The internationally acclaimed Groote Schuur Hospital celebrated its 80th anniversary in 2018. Former chief director of the hospital and University of Cape Town 1975 medical graduate, Dr Norman Maharaj, reflects on his connection with the hospital at its 80th birthday celebration in 2018.

My association with Groote Schuur Hospital (GSH) comprises three chapters, spanning a period of 31 years between 1973 and 2004.

I started my clinical years of medical school in 1973, most of which were spent in the wards of GSH. These were the deep and oppressive apartheid years of separate wards, racially segregated student groups and mostly unsympathetic university lecturers. Our most humiliating experience at that time was to sleep in a makeshift 'black' obstetrics ward in order to fulfil our obligation of delivering our quota of babies. Credit has to be given to Professor Olando Meyers (Internal Medicine) and Professor David Dent (Surgery) for their unique support and teaching during this time. There were very few choices where we could serve our internships, and many of us opted for Livingstone Hospital in the Eastern Cape. 

I returned to GSH in 1981 (my second chapter) to work in the medical emergency unit, having followed Dr Aziz Aboo, who had been appointed as the specialist for the unit. Dr Aboo had taken me under his wing in Kimberley Hospital and taught me every clinical skill I have and which I could effectively apply throughout my clinical years. One could hope for no better teacher, mentor, colleague and friend — a friendship which lasts to this day. On occasion, he would still extricate electrocardiograms (ECGs) from his collection to push the boundaries of my knowledge when I visit him at home. These were the most memorable of the years spent at GSH. These were the pinnacle of my years as a clinical practitioner — years of resuscitating moribund patients, solving difficult medical presentations, honing my skills in intubation and ECG analysis, and sharing with my nursing colleagues the basics of these.

These were also the years when ambulance men (very few women at the time) were being trained as ambu-medics and having to take them through their paces. I was the senior Medical Officer and mostly in charge of the G2 anteroom, where the daily routine started with clearing the holding area of patients from the night before awaiting blood and x-ray results, and having to make critical decisions whether to discharge or refer for admission.

Lasting relationships were forged with (sometimes difficult) registrars, many of whom are successful specialists in their fields today. Lasting relationships were also forged with Senior House Officers (SHOs) who passed through the unit. People such as Lynn Denny, Lucy Linley and many others are remembered with fondness. I sincerely believe that we had the most dedicated and best group of nursing staff — professional, enrolled and staff nurses ably led by Mrs Patton as their sister in charge.  

The 80s were also the years of my political activism, inside and outside of the hospital environs. The post-1976 years of student uprising and resistance continued unabated but in the 80s workers started picking up the cudgels, which heralded in the formation of COSATU (Congress of South African Trade Unions), NACTU (National Council of Trade Unions) and many independent unions. The streets were burning and health workers, my colleagues, were often confronted with difficulties such as getting to work on time or reporting for duty. Many were victimised for these transgressions and such unjust actions could not go unchallenged. Low-paid general assistants from the townships were mostly affected and the need to organise became an absolute necessity.

Lots of my free time was spent organising and in meetings with workers at GSH and often at surrounding hospitals, such as Somerset, Conradie, Victoria and Mowbray Maternity. The E-floor lecture room at GSH soon became too small for some of these meetings and we relocated to the bigger Nico Malan Hall and to Gugulethu over the weekends.

At the time, public servants were represented by 'sweetheart' staff associations, divided along 'racial' lines and having to use the enfranchised Public Service Association as their proxy to extract meagre workplace concessions from the authorities. It was from the Nico Malan Hall that we organised work stoppages and sit-ins in order to get the attention of the powers that be — to no avail. 

As a medical doctor, I was at risk of being disbarred by the Health Professions Council at worst and being dismissed by the health authorities for unauthorised activities at best. The challenge was to avoid either. I served as a dedicated doctor and made sure that I could not be found wanting in terms of my clinical responsibilities while engaging in these “unauthorised activities”. These responsibilities were put to the test when I admitted two political detainees from Pollsmoor Prison for complications from a hunger strike.

The following week, one of them was brought to the emergency unit with serious physical injuries, which were absent the week before. The dilemma was whether to report this to the health authorities or to my political allies outside. Not sure of the response from the authorities, I opted for the latter and we successfully interdicted the respective ministers of Police and Prisons, the first such successful interdict against the apartheid regime at the time. 

The Health Workers' Association became the Health Workers Union and culminated in what I regard as the first and most successful public service strike in February 1990. There were five demands: wage increases for general assistants who, at the time, were earning a pittance of R245 per month; access to the pension fund from the Temporary Employees Pension Fund to the General Employees Pension Fund (GEPF); maternity benefits; recognition as a Trade Union; and "No" to privatisation. These were far-reaching demands and, if agreed to, would be applicable not only to the striking workers but to the entire public service. 

