Senior clinicians have warned of a healthcare crisis if Charlotte Maxeke Academic Hospital remains closed. (BigFive Images/ Gallo)
Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) was ravaged by fire on the night of 16 April 2021. A small fire, which started in a store area on the second floor, ran out of control resulting in the eventual collapse of part of the parking structure on the third floor, and subsequent structural instability of parts of the northern side of the hospital.
That night will remain ingrained in the minds of all staff who worked at the hospital at the time – frantic messages and calls for “all hands on deck” with many clinicians, from interns to heads of department, coming in to evacuate patients amid smoke and the fear for their lives and the lives of their patients.
Patients were moved out of every ward in the hospital by doctors and nurses via the lifts despite the fire raging below, as many were unable to walk or get out of bed, to the main entrance of the hospital where an emergency evacuation took place. The sheer logistics of evacuating the hospital was astounding – more than 800 patients moved to one of ten or more facilities across the province in the space of twelve hours. Patients were moved to facilities nearby, such as Helen Joseph Hospital, and as far away as Steve Biko Academic Hospital in Pretoria, Far East Rand Hospital in Springs and Dr Yusuf Dadoo Hospital in Krugersdorp, with the teams managing them following to continue clinical care.
The 1 088-bed Charlotte Maxeke hospital opened in the late 1970s. There are five blocks, each housing a specific discipline, with some overlap. The main corridor of the hospital, Hospital Street, is 350 metres in length and is located on the fifth floor. The four floors below house three floors of parking and one service floor, known as the tunnel, with the four floors above housing wards and theatres. Each floor above the fifth has an “inter-floor” housing electrical and plumbing fixtures, meaning that the top floor, the ninth floor, is effectively the 13th floor.
The area affected by the fire was the entire north side of Block 4 (Medical) as well as parts of Block 3 (Surgical) and Block 5 (Medical). This has resulted in the closure of nine wards, including the infectious diseases, pulmonology, cardiothoracic, psychiatry, renal and neurology units, and three ICUs (general ICU, cardiothoracic ICU and coronary care unit).
The wards in question account for 270, nearly one quarter, of the hospital’s beds. In addition three areas used for outpatient clinics are also closed, including one of the first HIV clinics opened in the city and areas used for multidrug-resistant TB, renal transplants, cardiology, neurology and dermatology clinics. The devastation this has caused to patients in Johannesburg and the pressure placed on other facilities is unmeasurable.
Nearly 2 000 parking bays have been affected by the fire, resulting in staff and patients parking on the road surrounding the hospital, with many cars stolen and broken into over the past few months. A deal was brokered with the University of the Witwatersrand for the use of 300 bays, but with the return to in-person teaching this parking will return to Wits in January 2022.
No effort has been made to find alternative parking for staff in the six months since services resumed at CMJAH. A tender has only recently been advertised and closes on Christmas Eve, meaning alternative parking is unlikely to be available until the second quarter of 2022.
Morale among staff at CMJAH is at an all-time low, with constant challenges experienced following the fire. Clinical services have been curtailed given the loss of physical space — patients are constantly turned away given the lack of parking and limited access to the building with frustration and discontent building among staff given the lack of communication from the Gauteng departments of health and infrastructure development.
An open letter to President Cyril Ramaphosa, penned by the head of internal medicine, begging for help in expediting repairs to the hospital has gone unanswered without any acknowledgement of its existence.
Doctors and nurses remain in state practice because of a sense of duty and social responsibility. After all, private practice is far more lucrative, yet many are now looking at alternative options given the daily hurdles faced at CMJAH.
CMJAH staff and management remain in the dark regarding repairs to the affected parts of the hospital, with no work commenced besides the propping-up that occurred following an initial delay of two months. The Gauteng department of infrastructure development has given vague guarantees of the second quarter of 2022 as a probable start date for repairs but this lip service remains mere “pie in the sky” as no guarantees made to date have been fulfilled.
No definitive plan has been offered to the section of the hospital that was damaged by the fire and the concern remains that a lack of available funding is the reason for this. This is evident given that initial repairs to the hospital, to the block furthest from the fire, are being undertaken by the Solidarity Fund and this only after much reluctance and many challenges from the infrastructure development department.
CMJAH is one of South Africa’s flagship hospitals, providing quaternary level care to southern Gauteng and, together with Chris Hani Baragwanath Academic Hospital, to parts of the North West, Mpumalanga and Limpopo provinces. We cannot allow this hospital to remain unrepaired for much longer without grave consequences to our patients becoming a reality.
It is imperative that a solution is found. The infrastructure department’s financial year began in April 2021 yet no money has been made available to aid with the repair work despite the fire occurring 16 days into the financial year. We ask for accountability and transparency of funding and spending to date from the health and infrastructure departments, excluding what has come from the hospital’s normal budget.
We call on the auditor general to investigate and disclose the budgetary spend to date as the public and the staff of CMJAH have a right to know where their tax money is being spent to help us understand how lives can be put at risk and why and how can we allow a fractured health system to be further compromised.
The impact of the apathy of the relevant Gauteng departments has far-reaching consequences in the short term, but this lack of investment further undermines the vision of the NHI. The silent voice of the ministers of health, finance, public works, and the presidency following the open letter penned a week ago is deafening.
It is time for the government to remember that they work for the people, not for themselves, and perhaps instead of more of the same, corruption and self-enrichment, focus can be turned to the needs of the people. If the government is unable or unwilling to expedite the repairs needed to ensure our patients’ basic constitutional right to access healthcare perhaps now it is time for them to admit their inability to solve this problem and to investigate a private-public partnership to repair our facility?
The Solidarity Fund, which has proven its track record in the last 18 months through the rapid completion of two ICUs, both activated within six weeks, likely at a price cheaper than the usual tender proposals, is the perfect group to lead this. Let’s give a tax break to all those who contribute to the rebuilding of CMJAH similar to the Covid-19 tax break. Hand over the responsibility of the project to a public-private partnership with the Gauteng departments of health and infrastructure development with the clinicians of CMJAH serving as oversight. This can be done under the leadership and guidance of the national government, but the time for action is now.
In this, the year of Charlotte Maxeke, we are reminded of the quote that sits on the wall of our hospital: “This work is not for yourselves. Kill that spirit of self and do not live above your people but live with them, and if you can rise, bring someone with you.”
Stop the blame game. Stop the lies. Stop deferring responsibility and accountability. Help save the Charlotte Maxeke Johannesburg Academic Hospital.