Hospital a terminal case

Thousands of patients who visit Ngwelezana Hospital each day are facing a bleak future

Lack of senior supervision has led directly to at least one death that I know of, and I have heard of several more - Prof Philip Barker

Last year saw the loss of the only Consultant Physician – with no replacement – so that junior staff on the Medical Wards now work with no senior supervision in that specialty. ‘This is of questionable professional integrity and legality,’ said Barker. ‘Lack of senior supervision has led directly to at least one death that I know of, and I have heard of several more. ‘We cannot provide adequate care for our local population, let alone the referring 22 hospitals and 17 clinics that we are also expected to care for without the appropriate resources. ‘This year alone I have lost six nurses from our Burns Unit with no replacement, and similar losses have been commonplace throughout other areas of the hospital, notably the Intensive Care Unit (ICU). ‘The ratio of nursing staff to patients in the ICU should be 2:1, but it has never been that high in my time here. ‘In fact, it is often less than 1:1 so that beds have to be closed to try and make it safe. ‘Even so, overstretched and overtired nurses make mistakes, and some of them are lethal.’

Scarce resources
Area Manager, Dr Similane, visited Ngwelezana last December and announced that savings of R11,8-million were to be made within the financial year, without any reduction in services, ‘in order to meet our responsibilities to our referring population’. This was challenged by Prof Barker, who argued that Province had a responsibility to provide the resources to provide care for the 3.5-million in Ngwelezana’s referral base. He claimed that within the hospital itself, the Executive have consistently failed to even invite its Heads of Departments to regular meetings to discuss the issues of health care provision. ‘And at Departmental Head meetings, management representation is notably missing, particularly by the Chief Executive and Human Resources. ‘This has been a constant feature of the administration of the hospital over many years, and Dr Barrett, the resigning Head of Anaesthetics, has made it clear that one of his reasons for going is the total lack of any kind of response from management to his pleas for more staff. ‘This goes back over many years – predicting just the sort of implosion that is happening within the hospital for lack of staff.’

Appeal
‘The potential for a superb hospital is being lost through inept and secretive administration,’ said Barker. ‘Middle grade doctors from abroad, who form the bulk of such crucial services such as Surgery, Anaesthetics and Emergency Medicine, will no longer come to work at the hospital if the seniors to teach them have left. ‘The residue will be a failing district level hospital, quite unable to meet the needs of its huge referral population. ‘Already the services are so attenuated that there are no anaesthetists available for three nights of the week, making emergency surgery impossible. ‘Deaths have resulted from this. ‘The Heads of Departments have no confidence in the Executive who seem completely uninterested in communicating with their clinical colleagues. ‘More will leave; it is such shame.’

Barker’s list of accusations also includes the following allegations:
• While it is said that posts are not frozen and that more staff can be recruited, there are apparently no funds to pay additional staff.
• Last year it came to light that money was apparently disappearing to pay ‘ghost workers’, and 24 computers were removed from the hospital (18 from Human Resources) to investigate this.
No comment has been made by the Executive on the findings of the investigation, and it appears that no independent audit has ever been made of hospital funds.
• Equipment is neither maintained nor replaced.
Prof Barker complained that the two dermatomes and meshers (used for taking skin for grafting and expanding it) which are basic tools for the Burns surgeon, went for repair over a year ago and now no trace of them can be found.
• In the Ophthalmology Department there is now no functioning laser or ultrasound machine, meaning that patients can no longer be treated for impending blindness from their diabetes, and that patients awaiting cataract surgery or suspected of having a detachment of the retina have to travel to other hospitals for assessment.
• For over a year, patients with bleeding from the gut can no longer be investigated as there is no functioning telescope for looking to see where the bleeding is coming from.
Some may bleed to death for lack of a diagnosis and appropriate treatment.