From porters to engineers, hospital employees deal with ongoing financial constraints and a lack of personnel while delivering top-tier care...
From porters to engineers, hospital employees deal with ongoing financial constraints and a lack of personnel while delivering top-tier care at one of South Africa's most renowned healthcare facilities.
- Writer Sean Christie and photographer Jay Caboz spent several days exploring Groote Schuur Hospital, gaining exclusive inside access and interviewing staff members ranging from porters to medical administrators about the challenges of managing one of South Africa's key healthcare facilities.
- A 1934 Rolls Royce generator that continues to operate the boiler system, alongside cutting-edge cardiac surgery robots, demonstrates the long medical history and innovation at Groote Schuur, along with ongoing issues of insufficient funding and staff shortages.
- "If you're aiming to work within public healthcare in South Africa, it's beneficial to become accustomed to uncertainty," notes hospital CEO Dr Shaheem de Vries. This is a depiction of the individuals dealing with such uncertainty on a daily basis.
In a recent conversation with Bhekisisa, Dr. Shaheem de Vries, the CEO of Groote Schuur Hospital, indicated that the hospital itself would make for a more compelling story, urging us to return and speak with a wide range of employees, from porters to medical administrators. We didn't need to be asked twice. Writer Sean Christie and photographer Jay Caboz spent multiple days exploring the hospital grounds, experiencing an uncommon degree of access.
Place of ambiguity
We gather outside the neo-classical front of the former hospital, now called Old Main Building. The wind causes the heads of the courtyard palms to sway, while a group wearing caps, headscarves, hijabs, and bucket hats passes by. In a corner of a parking lot, smokers look at their feet. Close by, outside the "new" Main Hospital, some patients with bandages and patches enjoy the sun in the shade of the wind. A statue of Hygeia, the daughter of Asclepius, the god of medicine, watches over everything.
We go in, pass security, and almost instantly get lost, ending up in theHeart of the Cape Town Museum, which honors the first heart transplant between humans, carried out here by Christiaan Barnard.
The museum is shut and empty, creating an uneasy sense of intrusion while among the medical wax figures, performing their pioneering tasks. There is even a dog with a tube in one of the exhibits (as the team was preparing for the surgery, the) experimentally transplanted 48 hearts into dogs). Barnard, incidentally, wassuggested for the Nobel Prizein medicine and physiology in 1968, but it was another outstanding intellect from Groote Schuur, Alan M. Cormack , who received the award in 1979 (together with Godfrey N. Hounsfield) for his contributions to the development of CT [computer tomography] scanner, which enabled a thorough X-ray of the body.
Nearly half a century later, Groote Schuur continues to hold a strong reputation for cardiothoracic surgery , and continues to be a source of clinical firsts. There is another story, however. ATeam from the South African Human Rights Commissionvisited the hospital earlier this year, highlighting issues with infrastructure, acts of vandalism, and a lack of staff. In September, the hospital revealed that its new and highly anticipated trauma centre is underfunded by tens of millions of rand.
A statement made by the hospital CEO, Dr Shaheem de Vries, resurfaces: "If you intend to work in public healthcare in South Africa, it's beneficial to become accustomed to uncertainty."
How much uncertainty can a single organization accommodate, though? We look forward to discovering more, but for the time being we require assistance.
The technician: "Oily, soot-covered craftsmen keep this place running"
The challenge with Denton Smith, the engineering director, is staying on top of things. He understands the facility better than anyone. It's a large structure, and if you wish for him to give you a tour, be ready to move quickly and take shortcuts: via tunnels, skybridges, and concealed passageways.
He leads us along a rising corridor in Old Main Building (constructed on the steeply inclined Mowbray Ridge of Table Mountain), with aged Formica gleaming under his feet. He is of short stature, sturdy, and dressed practically. His phone, which he holds in a hand that has lost several fingers, keeps emitting a cheerful whistle.
"Paper cuts for engineers," he explains.
Leaving through a door at the rear, a softly smoking chimney rises — a landmark that has led to many years of incorrect information ("It's the flue of the crematorium" or "the old laundry").
"False, it's the exhaust from our boiler room," Smith clarifies, taking us into a large, hangar-style building where multiple big boilers generate the steam that controls the temperature in the hospital. In case of a power outage, an old generator activates.
"It's a 1934 Rolls Royce, almost a hundred years old and still performing its function," explains Smith, who will soon take us to more recent facilities: nuclear bunkers used for radiation therapy and hybrid operating rooms equipped with cutting-edge imaging technology. Everything—both the vintage and the latest advancements—is under his responsibility, not just the machinery but every system and building.
