It’s been 10 months of stuttered progress, missed deadlines, and limited communication on why the Gauteng provincial government has been unable to get Charlotte Maxeke Academic Hospital fully reopened after a fire last April. The Gauteng government has now put it down to a “disagreement” between the Gauteng Departments of Health and Infrastructure and Development.
“The two departments were not able to agree on the scope or the budget and I had to step in and mediate from the Office of the Premier in December,” Acting Director-General in the Office of the Premier, Thabo Masebe said at a media briefing held at the hospital on 17 February.
Management and oversight of the Charlotte Maxeke Hospital as a provincial asset were split between the two departments. The City of Joburg is also responsible for maintaining the likes of fire hydrants that would have serviced the facility.
Along with this damning reveal, it has emerged that just days before on 9 February a proclamation was gazetted to transfer the hospital to the sole management of the National Department of Health, away from the Gauteng Department of Infrastructure and Development. The oversight for the rebuild will also now fall under the national health department with Ayanda Dakela, head of infrastructure at the National Department of Health, in the hot seat.
A new timeline for repairs
Dakela’s timeline for a full return to services stretches till the end of 2023. He considers this a “fast-tracked” timeline, as they had first targeted to finish around 2027, he said.
Meanwhile, the continued shutdown of services and functioning at the specialist academic hospital is causing crises for patients, staff, trainee doctors, and health workers from Gauteng and also surrounding provinces.
Pressure at the facility and still-fumbling management was clear, with the media briefing delayed by 90 minutes as the officials met separately and then an electricity feed problem forcing a venue change. Outside the hospital, the roads were congested with double-parked cars because staff have nowhere to park and no alternatives have been arranged.
No budget details
The officials at the briefing could not give a budget for the remedial work, with Masebe saying that the number would become clearer once Dakela’s team undertakes damage assessments together with the Development Bank of South Africa (BDSA) that has been leaned on to help fund this rebuild.
But experts say these engineering assessments should have been done immediately after the fire in April 2020. Opposition parties, the hospital’s university partners, donors, and NGOs have called for urgent assessments as they have been wanting to step in to assist.
Dr Imtiaz Sooliman, founder of disaster response charity Gift of the Givers, called a structural assessment the essential “template” that allows companies and people to understand where and how they can help.
Gift of the Givers reached out in the early days after the fire, but Sooliman said initial conversations simply went silent “and this dragged on for the whole year”.
Now, Gift of the Givers has received a memorandum of understanding to continue working at the site, starting with the structural assessments. Sooliman said their provisos in getting involved are that no monies be handed over to government and that government will not interfere with the appointment of contractors.
“I have made it clear that I have met with the SIU (Special Investigating Unit) and will not hesitate to pass on any information about corrupt practices that we come across on this project at Charlotte Maxeke,” Sooliman said.
Gift of the Givers has a proven track record in building and equipping hospitals in record time and also for not wasting resources or bowing to political whims.
Still many questions
Questions remain over why and how the fire broke out in the first place, and why the fire could not be contained. There are also questions about the building’s fire safety compliance before the April 2021 blaze – signalling years of neglect and lack of maintenance over time.
Questions also remain about bills being racked up – including a reported R8 million a month, according to a hospital insider, being paid to companies appointed by the Department of Infrastructure and Development, apparently, to secure and prop up damaged sections of the hospital. In the limbo of construction work, these companies are cashing in.
“we cannot investigate ourselves”
Corruption allegations across departments in the provincial government also continue to swirl. It comes off the back of the Special Investigations Unit’s (SIU) work that led to the suspensions a week ago of nine senior officials from the Departments of Infrastructure and Development and Health. The SIU’s investigations were in connection with R500 million meant to be spent to upgrade the donated AngloGold Ashanti Hospital into a 181-bed COVID hospital. The hospital never opened.
There also still needs to be accountability for reports of contractors working on projects funded by the Solidarity Fund’s R68 million injection at Block 1, which is one of five on the hospital campus, being threatened and intimidated.
Questioned about corruption and compliance failures at the media briefing, Masebe deflected these matters to other agencies – from the police, the City of Johannesburg, and the SIU. “We cannot be investigating ourselves… we are also eagerly awaiting their reports,” he said. He also said that they “were not hiding from the media’s questions”.
Patients and staff bear the brunt
The ten-month impasse has ultimately come at the cost of patient care. There are concerns that some cancer patients have been sent home to die or have simply fallen through the cracks.
Doctors, nurses, and other healthcare workers, already under enormous pressure of steering the country through two years of COVID-19, have also exited the public health sector.
This personnel and patient loss were confirmed by the hospital’s CEO, Gladys Bagoshi, at the briefing. She acknowledged that they have not been able to reach all the patients lost to care since the fire. She could also not quantify staff attrition but admitted the dual burdens of COVID and the fire have taken their toll.
Other hospitals under pressure
This toll translates as breaking point crises at facilities like Chris Hani Baragwanath Hospital and especially Helen Joseph Hospital, which is geographically closest to Charlotte Maxeke Hospital. Effective contingency plans for re-directing and managing patient streams at surrounding hospitals have been in place since the fire.
Dr Jeremy Nel, head of Infectious Diseases at Helen Joseph Hospital, said that in the week of the fire at Charlotte Maxeke Hospital, their numbers of people needing a bed skyrocketed from an average of around ten a day to between 50 and 70 people a day.
“It means people are waiting on benches and in chairs. They are seen by doctors there, they take their meals there, and get their medicines there. There isn’t a lot of privacy and people are on top of each other.”
Nel said that there’s a noticeable influx of trauma patients and psychiatric patients.
“We now have in excess of 30 psychiatric patients who would have been admitted to Charlotte Maxeke being crammed into a small area in the emergency department, which is not designed for psychiatric patients,” he said.
Nel said even the announcement that the delayed re-opening of Charlotte Maxeke’s casualty ward is set down for the middle of March, will only alleviate part of the strain.
“The current situation at Helen Joseph is unsolvable at this level. The problem can only be solved once all the wards at Charlotte Maxeke are fully opened. If that isn’t going to happen soon, then the province must find alternative arrangements, including for the psychiatric patients that are swamping Helen Joseph,” he said.
Nel said staff morale has also plummeted even for professionals accustomed to managing extreme crises.
“This kind of long-term neglect and this long delay with nothing to show for progress is incredibly damaging to staff morale and has an impact for student training that will result in bottlenecks,” he said.
For Professor Adam Mahomed, head of internal medicine at Charlotte Maxeke Academic Hospital, there is no more room to sugar-coat the dire situation that has played out over the past ten months and that will continue even as this new plan of action plays out.
Mahomed said that even as renewed remedial work gets underway at the hospital, there are questions that need answering.
“The Auditor-General needs to explain to us the Department of Infrastructure and Development’s budget and how the money has been spent over these past few years,” he said.
He also wrote to the Public Protector after her office responded to a media interview he gave. “I put it all down in writing I have since then not heard back from her,” he said.
Mahomed said the delays and excuses are another indictment that healthcare for the poorest of patients who rely on public sector facilities is in reality a low priority to government.
“We have long been saying to government that if they are not willing to do the work, then they should just hand over the fixing of the hospital to the doctors – not even hospital management and well-run, well-resourced organisations that have proven themselves… Government must just step back and not tie anyone’s hands with bureaucracy and illegal tenders,” he said.
*This article was published by - Spotlight– health journalism in the public interest.