Open letter from Gauteng doctor to health dept: 'How do you sleep at night?'

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Dear administrators,

Last week I attended the funeral of a 13-year-old patient of mine who I have looked after for years at Rahima Moosa Mother and Child Hospital.

Today I counselled two mothers, informing them that our resuscitation measures had been in vain.

I wish you could be there to see the pain and grief that these parents and their families go through.

Children are dying and the horrendous conditions in our public hospitals are contributing to their deaths.

I wish you could come to our unit and see doctors trying to intubate children and administer cardiopulmonary resuscitation by their mobile phone’s torch, as the power has failed … again… Or the cold neonate whose incubator went off with the loss of power (from load shedding) and did not keep him warm.

How about excluding a mother-and-child hospital from your load shedding schedule? Our generators are unfortunately inadequately sized to supply the hospital.

I wish you could come and explain to parents that their child needs an urgent computerised tomography scan of the brain but he’s going to have to wait, since our scanner has been broken for nearly three months, Chris Hani Baragwanath is overflowing, and Charlotte Maxeke has had crucial parts of its scanner stolen.

He ended up waiting for 48 hours, when the Nelson Mandela Children’s Hospital managed to assist.

I wish you would come and look at the toilets when the water has been off because the local water reservoir was running low.

Or, even better, come and see how hospital-acquired infections spread like wildfire through the neonatal ward because the taps are dry, and washing your hands while lifting a five-litre water container after examining each child is just not feasible.

No, scrap that. Please come out of your ivory towers and come and use our lidless toilets. (There is one for fathers on the ground floor; the rest are off limits to men.)

Perhaps you could come and try to manage a critically ill little patient without the benefit of blood test results, as the National Health Laboratory Service’s turnaround time is frequently more than 24 hours at our hospital.

Or see doctors drive around to different hospitals trying to acquire essential supplies that are not available at our hospital.

I could go on, but want to pose some questions to you:

Would you admit your child to this hospital?

Would you trust the overburdened and burnt-out healthcare staff to look after your little one in their hour of greatest need?

And if you wouldn’t, how do you manage to come to work every day, fail at your job of ensuring basic healthcare for the people you serve and still sleep at night?

Having worked in the public sector for 21 years, I can tell you frankly: things are falling apart.

If your healthcare workers are the centre of providing care, we cannot hold. Things are going backwards, fast. The care that is being provided in your less than glittering hospitals is getting worse every day.

Are you worried about the greedy lawyers who are waiting in the wings, suing your department for millions because a premature infant went blind because there was no functional meter (which costs less than R1,000) monitoring her oxygen delivery?

You should be, because money is being wasted on paying negligence lawsuit compensations rather than preventing the problem in the first place.

And before you ask, yes, these issues have been raised with management repeatedly, including two reports on the critical state of the neonatal wards and obstetric services in 2016 and 2021, and a more recent letter on 11 April 2022 detailing the disastrous state of the hospital.

The “correct procedures” have been followed, with no visible response. Have you read the reports?

I can predict your response: “Illegal foreigners are clogging the system.”

Well, if you don’t control the borders or have a functional Department of Home Affairs to deal with refugees, you cannot blame desperate and indigent people for trying to improve their lives and seek care when they or their children are ill.

The truth, though, based on Statistics South Africa data, is that at least half of the one million immigrants into Gauteng between 2016 and 2021 were from Limpopo, KwaZulu-Natal, Mpumalanga, and so on. Yes, South Africans.

Despite the ever-expanding demand for health services, the Gauteng Department of Health budget is decreasing in real terms.

And when the Covid-19 budget gets allocated, it goes to hospitals that are struggling to function, such as the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and cuts out hospitals managing the redistributed workload such as Rahima Moosa Mother and Child Hospital.

Yes, I know you claim the CMJAH Emergency Department is “open”, but since it only accepts patients stabilised at other hospitals, and the Gauteng emergency medical services are unable to provide ambulance transport within a reasonable time, it remains nonfunctional.

I’m sure district hospitals in Gauteng are feeling the same pain.

I’m fully aware we are not alone or special, and that other hospitals and different disciplines across them are facing equally atrocious conditions.

I do, however, have a calling; a calling to be a paediatrician and to provide the best care I can to our little patients, and a calling to advocate for those without a voice.

I guess your inaction and disregard for the health of children does not matter, since children cannot vote and so why should you bother to meet their needs?

While Nelson Mandela, Chris Hani, Charlotte Maxeke and Rahima Moosa are turning in their graves, disturbed by the dismal conditions at hospitals bearing their names, I want to reassure them that we, the frontline healthcare workers, will keep fighting to maintain the health and wellbeing of our vulnerable children.

But it would be nice if you did something too.

Dr Tim De Maayer is a paediatrician at Rahima Moosa Mother and Child Hospital, where he has worked since 2009. Before that, he worked in other public hospitals in rural Limpopo and trained at the University of the Witwatersrand. He is passionate about children’s rights, health and wellbeing.

*This story first appeared on Daily Maverick.

Note from Mark Heywood, the editor of Maverick Citizen

This article is a cry from the heart.

It arises from moral injury occasioned by silence, from a doctor’s Hippocratic oath and after years of unsuccessful efforts by healthcare workers at Rahima Moosa Mother and Child Hospital to have the problems it describes attended to.

Knowing the risk of victimisation for speaking out, careful consideration and discussion with peers accompanied the decision to publish.

The best response of the Gauteng Department of Health and the hospital CEO to the article would be to admit and urgently fix the problems it raises, not shoot the messenger.

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