SA hospital shocker

No drill, no operation. This was the scene facing a patient at Chris Hani Baragwanath Hospital recently.

A “frustrated” orthopaedic surgeon at Chris Hani Baragwanath Hospital in Soweto, walked out of a hip-replacement surgery after he was told that the “vital drill” he needed for the op, was being held by unpaid repairers, according to an article in the May edition of the South African Medical Journal (SAMJ).

Crumbling at the core
The 3000-bed academic hospital in Soweto also hit the headlines when a 16-year-old boy died of suspected meningitis.

The Gauteng Department of Health issued an official apology to the boy’s mother, who told reporters that doctors at the hospital had misdiagnosed her son four times and left him untreated for three days, before he was diagnosed. There was apparently no bed for the schoolboy in the hospital's intensive care unit for the three days he was in hospital.

Evidence points to a healthcare system that is crumbling at the core. Overworked doctors have staged countrywide protests to demand fair pay and better working conditions. The Business Day newspaper reported that bus drivers were now earning more than junior doctors, who have to complete six years of study.

The Health Professions Council of SA has issued more than 20 000 certificates of good standing to medical practitioners since April 2003. The majority of these certificates are requested by doctors applying for positions overseas.

And now emergency workers in Gauteng – who provide essential services such as fire fighting – have joined the protest, after a delay in the implementation of a wage agreement.

Equipment suppliers owed millions
The incident at Chris Hani Baragwanath hospital is merely a symptom of a very sick system. And while healthcare workers have been trying to plug the holes for a very long time, it is clear that the ship is sinking.

Several of the hospital’s departments are operating at sub-optimal levels due to malfunctioning equipment, unpaid bills and fed-up suppliers, who have had enough of empty promises. The SAMJ article reports that one equipment supply and repair company is owed R140 million, with Chris Hani Baragwanath’s tally accounting for R8 million, unpaid for 18 months.

The list of issues at the world’s largest hospital is endless:

• The hospital’s neurology department went for 3 weeks with only one working CT scanner resulting in the withdrawal of vital services. At one stage in March, things got so bad that the only remaining CT scanner was being used “around the clock”.
• During the same period, mammography and gastrointestinal screening were cancelled.
• Equipment suppliers are threatening to remove vital components from equipment unless they are paid.
• Zeiss refuses to fix broken microscopes, due to non-payment.
• General Electric, who have an MRI suite in the radiology department, have not been paid.
• Several hospital theatres have faulty or unusable air conditioning and filtrations units because the manufacturers refuse to replace or repair them until they are paid.
• Hospital laundries and kitchens are in chaos due to unpaid bills and clumsy administration.

Doctors’ dilemma
A senior doctor reports that the situation is the worst it’s ever been. “The only reason we don’t have clear-cut deaths is because we always make a plan,” he says in the SAMJ article.

Many doctors are afraid their willingness to “make a plan” for the sake of their patients may also land them in hot water with the Medical and Dental Professions Board, who handle professional conduct enquiries.

Entangled in this nasty web of maladministration and financial woes sits the susceptible patient, too poor to seek private care and wholly dependent on the health services provided by the state.

“It’s really sad for the patients. They get played as pawns in a game of inefficiency,” says another healthcare provider in the article. Doctors interviewed say the problem is not a shortage of money, but rather a “management problem”.

The hospital’s head of surgery, Professor Martin Smith, says he has been forced to “beg” suppliers to repair equipment. Equipment suppliers, too, are engaged in a delicate balancing act – at risk of losing large government tenders if they cause a fuss, or facing near bankruptcy if they continue this way.

Introduction of NHI
In the meantime President Jacob Zuma told Parliament in his first state of the nation address that improving South Africa's health care system was a top priority for his government. "We are seriously concerned about the deterioration of the quality of health care, aggravated by the steady increase in the burden of disease in the past decade and a half."

Zuma said the administration would enter into public-private partnerships to "rehabilitate public hospitals" so that the state could move to implement a National Health Insurance scheme.

The proposed introduction of a National Health Insurance scheme by government has already received much criticism, despite still being in its infancy. Some economists predict that taxpayers will need to fork out an additional 58% in tax each year to fund the NHI rollout, according to an article in What’s new DOC, a publication aimed at health practitioners.

The Democratic Alliance has also questioned the affordability of the proposed scheme, labelling it as “expensive and complex”. The party has called for the NHI system to be placed on hold, while the current system is made to work more efficiently.

Doctors at the coalface seem to agree that operational inefficiencies in the functioning of the healthcare system, rather than a shortage of cash, are responsible for the crisis.

It is hard to believe that healthcare practitioners will be prepared to dig deep, yet again, and try to plug the holes of another untimely, ill-conceived idea from an incoming administration.

Share your comments on this issue below.

(Thania Gopal, Health24, June 2009)

Sources:
Bateman C. (2009) No pay, no cure – can our hospitals be salvaged? South African Medical Journal, May 2009, Vol.99, No.5
Hudson, M. (2009) Revealed: Details of the ANC's NHI Plan, What's new DOC?
Sapa

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