The Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) caught fire on April 17 2021. A year later the city’s once premier public-sector hospital is still fighting for its life.
On what should be a busy Friday morning this autumn, things are muted at the facility on the Parktown ridge, a landmark since it opened in 1979. There are no wailing ambulance sirens or spinning emergency lights rushing patients to the hospital. Ambulances stopped coming a year ago when the casualty department closed. It hasn’t reopened.
A lone security guard sits in the foyer at casualty. Her only company is a sign for “porters” propped up against a wall.
Charlotte Maxeke’s casualty unit used to be world-renowned. Its expertise in managing high volumes of trauma cases attracted trainees, visiting faculty and medical students from around the world. In turn, it was a training ground credited for polishing trauma doctors and surgeons, many of whom went on to become world leaders in their fields.
Ostensibly the holdup in re-opening is because a broken CAT scanner, a critical piece of equipment for trauma cases, cannot be fixed until a missing part is acquired. A year later this has not happened.
Ayanda Dakela, head of health facilities and infrastructure at the national department of health (NDoH), was tasked with overseeing the rebuild in February. It came after months of inaction and infighting between the Gauteng department of health (GDoH) and the province’s department of infrastructure and development (GDID).
Responding to questions, his office acknowledged incidents of vandalism and theft at the unit. “The CPU for the CAT scanner was stolen and cables for the scanner were cut into pieces. Two distribution boards were stolen, and a few copper pipes were stolen.”
He added that three GDID technical officials were arrested in connection with these crimes.
It all amounts to another missed deadline. In February hospital senior management and officials from the national and provincial health departments held a media conference confirming a mid-March reopening date for the unit. Later this was shifted to April. At the end of April it was still closed.
At the hospital it is the silence you notice first. Then you realise how the lack of parking space is affecting its day-to-day running.
The fire broke out in the parking area of the building and raced up nine floors. These sections have been closed, meaning finding a parking spot is a scramble. Even now there are no contingencies for alternative parking or shuttles to accommodate doctors, nurses, staff, patients or visitors.
People mostly have to park outside the grounds. They double park and often obstruct traffic by leaving their vehicles in front of hospital entrances. At the main entrance people park in the incoming traffic lane, leaving vehicles that need to pass with no option but to drive into oncoming traffic lanes. There is no space to make a U-turn and while Spotlight was there security made no effort to help prevent these jams.
Beyond being an irritation, the parking crisis means doctors can’t keep to schedules, ill patients have to walk longer distances and patient transport is delayed.
A navigator for oncology patients said she sometimes gives up trying to get into the hospital, resigning herself to try another day.
For staff already pushed to the limit after being at the forefront of fighting Covid-19, the parking fiasco is the final straw. Morale is in a nosedive and each month brings more doctors’ resignations.
A senior doctor summed it up: “You get frustrated when you can’t find a parking at the mall; now imagine that every day you come to work and that’s what you have to deal with. As you work you worry that your car has been stolen or broken into, or that when you walk to your car after your shift you might be robbed or attacked.”
Inside the hospital more failings become clear. While the main walkway, Hospital Road, is busy with people connecting to different sections of the facility, it’s now also a waiting area. In part it’s a measure to ensure patients maintain social distancing, but it’s also because nine wards were closed down after the fire, meaning even corridors have had to be repurposed.
At the cardiology unit outpatients are forced to wait in stairwells or on chairs outside the lift areas. It’s one of the specialist wards that is still only partially open.
The oncology unit was out of operation for almost four months after the fire. Charlotte Maxeke was the only public hospital in Johannesburg where radiation treatment was available, the next closest facility being Steve Biko Academic Hospital in Tshwane, 55km away.
But reopening hasn’t cleared the backlog of patients who need treatment. It just keeps growing. According to The Cancer Alliance, a group of non-profits and activists, there are patients who have been on the waiting list for two years. Many die before they make their next appointments. They have also started to notice patients’ cancers returning, people having fallen through the cracks during the months of shutdown.
