Baragwanath Hospital, Soweto: a history of medical care 1941-1990 by Simone Horwitz (review)

In the weeks leading up to the national elections of 7 May 2014, discussion of health care policies and infrastructure occupied a far more central place than has yet been the case in South African electioneering. While all parties agreed that the country’s public health system is still failing to meet citizens’ Constitutionally-affirmed right of access to health care, the forcing of this recognition into the political arena has in part had to come ‘from the ground up’, from those who work at state hospitals and clinics, including at South Africa’s ‘legendary’ Chris Hani Baragwanath Hospital in Soweto. With just under 3,000 beds, the hospital is amongst the largest in the world, and has a far higher ratio of patients than WHO recommended standards. In October 2013, in a well-publicised media protest, eight Baragwanath doctors were photographed holding aloft posters stating, for example, ‘Patient in need of simple operation discharged (theatre lists too long). He died a few weeks later’, and ‘Tired Doctors (Shifts Longer than 16 Hours) = Compromise of Patient Care And Doctors Safety’. One young doctor was quoted as saying, ‘“I really love my job. I love working here, but it’s just extremely difficult to look my patients in the eye and feel that I’ve done my best for them… We just feel like we let them [our patients] down”’. Ominously, the report added: ‘She’s scared about speaking out – if she’s caught, the consequences could change the course of her career’ (Green 2014).

As Simone Horwitz’s book, Baragwanath Hospital, Soweto: a history of medical care 1941-1990, powerfully illustrates, unfortunately, South African medics have long had to struggle against the governments that fund them and the broader economic and political terrain in which they work in order to improve not only their own working conditions, but also to ensure even the most basic care for, if not the very lives of, their patients. The time period covered – 1940s to 1990 – is of interest for those concerned with apartheid era health, medicine and policy, for unlike many of the other major hospitals already researched Baragwanath (named the Chris Hani Baragwanath Hospital in 1997: it is most usually simply referred to as ‘Baragwanath’ or ‘Bara’, however) had neither a nineteenth century liberal nor Christian missionary foundation. Rather, it was a secular institution established at a time when the Union of South Africa was on the cusp of a new national health care era, which would have seen a wider community health-care clinic model (7). Instead, over the next half century or so there was the entrenchment of an already massively lop-sided health-care system and an emphasis on curative hospital-based medicine.

The dissertation on which this book is based had the title ‘A phoenix rising’, and it is one that might have been retained in the title of the book (though with a question mark after ‘Rising’, perhaps) as the metaphor is woven through the chapters and works as a graceful mode of periodising the different stages of Baragwanath Hospital’s history. Horwitz identifies four major phases (or phoenixes, if you will): the first, brief, phase was during the 1940s from when the hospital was hurriedly constructed as the Imperial Military Hospital for convalescent Commonwealth soldiers, to its transfer to the Transvaal Provincial Authority in 1947-8. Initially, the hospital ‘took over’ black patients from Johannesburg General Hospital. It also became the University of the Witwatersrand’s teaching hospital. This three-way relationship was significant, since biomedical research was in part facilitated by the sheer amount of clinical patient data that could be drawn on at Baragwanath; but also the relationship with Baragwanath and Soweto helped to radicalise later generations of Wits students. Gaps in authority could lead to frustrations, but could also be exploited to the hospital’s advantage on occasion.

The second ‘phoenix’ phase lasted from 1948 through the decades of high apartheid. While facilities were segregated...