When the Charlotte Maxeke  fire caused the evacuation of 700 patients and the destruction of an estimated R40m in hospital supplies, Gauteng Health denied reports that the hospital did not meet fire regulations. A Spotlight investigation tells a different story.

Ufrieda Ho writes for Spotlight:

Just weeks before a fire tore through parts of Charlotte Maxeke Academic Hospital in Johannesburg on 16 April 2021, a fire safety audit at the hospital was signed off and in March a hospital fire and safety team met, according to Gauteng Health. Yet the department’s spokesperson Kwara Kekana also confirmed in response to questions from Spotlight that “the smoke doors are not used as the magnetic system on the doors was no longer effective and they were recommissioned”.

She also confirmed that fire hydrant couplings were not compatible with the fire hoses on Johannesburg fire service fire engines because “some had been stolen”.

Two senior firefighters, who asked to remain anonymous, told Spotlight that the two failings mentioned by Kekana alone would sink a basic inspection or compliance audit. It was also not only the fire doors and the hydrant couplings that were faulty at Charlotte Maxeke. They say firefighters were not given building and floor plans of the hospital’s emergency exit plan when they arrived on the scene on the day of the fire.

Smoke-detection systems, fire alarms, sprinkler systems and the mechanisms that would have triggered the magnetic smoke doors were also not in working condition. And besides the non-compatible hose couplings there was also low pressure to the hydrants.

The Charlotte Maxeke fire was the fourth in six years at public health facilities in Gauteng. In February 2021, a fire broke out at Carletonville Hospital, in May 2019 there was a fire at Bheki Mlangeni Hospital in Soweto, and one at Tambo Memorial Hospital in Boksburg in May 2015. A blaze in September 2018 devastated the provincial health department’s head office in the Bank of Lisbon building in Joburg’s inner city and claimed the lives of three firefighters.

The Johannesburg fire service is ‘in shambles’, two firefighters, Nathi and Richard, told Spotlight. There are only four working fire trucks for the entire city.

There has also been an ongoing political blame game, as well as a court battle: Former mayor Herman Mashaba’s multimillion-rand deal to procure specialised fire engines in 2019 was never delivered on. Then, in April 2021, the deal was ruled unlawful by the South Gauteng High Court.

Nana Radebe, spokesperson for Joburg Emergency Services, confirmed they currently have just over half of the equipment – 51 of 92 items – needed for the fire service to meet national fire safety standards (the SANS 10090). Radebe also says high levels of non-compliance to fire and safety by-laws within the city continue to be a headache for the 1,271 firefighters employed at the city’s 29 fire stations.

The Charlotte Maxeke Hospital fire adds to a long-standing and tightly knotted occupational health and safety crisis in the public health sector in the province.

Craig Househam, a retired professor of paediatrics and child health and former head of the Western Cape Health, was also part of Gauteng Premier David Makhura’s intervention team meant to devise a “recovery plan” for the province’s health department in 2018. Househam serves on the board of the Office of Health Standards Compliance and the South African Health Products Regulatory Authority.

He said that in the provincial health department the problem is underpinned by accruals or spiralling cycles of unpaid debt that keep budgets constrained. “The tendency then is to look where the impact is not immediate and maintenance budgets and equipment budgets often suffer as a result.”

Working out a strategy to solve the health and safety problems in the province begins with recognising that the maintenance of health facilities is a highly specialised area, Househam added. “You need a strategy that puts the right people in the right places with the right expertise. They need to be given the powers and authority to do their job properly without interference. The solution lies in meritocracy.”

Laeticia Rispel, a professor of public health at Wits University, said the fire represents terrible gaps in oversight, leadership and accountability at all levels in the health system. She said bloated bureaucracies are adding to the fracture in government departments and she called out an entrenched culture of self-preservation in the public health sector – where people are “depressed and dysfunctional and doing just enough to stay under the radar”.

In addition, there was a fear of speaking out because of victimisation. This added to a lack of transparency and the absence of sustainable change.

“There are at least 29 senior posts at the hospital that need to be filled, so at the basic level we have a leadership vacuum. Then there’s a fracture between the Department of Health and the Department of Infrastructure Development that just creates bigger bureaucracies and less space for people like CEOs or HODs (when these positions are permanently filled) to make decisions and to implement change. And there’s a South African syndrome, it seems, of setting up yet another task team or another inquiry but no sustainable change or leadership management and governance,” Rispel said.

Democratic Alliance member of the provincial legislature Jack Bloom said the setback of damages and disruptions caused by the Charlotte Maxeke Hospital fire is just one of the latest blows to service delivery in Gauteng. “Gauteng Health has estimated that it will cost about R6-billion to ensure health and safety compliance for all 32 public hospitals in Gauteng. This includes R394-million to fix Charlotte Maxeke Hospital – but little of this has been budgeted,” he said.

He also noted that in 2019, former Gauteng health MEC Dr Bandile Masuku, who was axed in October 2020, admitted that “no state health facility in Gauteng had been assessed as complying with the Occupational Health and Safety Act”. This included general machinery regulations, electrical installation regulations, firefighting equipment, lift regulations, storage, exits, stairs and aisles.

As reported last month in MedicalBrief, Gauteng Health had initially insisted that Charlotte Maxeke Academic Hospital and its fire hydrants were operationally compliant. It denied earlier reports that the hospital had no working fire hydrants, a claimed by Wynand Engelbrecht, the CEO of Fire Ops SA, a private company that took part in the fire-fighting operation.

The fire broke out at 11.30am on Friday, and at 9.30pm the health department said it had “reignited”. But Engelbrecht disputed this. “There is no such thing. The reason the fire couldn’t be controlled continuously is because the fire hydrants on the premises are out of commission. They are not working because of a lack of maintenance.”

Health Minister Dr Zweli Mkhize said during a site visit to the hospital that an estimated R40-million in hospital supplies, mostly personal protective equipment (PPE), were lost during the blaze. The minister initially set 3 May as the date for the reopening of the hospital. It remains closed, as at 20 May.

In 2017, the Department of Labour inspected seven Gauteng hospitals for biohazard and other safety issues. Each one failed to meet the required safety standards. Charlotte Maxeke was not one of the seven inspected facilities.

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