Even before the fire the alliance repeatedly warned the unit was buckling because of a mounting staff and equipment crisis.
In March the GDoH said the province had invested more than R500m in procuring five Linac accelerator cancer treatment machines in the past two financial years. These are used for radiation beam treatment. However, it said “a machine meant for CMJAH is yet to be commissioned”. The department also acknowledged that “CMJAH and Steve Biko Academic Hospital do not have enough human personnel to run all the machines at full capacity”.
Whole wards at CMJAH are still closed, noticeable because of bright green scaffolding struts that start at the bottom-floor parking areas and run up through affected sections of the building.
Some sections, such as the psychiatric clinic, have been abandoned, the walls still covered in soot and water marks. Hospital furniture and debris still fill the corridors. There’s just a handwritten note on the door that reads: “558 moved to Helen Joseph.”
The knock-on effect is that Helen Joseph Hospital is swamped with psychiatric patients and forced to accommodate people in the emergency ward, one that is not equipped to manage such patients. This poses a risk to patients who could harm themselves, other patients and staff.
Responding to questions about contingencies for psychiatric patients, Gauteng health spokesperson Kwara Kekana forwarded a press release dated March 25 that was presented as a joint statement by minister of health Dr Joe Phaahla and Gauteng MEC for health Dr Nomathemba Mokgethi.
It states: “Helen Joseph Hospital has increased its mental healthcare bed capacity, as well as repurposing a temporary structure to house more patients.”
It also “acknowledge[s] that this intervention is still not enough to address the increase in demand”.
Meanwhile, the continued presence of temporary support structures looms as a constant reminder that a year after the fire much of the hospital is on life support. The rental cost for scaffolding amounts to an estimated R5m to R8m a month, according to a hospital insider. The company providing it, Viva Formwork and Scaffolding, gave notice at the end of March that it intended to remove the support structures, citing nonpayment by government. Since then the NDoH has said it has extended the contract at a new rate until May 15.
The target now is for completion of work to take place as follows: emergency unit by April 2022 (missed), block 1 by March 2023, block 2 by July 2023, block 3 by October 2023 and blocks 4 and 5 by November 2023.
But the joint statement by the minister and MEC acknowledged that accrued debt in the province stands at R5.8bn and dates as far back as 2013. They acknowledged it “affects the cash flow of the department and our ability to pay suppliers on time”.
There are other signs that work has happened at a stuttered pace at best over the past year at CMJAH. The installation of fire doors is incomplete, leaving some areas without any. The absence of fire doors or ones that work was a key reason given by fire fighters who spoke to Spotlight as to why the fire could not be contained and caused such extensive damage.
Spotlight requested a copy of the outstanding structural engineering assessment report and outstanding fire report. Dakela, however, said this process was only undertaken at the beginning of April, with a preliminary report expected by May 15. He also revealed that no fire report or assessment had been conducted “by the department of infrastructure development since April 2021 to date”.
Authorities put the work undertaken to extend to “deep cleaning of blocks one to eight, installation of HVAC (heating, ventilation and air conditioning), health technology equipment, electronic fire detection, evacuation system and wet fire installations. Applications for occupational health safety approvals and certificates have been submitted to the City of Johannesburg and are being processed.”
The target now is for completion of work to take place as follows: emergency unit by April 2022 (missed), block 1 by March 2023, block 2 by July 2023, block 3 by October 2023 and blocks 4 and 5 by November 2023.
The estimated budget is just less than R1.1bn. This will be raised from the Development Bank of South Africa and National Treasury’s emergency budget. NGOs are also helping. The Solidarity Fund is responsible for the compliance requirements of the casualty department, Gift of the Givers will work on the new stores facilities and the Spire Fund will work on a detailed assessment of affected areas, the NDoH said.
This article was first published by Spotlight.
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