"Listen, you need to have a passion for it [hospital engineering]," he states.
For Smith, the bug bit when he was around three years old. His father worked in hospital engineering, and he spent his childhood in the backrooms of hospitals. After finishing his national diploma, specializing in electrical and mechanical engineering, Smith completed his in-service training in the private sector. Following roles at Karl Bremer and Tygerberg hospitals, he was entrusted with managing the medical gas department at Groote Schuur in 2006, and later became head of engineering in 2010. Despite his extensive responsibilities, the department is consistently underfunded, but Smith enjoys tackling challenges.
"We have approval for 157 staff members, but our funding covers approximately 76. It's challenging, but we manage to cope," he states.
In 2012, Smith's department was officially acknowledged as a training center for Technical and Vocational Education and Training (TVET) colleges. This provides additional support at a low expense.
We rush through different workshops. The experience is just as much about the sense of smell as anything else: scents of cut wood, burned metal, oil, and cooling slag.
Engineering in hospitals has consistently remained behind the scenes in South Africa, often overlooked and undervalued due to our dirty and soot-stained appearance.
Smith has plenty of supporting stories: there was the time a fire started in the hospital's "umbilical," which contains "all the main connections: gases and communications and things like that." And then there's the 2019 Legionella outbreak In the hospital's water systems, the engineering team addressed the issue by inserting hundreds of chlorine floaters into the hospital's 54 storage tanks, making it the first medical facility globally to fully eliminate Legionella bacteria, which leads to Legionnaires' disease, a serious type of pneumonia, as well as the flu-like condition known as Pontiac fever.
We reach Service Street, the primary route for deliveries to and pickups from (rest in peace) the Main Hospital. It also serves as the hospital's core, supplied by two 11,000-volt cables. Major pipelines for gas and air extend upward.
Between each individual patient floor, there is an intermediate floor that houses all the services, ranging from sewage pipes to telecommunications. Many people believe this is a 7-floor building, but in reality, it has 16 floors.
One of the floors is referred to as Theatre Street: a lengthy avenue adorned with faded animal photographs from the 90s. At the far end, a green door in the primary theater area leads to a modest office.
" I entrust you to skilled hands," says Smith.
Specialist nurse: 'It's not a fairytale, but it is effective'
Sister Janine Watson glances at us and smiles.
"Most people refer to me as Nina, I'm quite casual," she says, and in the same sentence shows us the theater changing rooms, where we can locate the scrubs we need to wear before moving on.
"30 meters down the corridor, turn left at the yellow sharps container, go through the door, and walk all the way to the far end of the changing room," she says.
Watson can't afford to be vague. Her official position is assistant nurse manager, specialty theatre ("Yeah, it's a bit of a tongue-twister"), and she is directly in charge of roughly 160 staff — and indirectly oversees another 80 or so.
Her mother, a nurse, managed a ward at Old Hospital for many years, and Watson was cared for at the hospital's nursery. After finishing the then R425 nursing certificate, Watson sought employment at Groote Schuur.
"I had no desire to work anywhere else," she states.
For 19 years, I worked as a cardiothoracic scrub nurse, and I managed the department for 14 of those years. I would still be part of the team if invited. When you're in sync, working repeatedly with the same person, it feels like a dance; no words are needed, and the hands naturally find each other," she says, leading us into the hospital's recently renovated thoracic operating room, where a patient is undergoing a lung transplant.
For those unfamiliar with the situation, it's an unusual sight: a group of men and women are positioned around a table, where a patient's chest is open and covered. One might anticipate quiet conversations, but instead, people are speaking in regular tones. A tube filled with blood connects to a machine (the ECMO — extra corporeal membrane oxygenation machine), monitored by two perfusionists, and then returns to the patient's body with a much more vibrant red color.
"It supplies oxygen to the blood, eliminating the need for human lungs. It has truly been a game-changer," says Watson.
Nearby, a shiny new four-armed surgical robot is positioned in a theater. Watson remains calm, stating, "It's not AI, it can't perform surgeries independently. It's just a very costly pair of scissors," though she speaks with a sense of pride.
In a way, Watson serves as a living advertisement for Groote Schuur, yet she remains completely candid about the hospital's difficulties.
"Since the 1990s, we have faced multiple waves of financial and personnel expenses, with the latest occurring in 2023. This is a significant issue for patients and the healthcare system in the Western Cape," she states.
A portion of the issue, within her area of influence, is systemic.
