Groote Schuur Hospital – World-Class in Challenging Times

Post-pandemic, the famous Groote Schuur Hospital, one of South Africa’s premier health and academic institutions, strives to continue to provide world-class care to patients in the region.

Perched high upon the hill in the shadow of Devil’s Peak at the foot of Table Mountain stands Groote Schuur Hospital, which provides public health care to the population of the Western Cape and beyond.

Opened on 31 January 1938, the hospital boasts a proud 84-year history of service excellence. Throughout the earlier years of its existence, Groote Schuur was always known as the ‘Hospital of the People’, providing the same high-quality care for rich and poor of any colour and ethnic background, hence becoming the hospital of choice for anyone living in and around Cape Town.

Locally, Groote Schuur Hospital (GSH) is renowned as the training ground for some of South Africa’s best doctors, nurses, and other allied health professionals. Internationally, Groote Schuur gained global fame when, in December 1967, a young University of Cape Town-educated surgeon named Christiaan Barnard completed the world’s first successful human heart transplant.

Today, the hospital is an internationally celebrated research institution and is highly regarded for its clinical and teaching activities. This has remained unchanged in the wake of the pandemic that has profoundly affected health care not only in South Africa but around the world. The consequences of the last two years are still being painfully felt, admits Dr Bhavna Patel, GSH’s CEO.

The Aftermath of the Pandemic

“The effects of Covid significantly affected our hospital from March 2020 until about February 2022. Patient care had to be curtailed to admit Covid-positive patients, resulting in about 10,000 missed elective surgeries, as well as many lost outpatient appointments and radiological investigations, among others. This has brought on an unparalleled crisis to the healthcare system not only in South Africa but throughout the world,” she said. “Unfortunately, it is impossible to just pick up where we left off in March 2020.”

“We realised that there is a need for a critical re-thinking and restructuring of the health service with internal re-distribution of resources. This in itself is challenging, since the gains made during Covid of setting up a whole-of-hospital response seemed to have been forgotten and our staff started concentrating on how to deal with their massive backlogs. However, this is not possible and despite our efforts to re-prioritise the backlogs, we would not be able to cover all the needs and meet the current patient pressures.”

She explained that a strategy was adopted of planning for resurgence, recovery and then reset the services. Planning for resurgence involved developing an implementation plan that is adaptive to the change in the number of Covid-positive patients. Recovery involved addressing some of the lost needs and reviewing how these can be prioritised. Reset will require a re-think of the services and how to go forward. “This is not just a hospital response, but a health system response, which we are currently engaging in,” Dr Patel pointed out.

Achievements in Challenging Times

She reflected that the pandemic has put the health of the hospital’s own employees starkly in the spotlight. “Our staff had truly been the heroes of the pandemic. Despite fears for their own health and that of their families, despite having lost loved ones and despite becoming ill themselves, they remained true to their professions and continued to treat our patients.”

The need for self-care and support was so evident that the hospital appointed a psychologist and an occupational therapist, who together with other counsellors and the Psychiatry team had spoken to the staff every day either individually or as teams. “This has proven to be so beneficial that post-Covid, we decided to open a wellness centre for our staff that includes the psychological support aspects, but also a small gym, yoga and many other activities for their health.”

Despite the grave circumstances, much has also been achieved over the last year. Early in 2022, the hospital became the first public facility in Africa to have assisted robotic surgery with the da Vinci Xi robot. Dr Patel explained that surgeons have been trained to perform not only urological procedures but also gynaecological, colorectal, and cardiothoracic procedures.

Given the fact that many paediatric patients were being affected by chronic medical conditions and reaching adolescence without being transitioned into adult medical services, the GSH opened a facility called ACE, where adolescent outpatient services are offered jointly by paediatric and adult clinicians. Another facility – the Diabetics Centre – was set up within the hospital, focusing on the multidisciplinary care of diabetic patients to offer a one-stop care facility for diabetic patients, the number of which has also increased.

Moving Forward

GSH continues to be one of a kind – it is the only public hospital in South Africa that offers transplant services for heart, liver, lungs as well as kidneys. Dr Patel explains that GSH is in the process of setting up a unit headed by a transplant specialist to bring together all the physicians and surgeons to work collaboratively to increase the number of transplants done.

But the imminent issue is to handle a large number of surgical case backlogs, she stresses. With extra funding, two additional theatres were commissioned along with 20 beds to create a Day Surgery facility. “Over the next two to three years, we hope to operate on 3000 more patients. After the project period, the facility will continue to function as a Day Surgery unit.”

Although much appreciated, this help is far from sufficient. “The biggest challenge at present are the unprecedented patient pressures we are experiencing in our medical emergency unit as well as our psychiatry unit – with huge numbers of very sick medical patients and many psychiatric patients coming to us in need of care. Our beds are all full,” Dr Patel stated.

“A second challenge is to manage the staff pressures as a result of these patient pressures. Our staff feel overstretched and overworked,” she added, affirming that a systemic response is the only way to address these issues.

“Our focus for the next 3 years will be on health systems, strengthening and developing a renewed strategy of how we will meet patient needs with our available resources,” she said, adding that her personal vision remains unchanged: “I wish to continue to see Groote Schuur Hospital continue to be centre of excellence where both the staff and patients feel valued and cared for. To continue to be a leading innovative healthcare institution. This is something that I would really like us to sustain going forward.”

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