Severe shortage of beds for newborns hits Gauteng
Rights commission panel grills provincial health chief who blames severe overcrowding for infant deaths
There were not enough hospital beds for newborns in need of care and ventilators in the entire Ekurhuleni metro, east of Johannesburg, last week.
This saw the Gauteng department of health rushing to find alternative places for babies who needed lifesaving care.
The head of the provincial health department, Prof Mkhululi Lukhele, used this example to illustrate the severity of overcrowding in neonatal wards.
In extreme cases the private sector had been approached for beds or ventilators.
Lukhele was asked to appear before the SA Human Rights Commission (SAHRC) on Tuesday following its investigation into health problems in the province in 2018.
He said overcrowding was behind infections. Six babies died from Klebsiella infection at Thelle Mogoerane Hospital in Vosloorus, Ekurhuleni, while there was also an outbreak of necrotising enterocolitis at Rahima Moosa Hospital in Johannesburg, which caused nine infant deaths.
The root cause of these problems was “overcrowding of hospitals”.
Lukhele said Klebsiella was a very common infection.
“This overcrowded system is a reality.” He added that infants who died had low birth weight, which made them very susceptible to infections, while some were born prematurely.
“The more you come into the world before Mother Nature has prepared you, the higher the risk.”
However, he said there were too many babies being born at specialised hospitals instead of smaller ones. “The majority of babies at Thelle Mogoerane should not be there. These low birth weight babies should be there.
“It is a challenge to turn back people who should be delivering at other clinics. If you do, the media reports he was chased away from a hospital.”
Suggestions to improve babies’ health and reduce infections included trying to have midwives at all facilities and encouraging low-risk pregnant women to go to smaller hospitals for antenatal care.
In response to the deadly outbreak, the Thelle Mogoerane Hospital neonatal ward has been moved to a larger, newly renovated space and special cleaning machines have been installed to make it easier for nurses to wash their hands.
“There is no way a visitor could get in there without washing their hands.”
Lukhele said that despite Gauteng Health being “caught out by overcrowding and high demand” it did not allow babies to share cots, as had allegedly occurred in other provinces.
Under cross-examination at the SAHRC, he covered many problems at provincial hospitals, including: Severe shortage of medical staff in hospitals;
Under-budgeting by the health department;
About R6bn owed to medical suppliers;
Exhausted and bad tempered staff;
Difficult decisions doctors had to make when facing too many patients and limited resources. About the ageing Rahima Moosa Hospital, Lukhele said poor “infrastructure was a high risk”. He suggested that in many cases hospitals would have to be rebuilt.
“The structure is really old and if you have to do anything you have to start afresh. Infrastructure is a challenge.”
When asked by legal officer Thenjiswa Nxumalo what was being done to keep specialists in the public sector and stop them moving to the private sector, he said: “NHI will solve this problem. The NHI and health systems are strengthening.”
Later, she asked him again, saying that when the commission investigated the long wait for cancer care, it was clear there were too few radiation oncologists in the state sector.
Nxumalo said: “The main issues were specialists in the oncology department. It is difficult to get them to stay. Can you please address this?”
Lukhele replied: “When it comes to oncologists, it is one of few scarce specialities. Ageing and HIV and cancer is increasing. HIV came with funny tumours as well.”
Radiation departments were placed at academic hospitals to entice specialists to remain in the public sector and become professors, and in some cases private doctors gave a day of their time.
SAHRC commissioner Buang Jones responded: “I am still not clear how you will retain them.”
Jones also asked Lukhele to expand on his promise that the NHI would fix things.
“We are always told NHI will solve a myriad of problems.”
But Jones said they couldn’t wait forever. “When will it [NHI] kick in?”
Lukhele said: “The challenge is setting and implementation. The UK system [universal health care] took about 40 years or so. It is something informed by WHO. They call it universal health care ... To not have health because you don’t have money means your human rights are compromised as a country. It’s something you can’t have coming tomorrow.”
He did not give a time frame or clarity on the NHI. Jones said the SAHRC would not issue a report with adverse findings on the Gauteng department of health but would “engage” with the department to find solutions and sign an agreement after the May elections.
“We will still continue to assert our powers where there are challenges and failures. We are hopeful an agreement will put forward lasting solutions.”