We are simply not training enough nurses. Twenty-one percent ofnurses listed on the SANC [South African Nursing Council] registryMore than 60 years old, an additional 27% are above the age of 50. In the next decade, we will only be able to train half of those who are set to retire. "It's alarming," notes Watson, who currently has six specialized and fourteen general positions available.
Among her caregivers, the shadow of exhaustion is significant.
Most employees work from Monday to Thursday, covering your standard 40-hour workweek, and then have overtime on Friday, along with occasional shifts in one of our public-private partnership projects that run on Saturdays. We maintain strict limits on overtime, yet everyone here operates under significant stress. Nurses travel from as far as Atlantis and Grabouw, meaning they depart home at 4:30 AM and return at 9 PM via public transport, in areas that are unsafe and all the rest.
Watson asserts that Groote Schuur continues to provide quality service, nevertheless.
"If there was a serious problem with me, such as a car accident involving multiple complications, I would prefer to come here rather than go to a private facility, as you have all the necessary expertise available, and the staff are very committed. It's not a perfect scenario, but it functions effectively," she states.
The supervisor asked, "Are we able to meet all the requirements?"
Between 10,000 and 12,000 individuals pass through the hospital complex each day, ranging from patients to representatives of medical suppliers. Along the broad avenues of the Main Hospital, nearly every activity that occurs on a street is taking place: families meet, old acquaintances reunite, while being cautious not to interfere with staff members using heavy-duty cleaning equipment.
Medical professional Belinda Jacobs is located at the center of everything. She is small in stature, speaks gently, and admits to feeling a bit tired.
From lack of staff and insufficient supplies to harassment and exhaustion, every issue within the hospital stems from its management. Even top performance requires oversight.
"Please don't misunderstand me, it's encouraging to have these life-saving technologies, but they come with their own difficulties," Jacobs mentions, who began his career at Groote Schuur as a medical officer in 2001.
When we eventually obtained our own MRI (which captures detailed images of the body) about 15 years ago it was amazing, we felt very proud and enthusiastic, but now it has become a seemingly difficult challenge. We are currently conducting 800-900 MRIs each month, whereas when I began, we only outsourced 50 per month. What medical science can achieve today is remarkable, yet we are nearly at a stage where we must question, 'Can we handle these demands?'
A significant increase in the city's population, combined with a reduction in the number of individuals who can afford healthcare, and a budget that fails to meet the requirements, has resulted in a scenario, according to Jacobs, "where we must accomplish more with fewer resources."
"Residents of Cape Town see Groote Schuur Hospital as their own, and often don't follow the strict referral rules that are in place. This leads to additional strain as the hospital deals with growing demands while continuing to ensure patient safety and respect. Nevertheless, it is our duty to push for what is required," she states.
Difficult choices are made daily, and there are facilities, such as kidney dialysis, where availability is tightly regulated.
"It can be extremely challenging to inform patients, 'We're sorry, we can't provide you with the resource necessary for you to keep living.' We have a better understanding today of the moral harm inflicted on our staff in these situations. There is now a stronger emphasis on the well-being and health of our staff," she states.
Jacobs volunteers to guide us to the main entrance of the porters' domain, the initial hospital group that most patients and their families come into contact with.
Porters: Demanding physical work, gentle approach
The duty of the porter is to transport the patient securely from location A to location B, using a wheelchair, stretcher, or bed. That's the main idea, according to Sibusiso Sonjica, although he emphasizes "much more is involved than one might expect."
You must be capable of managing a patient, both physically and in other aspects. We perform log rolling. In cases of potential spinal injury, we use Patsliding.
Alongside technological advancements, the most significant change in recent years has been the increase in gunshot injuries, largely driven by gang-related activities. Sonjica notes that the individuals who arrive are often enraged and in a state of fear, "and at times, they are pursued by another group seeking revenge."
Sonjica was working one evening when a patient arrived with a bullet embedded in his pelvis.
He wasn't in a critical condition, and since the specialist was delayed, the nurses told him to wait. He started arguing with them, so I began speaking to him in a language you don't learn in school, this tsotsi-taal. 'My bru, don't act like that,' and things like that, and it calmed him down. Sometimes you end up in situations you weren't prepared for, but your instincts take over and you use the knowledge you have, whether it's cultural, street-smart or professional.
The demand for compassionate human connection reached its peak during the COVID-19 crisis.
Family members were not allowed to visit patients, and some, particularly these traditional uncles, did not want to hear anything in English, so the doctor would say, 'Could you please explain,'" Sonjica remembers, noting, "Porters had to be versatile: part porter, part counselor, and part translator.
Alongside patients, the individuals that porters frequently encounter and need to manage are nurses.
