More resources can bring down the high number of deaths of new-born babies at the Chris Hani Baragwanath Hospital which occur despite hard-working staff who do what they can with what they have.
This is my conclusion after I visited the neonatal and maternity departments at the hospital yesterday with my colleague Dr Neil Campbell MPL. We were escorted by senior officials and allowed to see or ask whatever we wanted.
The hospital delivers about 1900 babies a month, but should ideally deal with no more than 1400 babies a month.
These are mostly complicated cases that cannot be dealt with by a lower level hospital or clinic. About 12% of patients are foreign-born, some of whom come directly to give birth at the hospital.
There are 18 ICU beds for babies, but there should be between 24 and 30 ICU beds.
Broken equipment is not repaired speedily because of lack of budget or companies not paid for their services. Current broken equipment includes radiant warmers, incubators, CritiCool machines to cool babies, monitors and ventilators.
For instance, only two out of five CritiCool machines are now functioning.
If ICU beds are not available then babies are referred to other hospitals, mostly nearby but sometimes as far away as Klerksdorp.
There are currently 15 staff vacancies but the staff establishment as a whole needs to be increased.
Ideally, there should be one nurse for each ICU bed, but one nurse looks after two ICUs.
The majority of deaths are due to prematurity and infection, which often go together because a low birthweight baby has low immunity.
The hospital uses a birthweight cutoff of 750 grams to do Continuous Positive Airway Pressure therapy (CPAP) to assist them to breathe.
Comfort care is given for babies below this weight, a small number of whom do survive.
The cut-off point at some other hospitals is lower – it is 700 grams at the Charlotte Maxeke Johannesburg Hospital.
I was disturbed to hear that some of the infections are due to babies being placed too close to each other. This is something that needs to be fixed urgently, and we heard that there are plans to expand and renovate the unit.
The overflow of patients can also contribute to deaths from asphyxia (lack of oxygen) because of delays in being seen to.
Congenital deaths are those that cannot be avoided.
My view is that it is a disgrace that the maternity and neonatal units at this hospital have not been renovated and expanded despite many announcements about this over many years. The corridors and cubicles are dingy, which is not pleasant for staff and patients (see pictures here, here and here)
Staff do their best under the circumstances. They have a good spirit and do what they can under adverse conditions. They are distressed when they get blamed for things that are out of their control.
The easiest to fix in the short term are staff vacancies and the repair of broken machines. Expansion and renovation should be prioritized and the staff establishment expanded to accommodate the vast number of patients.
The maternity unit delivers the most babies in South Africa – 61 507 infants between 2014 and 2016, of which 1338 (2%) died.
Many of the baby deaths cannot be avoided because of adverse factors, but the death rate can definitely be brought down by expanding capacity in staff, equipment and facilities.