The 550-bed Kimberley general hospital has won a number of awards for management and innovation, and is considered a case study in transformation. In the past six years, it has expanded from employing 38 fulltime doctors to 115, plus 40 community service doctors and 30 interns.
How has it bucked the trend?
“We have the second-highest doctor-patient ratio, after the Western Cape. But we are really struggling to keep nurses,” said Dr Hamid Shabbir, the flamboyant CEO who could have stepped out of a Bollywood movie. Originally from Pakistan, the exuberant Shabbir has been with the hospital since 1993 and is now CEO.
“The critical thing in keeping professional staff is to provide sufficient respect and make sure that they work in a healthy, safe environment,” said Shabbir. “Salaries play a part, but they come a little lower.
“Just yesterday, I was approached by a group in Kuwait and offered R140Â 000 a month tax free to go and work there,” he said. “We can’t compete with things like that.”
Exit interviews with young doctors leaving the hospital established that most were leaving either to work overseas because they were under pressure to pay off student loans, or to go to an academic hospital so they could specialise.
“We took an important decision that has not happened in the country before. Whatever bursaries or loans a community service doctor has, usually about R150Â 000, we will pay off immediately if they agree to stay here for three to four years,” said Shabbir.
“Approximately 90% of the community service doctors have opted for this, and we are about to go one step further and offer this to the interns as well. We have also identified close to 40 students in medical schools from the Northern Cape and have offered to take over their loans if they come and work in the province.”
Kimberley has also linked up with the University of the Free State’s medical school in Bloemfontein and succeeded in being accredited as one of its training institutions. Those who need to be based in BloemÂfontein to specialise are also helped to do so.
But, said Shabbir, nurses remain a critical problem. Last year, enrolments at the nursing college doubled, and the previous year the intake was up by a third. But it takes four years to train a professional nurse, so the province’s 942 professional nurses have to make do for now. “Salaries are determined centrally, and we can’t expect a big renumeration package to fall out of the sky. But we would like all professional nurses to get the ‘scarce skill’ allowance,” said Shabbir.
The system is working, but it’s not without problems. Many nurses “moonlight” at private hospitals, said Sister “JP” Bezuidenhout, head of the accident and emergency and surgical units. Then they call in sick when they are supposed to work at their real jobs.
Back in the emergency unit, the nurses work flat out with little time for a break. The pressure is particularly high in medical emergency cases where patients do not have obvious wounds and the source of their pain needs a lot of investigation. Some of these patients have waited up to six hours before being attended to.
Ashton Boggenpoel, a community service doctor, was attending to a patient whose girlfriend had stabbed him in the face with a broken bottle. Boggenpoel stitched him up neatly, pulling the wound together tightly as he spoke of working conditions in the province.
The barren fruits of Kimberley’s bleak social environment manifest themselves in the unit: about 400 stabbings a month, mostly alcohol-related; approximately 20 attempted teen suicides; car accidents, usually alcohol-inspired, bring in another 300 patients.