Gauteng running out of nurses

Gauteng medical staff, overwhelmed by growing numbers of Covid-19 patients, now also have to worry about a staff shortage.

The crisis is linked to the closing of Johannesburg's Charlotte Maxeke Academic Hospital in April because of a fire. Nearly 3,000 medical staff at the hospital, many of them specialist nurses and doctors, were seconded to other hospitals.

This week Charlotte Maxeke CEO Gladys Bogoshi revealed that her staff were running a Covid-19 ward at Chris Hani Baragwanath Hospital, a 120-bed Covid-19 ward, a 10-bed ICU and a 14-bed high-care unit at Germiston's Bertha Gxowa Hospital, a 20-bed general ward at Leratong Hospital and a 23-bed ICU ward at Helen Joseph Hospital.

Charlotte Maxeke's partial reopening this week was meant to be good news, but an apparent lack of communication about plans for how and when patients and staff will return has stoked fears of a staff crisis.

Helen Joseph Hospital staff said their situation was "beyond a catastrophe". An emergency room worker said: "With the closure of Charlotte we had to deal with a large number of additional patients. Then the third wave hit and our patient numbers soared."

They deal with rising patient numbers and worsening shortages of supplies.

"That's because of the additional Charlotte patients. We have run out of basic supplies. For weeks we have been short of syringes, certain needles and intravenous tubes," the hospital worker said.

"The situation is so bad that, on average, we have to hook up four patients to an oxygen port. At the peak of the first wave we averaged two patients to a port. Four patients to a port means they get less oxygen. Patients are sitting on floors as close as possible to beds to ensure they are first in line for the next available oxygen mask."

She said that on average the hospital had 70 patients a day waiting in the emergency room for space in wards.

"The fear is staff will leave but their patients will remain because there is no proper plan to move them or they are too sick to move."

Helen Joseph Hospital CEO Relebohile Ncha and Bertha Gxowa Hospital CEO Zodwa Mofokeng referred questions to the Gauteng health department.

Leratong Hospital CEO Dr Dieketseng Moloi dreads the day when Charlotte Maxeke staff leave. "They meant the difference between life and death [here]."

She said Leratong has recruited six more doctors but it was difficult to find experienced specialised nurses who could operate ventilators.

"With patients from the third wave overwhelming us, lots of nurses we had, had to help with Covid-19 screenings and vaccinations. If the [Charlotte Maxeke] nurses leave soon I don't know what we will do because we have not had time to recruit additional staff," said Moloi.

Charlotte Maxeke emergency doctor Suheyl Essa said there were discussions to get staff back to the hospital soon "but everything is up in the air, with no one knowing what's going on".

Dr Angelique Coetzee, who heads the South African Medical Association,
said: "Now, when the country is in the midst of the third Covid-19 wave, the government is suddenly running around trying to stop our health system from collapsing. It's too late."

She said if Charlotte Maxeke's reopening was haphazard there would be the risk of a staff shortage. "Thousands of patients, too sick to be moved, risk being left without the necessary care."

Professor Daynia Ballot, head of the Wits School of Clinical Medicine, said since 2010 there had been a shortage of about 47,000 nurses.

The Democratic Nursing Organisation of SA said it doubted that the government would be able to hire competent people to fill the gaps.

The union's Gauteng leader, Bongani Mazibuko, said finding experienced and qualified ICU nurses would be hard. "We've always had a skills deficit in that area, now with Covid you can just imagine what is happening."

According to Mazibuko, an ICU nurse is supposed to care for only one ICU patient but at the moment, in Gauteng, they care for three or four patients each.

"What they also did was to take the same nurses who were working in clinics and hospitals and put them on the [vaccine] rollout programme," he said.

Victor Mendoza, of V&A nursing agency, which arranges placements countrywide, said his agency had so far been able to acquire staff from outlying areas like Hammanskraal outside Pretoria, and Brits.

He said there were not enough speciality nurses because the South African Nursing Council had not accepted new intakes for such nurses "for the last couple of years".

Gauteng health department spokesperson Kwara Kekana said 526 doctors and about 2,000 nurses from Charlotte Maxeke had been deployed to hospitals across the province. "The staff return is planned to be done in phases," she said.

Bertha Gxowa's staff complement was sufficient for the number of allocated Covid-19 and non-Covid-19 beds. "An additional 174 Covid-19 posts were approved from October 2020," said Kekana.

At Helen Joseph Hospital, Kekana said, "the hospital has a recruitment plan of filling posts as soon as they are vacant, and to continually request additional posts".