The hospital has left the building

By Dr Shahra Sattar

On Duinefontein Road in Manenberg there is a building that used to be GF Jooste Hospital.

This building is not beautiful by any stretch. There are no glittering mosaics or eco-friendly manicured lawns greeting you at its entrance promising a fantastic service.

No, this building is surrounded by a train track, a highway and the homes of the marginalised. Here you are greeted simply by two austere steel doors bound together by a heavy chain. Doors that have swung open and closed for 18 years, according to the rhythm of life and death.

Initially operating as a convalescent facility, it was identified in 1996 as a place that could provide a higher level of service to the surrounding communities. It was at that time the only hospital servicing the “Cape Flats”. Situated in Manenberg it had an enormous drainage area that reached as far as Mitchells Plain and Khayelitsha, and thus serviced approximately 60% of the population of Cape Town. The other health facilities shared the remaining 40%.

Birthed into existence as a desperate response to the legacy that apartheid left on the South African health system — the hospital was a bricks and mortar manifestation of a forgotten community’s fight for survival.

Yet, despite the overwhelming tsunami of patients constantly flooding the gates, this hospital remained resolute in its commitment to help the helpless. In a community notorious for its gangsterism, substance abuse and high burden of disease such as TB and HIV, GF Jooste was a beacon of hope for the sick and the dying.

Officially zoned as a level one district hospital, in reality it unofficially operated as a secondary level facility in order to cope with the complexity of cases that came through the door. Through the persuasion and persistence of passionate clinicians, GF Jooste grew into a thriving and bustling centre of unofficial academic excellence. Some of the brightest minds in the country headed up the various specialist departments and the “hospital that should never have been” surpassed everyone’s expectations.

It gained a reputation both as an intense and overwhelming place to work but one where you would be exposed to clinical excellence. It gained accreditation from the Health Professions Council of South Africa to train students, interns and registrars who were specialising in specific disciplines. There were professors and consultants in each of these disciplines who were committed to teaching us and who were passionate about giving the community the level of medical care they deserved.

Thus when the news broke that the hospital was being decommissioned due to it being “in a state of disrepair”, it was like hearing that a loved one had been diagnosed with an incurable illness.

The community was aghast and angry. The staff were in shock. The hospital had achieved so much in just 18 years, now to be cut down in its prime. Why not renovate it in stages? Why rip apart an entire family of staff that had devised their own efficient system of seeing patients even in dire working conditions? These were some of the many questions that were raised. But like many of the very patients it treated, GF Jooste hospital started its life off on the back foot and ultimately the environment it was in was what determined its life’s prognosis.

A hospital is a building that treats the end result of an ill society. Poverty, poor sanitation, overcrowding, lack of education, substance abuse, unemployment, poor nutrition, poor planning — the hospital bed becomes a platform upon which the social determinants of health are displayed. A hospital witnesses it all and while it is not equipped to fix social problems, it can offer relief from suffering to the victims of social injustices.

GF Jooste and its community have suffered these past few months. It is a surreal and sad thing to watch a hospital die. One suddenly becomes aware of the physicality of the place. How bizarre it is that where before you could run over to the friendly radiologist and ask her to quickly report on an X-ray, now the X-ray machine is being dismantled and is travelling past you out the door in parts.

Like a terminal patient whose organs start shutting down, one by one the departments have closed, and the bright minds have taken their talents elsewhere. The emergency centre, the hospital’s beating heart was the last department still functioning in the last stages. Up until the last second, even as the walls were being stripped around us, we were still treating patients in this unit. But at midnight on July 3 2014, even the emergency centre ground to a halt and GF Jooste closed its doors to the public.

A sad day that prompted reflection on why a grand medical community was seemingly destroyed for a new lick of paint.

But those of us who had the privilege of working inside its walls we know this: no matter how new or old the exterior, a hospital is not, and never will be, a building. A hospital exists because of the commitment of the people in it.

It is the cleaner that mopped that old corridor with such grace that it looked like he was dancing across a gleaming stage. It is the porter that knew exactly by the blink of your eyes above your N95 TB mask that he needed to come and help you position a patient for a successful lumbar puncture. It is the lady in the kitchen who stopped to feed the stroke patient, even though it was not “part of her job description”. It is that eccentric professor who dropped clinical pearls wherever she went. It is the nurse that saves you from embarrassment by gently suggesting that you may have forgotten the correct dose of a drug. It is the team you worked with on the end-of-month trauma weekend that knew their roles in a resuscitation so well that each patient that crashed got the best of all your individual strengths, because nobody was going to die on your watch dammit! It is the mother whose child you could not save who in the middle of her grief still thanks you for trying your best. It is the boss that demands excellent work from you even when you are exhausted but who also defends your actions to anyone else who dares question them. It is the patient that crept into your heart, the colleague who made you laugh when you wanted to cry. It is the family you became a part of.

GF Jooste is dead. And there is no tombstone to engrave a tribute. But the people, its family members, they leave with the spirit of GF Jooste alive and kicking in their hearts. The lessons they learned and the love they felt, that living tribute will be practiced on new patients and new colleagues for the rest of their lives. And nobody can ever decommission that. Long live GF Jooste.

Shahra Sattar is a medical doctor.