grant from the NDoH and the Health Professions Training and Development Grant (from the Department of Higher Education), which are provided to the GDoH. But because RMMCH is not designated as an academic hospital, despite its staff fulfilling all the academic requirements referred to above, “none of the money from these grants is being allocated to these hospitals, and consequently the perennial staffing constraints”.
Madhi says the decision to designate hospitals as “academic and/or tertiary hospitals would be the prerogative of GDoH and NDoH — but obviously has financial implications”.
In his belief, “Considering the patient profile at Rahima Moosa and Helen Joseph hospitals, they do merit recognition as tertiary hospitals.”
Madhi points to “the severe shortage of tertiary hospitals in Gauteng where one-quarter of SA’s population live, and which also serves as a referral hub for tertiary care for many surrounding provinces which do not have tertiary hospitals”.
In response to our questions, Kwara Kekana, the spokesperson for the MEC for Health in Gauteng, reported that: “The Gauteng Department of Health is in support of reclassification to a tertiary hospital. An application has been submitted to the National Department of Health in that regard.”
This is welcome news, but cold comfort for those on the frontline of the immediate crisis.
Healthcare workers face a dilemma. They say they are afraid that they will be punished for speaking to the media. But, says one, “It is no longer acceptable to keep quiet. All of us are seeing children suffer.”
They feel that they are being exposed to moral injury, defined by The Lancet as “the strong cognitive and emotional response that can occur following events that violate a person’s moral or ethical code. Potentially morally injurious events include a person’s own or other people’s acts of omission or commission, or betrayal by a trusted person in a high-stakes situation.”
Says another healthcare worker: “While authorities may fuel the xenophobic sentiment by blaming this crisis on the high number of immigrants requiring hospital care, it is abundantly clear that the real crisis is a lack of political will, poor administration, corruption, and looting.”
And he ends with a blunt warning: “There must be no mistake when the next child dies. Politics, and not the burnt-out clinicians, nor poor refugees, are to blame for its death.” DM/MC
Below we publish in full the responses to our questions to the GDOH and CEO:
RESPONSE TO MEDIA QUERY FROM DAILY MAVERICK, 26th Feb
1 Is there a crisis in the quality of care at Rahima Moosa Mother and Child Hospital?
- Can you confirm that in the last decade the number of deliveries at the hospital has gone from 10,000 to 16,000 but that there has been no increase in the hospital’s staff or budget?
Yes, on average.
- Why is the hospital not considered a tertiary hospital?
Rahima Moosa Mother and Child Hospital is classified as a regional/specialised hospital but renders tertiary services without a tertiary grant. The Gauteng Department of Health is in support of reclassification to a tertiary hospital. An application has been submitted to the National Department of Health in that regard.
- Can you confirm that Covid-19 posts are being withdrawn from the hospital? How many posts and what positions are these posts?
At no stage have Covid-19 posts been withdrawn. The contracts for Covid-19 posts came to an end consistent with the terms of contract as at 31 March 2022.
The budget that was allocated has enabled the institution to employ 144 employees in the categories of Medical, Nursing, Allied Professionals, Administration and Support staff in the financial year 2021/2022.
- Are patients’ lives in danger because of essential equipment shortages, particularly children?
Patients’ lives are not in danger and there is enough essential equipment. The hospital Equipment Committee is functional in ensuring adequate equipment needs for patient care.
- Is it true that there are only two functioning saturation units in the neonatal unit? Is this sufficient to meet needs?
It is not true. We have enough functioning saturation units in our neonatal units. Yes, they are sufficient to meet the needs of the facility.
- Have there been stockouts of essential medical supplies, which pose a threat to patients’ lives?
There has been stockout of essential medical supplies; however, when this happens there is always alternative medication prescribed and supplied.
- Is the hospital sewerage infrastructure “collapsing”?
The hospital does have challenges with sewerage infrastructure due to the age of the hospital (79 years old). We are working closely with the Department of Infrastructure Development and Infrastructure at the Gauteng Department of Health to address the challenges. We are also engaging external stakeholders in engineering.
- How strong is infection control in the hospital? Have there been recent life-threatening infectious disease outbreaks in the paediatric wards?
Infection prevention and control is not ideal due to overcrowding. We have had infectious disease outbreaks in the paediatric wards.
- Have you alerted the Gauteng Department of Health to the problems at the hospital? Have they responded?
Yes. We are working together with the Gauteng Department of Health, the District Health System, Local Government, National Department of Health, and community leaders to find short-term, medium-term and long-term solutions to our challenges. DM/MC