An audit this week reveals the gangrene of immorality eating away at Chris Hani Baragwanath hospital, writes Belinda Beresford
Vulnerable and in pain they may be, but patients at the world’s largest hospital have no guarantee they will even have sheets to cover themselves when they finally make it past the chaos of admissions into bedraggled Chris Hani Baragwanath in Soweto.
Bed linen is in short supply, stolen by staff or patients, on sale outside the hospital gates, or gone missing in myriad ways for example, a sheet stuffed down a toilet because a staff member didn’t feel like taking it to the laundry.
Nor is the ethos of the Hippocratic Oath much in evidence. Almost 40% of patients have been verbally and 9% physically abused by nurses. About 27% of patients have been verbally abused by other hospital employees such as porters, while 8% reported doctors as the culprits. Staff themselves back up the patients: almost half the clinical workers have seen one or more cases of verbal abuse of patients, and more than a quarter have seen physical abuse. Patients and staff report neglect and negligence in treatment and care.
Even higher numbers of staff report being attacked by patients more than 50% physically. There are anecdotal reports of guns being brought into wards, rape and sexual harassment. Theft, fraud and neglect are becoming part of the hospital’s culture, along with growing staff indifference to patients and colleagues.
A female doctor says that “doctors shout at patients, throw specimen bottles at them, patients are not seen for days on end and found a week later either dead or much sicker … Nurses drag patients along the passage by the pyjama collar. Nurses tell patients to go home and die; nurses drink tea and chat instead of attending to their duties.”
This was just one of the observations made by staff during a study conducted into Chris Hani Baragwanath by the Ethics Society of South Africa (EthicsSA). Commissioned by the hospital’s CEO, Dr Reg Broekmann, the R80 000 report records failures of management, of physical infrastructure, of morale and of morality. It also records the immense strain the hospital is under; staff numbers have fallen from 7 000 to less than 5 000. One nurse reported having to cope with 68 patients.
Almost 23% of staff members see nothing wrong with asking for “tips” from patients and one in five patients see nothing wrong in giving money to staff for service or treatment.
The study found staff values were questionable in other areas. Although three-quarters of staff said serving the greatest number of patients was top priority, next on the list was avoiding bad publicity regarded as a more important issue than a good work ethic.
Camera surveillance has failed to stop the haemorrhaging of medication from the hospital. In fact, the hospital doesn’t even know how much it is losing, because it has no idea how many drugs are dispensed legally through prescription, or illegally.
Problems run from the highest to the lowest. A female paediatric nurse complained of general workers going home at 10am while a doctor complained of consultants leaving at the same time. Other nurses have told of porters refusing to push patients to the operating theatre, leaving the surgeon and anaesthetists all scrubbed up with nothing to do, while the backlog of operations increased. EthicsSA reports that when doing the study doctors were the most reluctant to take part, some even ripping up the questionnaires in front of interviewers.
A third of the staff know of moonlighting colleagues. Broekmann points out that “some staff in fact moonlight in the daytime”. The prime culprits are doctors, many of whom concentrate on their private practices at the expense of Bara.
Security the lack thereof intimidation and violence were other major problems. One senior nurse was reported as saying that she couldn’t exert discipline, because she would be fearful of her own safety.
A major problem for managers is their restricted ability to exert discipline a point recognised by staff of whom more than 40% felt that management were basically powerless. A staff member cannot be fired by the hospital management, only by the head of the provincial Department of Health.
Broekmann believes that many of the problems are a result of the phenomenal stress under which people work, especially given the impact of HIV/Aids. Staff switch off and become uncaring in self-defence. The majority of staff are still proud to work at Bara, and Broekmann is confident that this reservoir of pride and goodwill means that the hospital’s “putrid” environment can be turned around.
But to do so requires the support of people outside as well as inside the hospital. The hospital is planning to ask the private sector for help in the form of donated expertise. It is also asking for more money and resources from the state to hire more staff and to get equipment. But the signs are not that good no one from the Gauteng provincial government bothered to turn up to be briefed on the report.