"Some nurses have a dismissive attitude towards porters," Sonjica remarks, although he quickly adds that he has observed some improvements.
We now hold quarterly meetings for all employees, with the aim of reducing the hospital's hierarchical structure. It is beginning to make a difference. Ultimately, if our colleagues are not satisfied, the patients will not be either.
Sonjica, who studied to be a baker, believes he was summoned to hospital work through a dream.
"The rewarding part is when you witness a patient who's ill and feeling very down, and you enter with an optimistic attitude, saying, 'Hey, buddy, don't worry, you'll be okay. Give it a week or two, your eyes will become white. You'll eat well, and when you're released, we'll have meat in the place.' You might find this amusing, but it has actually occurred," says Sonjica, who was part of his choir performing in a well-known mall when a voice called out.
Porter!" he shouted, "Porter!" No one ever calls me that, so I realized he was a patient. Later, he hugged me and said, "I appreciate it," even though I didn't administer any injection, just offered positive energy. It gave him hope, and suddenly, he's like me now, not a patient but an ordinary person.
Cleaner: From Mopping to Measurements
To reach the finance department, we once again require Smith's assistance.
He takes us below ground, into corridors filled with discarded beds, sterilizers, computers, and fax machines. In one underground room, there's even an old fibreglass Santa Claus, according to Smith, who was removed because a patient found the menacing glint in its eyes unsettling.
He takes us outside room 45, a plain door located in an unremarkable corridor at the rear of the building. It's lunchtime, and except for one individual seated at her desk, the office is empty.
Waving, Nicole Mckay-Sias replies, "You're welcome."
There are 18 different job levels or salary grades within the government, and Mckay-Sias is at level five, holding the official position of fees administration clerk. She initially began her career outside of this structure, working as an agency-employed cleaner at Groote Schuur. In order to enter government service, she applied for a position in a part of the city known for gang-related violence. She remained there for six months and witnessed events she would prefer to erase from her memory.
"In a place such as that, there is no development, just mere existence. However, you learn to rise each morning and don armor, and simply carry out what is necessary to make it through the day," she states.
Mckay-Sias went back to Groote Schuur as a domestic worker (level 2), serving in the cardiothoracic department.
There, I discovered that each individual in the ward could play a role in the recovery process. I was approachable. I was hardworking and willing to assist, and the patients would often request me specifically. They'd ask, "Where is Nicky?" — that was the nickname they gave me. When the nurses noticed that I was making a positive impact on the patients' lives, they told me I shouldn't be a cleaner for the rest of my life, that I had the potential to achieve more.
During the country's COVID lockdown, Mckay-Sias volunteered for duty.
I recall it was raining when the initial wave began. I was alone with another girl in the ward, as no one else wanted to stay. We often worked extra hours, but it was rewarding at the end of the day since many patients appreciated our assistance and the genuine care and empathy we showed them.
Working in the hospital wards as a cleaner was not always enjoyable, though.
"Many individuals understand the idea of structure and rank, perceiving the doctor as a significant figure. People might show less respect towards nurses, and when these nurses refuse to tolerate their behavior, they often vent their frustration on the cleaning staff," she states, acknowledging that she once had a short temper but developed patience while looking after an ill family member.
In 2023, Mckay-Sias participated in "experiential learning," an internal initiative that provided opportunities to gain experience in various positions within the hospital.
"I spent six months in finance. I had no knowledge of computers, but the people in that department were very supportive, and now I can handle it effortlessly," she says.
She was successfully appointed to her present position that same year.
A portion of the role involves gathering unpaid income, and Mckay-Sias notes that it can be "truly heartbreaking, as individuals are facing financial difficulties, particularly due to the impact of COVID-19."
"Occasionally, families are unable to resolve the financial matters after a loved one's death. At times, they don't have enough funds to visit the Master's office (master of the High Court) to obtain the necessary document to close the account. I strive to assist everyone, but it's not always feasible," she explains.
Mckay-Sias believes she has more to contribute to the hospital, and more to demonstrate to herself.
I arrived here with only a high school diploma, yet I continue to learn daily, in a positive manner. Collaborate with your team, rather than competing against them. Don't hesitate to seek assistance. Don't be afraid to acknowledge when you've made an error. These are some of the lessons I've acquired.
This narrative was created by theBhekisisa Center for Health Journalism. Register for the newsletter.
Copyright 2025 Bhekisisa Centre for Health Journalism. All rights reserved. Distributed by AllAfrica Global Media (Healthy Survival).
Tagged: South Africa, Economy, Business and Finance, Health and Medicine, Southern Africa
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