When Jerome Loveland first stepped into the paediatric surgical ward of Chris Hani Baragwanath Academic Hospital in 2006, he found it much the same as when it had been built in 1954. Twelve years earlier in 1942 saw the official opening of what was then the Imperial Military Hospital Baragwanath, now 80 years old. In the time since, both very little and very much have changed.
Estimates show that 84% of South Africans depend on public healthcare. This is to say, the vast majority depend on a system that is negligent at best and exploitative at worst. Suspended Public Protector Busisiwe Mkhwebane visited a series of public hospitals in Gauteng in 2020 and concluded that the Gauteng Department of Health had failed to ensure appropriate conditions for the delivery of healthcare services. That same year, a probe by the Special Investigation Unit revealed that national, provincial and municipal government all exploited South Africans at their most vulnerable, generating billions through irregular Covid-19-related procurement contracts.
Millions of rands worth of medical equipment and supplies were destroyed in 2021 as Charlotte Maxeke Johannesburg Academic Hospital went up in flames. It took more than a year to reopen. This year, Tim de Maayer was suspended (and quickly reinstated) for showing the Gauteng health department the deadly effects of its incompetence, all while austerity-driven budget cuts continue.
This and more have led many to view the public health system in South Africa as being beyond repair. As a young surgeon Loveland, now the head of paediatric surgery at Baragwanath, felt much of the same outrage towards the state of public hospitals. "I'm not a politician by any means," he says, "but I was very irritated that more hadn't been done to improve Baragwanath Hospital since 1994."
Taking action
Rather than let despair get the better of him, Loveland chose to embrace the possibilities presented by a hospital in desperate need of improvement. "I saw a huge opportunity to come here and start making a difference, and we did that."
He founded and is chairperson of Surgeons For Little Lives, a non-profit organisation based at Baragwanath. "The organisation," Loveland says, "was launched in 2015, with the aim, simply, of improving the care that we provide to children that require surgery." Among its objectives is to improve the facilities where medical care takes place, which Baragwanath and Charlotte Maxeke Johannesburg Academic Hospital are unable to do themselves.
"The idea behind the charity was that if we're able to give a superior quality of care in the private sector, why can we not give it to our patients here in the public sector?" asks Nirav Patel, a consultant paediatric surgeon at Chris Hani Baragwanath Academic Hospital and director of Surgeons for Little Lives.
Lucia Nkuna, 39, is a mother for whom Loveland and Patel's words are more than just bold assertions. "I still can't believe he's here," she says of her 13-month-old son, Luphumlo. "Initially I was worried. I was scared," she says, having discovered a rare condition in her son blocking his excretory ducts. "Going more into Google, the only thing that I saw was complications, more complications, more complications. The ultimate end result for this condition is death ... [But] when I saw him after the surgery, I actually had hope that, you know what, he made it."
In the best interest of patients
It is no coincidence that the board of Surgeons for Little Lives is made up almost entirely of paediatric surgeons. Tarlia Govender, 32, has brought a fresh pair of eyes in identifying what it is that makes Surgeons for Little Lives' intervention positive. "No one can tell you the issues better than we can, and that's why it's by surgeons for our patients, and I think that's why it's so effective."
Among the issues she speaks of is what De Maayer's open letter emphasised as a common experience, especially among paediatric surgeons in South Africa. "The hardest thing for us is the hours that we work. Everything that we do, we choose to do it, but if despite that, and because of the system, your patients die, it's a very big struggle," Govender says.
It is in response to this struggle that Surgeons for Little Lives emerged and continues to operate. "I'm a clinician," Patel says. "My job is to come here, treat patients with respect, always be available, be caring and give them the best possible medicine that I can. When all of these other issues make it difficult for us to be able to do that, these are the alternative ways that we find in order to circumvent the problem."
"While we cannot absolve the Department of Health of their responsibilities, it remains incumbent on us to act in the best interests of our patients," Loveland said in a 2019 lecture.
Holistic care
Surgeons For Little Lives boasts many examples of tangible improvement, including advances in the standard of facilities, its training programme, research, and more. For its members, however, charting its effectiveness has hardly been a quantitative process. Its most important contribution, according to Govender, is that "we can offer [patient's parents] sleepover facilities so that they can be part of their child's care, because there can be nothing more traumatic than your child undergoing an emergency surgery and you can't be near them".
When her 13-month-old son, Ntandoyenkosi, had to be operated on, Banele Mthwalo, 29, stayed in one of these parental sleepover facilities, part of Surgeons for Little Lives' expanded out-patient clinic. Travelling from Katlehong each day to be near Ntandoyenkosi would have cost her R300 a week, Mthwalo estimates. Instead, she stayed for an entire month in an environment where "they care for the children as if they are their own children".
Mthwalo equally appreciated the outside playground to which her son could escape. "It really helps," she says. "When he's there he forgets for a little while about the problems. When you see your child playing, you get happy, you see that he's all right. It really helps. The stress goes down a bit."
To Govender this means a lot too. "It's the dignity that we give our patients. And that does make it easier to come to work every day and have hope."
'So much is possible'
While Loveland and Patel are content in the work they have done, the fact that they had to do it in the first place reveals much. "We don't even have to talk about Surgeons for Little Lives and paediatric surgery," Patel says. "We just have to talk about electricity, water, linen. Those types of things shouldn't have to be an issue that a poor patient in South Africa needs to contend with when they come to the hospital implicitly trusting you to offer them help. And then you can't offer them that help because of all of these structural and systematic problems, that is absolutely disgraceful."
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To Loveland, perhaps the organisation's most significant success has been that it has made strides where many view the problems facing healthcare in South Africa as intractable. "I think there's huge lessons that people can take from this because it's completely doable," he says. "The projects that Surgeons for Little Lives have put together are exactly what the aims of the National Health Insurance are: it is to improve access to high-quality care without breaking the bank."
Patel's opinion is similar. "It demonstrates what is possible if we work together with a common vision, regardless of the challenges that we face. So much is possible."
Their hope is that some of these lessons are taken beyond the walls of Chris Hani Baragwanath Hospital, to public healthcare across South Africa. "Certainly we have our role to play, but we're not the answer," says Patel. Part of that answer, according to Govender, is that "it requires good access to us ... the most important thing is outreach, where we uplift the peripheral hospitals, and that we build our infrastructure so that we're not leaving children out in the periphery because we're saying, 'I'm so sorry, but Bara can't help you today.'"
Loveland, Patel and Govender value above all the impact their efforts have on their patients, and for Nkuna and her son the effect is clear: "I'm actually eternally grateful for Surgeons for Little Lives for what they did. They gave him a second chance. He took it with both hands, and he came out of it like a king."
