Gauteng hospitals need water resilience

The water cuts that have again affected the Helen Joseph and Rahima Moosa Hospitals highlight the urgent need for water resilience measures at Gauteng public hospitals.

Hospitals should never run out of water as it shoots up the risk of infection and disease.

It is also very distressing for patients, and surgery backlogs rise when operations are cancelled.

With the latest water cuts, the toilets became smelly, and relatives had to bring in water when visiting their loved ones.

The Pholosong hospital on the East Rand has also been affected by water cuts since last week when Rand Water reservoirs ran low.

And earlier this month, Edenvale Hospital had a water shortage because of a burst internal pipe.

Water resilience measures should include increased reserve water storage, the digging of internal boreholes, regular maintenance of water pipes, and pumps to get water to higher floors when water pressure is low.

Every hospital needs a water plan in our new reality where flowing water can no longer be taken for granted.

7457 patients infected in Gauteng hospitals

A total of 7457 patients picked up an infection in Gauteng public hospitals last year, mostly due to poor infection control measures.

These figures were revealed by Gauteng Health and Wellness MEC Nomantu Nkomo-Ralehoko in a written reply to my questions in the Gauteng Legislature.

The technical name for hospital-acquired infections is nosocomial, which refers to infections caught in hospitals, often caused by organisms resistant to antibiotics.

According to the MEC, there are weekly and monthly Healthcare Associated Infection (HAI) surveillance records, but no data was collected for 2020 and 2021 because of Covid.

In 2022, 7457 (6.4%) of 116 366 patients got nosocomial infections, of which 5032 were in the seven central and tertiary hospitals, broken down as follows:

• Chis Hani Baragwanath Hospital – 1542 infections
• Steve Biko Hospital -1365 infections
• Charlotte Maxeke Johannesburg Hospital – 1157 infections
• Helen Joseph Hospital – 613 infections
• Kalafong Hospital – 337 infections
• George Mukhari Hospital – 312 infections
• Tembisa Hospital – 238 infections

The 9 regional hospitals accounted for 1617 (22%) of all hospital-acquired infections, ranging from 138 infections at Pholosong Hospital to 626 infections at Leratong hospital, which is more than double the next highest figure of 255 infections at the Rahima Moosa Hospital.

Amongst the 12 smaller district hospitals, the Kopanong and Odi hospitals had the highest number of nosocomial infections – 194 and 176 respectively.

The most prevalent nosocomial infection is CRE/CPE, which are Carbapenem-resistant or Carbapenemase-producing bacteria that cause a variety of infections including urinalysis tract infections, wound infections, gastroenteritis, meningitis, septicaemia and pneumonia.

There were 1038 ESBL infections, which are resistant to penicillin, 980 cases of Acinetobacter Baumann MDR/XDR, and 584 cases of Clostridium Difficile, which inflames the colon and can be fatal.

Also of concern are 468 cases of Klebsiella Pneumonia, which has caused deaths of babies in previous outbreaks.

The antibiotic-resistant infections are a particular horror as they are difficult to treat, leading to longer hospital stays and sometimes even death.

It is distressing that more than one in twenty patients will pick up an infection while in hospital.

There appears to be a sharp rise in nosocomial infections as there were only 975 such infections in 2014 according to a previous official reply to questions, but this may partly be due to improved monitoring. Whereas Chris Hani Baragwanath Hospital had 376 nosocomial infections in 2014, these have rocketed to 1542 last year.

The latest figures indicate the need for tight infection controls and proper hygiene to cut hospital infections as much as possible.


Water woes and low temperatures cut ops in Gauteng hospitals

More than a hundred operations were cancelled in three major Gauteng hospitals last week – in one case because of a water cut-off, a flooding in another case, and also a heating failure in operating theatres.

At the Helen Joseph Hospital, surgical instruments could not be sterilised because the autoclaves had no steam due to the water shortage.

On Friday last week, about 30 operations at the Chris Hani Baragwanath Hospital (CHBH) were cancelled because the main theatre complex was flooded.

And many operations were cancelled at the Charlotte Maxeke Johannesburg Hospital as temperatures in the theatres were too low due to a heating system failure.

The impact of these cancellations is devastating for patients who may have waited more than a year while suffering in pain.

Surgeons are frustrated because factors out of their control lead to operations being cancelled and the surgery backlog keeps growing.

