St. Mary’s Hospital was built in 1927 but was initially established by a group of Trappist monks in 1882. Several of the monks were ‘healers’ and it soon became apparent that medical care was required in the community. They appealed to women in their home parishes for assistance. Five women responded, and they formed the foundation of the Missionary Sisters of the Precious Blood, the order of nuns that still owns the Hospital today.
During the Spanish Influenza epidemic of 1918, it became apparent that the three mud huts that were used as a ‘hospital’ were woefully inadequate and fundraising plans were implemented to build a modern hospital. As word of the hospital spread and the numbers of patients increased, so grew the need for skilled nursing staff, and in 1933, St Mary’s Nursing School – now a non-profit company – opened its doors, the beginnings of a facility with a reputation for training some of the finest nurses and midwives in South Africa.
Although the Hospital is owned by the Missionary Sisters of the Precious Blood (a Catholic Religious Order), the day-to-day management of the Hospital has been handed over to an inter-vivos Trust – St Mary’s Catholic Mission Hospital Trust. The Hospital is a registered Non-Profit Organisation (NPO) 043-932 and Section 18A-exempt organisation and is situated in the Mariannhill Mission Complex, located on the outskirts of Durban, KwaZulu-Natal, South Africa. It is a 200-bed, Level One District Hospital, serving a population of approximately 750 000 people living in the Inner and Outer West Operational Entities of the Durban Metropolitan Area. This area – according to the 2010 National Antenatal Sentinel HIV & Syphilis Prevalence Survey in South Africa (including children aged 10-15 years) – is one of the top 5 highest HIV prevalence rate municipal districts in the country at 41.1%. It is the referral Hospital for some 21 Government Provincial and Municipal Community Clinics and operated with a budget of R160 million (2011/12), now reduced to R140 million (financial year 2012/3) as the initial United States Government (PEPFAR) grant of five years ended on 31 May 2012 with a small extension to 31 May 2013.
As St Mary’s Hospital is the only District Hospital for the area, annual service level agreements are signed with the KwaZulu-Natal Department of Health each year and the Hospital operates as “State-aided” District Hospital on behalf of the Department of Health and is subsidised by the Department of Health. The Hospital had previously sourced funding from the United States Government for the period June 2007 to May 2012 under the PEPFAR initiative. The final financial year of PEPFAR funding amounted to R53 million for Anti-retroviral Treatment, HIV Prevention such as PMTCT and Male Medical Circumcision, Care and Treatment of Hospital patients and Government Clinic support. However, the end date of this grant was May 2012. A cost extension for one year was received for the amount of US$1.3 million to close out these programmes. The Hospital’s PEPFAR funding will cease completely in May 2013.
Eighty eight per cent (88 %) of the Kwazulu-Natal population is without medical aid or insurance and relies on public health services. The patients attending St. Mary’s Hospital are drawn from historically disadvantaged semi-rural communities where access to education, the learning of skills, employment and adequate health care facilities were severely restricted. Poverty, malnutrition, disease and violence still predominate. The demand for health services is increased by the disease burden emanating from high poverty levels and unemployment in our catchment area. Patients and their families have little or no means to pay for health care services. Over the last few years, the income stream from account payments for health care services indicates that less than 10% of our patients can meet their already discounted obligations to St. Mary’s Hospital.
In addition, the Hospital is faced with various social problems related to financial constraints. Families cannot afford to collect patients immediately upon discharge and at times a few children remain in hospital care for extended lengths of time as contact details for relatives are either incorrect or not provided. St. Mary’s Hospital employs community social counselors to investigate and locate family members who will be responsible for the future care of the child. Family members are also unable to visit patients regularly and thus the family is not aware of the patient’s health progress over time.
The disease profile of the majority of the patients at St. Mary’s is related to opportunistic infections related to HIV and AIDS; malnutrition, gastroenteritis, TB, lower respiratory infections etc. The Hospital also attends to complicated births, which include a high number of teenage pregnancies, pre-term labor and the need for repeat caesarian sections. As the Hospital is a level one district hospital, difficult and complex illnesses and medical emergencies are referred to level two hospitals through the district referral pattern of the KZN Department of Health.