Emergency: Help us help patients

"I really love my job. I love working here, but it’s just extremely difficult to look my patients in the eye and feel that I’ve done my best for them when I have to say ‘sorry we don’t have this really important medication’, for example," says a young doctor working at Chris Hani Baragwanath Hospital in Soweto while nervously fingering the stethoscope around her neck.

"We just feel like we let them [our patients] down."

She’s scared about speaking out — if she’s caught, the consequences could change the course of her career.

Eight doctors working at the hospital turned to Bhekisisa as a last resort to try to better their working conditions and, in turn, the quality of care they are able to give to patients.

Broken equipment, lack of essential medication and not enough resources to deal with the enormous patient load are just some of their concerns.

They say these are mostly small issues that could be easily fixed if management gave them enough attention.

"We’re expecting a knee-jerk reaction from the hospital: management will probably put more energy into finding out who the culprits are rather than improving service delivery, but we hope we see some change" the young doctor says.

"We’ve been through the avenues available to us — we put in complaints or make a noise to management about something and nothing gets done," she says. "This is a plea — help us to help our patients."

The doctors, who say they do not represent all staff at the hospital, shared their grievances with the Mail & Guardian by creating signboards stating their concerns and posing with them.

"At Lillian Ngoyi clinic, right next to Bara, there is no working electrocardiogram machine, which measures the heart’s activity and can detect a heart attack, enlarged heart or heart failure, as well as many other things. This simple piece of equipment is essential at a primary healthcare centre where hundreds of patients a day complain of chest pain. Without this machine patients are either sent home or get referred to Bara. We end up getting overloaded with these patients, some of whom needn’t have come to the hospital. The clinic should only refer emergencies to us but it is difficult to tell which is an urgent case or which is just acid reflux, for example, without this machine."

"Last year about this time in the medical ­admissions ward there was no cutlery for several months. Patients had to eat their food with tongue depressors [flat wooden sticks doctors use to look down a patient’s throat]. This still happens periodically in some parts of the hospital. What about the patients’ dignity?"

"I recall an obstetrics night shift in February last year — a first-time mother was waiting her turn to be seen. She was anxious and in pain and after hours of sitting on the narrow wooden bench alongside dozens of other women she repeatedly asked to see a doctor but was curtly told that she must wait her turn like everyone else. No doctor was ever notified of her condition. Eventually, she made her way to the toilets. I heard her screams and shouts of ‘my baby!’ from across the ward and arrived just in time to deliver the child on the floor of the toilet. The child had sustained some injuries. It was unclear whether this was a complication of the labour itself or due to the somewhat unorthodox delivery. The child, a boy, made a full recovery after several days in high care. When patients arrive they are rapidly assessed by a nurse and assigned a status — urgent or less urgent. This should be done by a doctor or a senior nurse but it is often done by nursing students.”

"A special x-ray machine used in theatre in the orthopaedics department — that is essential for some operations — was not available from February to about August. You need it for about 50% of the surgeries to check bone ­alignment while operating. About five to 10 patients were affected on a daily basis, with their surgeries getting delayed. Surgeries were often done without the machine and some had very poor results — the next day you would see the pins were put in the wrong place and the patient would have to go back into theatre to get that fixed. On a weekly basis, during these months, about one to two patients suffered botched surgeries. There was an elderly patient who stayed in bed for weeks waiting for hip surgery and developed a septic bed sore and had to go to theatre just for that. Elderly patients were also at risk of developing pneumonia and other infections because they were immobilised for so long — some even died as a result. These machines come with a guide to how often they should be serviced. Usually it’s annually or every six months, but they only get attention once they are completely broken."

"I was working in the ­psychiatry department [for four days] and the hospital was completely out of stock of an antipsychotic tablet called Risperdal. It’s a common drug that many patients need. We had to either keep these patients — many of them schizophrenic — in ­hospital where there are limited beds, or discharge them and give them a less effective version of the drug. It’s such an essential drug, it made me wonder how this shortage could ­happen at all."

"I saw a woman in admissions who was in labour. She had an abnormal CTG trace [foetal heartbeat] so I placed her on the emergency Caesarean section list but she ended up waiting all night. When she eventually got into theatre — second on the next morning’s list — the baby was in distress, which could mean any number of complications. Luckily, in this case, the baby survived. Each night we have 35 to 40 patients for Caesarean sections that take about 45 minutes each, with only two theatres running. Often on a Friday night half of the nursing staff don’t pitch, which means we can only run one theatre. There should be a secondary-level hospital in the area that can take the less complicated cases. Bara serves such an enormous population, we can’t cope."

"A good friend of mine was driving home after a 36-hour shift in the surgery ward and dozed off at the wheel. He ended up driving into the back of a truck. Luckily, he and the truck driver were uninjured but this kind of thing happens all the time. As an intern, especially in the surgery and internal medicine wards, you arrive at work before 8am then work all day and through the night. In the morning you do a ward round explaining the patients’ status to a specialist. After that you carry out the specialist’s prescriptions (schedule an ultrasound or blood test, for example) and you end up leaving work at about 1pm or 2pm — a shift of over 30 hours. You don’t often hear about this. I think it has to do with the idea that we’re supposed to be able to handle it, but so many of my colleagues have fallen asleep at the wheel. There should be a standard handover at 8am to another doctor who can take over after the ward rounds to finish the work for those patients."

Photos by Oupa Nkosi

"One of my diabetic patients came to hospital with a small wound on his heel that needed an operation to clean it. But due to long theatre lists as well as one of the vital members of the theatre team not arriving at work, this patient’s simple operation was delayed for about two weeks. He was discharged eventually and was given a date to come back, at which time he would be admitted again for surgery. He arrived back in an ambulance a few weeks later, before his return date, because he had developed overwhelming sepsis. The operation was done, but he died soon afterwards. It was extremely difficult to explain to the family how we could have discharged a patient who needed an operation."