Poor maintenance is largely to blame for the recent spate of surgery cancellations. It is unacceptable that leaking pipes flooded the CHBH theatre complex, while Helen Joseph Hospital has repeatedly failed to fix their water shortage.

Responsibility for hospital maintenance should be removed from the incompetent and corruption Gauteng Department of Infrastructure Development.

It should be devolved to competent hospital CEOs with an adequate budget to fix long-standing infrastructure weaknesses.

Clean linen shortages in Gauteng hospitals

Clean linen shortages have been experienced by 23 out of 34 Gauteng public hospitals since January last year, disrupting surgery and increasing the risk of infection for patients in wards.

This is revealed by Gauteng Health MEC Nomantu Nkomo-Ralehoko in a written reply to my questions in the Gauteng Legislature.

Helen Joseph Hospital was particularly hard hit, with shortages of scrubs, gowns, drapes, sheets, pyjamas and nightdresses, towels, blankets and pillow cases. These shortages occurred multiple times for a total period of 42 days, and caused 81 operations to be cancelled.

Chris Hani Hospital had various shortages of clean linen, including draw sheets, blankets and pyjamas. Theatre operations were hampered and 9 operations were cancelled.

At Charlotte Maxeke Johannesburg Hospital there were intermittent shortages of theatre gloves and towels, sheets, blankets and gowns for a total period of 12 weeks.

Sporadic linen shortages at the George Mukhari Hospital caused about 32 operations to be cancelled, and they sometimes had to borrow linen from other hospitals.

Many hospitals have linen shortages because of production problems at the Dunswart and Masakhane provincial laundries which they are obliged to use. These include the Tembisa, Pholosong, George Mukhari, Kalafong, Sebokeng, Tambo Memorial and Far East Rand hospitals.

The Mamelodi hospital has given up on the Masakhane laundry and only uses private laundries.

Other hospitals also use private laundries but some claim this is forbidden by the Gauteng Health Department.

Concern was expressed by hospitals about the impact on infection control. Kopanong hospital, for instance, notes that relatives bring in blankets for patients.

It is unclear why hospitals are largely forced to use the poorly managed and expensive provincial laundries where machinery constantly breaks down.

The continued operation of these laundries should be reviewed as laundry shortages are a constant hassle in public hospitals.

Hospital managers should be free to make the most cost-efficient arrangements with reliable suppliers so that optimal patient care is provided.

600 patients wait for wheelchairs at Gauteng hospitals

Six hundred disabled people are waiting for wheelchairs at Gauteng hospitals, mostly because of delayed wheelchair deliveries.

This is revealed by Gauteng Health MEC Nomantu Nkomo Ralehoko in a written reply to my questions in the Gauteng Legislature.

The largest shortage is at Chris Hani Baragwanath Hospital where there are 253 patients on the waiting list for wheelchairs. Reasons given are as follows:

• Delays in ordering processes, delayed deliveries of wheelchairs by the supplier.
• Insufficient storage for bulk wheelchairs.
• The current storeroom was flooded.

Wheelchairs are due to arrive at this hospital by 30 June this year. Meanwhile, they intend to improve the processing of orders, placing orders more frequently for smaller quantities to mitigate for lack of storage, and they will motivate a container to store wheelchairs in bulk.

Other hospitals where wheelchair deliveries have been delayed include the following:

• Tambo Memorial Hospital – 44 patients waiting for wheelchairs
• Tembisa Hospital – 11 patients waiting for wheelchairs
• Edenvale Hospital – 5 patients waiting for wheelchairs

The City of Johannesburg Primary Health Care (PHC) facilities have 105 patients waiting for wheelchairs, while Ekurhuleni PHC facilities and West Rand PHC facilities have 98 and 84 patients on their waiting lists respectively.

Therapists at the PHC facilities are now calling all patients on the waiting lists to receive their wheelchairs.

It is distressing that so many disabled people have to wait for wheelchairs to restore their mobility.

Imagine the suffering and indignity of vulnerable people who needlessly wait long periods for wheelchairs.

The supply management of wheelchairs needs to be tightened up as there is a sufficient budget to cover the assessed need for wheelchairs.


Three Gauteng Hospitals and 71 clinics run out of diesel

Three Gauteng public hospitals and 71 clinics have run out of diesel in the last year, causing service delivery delays, water shortages, thefts, equipment damage and fridge failures.

This is revealed by Gauteng Health MEC Nomantu Nkomo Ralehoko in a written reply to my questions in the Gauteng Legislature.

