The Johannesburg hospital has started reopening as the fire damage is repaired but delays, security issues and dubious health and safety compliance are affecting staff retention.
Section27 has welcomed the reopening of Charlotte Maxeke Academic Hospital in Johannesburg, but the public interest law centre’s head of health Sasha Stevenson says it is worried that psychiatric services at the hospital may be reinstated only at the end of 2023.
The first patients were admitted on 4 May, mostly from Helen Joseph Hospital, and just under 800 are receiving healthcare at the facility. There are many psychiatric patients awaiting admission, but as of 9 May, only 15 had been transferred to Charlotte Maxeke.
Stevenson says the emergency department at Helen Joseph catering for psychiatric patients has been overwhelmed. “This move is one that will no doubt relieve some of the pressure on Helen Joseph, but the numbers we are looking at are just not sufficient to relieve all of the pressure,” says Stevenson.
Section27 wrote to the Department of Health on 4 May with suggestions on how to resolve the issue of psychiatric bed shortages at Helen Joseph. They are waiting for a response.
“There needs to be a more sustained response to relieve some of the shortages and make sure that the mental healthcare users are being cared for over what looks to be another 18 months,” says Stevenson.
Block by block
The effects of the hospital being closed since the fire can be felt across the facility and the province, she says. “The position of patients who need mental healthcare services is really quite acute because the Charlotte psych and mental health unit was quite substantial and had in recent years been capacitated further … The loss of that unit is really very problematic.”
The hospital’s accident and emergency unit was scheduled to start operating at 40% to 50% of capacity on 11 May. Three of the unit’s seven areas have been opened. The rest will be opened next week, once the crucial CT scanner is online and operational.
Addressing the media on 8 May after visiting level six of block one, Minister of Health Joe Phaahla said an estimated R68 million has been spent on the unit so far.
Work now begins on the rest of block one. The affected blocks will reopen over a period of months, said Phaahla. The project is expected to be completed by November 2023. For now, the hospital can take only priority one and two patient referrals from other hospitals, restricting walk-ins and the number of patients brought in by ambulance.
Security issues
A fire destroyed part of the hospital in April 2021, displacing hundreds of patients and destroying millions of rands worth of medical equipment and supplies. Many wards had to be closed, including neurology, psychiatric, oncology and paediatric. A structural fire report was due on 15 May, but its release has been pushed out to the end of June.
The national health department took over repairs from the Gauteng Department of Infrastructure Development on 4 March. At a portfolio committee of the latter in March, it was announced that the provincial department had overspent on Charlotte Maxeke by 138%, with a completion rate of 72%.
The national health department, provincial health department and the Development Bank of Southern Africa have done a block-by-block assessment of the hospital and developed a plan for the rest of block one.
Modise Mokwena, the regional secretary of the Johannesburg branch of the National Union of Public Service and Allied Workers (Nupsaw), called attention to the issue of security. Union members had their cars stolen because of parking issues at the hospital caused by the fire. Copper pipes worth R30 million were reportedly also stolen in 2021. This made it difficult to justify a R40 million security budget.
“It is important for the health department to address the issue of theft and vandalism since the CT scanner was vandalised during a time when security was beefed up thanks to a security budget,” said Mokwena.
Phaahla explained that the CT scanner, which required imported parts, should be online by next week. But Mokwena said there is more than one CT scanner in the hospital and it must be clarified which one is being repaired as the union’s radiographers need clarity.
Staff resignations
The hospital has more than 5 000 staff and has trained just over half of them on the new fire alarms and drills, but training remains ongoing. Despite the partial reopening, Mokwena said members are not confident that other hospital wards are fully compliant with occupational health and safety standards and legislation.
Phaahla confirmed that the department has received the required occupational health and safety approvals and certificates for the reopened unit from the City of Johannesburg.
“It wasn’t only the casualty department that was not compliant. Even the other wards were not compliant in terms of fire. You will find that the work that has been done has been done in the casualty department, but they are not addressing the issue of the other wards and whether … they are fire compliant,” he said.
There has been a wave of resignations that chief executive Gladys Bogoshi did not comment on, but she confirmed that the hospital is sitting at a vacancy rate of 11% with 643 vacant positions. Bogoshi, who was previously the chief executive of Helen Joseph, has headed Charlotte Maxeke for nine years and has not been held to account for the declining conditions and delays in rebuilding the hospital.
Mokwena said staff morale is low and more than half of the employees in the trauma department – mostly Nupsaw members – have resigned, leaving at least 15. “It simply tells you that the people who have got the skill to give the service to the public are no longer there … so the members of the public have their lives in danger.”