The racial composition of Groote Schuur Hospital's patients and staffs

 This piece is about the racial composition of Groote Schuur Hospital’s patients and staffs. It was determined over numerous visits to its outpatients departments (OPD) and an in-patient ward. Direct observation is the primary method of research data gathering.

Groote Schuur is one of Cape Town's two major teaching hospitals, the other is Tygerberg in Bellville. There are secondary facilities in the metro too. Patients are referred to Groote Schuur from all over the city and Western Cape. It is attached to the University of Cape Town's Medical School. It has the full range of specialist departments and facilities. It is the only public hospital in South Africa to have the Da Vinci Robotic Machine, one of a few in the country. 

The hospital falls under the Western Cape Health Department (WCHD) whose head is Dr Keith Cloete (2020 to present). Dr Bhavna Patel is CEO and Dr Belinda Jacobs is manager: medical services (COO).

The Western Cape has 5.5 million people and Cape Town metropolitan region 4.3 million. The racial demographics of the Western Cape is: brown (”coloured") 50%, black 32%, Indian 1% and white 17%. Of the City of Cape Town: brown 42%, black 39%, white 16%, Asian or Indian 1% and other 2%. The last includes an unknown number of aliens of all nationalities but mainly African, Near Eastern and Asian.

The higher numbers of blacks in the city (39%) compared to province (32%) is due to in-migration particularly from the Eastern Cape as people seek socio-economic opportunities in Cape Town. South Africa's other major urban centres, Gauteng especially with the most migrants, are also seeing the same. 

The DA-led Western Cape Government says this migration is placing a huge, almost breaking strain on its health and social resources. But WCHD is well resourced, receiving budget increases twice inflation. Contrary to their claims, the increase in patient numbers are a modest 3% (2019) and match the increase in WCHD's staffs. 

But employee costs account for 55% of the department's budget. The hospital, like many government departments, is overstaffed at all levels with duplication of duties and underemployment. The average annual salary in the department is over R700,000. A 5% reduction or saving in employee costs would free R1.2 billion for redistribution to other essential services like assets that have been drastically reduced or for a savings for the government.

Groote Schuur's estimated racial composition:

1. Patients: Brown 50%, black 30% and white 20%. (Since the numbers of Indian, Asian and other patients are relatively very few, for convenience they are included under brown unless stated otherwise.) 

2. Doctors: This varies by department but overall around 50% black, 40% white and 10% brown. Consultants and specialists are split equally among whites and blacks. I have not observed brown consultants. Almost all heads of department, who also hold the same titles at the medical school, are white.

3. Nurses and nursing aides: black 70% and brown 30%. I have not observed any white nurses. Porters: brown 70% and black 30%.

4. Radiographers and other ancillary medical staff: Radiographers are mostly brown, about 80%. I have not observed other healthcare staffs, and in sufficient numbers, to determine their race.

5. Frontline clerical staff: Brown 70%, white 20% and black 10%. I have not observed sufficient numbers of back office staff to make a determination but likely the majority are brown. Groote Schuur's executive management too are largely brown (Patel is Indian).

6. Cleaning and entry level support staff: Entirely black. 

7. Medical students. These are not staff per se but they do attend to patients. Black 40%, white 40% and brown, Indian and Asian 20%.

Commentary

The low numbers of white patients indicate this group's affluence which has not changed post-apartheid. Around 80% of whites have medical insurance and therefore access to private healthcare (the figure for blacks and browns is the mirror image, about 20%). Private healthcare consumes 80% of the country's total medical expenditure, leaving the majority of the other racial groups to use public health facilities. White affluence is indicated in poverty figures: only 5% of whites are poor, with blacks at about 50% and browns 40% (depending on whether the upper or lower poverty boundary lines is used).

It follows that with browns (excluding Indians, Asians and other) being the Western Cape's and Cape Town's predominant population group, they would be the hospital's (and WCHD's) majority patients and employees. So, putting aside patients, that leaves employees which is anomalous to this pattern.

Browns fill semi-skilled posts like clerical and certain skilled like radiography (not medical doctor radiologists, though) and share certain unskilled posts with blacks - porters and basic clerical - where little to no training is needed. This is consistent with the country's historical, apartheid and even post-apartheid social milieu. During apartheid, browns were limited to occupying largely unskilled to semi-skilled including artisanal positions determined by limited education and job opportunities and job reservation. Medicine, like the other professions, were deemed to be a white privilege. 

The situation has not significantly changed after apartheid, though. Poverty and low incomes still limit brown's, Indian's and black's educational and economic prospects. And there is the further difficulty of a new type of job reservation, only now called affirmative action or black economic empowerment. This may explain where brown nurses have gone. The ones who are still there are older, mid to late career. Nursing at Groote Schuur Hospital is gradually moving almost entirely black. The only young nurses I observed are black with one single solitary brown/Indian male nurse.

It is the same with doctors. Brown and Indian medical staff - interns, medical officers and registrars (specialists in training) - are 10% to perhaps 20% depending on department - of staff. Black and white doctors, including consultants, are in equal numbers, although at times I observed only blacks. This is not to say this is a bad thing because during apartheid there were relatively low numbers of black doctors in the country, in general blacks relegated to unskilled labour. 

But the low number of brown doctors at Groote Schuur is noticeable especially given they are in the majority in the province. I have not observed any brown consultants. 

This situation is exacerbated by UCT Medical School's policy promoting black admissions to the medical faculty - undergraduate anc post-graduate - on the basis of racial transformation and that "race is still a proxy for disadvantage [sic]" former vice-chancellor Dr Max Price. Black applicants were admitted on grades as low as below 60%, browns above 60% and whites and Indians above 90%. 

The regime was changed to include economic factors after public outcry, with Price holding fast to his and the university executive's opinion. But based on the number of black students presently, it appears the university is maintaining its former policy despite black township students presenting a teaching challenge because of poor schooling.

The university's admission policy, which goes back at least 20 years, of promoting and lowering standards for brown and black medical students does not explain why there still so few brown doctors working at Groote Schuur during the period of my observation s from 2017 to present. Or why white doctors are still abundant, almost the same number department dependent, as blacks given that fewer places are reserved for them at medical school and it's harder for them to win one.

While I have observed browns make up about 20% of medical students at the hospital, the percentage of interns, medical officers and registrars are below that. The conclusion is UCT Medical School and Groote Schuur Hospital are employing more blacks and whites over browns.