Charlotte Maxeke Academic Hospital: A Whisper from the Past?

Its 4pm on a Thursday afternoon as I take my foster son to the Johannesburg General Hospital in Parktown. The “Gen” is now called the Charlotte Maxeke Academic Hospital after Charlotte Maxeke, an early 20th Century political and gender activist who is also the first known black female South African graduate. The significance of naming the country’s premier medical training facility after a re-discovered heroine escapes me at the moment. We pass the Wits Business School where I am supposed to be attending a master’s level course. I’ve also temporarily shut out the To Do’s pending on two work projects. Coupled to that, my wife is out of the country and my teenage foster son’s left side has ceased functioning as if he has had a stroke. I am stressed and stretched.
As we approach the ridge on which the Hospital sits, my phobia for public hospitals raises its very big head. I cannot remember a good experience with a public hospital and I pay a medical scheme a sizable amount each month to keep me and my family out of them. My foster child is a foreign national and therefore is not covered by my scheme. After sending us for MRI scans, our GP has strongly suggested we go to the Gen.
We arrive. My phobia immediately seems unfounded. A female parking guard is helpful and polite even though I’ve entered at the wrong entrance. She gives me quick advice on what my best course of action is and then allows me to park in the doctors’ parking bay. I’m pleasantly surprised to say the least.
My lifting spirits however soon come crashing down to earth.
My biggest fear with public health facilities is being killed through neglect. Like too many South Africans I have my bad memories. I’ve sat with friends and family on numerous occasions for eternities waiting to be attended to. A friend of mine lost a baby a few years ago at this very hospital purely due to nurses not attending to her or the child. Newspapers regularly report on cases of people dying in lifts or waiting rooms.
These fears wash back. Maybe they are groundless or maybe it is the well demarcated “Reception” area with no Receptionist in attendance. Or the “Information” Booth that stands empty. Or possibly the nurse who finally sees us after a long wait and abruptly asks: “What’s the Story?”
We tell her “the story” and she sends us to the Children’s section.
Here my flagging spirits attempt a revival. The Children’s section makes an admirable stab at being child friendly. There are bright yellow, blue and brown African murals of lions and suns and crocodiles painted on the walls. The place is clean and warm. It is not busy and there is a young female Indian Doctor on duty. I ask her if she can help me and she cheerfully promises to at least give us advice even if she can’t help us. The advice is to go back to the reception area and to open a file. I join the File queue. A 10 minute wait.
The Clerical officer is friendly and seemingly efficient. She gets all my details and that of my son. She asks how much our monthly household income is. I tell her. She lets out a loud YOOHH!
“Then they are going to charge you R350!” she exclaims. I stare back incredulously and ask her if she takes debit cards. She says no, clearly still shaken by the large amount I will need to fork out. I ask if there are ATM’s nearby and she directs me to them without any conviction. As she hands me my papers she makes a deal with me. I should first go and see the doctor and then come back to pay. “And maybe I won’t be here when you are finished”, she adds. I blink. Is that a hint? A reverse bribe? Don’t pay because you earn too much?!
I check that there are banking details on the invoice and go back to the Children’s Ward. We wait a short while and then are seen by another female Indian Doctor. She is very friendly and does a thorough examination of my son. She however doesn’t introduce herself or ask my name. The examination takes about 30 minutes.
She draws blood. I notice that she doesn’t use gloves.
She then sends us off to the X-ray Department. It is cold and crowded. The nurse behind the counter first finishes her conversation on her cell phone before attending to us. People stare blankly at us as we take a seat. An embarrassed young mother tries to quieten a crying baby. A young man lays on a stretcher in a neck brace waiting his turn. It looks like the modus operandi is for a Radiologist to collect a patient’s folders from the reception desk, holler out the persons surname and then walk off to their X-Ray rooms. The person gets up and follows. Most of the Radiologists are young, female and Indian. My tired mind wonders if there is a trend that is emerging in the South African medical field. One of the Radiologists comes and shouts out: “Mr Davids!” Mr Davids is a 60+ year old Coloured man who has a hard, eventful life carved into his face. He ambles off to return after 15 minutes. He sits down to wait. Next to him is a white man about the same age, in a smart dressing gown and slippers, hooked up to a drip.
We wait.
The Radiologist returns a little while later with Mr David’s X-rays. Mr Davids and the white gentleman stand up and leave together. They clearly know each other well. Two brothers-in -arms fighting on, in some old war movie comes to mind.
We wait.
