2023 is the crunch year to complete the restoration of the fire-damaged sections of Charlotte Maxeke Johannesburg Academic Hospital, but one month in, it has not been plain sailing.
There are doubts over timeframes, the quality of workmanship, compliance, and effective project management. Added to this are deepening concerns that theft and suspected sabotage continue and that HR red tape and inefficiencies are standing in the way of getting the right people into 774 vacant posts that need to be filled to meet the high demand for healthcare services.
According to Gauteng Department of Health's head of communication, Motalatale Modiba, the province is on track to meet its December 2023 deadline to complete repair work. There is a separate deadline for 2026 to complete fire safety compliance throughout the hospital.
Scramble for parking persists
January kicked off with what should have been the reopening of parking bays on the hospital campus. The parking levels were among the worst affected areas in the fire that broke out on 16 April 2021. Delays in getting parking areas reopened have had dire knock-on effects on the efficient running of the hospital. Staff and visitors have had to scramble to find parking on the streets around the hospital. This adds to traffic congestion and jammed-up appointment schedules even as the hospital is trying to play catch-up after healthcare services were disrupted by COVID-19 and the fire. Added to this, there have been reports of theft from motor vehicles as well as muggings and assaults of doctors and nurses having to make their way to and from their cars.
Before the fire, the hospital had 1 700 parking bays. Since the fire, only 229 have been accessible on the hospital campus and another 400 in sites around the hospital - it's a shortfall of about 1 000 parking bays.
Modiba told Spotlight at the beginning of February, "The construction of the temporary access ramp to level P3 is 100% complete. The only outstanding thing is the enrolment of the traffic management system to ensure a greater flow of vehicles into the parking, manage different parking zones, and vehicle access. The P3 parking bays will be available for usage soon."
'Criminal syndicates'
But DA spokesperson for health in the province, Jack Bloom says after his own site visit in January that continued delays to reopen this section is "gross incompetence that is causing misery as staff and patients hunt for parking every day and some sick people have to walk a long way from where they've found parking".
"It's not a great start for the year," says Bloom. He says delays are being made worse by the higher stages of rolling blackouts that have hit the country, even though the hospital campus is exempt from loadshedding.
"Another issue is that we still haven't been able to crack down on criminal syndicates operating at our hospitals. I believe what we're seeing in the media now is only skimming the surface of widespread corruption in the system," he says.
Insiders at Charlotte Maxeke have again raised alarms over ongoing theft that they say smacks of sabotage. According to them, the current situation is that cables and piping that run in-between hospital floors have been stolen or destroyed, resulting in disrupted oxygen flow that is fed to wards in Block 5 of the hospital. Block 5, houses, among others, the transplant unit.
Last year, the National Department of Health confirmed to Spotlight that vandalism and theft were rife. Investigations resulted in three officials in the Department of Infrastructure and Development being arrested in connection with these crimes.
Modiba did not respond to follow-up questions on how theft, vandalism, and sabotage are being dealt with by the provincial health department.
Repair work "on track"
Still, Modiba insists that the province is on track to meet both its 2023 and 2026 deadlines. Modiba however, also didn't respond to a follow-up question on what compliance protocols will be followed in the three-year gap till fire safety compliance is expected to be completed.
It was fire safety compliance being flouted (including non-functioning fire doors, hose couplings that were stolen or broken, and no floor plan available for firefighters when they arrived on site) that led to the April 21 fire spreading and causing the extensive damage it did.
The repair bill now carries a price tag of R1.16 billion. According to Modiba, just over a billion of this will come from National Treasury, with around R146 million from donors making up the remainder.
The restoration work plan has also had to be adjusted in the past few months. An initial approach to work on fire compliance in multiple hospital blocks at a time was rejected by clinicians because it would be too disruptive for patient care.
"Decanting will now happen on a block-by-block basis with compliance work estimated to be between six to eight months per block. Services will keep rotating within the facility while contractors work from one area to another," Modiba says.
He also tells Spotlight that the emergency unit which only reopened in May last year - and at the time only for referral patients - is now fully functioning. "All specialities are now present at the facility; there are no longer services that are being remotely rendered at other facilities," he adds.
Modiba says that the hospital currently runs 1 024 beds compared to the pre-fire status of 1 138 beds. This comprises 1 068 public beds and 70 Folateng beds. Folateng is the private ward within the hospital. There are 108 ICU and high-care beds and between 60 000 and 70 000 outpatients per month.
Meeting demands amid HR issues
Professor Adam Mahomed, head of the Department of Internal Medicine at the hospital, says meeting these massive demands when whole units and blocks have been out of commission has been a feat of adapting by doctors and nurses who have optimised ward space and found ways to repurpose parts of the hospital.
"Wards that used to fit 20 to 24 beds, we now have turned into wards that fit 32 beds," he says.
Mahomed says it's not optimal and amounts to trying to function in an overburdened state, especially with gross staff shortages. He says they expect the healthcare need to increase from the current numbers to having to run 1 400 beds in the hospital.
"We are seeing more people and sicker people coming through the doors because, during the COVID years, many people were not coming for healthcare or taking their chronic meds. We are also still playing catch up in oncology and surgery."
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Mahomed singles out inefficiencies in the hospital's human resources department as the biggest stumbling block. He is calling for an independent audit and investigation into how human resources at Charlotte Maxeke is being run.
According to him, there are mounting questions around irregularities of why positions are not being filled timeously, or seemingly deliberately delayed and not just as a tactic to wait for budgets to refresh with the new financial year in April.
Some examples of "silly paperwork", he says, are sessional doctors who have worked in the public sector previously being asked to produce matric certificates from 40 years ago. Other doctors have been asked to produce police clearance certificates, while others are asked to have proof of citizenship issued by the Department of Home Affairs.
According to Modiba, Charlotte Maxeke Hospital has 5 334 approved posts and 774 vacancies currently. Of the 774 vacant positions, 253 vacancies are in administration and support, 40 for allied workers, 124 in medical, and 357 in nursing.
Mahomed says, "We need to have staff that will be able to accommodate 1 400 beds and we need to have increased resources allocated for a hospital that is already over-burdened. We need to get HR to stop with the red tape, silly paperwork, and bureaucracies. "Bureaucracy is hampering us from getting actual resources to the people - HR bureaucracy is killing people. Politicians and management are still running healthcare when they should be taking input from those who are on the ground."
