Anatomy of Charlotte Maxeke
Hospital in crisis
- Staff needed: 80.
- Vacant posts: 18.
- Cancellation of 16 to 20 surgical lists a week, resulting in increased waiting lists, of four weeks, for all breast cancer patients. Lists likely to lengthen further.
- Only one consultant instead of three.
- Endoscopic lists have been cut by 50% - the waiting list increased from 10 days to four weeks.
- No colorectal ability. Almost all complex colorectal cases have to be referred.
- From September 1, only one consultant.
- Waiting lists for breast cancer to increase by two weeks for every month that cancellations take place.
- From next month, the head of the department will be on a six-month sabbatical, leaving only one of three consultants. This will result in closure for two days a week of the hospital to all emergency surgical admissions.
- No in-house cover for emergencies and no night cover.
- Number of doctors reduced from two to one.
- The trauma unit will be closed to all "walking wounded" - about 40 a day will have to be referred to other hospitals.
- Only one resuscitation to be dealt with at a time. If more than one patient needs resuscitation, the other will probably die. "Additional resuscitations may not have medical intervention available, and survival will be prejudiced."
- No transfers from other hospitals will be accepted.
- From November 1, the head of the unit retires, resulting in closure of unit to all admissions for one or two days a week.
- 25% reduction in doctors, with only two doctors available.
- No emergency cover available from 4pm to 8pm four days a week, meaning no children will be attended to for four hours on those days.
- All paediatric surgical emergencies will be referred to Chris Hani Baragwanath Hospital.
- No liver transplantation possible.
- 10 registrars for a total of 37 posts (plus three on maternity leave).
- Four of a total of six medical officers (doctors).
- Department has a 23% vacancy rate.
- Some potential registrars went elsewhere after a long delay before they were told of their appointment.
- Cancellation of four routine theatre lists a day (15 to 25 patients a day).
- Supervision of registrars/medical officers in theatre compromised because the number of supervisors per consultant has increased, resulting in potential medico-legal implications.
- Theatre training compromised.
- Number of emergency anaesthetists reduced from four to three per shift.
- Cardiothoracic, neuro- and paediatric surgery will have to sacrifice some elective procedures.
- At present only two doctors, but this will increase in the next six months.
- At the time of the Norovirus infectious outbreak two years ago, Gauteng health received staffing norms from Western Cape for Neonatology. Charlotte Maxeke had two neonatologists instead of the eight required, three registrars instead of 14, and one doctor instead of seven.
- Two new consultants and two new registrar's posts were allocated - but this is "still way below the norms".
- Serves about 12million people (40% of whom are under 14).
- "Failure to fill medical posts will certainly lead to substandard care."
- "Further major outbreaks of infection in our neonatal unit are inevitable."
- Waiting times for specialised clinics and HIV services will get longer.
OBSTETRICS AND GYNAECOLOGY
- At present 14 posts available, with five either vacant, unfunded or unable to be used to appoint consultants. Six doctors' posts, three vacant and one more from September due to retirement and a vacant registrar's post.
- Waiting lists for colposcopy and surgical management of pre-malignant cervical and vulval lesions is five to six months. No new patients accepted.
- Waiting lists for routine ultra-sounds is between three and four months.
- About 200 new antenatal and maternity patients attended to a day.
- Waiting list for elective gynaecological surgery is four months and will increase to six to seven months in the next two months. Waiting list for gynaecological cancer surgery to increase considerably.
- One doctor's contract expired in July and was extended to December. Two registrars will leave at the end of December.
- Three posts will be vacant.
- "Services and academic commitments cannot be achieved by not refilling the posts mentioned."
- Vacancies need to be filled in order to treat increased numbers of patients with HIV-related skin diseases. Doctors attend to at least 1000 patients a month.
HEAD AND NECK SURGERY
- "Because no new staff have been appointed, the department is forced to further reduce its workload."
- Only nine of 15 vacancies filled. By the end of November, this will have increased to 11.
- Only 14 patients booked per clinic.
- No bookings will be made for December.
- There will be no registrars.
- Four radiation oncologists. Three doctors are retiring and one left last year.
- ''We are only seven consultants now instead of required 11. This is putting a large burden on patient care as well as teaching and research in the department.''
- The department sees between 3600 and 3700 new cancer patients a year.
- Posts have been advertised but no interviews done.
- 153 nurses have left the hospital since January.
- Nurses on extended incapacity sick leave.
- Nursing staff stretched, resulting in high absenteeism, burn-out.
- Nurses unable to give proper nursing care, resulting in cutting corners and poor record keeping.
- Not all shifts adequately covered in ICU, high care, operating theatres.