Nurses’ Strike Puts S. African Hospital on Critical List : Health care: Walkout in Soweto spreads to other medical facilities. Hundreds of patients are prematurely discharged.

A crippling wildcat strike by thousands of nurses at Baragwanath Hospital spread Wednesday to other medical facilities, escalating a major health care crisis here.

More than 1,000 patients have been prematurely discharged or transferred to other hospitals in the three days since more than 1,700 nurses unexpectedly walked off their jobs at Africa’s largest hospital over demands for a 25% pay hike, officials said.

Baragwanath spokeswoman Hester Vorster said about 3,500 nurses--nearly the entire nursing staff--are now honoring what the government considers an illegal strike. She warned that the 3,400-bed hospital is in “a very critical position.”

“Basically, we are starting to close the hospital down,” she said.

All outpatient clinics, intensive-care units, operating theaters and other key services have already shut, she said. Nearly half the 80 wards have been closed. And all but the most critically sick or injured incoming patients are being referred to other hospitals.

At least 10 patients have died since the strike began, officials said, including two infants stillborn after doctors were unable to perform Cesarean deliveries without nurses available.

“We know there are people dying in the hospital,” said Dr. Andrew Steenhoff, an intern working in internal medicine. “What we don’t know is how many people are dying in the community because they can’t come here.”

Hundreds of nurses also have walked out of 13 health and maternity clinics elsewhere in Soweto, South Africa’s largest black community, as well as three other major public hospitals in the Johannesburg area.

“There’s absolutely no care for the 4 million people in Soweto,” complained Dr. Kiran Kalian, an obstetrician at Baragwanath. “This is not sustainable.”

Dr. Haroon Saloojee, head of the hospital’s neonatal ward, said nearly half the hospital’s premature, underweight or critically sick infants--usually numbering about 150--have been sent home or transferred to other hospitals.

“We’ve sent many babies home not really knowing what’s going to happen,” he said. “There’s no monitoring, no follow-up.”

No violence has been reported, but doctors at Baragwanath said several nurses initially refused to surrender their keys to hospital drug cabinets, forcing doctors to use over-the-counter painkillers instead of morphine or other narcotics.

“Patients are getting worse and worse,” said a doctor who asked not to be identified. “From 4 p.m., there’s basically no one in the wards.”

Only 17 senior nurses reported for duty Wednesday at Baragwanath to help care for more than 1,015 patients still at the hospital.

Doctors have added extra shifts, and nursing students, ward attendants, medical students and army paramedics have arrived to assist. Community groups also have appealed for volunteers to help clean floors, change sheets, feed patients and provide other basic services.

Government officials denounced the strike as illegal and warned Wednesday that those who don’t return to work by today may face dismissal.

The leaders of the three major health care unions said they oppose the strike because the nurses acted spontaneously without union leadership or support. The public service unions recently signed national contracts that provide 5% annual pay raises to most nurses.

Eileen Branigan, acting director of the South African Nursing Assn., which has 92,000 members, pleaded with the striking nurses to return to work. “You cannot use the lives of your patients as a bargaining chip,” she said.