Groote Schuur Hospital
Groote Schuur Hospital is one of the major teaching hospitals of the Associated Academic Hospitals' group. These hospitals are integral components of the Health Service of the Provincial Administration of the Western Cape. The main functions of the hospital are to provide patient care(especially at tertiary and higher levels), teaching and research.
This handbook is not intended to be an antibiotic textbook nor to replace the antibiotic section of the SAMF. Its function is to indicate the GSH antibiotic recommendations and to provide some additional therapeutic suggestions for a number of clinical situations.
THE dog-eared clinic card may one day be little more than a curious historical artefact if government's ambitious plans to overhaul the way patient records are stored is successful. The dream is that one day every South African will have their own smart card containing their entire medical history and current conditions * vital information that could mean the difference between life and death in an emergency.
Furious doctors are planning to march on parliament, and may even go on strike, over what they say is a crisis in South African medicine. They have: hit out at chronic under-funding by the government and the halving of budgets; claimed that the department of health is spending more on bureaucracy than patients; complained of appalling pay and working conditions; and, threatened to emigrate in their hundreds. The doctors' dissatisfaction has grown to such a degree that the SA Medical Association has become an affiliate of Cosatu. A weekend conference in Johannesburg to discuss strategies for doctors' survival was peppered with war talk. Dr Kgosi Letlape, head of the Medical Association, said although doctors were essential personnel and may not strike, this drastic action was still a possibility. But first we need to raise public awareness about our plight. Letlape said it was time for doctors to join forces and stand up and fight. We have been at the bottom of the food chain for too long. We are not going back. We will negotiate with the government. But if deafness ensues, we will resort to sign language, he warned. The doctors' anger was fuelled by the last-minute pull-out from the conference by the minister of public service and administration, Geraldine Fraser-Moleketi. She said she wasn't able to address the pay and working conditions of public sector doctors. Letlape said the association had tried desperately to create dialogue with the government but doors had been slammed in its face. If there is anyone out there with other remedies, herbal or otherwise, please try to help us, he said. Dr Mark Sonderup, chairman of the SA Registrars' Association, who works at Groote Schuur Hospital, said a sore point was the chasm between administrators and clinicians, as well as expensive top-heavy administrations. Groote Schuur, for example, had appointed a new chief executive officer and seven or eight medical superintendents since 1996, along with healthcare and nursing managers. There is a huge bureaucracy running a hospital that has lost half its beds in the past seven years. They seem to be spending less money on care and more money on administration systems, he said. The joint budget for Groote Schuur and Red Cross Children's hospitals was R1,1 billion in 1996. That had been halved to R525 million this year, but hospitals in the area were seeing one million more patients a year. Money is falling down the pyramid, allegedly to primary healthcare, but it's definitely not reaching those people who really need it. Is it going into administration and bloating the bureaucracy? Sonderup asked. Dr Timothy Berlyn, of the Junior Doctors' Association, said: As many as 60% to 70% of my friends in the medical sector plan to emigrate. Another 20% will stay to specialise and then they will leave. The majority of the rest of them will migrate internally - to the private sector. He said the migration was having an avalanche effect. As doctors left, those left behind picked up a bigger burden and became stressed. Then they left. It's a never-ending cycle. Professor Denise White, chair of the Medical Association's committee on public sector doctors, said she wasn't working in the public health sector for the money. We just want a fair deal to serve the people of this nation. White said the association had made many submissions to the department, but was stonewalled - something it would no longer tolerate. White said problems with working conditions included: understaffing, lack of essential medicine and equipment; inadequate support and supervision of junior doctors in rural areas; declining capacity for supervision and training of registrars; poor living conditions for community service doctors; lack of security at work; burgeoning patient loads; and the burden of diseases like HIV/AIDS and TB. (Di Caelers: The Cape Argus, 22 September 2003)
