The patient who went home (at least he had a bed there)

A man in his 70s entered the Baragwanath ward, carefully dressed in a suit, carrying his hat. He was asked to strip in the open ward, given standard issue pjyamas and assigned a mattress on the floor. He joined the queue outside the ward's two toilets.
When he could wait no longer he urinated in his pants. The next morning he asked to be discharged.

"He told me he was not well but at least at home he could sleep in a bed. He said be refused to pee in his pants again," a Baragwanath doctor recalls. This doctor's account is not unique. The letter published in the South African Medical Journal, which he and 17 other doctors signed, said nothing new about the conditions in Baragwanath's overpopulated and understaffed medicine units and the frustration of the medical staff working there. What these doctors fear most is not victimisation by the authorities who have demanded they sign retractions or face hearings. They are more afraid that once the controversy has died down conditions at Baragwanath's department of internal medicine will remain as inadequate.

They are also concerned that due to overcrowding, the standard of Baragwanath's postgraduate teaching is being adversely affected. Baragwanath Hospital was built by the British government as a service hospital for World War II soldiers. Today medical wards are still housed in the original brick and tin-roofed bungalows. There are six medical units in the department of medicine, each has between 35 and 40 beds and one has 50 beds. Occupancy ranges from 60 to 126 patients at any given stage.

According to a supreme court affidavit by Professor Leo Schamroth - who has worked in Baragwanath since 1955 and until last year headed the department of medicine - the occupancy of wards ranges between 150 percent and 300 percent. During a 24 day period in July 1986 2 305 patients were admitted to the wards giving an average of over 96 new admissions every day. Schamroth said it was almost impossible to provide adequate medical care in such conditions.

"It is difficult to find the right patients for the right medicines, patients are not washed on a regular basis, drips run dry, the nursing staff is tuned to a certain capacity and are not able to cope with the work load, medicines are frequently not given out and patients often can not be found. "For any given ward in which there are between 80and 120 patients (although the optimum capacity would be about 40) there is one bath, one or at most two functional lavatories and three wash basins."

The letter published in the SAMJ stated: "The conditions in the medical wards at the hospital are disgusting and despicable. The state of affairs isinhumane. Facilities are completely inadequate. Many patients have no beds and sleep on the floor at night and sit on chairs during the day. The overcrowding is horrendous. Nurses are allocated according to the number of beds and not to the number of patients. Ablution facilities are far short of accepted health requirements, and ethical standards are undoubtedly compromised."

Transvaal provincial authorities have admitted there is overcrowding at the hospital. But, they maintain, there have been moves to address the situation. However, Baragwanath doctors say these moves do nothing to alleviate the dire need in the medical wards. They point to the vast sums spent on new tight-security entrance gates to the hospital, and the wall-to-wall carpeted administration block which cost R4 429 800.

Director of Hospital Services Hendrik van Wyk outlined the province's improvements in papers before the supreme court at the end of last year.

  •  A new Soweto hospital, New Canada, was planned. Although first planned in 1963, Van Wyk said it was still on the waiting list. He blamed the economic depression, the curtailment of international loans and cuts in state funds for postponing - but not cancelling - this project. But Schamroth said in May last year Baragwanath's superintendent had advised him the New Canada Hospital would take at least 15 years to complete. He said many medical staff had no hope the hospital would ever be built. In addition, Schamroth said five wards - which if utilized could have provided 200 beds - had stood empty for 23 years at Baragwanath. They were ostensibly there to act as turnover wards for the new hospital. A sixth ward was used as quarters for members of the hospital's security staff.
  • Van Wyk said two new wards with 320 beds had recently been completed. Schamroth accepted more beds had been allocated to the medicine department over the years but said this did not "even have a peripheral effect on the enormity of the backlog". Over the years Schamroth has proposed that Baragwanath freeze admissions when the hospital is full, send patients to other hospitals and call in army doctors. The obvious solution is to end the racial fragmentation of health services. UCT professors SR Benatar and RE Kirsch wrote in a SAMJ editorial: "Only a unified health service will ensure that all South Africans receive the appropriate resources …"

Spending a fifth on blacks

The daily expenditure per patient at the Johannesburg General Hospital, for whites was R209 in 1985. The daily expenditure per patient at Soweto's Baragwanath Hospital was R45. These statistics were quoted in the September issue of the South African Medical Journal. In the same issue, a letter signed by 101 Baragwanath doctors slating conditions in the hospital's medical wards as "disgusting and despicable" sparked an ongoing controversy.

But the editorial, written by University of Cape Town medical professors RE Kirsch and SR Benatar, went further than the letter. "The evolution of Baragwanath's problems reflects decades of exploitation, of gross insensitivity to the needs - and aspirations of the black population which it serves, and an appalling inadequacy of national re- sources directed towards this hospital and its patients," the editors wrote. "Shortcomings in our health services are inextricably intertwined with those sociological, economic and political philosophies which underpin the policy of apartheid."

Even official figures contained in the Transvaal director of hospital services' annual report for the 1985/6 financial year back up claims of unequal spending. A comparison between the statistics given by the director, H van Wyk, for Baragwanath and the Johannesburg General illustrates this. The total expenditure of Baragwanath - which serves Soweto' s population of more than two-million - amounted to R94 491 839,58 in the 1985/6 financial year. The expenditure of Johannesburg General, which serves half-a-million whites in Johannesburg and Randburg - was more than R2-million more, and stood at R96.613 579,57. Calculation's on statistics tabled in Van Wyk's report reveal that:

  • The Johannesburg General spent an average of R70 per patient on sanitation, water and electricity. Baragwanath spent an average of R6 per patient on the same facilities.
  • The Johannesburg General spent an average of R319 per patient on pharmaceutical supplies while Baragwanath spent an average of R72.
  • Baragwanath spent an average of R30 on food provisions for each patient that year.

The Johannesburg General spent more than twice this amount on each patient The Johannesburg General had a 67,9 percent daily occupancy rate in its beds during the 1985/6 financial year. There was an average of 743,41 patients a day in the hospital's 1 095 beds for whites. Baragwanath had an average daily occupancy of 105, 1 percent: an average of 2 450,92 patients a day for the 2 331 beds. At the Johannesburg General, there was a total of 38 920 whites and 80 "non-white patients" admitted in 1985/6. At Baragwanath, there was a total of 120 380 black patients. Johannesburg General saw a total of 446 878 white out-patient and casualty patients in the 1985/6 financial year and no black patients. Baragwanath treated 1 344 720 "non- white" casualty and out-patients.  

This article originally appeared in the Weekly Mail.

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