‘Today I’m a nurse, a cleaner, a clerk and a plumber’

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We’re pacing along a stretched walkway connecting Chris Hani Baragwanath Academic Hospital’s internal medicine and pediatric wards.

It’s Tuesday, 22 November around 12pm. “We” are a medical intern who works at Bara, and me. 

Outside, people dressed in trade union garb hang about the main entrance of the hospital. They blocked the entry that morning. (It was still blocked when I arrived at 11ish, so I used the staff entrance).

Inside Africa’s largest hospital it’s chaos. Doctors are working, but there are almost no nurses. There are also very few admin clerks or service staff, for instance porters who move patients between wards or to theatres and back.

“Bara was a ghost town this morning,” says the intern, Ronnie*. (Ronnie helped me to get access to the hospital).

The hospital workers are striking as part of the country’s third national day of action this year. 

The strike was organised by public sector trade unions affiliated with South Africa’s major labour union federations, the Congress of South African Trade Unions, the South African Federation of Trade Unions and the Federation of Trade Unions of South Africa. The unions are demanding a 10% salary increase for public sector workers. The government is only offering 3%. 

Doctors were not asked to strike, but nurses faced pressure and intimidation to stay away from work, as several interns in the hospital that we’re walking past explain.

“There were a bunch of union guys going to each ward to check that there were no nurses around,” says Ronnie, pulling out his phone to show me a picture of a man in red regalia whom he had seen patrolling the hospital’s hallways earlier that day.

“A few nurses came in because they were concerned about their patients, especially if they work with children,” he says. “To avoid being identified, they dressed up as patients or in civvies.”

Outside one of the medical wards we meet up with another intern, Layla*. Layla says some of the nurses who did come to work this morning locked themselves in the wards out of fear of being found by union officials.

“They were so worried that they were chasing us [the doctors] out of the ward and locking themselves in,” Layla explains.

She looks nervous.

“Locking wards could cause serious problems if emergencies popped up,” she says, “because doctors would then have to start fiddling with keys to get into that ward to get to their patients.”  

The doctors left behind at the 3 200-bed facility had to keep working – mostly without nurses. “Today I’ve been a nurse, I’m a cleaner, I’m a plumber, I’m a clerk, and honestly I don’t know what to do,” another intern in the non-emergency surgery unit says. She’s simultaneously talking to me while recording patient notes on a computer.

Not only did the strike put enormous stress on doctors in her ward, it affected her patients too.

“It was decided this morning that all elective surgery [planned non-emergency procedures] would be cancelled for the day because there are no nurses,” the intern says. “Patients are frustrated, we booked them in for surgery today and when they got here we had to tell them to go home.”

In fact, many of the hospital’s non-emergency patients were being sent home to take pressure off the remaining staff.

“Lots of people are being discharged and being told to come back tomorrow to get their chronic medication. But I don’t think a lot of them will come back, so I don’t know what the long-term ramifications of that are going to be,” Layla says.

Ronnie explains that many of the patients who needed to stay behind will suffer from compromised patient care.  

“Some of the diabetic patients need to be continuously monitored and that’s now not really being done,” he warns. “You need to carefully monitor their sugar levels and give them insulin at very set times.

“If there aren’t enough staff at night it’s very possible that their sugar levels will become out of control and they’ll have to be sent to a high care environment, and there’s not enough staff to run those units anyway.”

I leave Ronnie and rush off to a different section of the hospital, where I meet with a fourth intern, who works in the maternity ward. Here doctors are frantically trying to work out where the medicine their patients need is stored and how to prepare it. 

He explains: “Doctors aren’t trained to mix drugs, nurses do that, so we’re now spending ten minutes Googling how to do that, and then we’re spending another ten minutes doing vitals for patients which is usually done by the nurses beforehand.”

The result? Treatment delays.

Fifteen women went into labour in the admissions area, because doctors couldn’t get to them in time, the intern says, the most he had ever heard of since he started working at the hospital.

“I’m on autopilot,” he concludes. “The best I can do is see and help as many people as I can.”

As I drive out of the sprawling facility’s staff gate, there are few signs of the chaos going on inside the hospital. The picketers who were demonstrating at the hospital’s main entry have left, and so have the reporters who were covering it.

But the exhausted doctors I spoke to remain. They are frightened of the effect the strike might have in the long-term.

In one of the children’s wards, nurses are usually looking after about 100 newborns on any given day.

If they don’t show up for the next shift, one intern worries: “That would be a disaster.”

* Names have been changed. 

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for thenewsletter.