In Focus: What the Charlotte Maxeke fire tells us about health and safety in Gauteng hospitals

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Charlotte Maxeke Hospital PHOTO: MSINDISI FENGU
Charlotte Maxeke Hospital PHOTO: MSINDISI FENGU

Just weeks before a fire tore through parts of the Charlotte Maxeke Hospital in Johannesburg on April 16, a fire safety audit at the hospital was signed off and in March a hospital fire and safety team met, according to the Gauteng health department.

Yet Kwara Kekana, spokesperson for the department also confirmed in responses to questions from Spotlight, that “the smoke doors are not used as the magnetic system on the doors was no longer effective and they were recommissioned”.

Smoke doors are used to prevent the spread of smoke in a building when there is a fire. She also confirmed that fire hydrant couplings were not compatible with the fire hoses on the Johannesburg Emergency Management Services (EMS) fire engines because “some had been stolen”.

They must show you that inspection report for the Charlotte Maxeke hospital because they are sending us into these places to die.
*Nathi, EMS member of 14 years

Spotlight has requested, but not received, a copy of the fire audit/ inspection report from the Gauteng health department, the department of infrastructure and development, and the EMS.

Fire compliance failures

Two senior firefighters from the EMS who spoke to Spotlight, said the two failings – mentioned by Kekana above – alone would sink a basic inspection or compliance audit. It was also not just the fire doors and the hydrant couplings that were faulty at the Charlotte Maxeke Hospital. They said firefighters were not given building and floor plans of the hospital’s emergency exit plan when they arrived on the scene the day of the fire on April 16.

The emergency exit plan is essential for those needing to enter a burning building. Smoke detection systems, fire alarms, sprinkler systems and the mechanisms that would have triggered the magnetic smoke doors, were also not in working condition. There was also water flow and low pressure to the hydrants besides non-compatible hose couplings.

READ: Subspeciality care disrupted following devastating Charlotte Maxeke Hospital fire

The two men asked not to be named.

The recent fire at the Charlotte Maxeke Hospital was the fourth in six years at public health facilities in Gauteng.

In February this year, a fire broke out at the Carletonville Hospital, in May 2019 there was a fire at the Bheki Mlangeni Hospital in Soweto and the Tambo Memorial Hospital in Boksburg on the East Rand in May 2015. The fire in September 2018 devastated a provincial health department’s head office in the Bank of Lisbon building in the Johannesburg inner city.

That blaze claimed the lives of three firefighters.

“These are politicians, they are telling lies and doing cover-ups – they must show you that inspection report for the Charlotte Maxeke hospital because they are sending us into these places to die.

READ: Was fire at Charlotte Maxeke hospital foul-play?

“With fire doors, we call these lifesavers because they can help you trap a fire – these should have been there,” said *Nathi, who has been in the EMS for 14 years.

Fire hazards in hospitals and other public buildings throughout the city are widespread. *Richard, who has been with the EMS for 22 years, said it ranged from lifts that have not been serviced for years; fire escapes that are obstructed and regularly used for makeshift storage and dumping space; fire extinguishers gathering dust or used as door stops and facility health and safety committees that are slack on fire safety compliance, if they meet at all.

A fire service ‘in shambles’

Added to this, Nathi and Richard said their own department of the EMS is in shambles. There are only four working fire trucks for the entire city. There has also been an ongoing political blame game and court battles. Former Johannesburg mayor Herman Mashaba’s multimillion-rand deal to procure specialised fire engines in 2019 was never delivered on. Last month, the deal was ruled unlawful by the Johannesburg High Court.

Nana Radebe, spokesperson for EMS, confirmed that they currently have just over half of the equipment – 51 out of 92 items – needed to have the city’s fire department meet national fire safety standards (the SA National Standard 10090). Radebe also said high levels of non-compliance to fire and safety by-laws within the city continued to be a headache for the 1 271 firefighters employed at 29 fire stations.

The tendency then is to look where the impact is not immediate and maintenance budgets and equipment budgets often suffer as a result.
Former head of the WC health department who was also part of Gauteng Premier David Makhura’s intervention team

The procurement process for new fire engines was now back at square one.

Nathi said the bottom line was that their ageing, depleted fleet could not cope. This was clear when the province’s flagship health asset – the Charlotte Maxeke Hospital – started burning on the Parktown ridge that early autumn day and could not be brought under control swiftly.