The young guy in the neck brace is joined by another man on a stretcher. They lay side by side unattended. The brace guy groans painfully. My phobia about dying by neglect sweeps back. This is how I remember public hospitals. Finally they call my son’s name. He shuffles off for his X-Rays. The two guys on the stretchers are also finally wheeled off. My son returns. We wait. We get the X-Rays. Back to the Children’s Ward.
We wait.
The Doctor who had attended us is joined by the first Doctor who had offered me the ‘advice’ and another young black male doctor. None of them wear white coats. Neither introduce themselves or tell me what they are going to do with my son. He is scared. They proceed to do what I believe to be a Lumbar Puncture. Only one wears gloves. They draw fluid from my son’s spine and check for meningitis. It is negative. The others leave us with Doctor “Advice”. She looks at the MRI scans and X-rays. She is clearly concerned. She explains to me that the situation with my son is very serious. She does another extensive examination and then leaves the room.
We wait. And wait.
Another Doctor enters. He looks more like a teenager about to write Matric than a Doctor. He is young, chunky and nervous. He starts asking us questions. He also doesn’t tell us his name. He fidgets through all the same questions we have been asked by both previous doctors. I ask him if this is necessary. He says he is getting more details than the others did. His accent is hard to pin down but when ask: “who lives in yawl house”, I guess Durban. After getting down the detail he proceeds to do my son’s 3rd examination of the day. Or is it night? I wait as he methodically does the examination. I look around the room. It is clean and sparsely equipped. A tap drips.
Meanwhile Doctor “Matric” is in full examination mode. He is testing everything. After being here for 3 ½ hours I’m less than impressed. Is there anything more he could find that the MRI’s and X-Rays couldn’t? There is however no stopping him as he checks reflexes and mobility and vision as well as if we have running water and electricity at home.
He finally finishes. He says we need to wait for another Doctor. We make small talk as we wait. He complains about the salaries doctors are paid and the workload he has. I am obliquely aware of the raging storm between Doctors and the Department of Health.
Later Dr “Advice” returns. It seems she is Dr Matric’s “handler”. He gives a detailed report back on my son. She grills him on things he may have overlooked. They re-examine my son as they discuss the 11 cranial nerves and other things that fly over my head. I’m impressed with the thoroughness but overkill is overkill. The examination takes the best part of an hour. I have the distinct imagine of my son as a text book that Dr Matric has to cram for his next exam.
They finally finish. Dr Matric complains to Dr Advice about his workload and what he needs to do before tomorrow. He leaves.
He never did give his name.
Dr Advice says we need to wait for a bed for my son. She leaves the room.
We wait. It is now 5 hours since we entered the hospital. I get up and close the dripping tap.
We wait.
My son is tired and I am bored. My anaesthetized mind tries to make something of the situation and thinks that maybe the boredom induced by such long waiting is part of the therapy. The fear and concern I had for my son’s condition have been replaced by blasé numbness.
The boredom and time wasted waiting is one thing. What grates at the ego (or is it the soul) is however the feeling of being ignored while you are present. That no one tries to meet the patient or parent at an emotional level. That no one thinks they need to give a name or that mine is important.
I remember being asked by the boss of a motor repair workshop not to interfere with or stare at the Auto-electrician fixing my car’s lights. Just-let-us-do-our-job-and-stay-out-of-the-way. It’s the same feeling.
The other impression I get is that it is somehow my fault for being there. That I’ve done something wrong by bringing this sick child to the hospital. This notion comes in the form of a bustling nurse who enters the examination room. She has large faded floral overall on and she busies herself inserting a drip into my son’s arm. She interrogates me on why we have come to the hospital. Her questioning is accusatory and piercing. I feel like I need to confess something.
We wait while she writes away on a report sheet.
She leaves the room. We wait.
30 minutes pass. My son dozes on the examination bed.
The Floral Nurse returns. She checks the drips and asks my son whether he can walk or not.
While he tries to assure her that he can walk, she decided loudly for him that he can’t and that she’ll get a wheel chair.
She leaves. We wait. The wheelchair doesn’t come.
We wait.
Later my mother will matter-of–factly recall that my experience was the same as what she remembered back in the 1970’s when she worked in a public hospital. The waiting and the rudeness is common knowledge.
That our current public health system hasn’t changed since 30 years ago under an Apartheid government is a chilling reference. Surely it can’t be that bad.
We wait. The wheelchair never comes.
I finally take things into my own hands and inform Floral Nurse that we will walk to the ward.
We leave together. She directs us to the lifts. The Paediatric Ward is on the 8th floor of 2nd Block. As we walk to the lift my son comments on how big the hospital is. It is also remarkably clean and seems to have been painted recently. The walk to the lift is actually slightly heartening. We reach the lifts. There are 3. One has a ‘Maintenance in Progress’ sign on. Another one, I would discover later, works some of the time. The one we enter works perfectly. Its zooms up silently and elegantly to the 8th floor. I am impressed.