The nursing shortage in Cape Town and surrounding areas is so bad that many managers won't give their staff time off to do advanced training courses. The advanced midwifery course at the university can accommodate 10 nurses, Clow said, but this year has four students. The child-nursing course, which can accommodate 15-20 nurses, has only nine. The Independent in London reported yesterday that Britain is continuing to loot the poorest nations of the world of their skilled medical staff to shore up the National Health Service (NHS) in defiance of a 2001 government ban on the practice. Figures from the Nursing and Midwifery Council (NMC) released yesterday show that 3 472 nurses from countries on the banned list were registered in the UK last year - almost a third more than the 2 638 who were recruited from developing countries two years ago, when the ban came into force. Most of the banned nurses are from Africa, where recruitment was 41% higher last year than in 2000/01. The biggest source is South Africa. The country supplied 1 480 nurses to Britain in 2002 and this year to date and a total of 6 739 over the past five years. NHS trusts are still critically short of the nurses they need to hit government targets to treat more patients and cut waiting lists. Although the NHS has recruited 37 000 more nurses since 1997, there are still shortages. Overseas recruitment is a way to fill the gap and NHS trusts are using private recruitment agencies to get round the ban. (Source: Jo-Anne Smetherham and Jeremy Laurence: The Cape Times, 13 May 2003 )
SA Medical Association chairman Kgosi Letlape has criticised Western Cape's health department for attempting to cut doctors' overtime pay, saying that a reduction would encourage them to leave the public health system and compromise patient care. The department has been embroiled in growing controversy with doctors over the past week. In addition to trying to reduce overtime pay, which accounts for about 30% of doctors' pay, the department has put a stop to non emergency heart surgery at Cape Town's Groote Schuur Hospital and Red Cross Children's Hospital until the end of the financial year. It has also banned medical personnel from speaking to the media. Letlape, met staff of the province's three tertiary hospitals and associated psychiatric facilities, said that the province had no right to tamper with a national agreement between the association and the national health department governing doctors' conditions of employment. The association would raise its concerns with the provincial government and the central government, he said. Letlape said there were other ways spending could be cut, such as cutting back on the administrative cost of having a national health minister and nine MECs. For doctors in Western Cape, the overtime pay issue is the culmination of a number of events affecting their earnings and working conditions. Promotions in the public health-care system have been frozen for the past 18 months, and a moratorium on filling vacant posts means that many doctors are working longer hours. (Source: Business Day 01 October 2002)
Research and training at Groote Schuur Hospital is set for a big boost with the opening of the state-of-the-art University of Cape Town Medical Centre, which will offer top-class treatment at cut rates to medical aid patients. The result of four years of intensive planning, the unique hospital will use the world-class specialists and other staff at Groote Schuur Hospital to provide medical care to patients who can afford to pay. But indigent patients will benefit too, with access to the most up-to-date medical equipment possible, thanks to the partnership between the University of Cape Town, the Western Cape provincial administration and Rhon-Klinikum, one of Germany's leading private hospital groups. Groote Schuur specialists have hailed the hospital, opened officially on Friday, as the answer to teaching and research constraints, the result of shrinking healthcare budgets that have hit the province's tertiary hospitals. With numbers of operating procedures restricted by budget cuts at Groote Schuur, the chance to gain experience in these procedures has been restricted. That, combined with the fact that equipment in the hospital is often old, has resulted in a drain of many medical staff to better-equipped private institutions. Njabulo Ndebele, UCT's vice-chancellor, said budget cuts and closures had reduced the clinical platform available for teaching and research. Although the university appreciated the reasons for the budget cuts, the result was that Groote Schuur could no longer provide all the human and material resources needed for sophisticated medical training and research. The hospital, which is easily accessible via an entrance in Anzio Road in Observatory, is the product of a R45-million investment by Rohn-Klinikum. It boasts 124 beds, and includes a medical department, surgical department, day clinic, high care unit, intensive care unit, radiology and angiography suite, an outpatient area and four fully equipped operating theatres. Although entrance is through the usual grey-walled corridors synonymous with Groote Schuur, once you pass through the automatic glass doors it's a different world. Philip Bornman, UCT's professor of surgery and head of surgical gastroenterology at Groote Schuur, said the new hospital would have one full-time consultant and four registrars' posts. The registrars would spend three-month stints in the facility while other staff would circulate between the two hospitals. Consultants were being encouraged to put in the private hours they are permitted each month at the new UCT Hospital. Explaining the financial benefits to private patients, Mark van Rensburg, full-time consultant at the new hospital, said the billing strategy, called global service, meant patients were charged a single amount for their operations. That included all costs for consultations and investigations, pharmacy, pathology, radiology and their hospital management. Although not all medical aid schemes were on board yet, discussions were continuing with a view to including them all. Nicky Padayachee, dean of UCT's faculty of medicine, said the medical centre was a pilot project that, if successful, could be used as a model across the country to help boost cash-strapped teaching hospitals. (Source: Cape Argus, 18 February 2002)