On Duinefontein Road in Manenberg in the Cape Flats stands a building that used to be GF Jooste Hospital.
It is not beautiful by any stretch of the imagination. There are no glittering mosaics to greet you at its entrance and promise fantastic service. There are no manicured, ecofriendly lawns filled with luscious indigenous plants encircling its perimeter.
This building is surrounded by a railway line, a highway and the houses of the marginalised and the poor. You are greeted by two austere steel doors bound together with 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 step-down convalescent facility, it was identified in 1996 as a place that could provide a higher level of service to the surrounding communities.
At that time it was the only hospital servicing the Cape Flats. Patients came to the hospital from as far as Mitchells Plain and Khayelitsha, and comprised about 60% of the population of Cape Town. This hospital served all these people while the other facilities shared the remaining 40%.
Fight for survivalBrought into existence as a desperate response to the apartheid legacy that crippled the South African health system, the building is a bricks-and-mortar manifestation of a forgotten community’s fight for survival.
Yet, despite the tsunami of patients constantly flooding the gates, this hospital remained resolute in its commitment to help the helpless. In a community notorious for gangsterism, violence, substance abuse and a high burden of diseases such as tuberculosis and HIV, GF?Jooste was a beacon of hope for the sick and dying.
Officially zoned as a level-one district hospital (a hospital with basic services such as emergency medicine and family physicians), in reality it unofficially operated as a secondary-level facility (a hospital with specialist services such as obstetrics and gynaecology, internal medicine and surgical specialists) 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.
Clinical excellence It gained a reputation as an intense and overwhelming place to work but one where you would be exposed to clinical excellence.
Word spread across the seas and GF Jooste was always hosting international guests, many of whom left with a deep respect for the tenacity of our healthcare professionals working with limited resources. They learnt the value of using their hands, eyes and ears to make a clinical diagnosis, because there was no funding to order every test or imaging modality available.
It gained accreditation from the Health Professions Council of South Africa to train students, interns and registrars who were specialising in specific disciplines. The disciplines offered included: radiology, psychiatry, internal medicine, surgery, orthopaedics, gynaecology, anaesthetics, infectious diseases and emergency medicine.
There was also a stroke unit, a physiotherapy service, a rape care centre, an excellent laboratory, a first-class pharmacy and dedicated social workers. There were professors and consultants in each discipline, who were committed to teaching us – and who were passionate about giving the community the level of medical care they deserved.
State of disrepairThus when the news broke that the hospital was being decommissioned because it was "in a state of disrepair", for those of us who have had the privilege of learning and working there 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 who 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 patients it treated, the hospital started its life on the back foot and ultimately the environment it was in was what determined its prognosis.
A hospital is a building that treats the end result of an ill society. Poverty, poor sanitation, overcrowding, lack of education, alcoholism, drugs, unemployment, poor nutrition and poor planning – the hospital bed becomes a platform upon which the social determinants of health are displayed.
A hospital witnesses it all and, although it is not equipped to fix social problems, it can offer relief from suffering to the victims of social injustices.
Watching a hospital dieGF Jooste and its community have suffered these past few months. It is a surreal, 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 for a quick report on an X-ray, now the 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.
All that was left functioning in the last stages was the hospital’s beating heart, the emergency centre.
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, even the emergency centre ground to a halt and GF Jooste closed its doors.
More than just a building It was a sad day that prompted reflection on the trading in of a grand medical community for a new lick of paint. But those who had the privilege of working inside its walls know this: no matter how new or old the exterior, a hospital is not, and never will be, a building. A hospital is people.
It is the cleaner who mopped that old corridor with such grace that it looked as though he was dancing across a gleaming stage.
It is the porter who knew by the blink of your eyes above your N95 TB mask that he needed to help you to position a patient for a successful lumbar puncture.
It is the woman in the kitchen who stopped to feed the stroke patient who couldn’t feed herself, even though it was not "part of her job description".
It is that eccentric professor who dropped clinical pearls of wisdom wherever she went.
It was the nurse who saved 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 who knew their roles in a resuscitation so well that each patient who 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 who demands excellent work from you even when you are exhausted but who also defends your actions to anyone else who dares to question them.
It is the patient who crept into your heart; the colleague who made you laugh so hard at the end of a gruelling 12 hours that your sides hurt.
It is the love, the loss and the family you became a part of.
People are what make a hospital.
And so when the last people left on the last day, the structure remained but in essence the hospital had already left the building.
GF Jooste is dead, but the people, its members, they leave with the spirit of GF Jooste alive and kicking in their hearts. Nobody can ever decommission that.
Long live GF Jooste!
Dr Shahra Sattar is a general practitioner who completed three years of clinical training at GF?Jooste Hospital while studying at the University of Cape Town (UCT). She also did a year of community service there after graduating. As a locum doctor, she did regular stints at the hospital. In addition to her medical degree, she holds a master’s degree in public health from UCTThe helpless have lost a lifeline
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