“One fire truck holds 4 500l of water. It’s not enough for a fire on even one floor of a building of that size [and] that’s why we need fire hydrants to be working. Water is our weapon, without water we will die,” he said.

When there are fires in hospitals, it is patients already in the most vulnerable state of being ill and who cannot be evacuated easily, who could die.

Occupational health and safety crisis

The Charlotte Maxeke Hospital fire added to a long-standing and tightly knotted occupational health and safety crisis in the public health sector in the province.

Craig Househam is a retired professor of paediatrics and child health and former head of the Western Cape health department. Househam was also part of Gauteng Premier David Makhura’s intervention team meant to devise a “recovery plan” for the health department in 2018.

He serves on the board of the Office of Health Standards Compliance and the SA Health Products Regulatory Authority.

He said in the provincial health department the problem was underpinned by accruals or spiralling cycles of unpaid debts that kept budgets constrained. “The tendency then is to look where the impact is not immediate and maintenance budgets and equipment budgets often suffer as a result.”

Househam added that in the case of the Charlotte Maxeke Hospital, the building was also old. Built in 1979, the building had not had the benefit of routine maintenance to extend its lifespan.

Working out a strategy to solve the health and safety problems in the province should start with recognising that the maintenance of health facilities was a highly specialised area, said Househam.

“You need a strategy that puts the right people in the right places with the right expertise. They need to be given the powers and authority to do their job properly without interference. The solution lies in meritocracy,” he said.

True costs

Laetitia Rispel, a professor of public health at Wits University, said what was lost with the damage to the Charlotte Maxeke Hospital went beyond what went up in flames and the millions it would take to rebuild.

“That day of the fire I felt a deep sense of loss because of the critical role that the Charlotte Maxeke Hospital plays and was playing especially as the country has been preparing for a possible third wave of the coronavirus. I was also thinking of the students who are not able to complete their training and of course the patients, many of whom don’t have an alternative other than that hospital,” she said.

The Wits Medical School flanks the hospital and the Charlotte Maxeke Hospital is the academic training ground for many of the university’s students.

For Rispel, the fire represented terrible gaps in oversight, leadership and accountability at all levels in the health system. She said bloated bureaucracies were adding to the fracture in government departments and she called out an entrenched culture of self-preservation in the public health sector – where people are “depressed and dysfunctional and doing just enough to stay under the radar”.

Rispel also said there was a fear of speaking out because of victimisation. It added to a lack of transparency and the absence of sustainable change.

“There are at least 29 senior posts at the hospital that need to be filled, so at the basic level, we have a leadership vacuum. Then there’s a fracture between the department of health and the department of infrastructure development that just creates bigger bureaucracies and less space for people such as CEOs or heads of departments [when these positions are permanently filled] to make decisions and to implement change. And there’s a South African syndrome it seems of setting up yet another task team or another inquiry but no sustainable change or leadership management and governance,” she said.

Impact on health services

Jack Bloom, the DA member of the provincial legislature, said the setback of the damages and disruptions caused by the Charlotte Maxeke Hospital fire was the latest blow to service delivery in the province.

“The Gauteng health department has estimated that it will cost about R6 billion to ensure health and safety compliance for all 32 public hospitals in the province. This includes R394 million to fix the Charlotte Maxeke Hospital, but little of this has been budgeted for,” Bloom said.

He also noted that in 2019, former health MEC Dr Bandile Masuku, who was fired last October, admitted that “no state health facility in Gauteng had been assessed as complying with the occupational health and safety act”.

Bloom said this included general machinery regulations, electrical installation regulations, firefighting equipment, lift regulations, storage, exits, stairs and aisles.

“We need to see the Special Investigations Unit reports on corruption and mismanagement, we need to push for the premier’s own call for lifestyle audits, and there should be prosecutions in light of the Life Esidemeni tragedy,” he said of the kind of overhaul needed in the provincial health department.

“Things are movingly frustratingly slowly but I am hopeful that SA Revenue Service and civil action will be able to close in on some of the big fish and that we even start seeing criminal charges,” Bloom said.

The Charlotte Maxeke Hospital has missed its initial target date to re-open some sections this month.

*Not their real names

This article was produced by Spotlight – health journalism in the public interest.

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