On the 8th floor we are greeted by newly painted, bright yellow walls and a row of Zakumis, the 2010 Soccer World Cup Mascot. The Paediatric ward is warm, seemingly well maintained and calm. We are shown to a room immediately. My level of impressed-ness revs higher.
We start unpacking. I open the bedside locker drawer. Cockroaches scurry away from the opening. My mirage of well-maintained cleanliness cracks.
As we unpack 2 nurses and an orderly enter. The nurses fire questions at me about why we are there, what exactly is wrong with my son and why I hadn’t given his medication at the correct time. I’m ready for these medical Inquisitions now. I plead ignorance. I get off with a sharp glare and a silent warning. They produce thermometers and consent forms. I sign. The younger of the nurses says curtly that they’ll take it from here and I can go now.
South African nurses have the reputation for being rude and cold. To their credit these two, and the ones I’ve met earlier, have tried their best not to damage that reputation in any way.
I leave after 6 hours, emotionally and physically drained. It will however turn out to be a 2 week sojourn with the Charlotte Maxeke Academic Hospital. I am there every day, sometimes for the whole day.
It is 4 days before I am able to meet the doctor attending my son. He only speaks to me after being called by the nurse because my son has been throwing up violently for a few hours. He challenges me on why I’m only coming to see him now. He retreats when I fire back about waiting for the last 4 days to speak to someone. I ask his name. He mumbles an indistinct reply, seemingly shocked that I could ask him such a personal question. He looks like (renowned academic) Prof Jakes Gerwel, so in my mind I end up calling him ‘Dr Jakes’. Dr Jakes recovers from the whole give-your-name-thing and starts giving me the low-down on my son’s condition. It is serious and he explains the various options of treatment that will be followed. He sounds knowledgeable and competent. The apprehension I have for my son’s health is slightly put at ease by at least knowing there is expertise and a plan behind the problem. Dr Jakes continues giving me a comprehensive outline on the illness, international research and possible outcomes. Dr Jakes clearly knows he stuff even though he does have a curious manner of staring into the distance while talking to you in a quite monotone, as if he addressing a lecture in the next room. I descend into my own fearful thoughts. But Dr Jakes is not done with me and seems drawn to converse with me, what with the-what’s-your-name-thing and all. He drones on in a quasi-intellectual monologue about people not coming to the hospital on time and how foreigners are filling the beds in the hospital. I’m not sure that I’m hearing what I’m hearing. He carries on about how the nursing staff is discouraged about not treating their own people and that what happened last May (with the xenophobic attacks) will happen again.
Possibly it is my extreme fatigue or the fact that you don’t want to upset the guy that’s looking after your kid – I just stare back stunned at what he has just said. In the time I’m at the Charlotte Maxeke, I only speak with Dr Jakes once again. I, to my shame, never get to ask him who a medical practitioner’s own people are.
In all I am there every day for the next 13 days.
In that time one sees many things in the wards, lifts and corridors of this titanic place. A premature baby is wheeled passed in an incubator; young children in school uniforms babble together on their way to the social work section; medical students with droopy eyes and files under their arms shout to one another across the corridors; a prisoner in orange overalls shuffles to treatment in leg irons accompanied by a disinterested policeman, groupings of medical professionals flock together chattering in medical jargon about ‘cases’; a woman argues loudly with her seemingly intoxicated male companion; smokers of all hues gather in the designated area to share a puff; people talk anxiously on cell phones. Most people look worried, sad or scared.
The overwhelming image you are left with is however about people waiting. Waiting in the reception areas, waiting at Casualty, waiting in the corridors, waiting at the X-rays, waiting at the Dispensaries. Waiting.
During our stay at the Charlotte Maxeke Hospital, Public Healthcare storms to the front of South Africa’s daily discourse. Most newspapers report that the public health system is on the brink of collapse. Doctors march on the Union Building wearing black arm bands mourning the ‘death’ of the public health system. There is a public outcry to revelations that truck drivers earn more than doctors and that doctors have been waiting for close on 2 years for a new salary grading system to be implemented. Articles, letters and phone calls from angry health workers fill our newspapers and talk radio shows. This is clearly a system in serious crisis, if not at war with itself.
It strikes me, as I sit next to my son’s bed waiting, that these revelations of the state of our public health system should hardly be surprising. My mother is right – our current system is exactly the same one that we experienced during Apartheid South Africa. In fact it is the same system that was imported into the Africa by the colonial powers and simply racialised by the National party government’s policies. All we’ve done is changed the names on the front door, taken away the ‘one race only signs’ and improved the technology. The culture and spirit of the system remain the same.