The Jubilee, Bheki Mlangeni, and Far East Rand hospitals ran out of diesel, as well as 20 Tshwane clinics and 51 clinics in the West Rand.

The MEC blames the shortages of diesel on load-shedding and gives the following effects when diesel runs out:

• Fridge failures which lead to non-adherence to cold chain processes and faulty fridges.

• Generators being damaged.

• Damage to lTC equipment.

• Increase in theft and losses.

• Telephone lines and Network connectivity affected.

• Services delivery delayed (mainly night duty).

• Water tankers can‘t pump water to facilities due to load-shedding and diesel shortage.

The annual diesel budget for the 2022/23 financial year which ends on 31 March was R142 million, but R148 million had already been spent by 30 January 2023.

It is inexcusable that so many hospitals and clinics have run out of diesel, causing suffering to patients and damaging equipment that will need to be repaired at extra cost.

The MEC also needs to explain why Tshwane and West Rand clinics ran out of diesel but not clinics in other areas.

The way forward is to ensure an adequate budget for diesel supply, and fast-tracking the installation of solar power so that hospitals and clinic are less reliant on erratic Eskom electricity supply.

Gauteng Hospitals don’t have fire clearance certificates

Fire risk at Gauteng’s public hospitals is high as only 2 out of 37 hospitals have valid fire clearance certificates, mostly because they don’t have floor plans and adequate fire detection systems.

This alarming information is disclosed by Gauteng Health MEC Nomantu Nkomo Ralehoko in a written reply to my questions in the Gauteng Legislature.

The only hospitals with valid fire certificates are the Thelle Mogoerane and Bertha Gxowa hospitals. While the Jubilee and Odi hospitals claim they have valid certificates this is only for part of their buildings as they do not have fully functional fire detection systems.

Responsibility for fire compliance falls with the Department of Infrastructure Development (DID) and hospital CEOs. Fire assessments should be done annually by the local authority and by the DID, but this does not always happen, and those that are done do not result in compliant hospitals.

In the case of Chris Hani Baragwanath Hospital, the last fire assessment was done in 2016 and they were found to be non-compliant. They recently engaged the City of Johannesburg and are awaiting the report on an inspection done in October last year.

Responses from other major hospitals include the following:

• Charlotte Maxeke Johannesburg Hospital “only obtains a valid fire clearance if it complies with the relevant fire by-laws.”

• George Mukhari Hospital is non-compliant due to old infrastructure and lack of maintenance.

• Steve Biko Hospital – the “ancient architecture poses a problem in meeting the revised and safety latest requirements.”

• Tembisa Hospital – non-compliance of the hospital infrastructure (safety hazards) and insufficient fire equipment.

• Helen Joseph Hospital – no hospital floor plans and the fire detection does not cover not all areas.

• Kalafong Hospital – the hospital does not have floor plans.

• Rahima Moosa Mother and Child Hospital – facility needs to be inspected and assessed for compliance, and a fire detection system needs to be installed.

• Edenvale Hospital – it was built in 1937, the last revamp was in 2006, and the fire safety systems are obsolete.

• Tambo Memorial Hospital – non-compliant with Ekurhuleni Emergency Services by-laws.

• Sebokeng Hospital – does not have functional fire equipment and insufficient emergency exits, and is awaiting the Department to do the inspection.

• Far East Rand Hospital – no emergency exit due to structural challenges, only some floors have emergency exit doors.

• South Rand Hospital – old infrastructure as it was built in 1954, and was declared non-compliant on 9 June 2021.

Some hospitals say they can be forced to stop operating if they are declared a fire hazard, while others claim they will remain open due to their critical mandate to provide health care.

There have been at least 8 Gauteng hospital fires in the last seven years. These occurred at the Charlotte Maxeke, Chris Hani Baragwanath, Steve Biko, Tambo, Bheki Mlangeni, and Carletonville hospitals, but none of them have adequate fire prevention measures to prevent a repeat.

It is scandalous that so little has been done to upgrade fire security at our hospitals. We need to know what firm measures are being taken to ensure staff and patients are protected from fire hazards.

R215 million to fix unsafe Gauteng Hospitals is returned to Treasury

The Democratic Alliance condemns the incredible incompetence that sees the Gauteng Health Department lose R215 million to fix unsafe hospitals because they failed to spend it.

According to the adjustment budget that Gauteng Finance MEC Jacob Mamabolo unveiled last week, the “delays in the implementation of occupational health and safety infrastructure projects causes a surrender of R214.7 million to the Provincial Revenue Fund.”

