In the heart of the Cape Flats,, located conveniently near Gugulethu and Mitchel’s Plain lies GF Jooste Hospital, a second level hospital that services the 2 000 000 people that live in this densly populated, incredibly low SES area. From the outside it’s a sprawling single story building with lots of security bars and barbed wire, but nothing special, but inside is a maggot infected wound.
According to the senior medical consultant and professor of medicine 14000 people walk into its door, only 9000 of them are permitted to see a doctor and only 3000 of them get admitted.
This compared to the relative luxury of Victory and Summerset hospitals, which serve 1 500 000 people, of which a larger proportion of patients use private sector hospitals. Victoria and Summerset have significantly fewer patients presenting to casualty of which a higher proportion are likely to be admitted for a longer period of time when compared to GF Jooste.
The casualty ward of Jooste is a room of human suffering. After people are triaged they go through to the casualty room and might be seen by a casualty officer. There is a 4 bedded cubical with separating curtains for resuscitating patients and then a much larger area where the bed-bound patients wait to see whether they are sick enough to be admitted. 6 beds line the one wall and 4 beds and 10 chairs line the other. In the middle of the room are medical supplies, desks and chairs for the doctors to work at. The room seems unreasonably spacious compared with the rest of the hospital.
Adjoining the casualty room is the holding area where patients sit or, if at deaths door, lie and await a bed. Those who were either too well to qualify for admission or too sick to survive long enough to be admitted have been turned away. Here patient in pain, feeling sick, some actually verging on dead can wait for up to 72 hours before a bed becomes available to them. Most of them have been awake for days and are significantly ill. En suite to this room is a room with blacked out windows where the screams and noise of psychotic patients add to the ambiance.
There are 2 medical wards at Jooste, each with about 45 beds. Approaching the wards the stench of faeces, urine, vomitus, sweat and / or sputum is overwhelming. In order to qualify for one of these rare beds a patient needs to be incredibly ill. People die all around, flies and fly paper and hangs from the ceiling and infectious diseases, such as multi- and extremely-drug resistant TB, permeate the air. The lack of important medical supplies such as soap and dismed is very noticeable.
Patient care and available resources are the primary problems affecting Jooste. Patient care issues primarily stem directly from lack of resources. The lack of resources stems directly from the government. The issue is categorically not an issue of resource distribution, but rather of resource allocation.
Victoria and Summerset hospitals are second level hospitals with which comparibility is possible. Groote Schuur is third level hospital which is also severly, horrificically understaffed and under-resourced. It makes no sense redistributing resources from Groote Schuur to a second level hospital because there will still be the same number of complicated cases that will need to be transferred from the second level hospital to the third level hospital. If resources are redistributed as above and more patients are seen at second level hospital, more patients will need to be transferred to third level hospitals, which would have fewer resources and more patients.
Redistributing resources from Victoria and Summerset hospitals to Jooste also does not make sense to me. Victoria and Summerset hospitals are functioning well and managing their patient loads adequately. If resources are redistributed from them it would result in failure of these hospitals to function properly in exchange for Jooste possibly function better. This makes no sense because one problem is being replaced by another problem. It is extremely illogical to break something that is working properly in order to fix something else. All the hospitals need to be working.
Furthermore the creation of additional primary level hospitals will hopefully increase access to health care for many people. This will result in more referrals to second and third level hospitals which will further buckle under the strain. It makes very little sense for the government to redistribute funds from higher level hospitals, which are already functioning at a sub-optimal level, to lower level hospital because this will put additional strain in terms of workload on the higher level hospitals at a lower resource level.
The resource problem at Jooste is so sever that the senior consultant was forced to choose between buying toilet paper or ceftriaxone – a life-saving antibiotic. The size of Jooste, in terms of bed, staff, equipment, medicines and facilities is in no way sufficient to serve its population. Human beings are suffering tremendously because of this foresight.
In one of the largest growing populations in South Africa, where millions of people that were disadvantaged by the Apartheid system, a hospital is desperately struggling to meet the needs of its population but its success is seriously limited because of a lack of resources from the government. The solution is simple in concept, but obviously less so in implementation. Jooste needs more money from an increase in health budget allocation, not from redistribution from other core health facilities.
In light of the fact that it would be a serious foresight to actively try to decrease the funding and quality of one service, especially one only just functioning, in order for it to be at an equal to another inferior service In keeping with the South African health rights charter and the principles of Batho Pele the local, provincial and national governments should assess the situation and Jooste and act rationally and local to make sure that they are maintaining their responsibility to the people of South Africa.
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