James Burke and Robert Ornstein in their book The Axemaker’s Gift point out that the roots of our modern public health system can be found in the early 1800’s and the French Revolutionary Wars. Burke and Ornstein note that the “situation (of) post-Revolutionary patients set the mode of behaviour between doctor and patient from then until modern times. In the main, patients were ignorant, illiterate soldiers accustomed to military discipline and being roughly handled by superior officers. With these wounded peasants began the modern reverence for the doctor of medicine, who from now on began to ignore the patient. Medicine was now free from therapy and healing (what the patient wanted) to diagnose and classification of disease (what the doctor wanted)”.
Cynically it isn’t hard for me to imagine Floral Nurse or Dr Jakes, doing their thing on the plains of Waterloo or the hospital ships of Trafalgar.
It comes to mind then that if making people wait and treating them as irritating distractions is the ‘front office’ way in the public medical sector, then very possibly it is the very same thing that doctors and medical staff experience when they try to engage with their superiors in the Department of Health. What’s that thing about chickens coming home to roost?
It is difficult to be unemotional or objective when trying to get a handle on public health in South Africa. Maybe because it looks, from the outside, as something that is so obviously screaming out for attention and not getting it. Maybe because South Africa is a sick country in need of healing; an unfortunate world leader in ‘third world’ epidemics such as HIV and TB as well as showing increasing and alarming incidences of ‘first world’ type maladies such as heart disease and diabetes. Or maybe it simply that the licence to treat people as illiterate and ignorant peasants was supposed to have been revoked 15 years ago.
And yet the doctors, nurses and administrative staff manning our medical system are ‘normal people’, I’d like to think, like me or you. These are not hoofed demons or callous sociopaths. They are instead, I believe, merely doing what is expected of them by the system they work in. A veteran nurse friend of mine confirms this by saying that the same medical staff found in the public hospitals, behave very differently once they move into the private medical sector. I wonder if it is because people in a private clinic can throw: “I’m paying for this” at you or is it because the expectations and working environment are different? I’m inclined to think it is the latter.
It occurs to me then, that the unintended significance of naming the ‘Gen” after a rediscovered African female heroine is profoundly evocative. In all South African cultures, black and white, it is considered rude and disrespectful to keep anyone waiting. In all South African cultures, to not introduce yourself appropriately is an insult. In all South African cultures, care for the vulnerable, the sick and the weak is culturally legislated. And in all South African cultures these values, norms and standards are usually promoted and protected by the mother-figure. Why then is it that people coming from those cultures leave those values at the door of our public institutions? Could it be that the naming of the ‘Gen’ is a serendipitous attempt to rediscover a humaneness that we’ve lost along the way. Or could it be that it is a quiet whisper in the ear from a long lost ancestor, to re-define our future by rediscovering what is excellent, dignified and compassionate about our past?
In President Jacob Zuma’s first State of the Nation address, he promises to give urgent attention to the public health system. The Presidents attention, the Doctor’s march and intense media attention have put Public Healthcare front and centre on the public stage. High level meetings are being held. Important decisions are being made. One hopes desperately that this attention will as a priority, focus on paying skilled professionals what they are worth, retaining them in the country for the good of our people and ensuring that they have every resource needed to do their jobs effectively. One wonders if you can also hope that the system would also take the opportunity to take a good look inward beyond the noise. To possibly take a look into its soul and assess whether it is possible to (re)train our health professionals and administrators in the fading tradition that is the spirit of uBuntu and in the very real need for ‘therapy and healing’ that is asked for by all of our people.
On the day of the State of the Nation speech, my son is discharged. We take the ‘good’ lift down.
Next to the Block 2 lifts on the Ground floor is the Hospital’s Vision Statement. It states that Charlotte Maxeke Hospital wants to be an “Accessible, Efficient and Caring Hospital”.
Reflecting on our stay, I must admit that accessibility has not been a problem. However if www.dictionary.com defines ‘efficiency’ as the ability to accomplish a job with a minimum expenditure of time and effort and ‘caring’ as serious attention, protection and solicitude, I am in a conundrum. My son it seems has been accurately diagnosed and treated for his medical condition. The ultimate objective of him making a full recovery is being achieved. But the time it took for this to take place and the dehumanised manner in which we have been treated leaves me ambivalent to the staff that works at the Charlotte Maxeke.
And then again, I suppose as we walk away, if we want a health system that is Accessible, Efficient and Caring, then like the lifts in Block 2, one and bit out of three...maybe is as good as it gets.
And if we want more...
Then maybe we should just...
Wait.