To avoid disbarment for engaging in strike action, I opted to resign and to show full solidarity with my fellow union members. We embarked on two weeks of non-violent, disciplined action with lots of vacillation by the government offering mediation through a retired magistrate and then a former GSH medical superintendent. Offers which we rejected outright. We finally met with the Directors-General of the Western Cape Administration and the Public Service Administration. We won victories with our wage and maternity benefit demands. The pension rules needed to be amended — a promise granted. That same year, the Public Service Labour Relations Act was promulgated, giving recognition to unionised workers. I returned to the Emergency Unit but was shortly informed that my presence at the hospital was “too intimidatory” and was asked to leave. A soft dismissal, as it were.  

Out of necessity, I went into private practice until 1996 when again, coerced by Dr Aboo, I joined the newly transformed GF Jooste Hospital. GF Jooste, at the time, was struggling to recruit doctors for a hospital situated on the fringes of Manenberg and Gugulethu. I served as both medical officer and medical superintendent. I was comfortably far enough from the Head Office authorities at the time and avoided the sense of being co-opted. 

I finally applied for the newly created post of Chief Director of Groote Schuur and Red Cross Children’s Hospital (RCCH) in 2000 on the advice of some senior colleagues. I remember demanding their full backing — "covering my back" for whatever changes were envisaged for these institutions. 

And so began my third and final chapter at GSH, from political activist or 'agitator', as others would say, to being in charge of these hallowed institutions. I arrived on the G-floor with a small office being prepared for me and no secretary. At my inaugural meeting, I asked for volunteers amongst the clerical staff present and was most fortunate that Di Terlien put her hand up. She became my right and left hands, a confidant and most able assistant without whom life would have been unbearable. I remember the professors not being sure how to address me, whereas the workers were comfortable with calling me by my first name. 

As chief director, my time was divided between the two tertiary hospitals and also serving as co-ordinator for the placement of medical interns, community service doctors and pharmacists. At some time during this period, I also acted as the medical superintendent for Conradie Hospital and was tasked with the responsibility of the decommissioning of this hospital into an acute section at Eerste River, the Spinal Unit’s relocation to GSH and the creation of a dedicated rehabilitation centre on the grounds of Lentegeur Hospital. All daunting and not very popular responsibilities. It was during this time that I survived a hijacking on the R300 road on returning from an after-hours meeting with Eerste River community members. 

Under grave suspicion as a former 'agitator', I had to gain the confidence of heads of departments, the deans at medical school and the registrar and vice-chancellor at UCT. Many of my decisions were questioned, changes were resisted, and at times it was a very lonely and thankless experience. Managing two important hospitals with the ever-present financial constraints was not easy. These hospitals were world-renowned for their excellence and I, at times, had to sacrifice the budget of GSH to protect the funds of RCCH so that the children would not suffer. Clinical heads of department were co-opted onto the hospital management meetings to encourage joint decision-making. Hospital performance management outputs were jointly scrutinised in attempts to bring about efficiencies. A greater emphasis on revenue generation became a necessity and I recall challenging the MEC (Member of the Executive Council) of Health at the time about choosing between indigent non-paying patients and paying patients.  

Mr Salie, the finance director appointed at the same time, became my 'go-to' man for up-to-date financial information and together we contrived to split the budget into 13 parts to guarantee less of an overspend at the end of the financial year. We also attempted to benchmark personnel and non-personnel expenditure within the various budget divisions. With Mr Salie and Dr Kariem’s help, a private revenue-generating ward was established, but we had to compete with the newly created UCT Private Hospital. A regrettable missed opportunity occurred at the time when I had suggested to the Department of Health (DoH) to purchase this facility when it became available. I had never been happy with the medical staff’s divided time between GSH and the private hospital. I had never been happy with some doctors spending an inordinate amount of time and hospital resources on contract research/drug trials. I had never been happy with our poor management of Remunerative Work Outside the Public Service (RWOPS) and regarded this as a betrayal of the needs of indigent patients. 

We requested greater decentralised inter- and intra-hospital management, but this was never fully agreed to. Quality of care measures were introduced. I was not pleased with a 95% public satisfaction rating when 5% translated into 2 500 dissatisfied members of the public walking our corridors at any one time. I fondly recall calling my first Town Hall meeting with the staff and being questioned by one of the junior managers about having to transport staff to the City Hall. These town hall meetings, held in a lecture hall, incidentally became an important vehicle for gauging the mood of the staff and gaining their confidence. Walkabouts through all parts of the hospital with respective medical superintendents and nursing heads also helped in assuring the staff of our good intentions. An internet café was created to assist staff who had no access to such services. A 'back-to-basics' campaign was started to ensure basic clinical, infrastructural and other needs. 

In the interim, the chief director’s position was changed to that of CEO for GSH and life became more bearable, but financial constraints remained. The hospital board, under the guidance of Dr Barday and then Mr Salwary, were forever friends to rely upon for much-needed support and assistance for basic equipment and other requirements.  

In time, I hope and believe that I gained the trust, if not the respect, of many. Unfortunately, I departed in 2004 and a memorable, life-changing experience at GSH came to a premature end when I joined the Public Service Commission. 

I cherish the many memories and friendships made and remain grateful for the opportunity to manage such a revered and excellent institution. I am in eternal debt for all the assistance and understanding received from so many during all my time spent at GSH. My sincere good wishes for the next 80 years.