Lynda Gledhill
At Coronation hospital in Coronationville on the West Rand, tiny infants, born premature and just days old, lie inside incubators struggling to breathe as nurses check their vital signs and mothers sit by their sides. Outside this ward, the hospital is struggling to overcome new hurdles and re-emerge as a viable, respected medical facility.
After fighting off threats of closure and finding a niche as the only women and children’s hospital in Gauteng, Coronation is now facing tremendous staff cuts that may force a reduction in services.
The Department of Health has ordered budget cuts that in the next year will cut the nursing staff almost in half, said Coronation’s superintendent, Dr AW Manning.
“With the elections next year, all they care about is maintaining fiscal discipline,” he said. “Maybe beyond the election we will have better talks than we are having now.”
The cuts come just as Coronation was starting to get back on its feet after decades of struggling to provide services, Manning said.
Coronation was built in the 1940s to serve nearby Sophiatown, said Professor Justus Hofmeyr, who has worked at the hospital for 10 years and helped oversee its transformation. When the township was destroyed, Coronation shifted its focus to serving Indian and coloured residents in areas like Eldorado Park.
Meanwhile, only two kilometres away, JG Strijdom hospital – now Helen Joseph – was built as a whites-only hospital. Wits University withdrew its backing of JG Strijdom and the hospital began to decline.
“In the 1980s we were unacceptably overcrowded,” Hofmeyr said. “Our capacity is 350 beds and we had 550. Meanwhile JG Strijdom was three-quarters empty.”
When hospitals were desegregated, competition between the two facilities heated up. While JG Strijdom had newer facilities and more equipment, staff at Coronation did not want to lose the connection they had with the community.
At first, JG Strijdom was designated a specialist hospital, while Coronation was kept as an academic, primary care institution. But Hofmeyr said this arrangement never really worked. “It was seen as a downgrade in services,” he said. “The services here declined while those at JG Strijdom picked up. The staff at Coronation were very unhappy.”
Three years ago the system was completely overhauled to try to achieve a balance of services at both hospitals, Hofmeyr said. JG Strijdom maintained medical and surgical functions, while paediatrics and obstetrics moved back to Coronation.
“This is only the second year we are fully functional,” Manning said. “We had to re-identify ourselves. It is only in the past six months that we are beginning to see the fruits of our labour.”
Efforts include creating paediatric wards with brightly painted cribs and dancing bears on the curtains. A few toys are scattered about to help mothers entertain their sick children.
While Coronation maintains critical and primary care clinics, these will most likely be one of the first things to be cut, Manning said.
“It will be difficult, from the community’s point of view, because they have always seen it as their hospital,” he said. “They could always walk through our doors.”.
Coronation and Helen Joseph now work together smoothly, Hofmeyr said. Shuttle buses take patients and staff back and forth, and doctors consult at both facilities. However, Manning said there is still a lot of tension among the nursing staffs and administrations.
“They still don’t see eye to eye on many things,” he said. Manning said there are many areas where it would make sense to combine, such as eliminating one supervisor and nursing matron. Also, maintaining one full pharmacy and having a distribution centre at the other facility.
Manning said budget constraints may eventually override other concerns. “The important thing is that Coronation does not lose its identity,” he said. “It should remain a speciality hospital and amalgamate only at a certain level.”
Hofmeyr said Coronation has begun to come into its own in terms of research and innovations in women and children’s health. It offers some very specialised services and receives patients from throughout Johannesburg. However, staff cut backs may threaten some of this work.
In addition to reducing nursing staff from 402 to 266, Coronation must cut eight doctors and about 80 support staff, Manning said.
“It’s quite dramatic,” he said. “You hit a critical mass and then you simply can’t maintain services any more. We will need to be creative.” Manning expects to close another 20 beds, bringing the total open down to 267, out of a possible 353.
Coronation’s challenge is to prove that it is a system that works, Manning said. “We need to sell the philosophy,” he said. “We don’t fit into some neat category. This is what Coronation has been doing since it was founded, and why staff have such a strong commitment to maintaining the hospital.”
“Everyone who works here is proud of our tradition,” Manning said. “During apartheid we still managed to be an excellent hospital that stood out above others. We still have this identity.”