A doctor recounts the challenging and shocking realities of working in resource-constrained hospitals.

Most medical professionals who have worked in South Africa have probably worked in a resource constrained hospital or facility at some point in their career, especially while they worked for the state. We all have our own stories and experiences to share. I am going to share a few of my experiences.

During my two years of internship I worked in a tertiary level hospital which was the only tertiary hospital in the province and the main referral hospital for the province.

The hospital has five floors and three sets of elevators. The first elevator set is in the front of the hospital and goes to all floors and wards. The middle set of elevators can only go from the ground floor and to the fifth floor theatre complex. The third set of lifts at the back of the hospital can go to all floors as well.  

The lifts in the hospital are so old that frequently either the front or back lifts would not work, which would mean patients needing to go to theatre from floors two to four would often be cancelled because of the elevators not working. This meant that patients who were on the emergency list could only be admitted to the ground floor wards because the middle lift was the only one able to go to the theatre complex. On some days, patients would walk up the stairs to theatre and then lay in recovery on the fifth floor until the lifts were fixed.

Another problem that frequently occurred was that there would be an electrical outage at the hospital and only the back-up generators serving the theatre complex would be broken. So while the rest of the hospital would have back-up power to continue caring for patients, theatre would be left in the dark. This resulted in surgeries that were in progress being completed with phone light torches, and three or four ventilator machines being used to complete one surgery because the battery on the machines did not last long enough!

Water is also a massive issue in the town where the hospital is located. The water can easily be switched off for three to four days at a time and the tanks at the hospital only supply the essential wards, like the renal ward, for example. As the theatre complexes are not deemed as ‘essential’, only red emergency cases would be done during this time, meaning all elective surgeries would be cancelled and rescheduled. The operating doctors would have to each scrub with a 500ml bottle of sterile/prepared water and after the surgery have the same amount of water to wash with.

While working at another hospital in the same town during one of these prolonged water shutdowns, the hospital was without water for many days and did not have any water tanks for backup. The nursing staff had figured out that the fire hydrant water came down pipes from the roof and that if they pulled the chain hanging down from the roof the water would come down. So, during these times, large black rubbish bins would be filled from this water and then taken into the bathroom in smaller containers for washing and flushing toilets.

On one particular Saturday afternoon in the casualty, it was so busy that all the beds were filled and all available ambulance stretchers were also occupied. When another emergency came in, the patient had no other place to lay but on the Lodox bed (x-ray machine). The patient had to lay on that hard metal bed for at least four hours before another bed could be made available.

We also had the common shortages that I know many state hospitals experience. Linen shortages is a widespread problem, meaning that patients almost always bring their own linen, and if it was an unplanned admission, often sleep with nothing.

A chronic staffing issue persists too. The radiology department was regularly very short staffed and would be closed between 4pm and 7pm daily with no CT scans being done after 10pm. To make matters worse, when the department was staffed enough to function, the CT machine would then malfunction, which meant no CT machine for the entire province. Patients that needed very urgent scans would then be referred to private facilities.

We also had the usual shortages of drip and blood drawing equipment such as short lines of certain gauge needles. Interns are very resourceful, soon learning which wards are the most well stocked and taking a few extra resources whilst working there. A emergency stash of your own needles, syringes and plasters quickly builds up because you do not always have time to spend 10 minutes looking for a certain piece of equipment.

I know all these experiences and stories may seem negative and portray the health system in a bad light, but all of these experiences are important and necessary to point out because they equip and shape us as doctors. They teach us valuable skills and levels of adaptability that we never knew we had. It is important to remember these experiences are over a long period of time and they are not necessarily the standard for day-to-day functioning in a facility, but they do happen and we should be ready for them.