This is despite the assessment that 19 out of 37 Gauteng public hospitals do not meet the requirements of the Occupational Health and Safety Act.

Non-compliant hospitals include the following:

Edenvale Hospital
Leratong Hospital
Yusuf Dadoo Hospital
South Rand Hospital
Far East Rand Hospital
Pholosong Hospital
Thelle Mogoerane Hospital
Mamelodi Hospital
Odi Hospital
Pretoria West Hospital
Tshwane District Hospital
Lenasia South Hospital
Heidelberg Hospital

The Department blames the underspending on the slow processing of invoices and the failure to create Purchase Orders for contracts.

Also, to blame is the corrupt and incompetent Department of Infrastructure Development as they rarely choose decent contractors who finish the job in time and within budget.

Meanwhile, patients and staff face the danger of unsafe hospitals.

This is what you get after years of ANC cadre deployment and corruption.

Former premier David Makhura promised repeatedly to “turn around” the Gauteng Health Department, and Premier Panyaza Lesufi makes the same baseless promises.

Real progress will only happen when the ANC is ejected from the provincial government.

8 Gauteng hospital fires in 7 years

The DA is concerned that yesterday’s fire at the Chris Hani Baragwanath Hospital is the third fire at a Gauteng public hospital this year, and the eighth fire in 7 years.

According to the Gauteng Health Department, the fire at Bara hospital occurred near the Covid-19 tents, and then spread to the laundry site before it was put out by City of Johannesburg fire services.

This follows a fire at temporary structures at the Steve Biko Hospital on 30 May this year, and another fire at this hospital on 12 June when there was a blaze in a linen closet in a medical ward.

All three fires were put out speedily, but it could have been far worse.

Other hospital fires include the following:

• severe damage at Charlotte Maxeke Johannesburg Hospital in April last year.
• a fire destroyed a store room at the Carletonville Hospital in February last year.
• a fire broke out at an administration block at Bheki Mlangeni Hospital in May 2019.
• dental rooms at the Tambo Memorial Hospital were destroyed by fire in July 2016.
• R7 million of medical supplies were destroyed by a fire in a store room at the Tambo Memorial Hospital in May 2015.

Furthermore, there was the fire that started at the Gauteng Health Department’s head office at the Bank of Lisbon building in September 2018, which burnt down the entire building and cost the lives of three fire fighters.

We still do not have a report on the Bank of Lisbon building fire, nor do we know the cause of the devastating fire at the Charlotte Maxeke Hospital.

The slow investigations and non-release of reports fuel suspicions of a cover-up to protect negligent officials and politicians.

According to a presentation at a recent meeting of the Gauteng Legislature’s Health Committee, only 50% of Gauteng public hospitals are compliant with the Occupational Health and Safety Act.

The DA will continue to press for the release of fire investigation reports, and for better fire prevention at our hospitals so that the lives of patients and staff are not at risk.

Are Gauteng hospitals ready for the 5th wave of Covid cases?

I am concerned that Gauteng Health Department lacks effective leadership as Covid-19 cases are shooting up in a likely 5th wave as we approach the winter season.

Last month the Acting Head of Department Dr Sibongile Zungu left for undisclosed reasons, and her post remains unfilled.

The Department has not had a permanent head since Professor Mkhululi Lukhele resigned in October 2020 after he was implicated in the misspending of PPE funds.

Other senior posts, including Chief Financial Officer, are still filled by acting personnel.

Yesterday (Sunday 24 April), there were 1727 new cases and 10 933 active Covid cases recorded in Gauteng, compared to 460 and 4 333 active cases a week before. This is an alarming jump.

At this stage we do not know the severity of the Omicron sub-variant which appears to be driving the new wave of cases, but hospitals can expect a flood of Covid patients in the next few weeks.

There are already 1272 Covid patients in both private and public hospitals in Gauteng, which has risen from below 1000 patients less than three weeks ago.

Acute shortages of staff are the main problem in treating Covid patients.

The scandal is that many of the newly built wards for Covid patients are empty because they have no staff or equipment.

Meanwhile, existing medical staff are mentally and physically exhausted by the strain of treating previous Covid patients and the backlogs in treatment for other patients.

Premier David Makhura has failed badly in not appointing competent and honest top managers to fix the perennial crisis in our hospitals which causes huge suffering to patients.

All empty posts should be filled as soon as possible to assist our hospitals to save lives and heal sick people.