Hospital Restructuring

I remember clearly my first impression of a hospital I went to as a ten-year old child perched in the middle of an open shrubby veld, with citrus farms that yielded juicy oranges almost every winter on the north western side. The nearest village to the hospital must have been a good 20 km away. With public transport still not affected by the explosion of the current gun-infested taxi-industry of the 90s, it must have been a pressing need that would make people visit the hospital. No wonder the queues of patients waiting to be attended to were relatively short within the hospital premises.

Compared to my granny&rsquos cow-dung polished mud-hut back at home, the hospital was the closest to my imagined heaven. The walls, freshly painted in orange (as if to match the nearby citrus fields) caught as much of my attention as the white clothed nurses who matched the neat surroundings. The fluorescent lighting at night seemed to bring out something angelic from this ever-smiling platoon of health workers as the dark night of the open lands hovered around. When I recovered my consciousness (after a minor surgical procedure), half a dozen of them stood around my beautifully spread bed in the virtually empty ward with all the caring smiles that even the best spring morning would have struggled to match.

I spent a full week in that ward doing nothing except to enjoy the easing of my excruciating pain down under. [I have since learnt that nowadays, it takes no more than a few hours for one to undergo a similar surgical procedure and be discharged on the same day.]

The nurses seemed to relish the challenge of waking ahead of the dawn chorus of birds and returning to their homes at dusk in order to complete a 12 hour long working shift at the hospital. The superintendent of the hospital instilled an orderliness that seemed to reverberate from his white coat every time he walked down the corridors of the hospital - normally, with the revered Chief Matron behind.

Twenty years later (about four years from today!), I was back at this once famous hospital, this time, not because of anything to do with my personal state of health. The changes that had occurred since my first visit greeted me before I even entered the hospital premises. Persistent drought had ravaged the citrus fields. The once open veld was now covered by numerous shacks of mushrooming informal settlements and villages within a 2 km radius of the hospital. It seemed as if the villages and the settlements had finally caught up with the hospital once shielded by the empty open veld around it. The once shining walls looked dirty as decaying old dark brown paint sheaths peeled off uncontrollably due to many years of neglect.

Many patients stood in long queues outside the hospital gates with those too weary to stand huddled under tree shades as the African summer sun blazed relentlessly. The nurses seemed to be dragging themselves as the mutter of their sighs was drowned by the heat wave steaming down the littered hospital corridors.

As I left later in the afternoon, I could not ignore the feeling relief that this time, I had not come to lose any of my body parts. I kept on wondering how many people in the long queues identified with my experience of twenty years ago. An experience, that I now realise, was not a real one. This hospital, like many, had been removed from the real problems of communities because its location made it inaccessible probably due to some grand ideological plan of the past.

As reality finally confronts the hospital, it is found wanting. Many hospitals are faced by similar situations compounded by dwindling resources and rising demands of communities for better health care. This issue of Update gives a synthesis of these challenges and possible suggestions for the effective management of the restructuring process.