By Charlene Smith
Chris Hani Baragwanath hospital in Soweto is a confusing mass of trolleys with ill people being moved along concrete walkways past construction workers, prisoners in leg irons, fast food vendors and a sudden, surprising oasis: a building surrounded by neat rows of clivias - the cardiac unit.
In a country with only 168 cardiologists in public and private practice, it is the best staffed cardiac unit in South Africa, with six cardiologists.
By contrast, Groote Schuur has three full-time cardiologists, Tygerberg has one senior and one junior cardiologist, Johannesburg Hospital has one, as does Pretoria Academic, Medunsa has two, Bloemfontein four and Albert Luthuli has three permanent cardiologists.
These doctors serve an estimated 12 million cardiac patients.
South Africa has one of the world's highest rates of cardiac disease, hypertension and diabetes.
Each week the unit sees an average of 200 new patients. They have a disproportionately high load of patients with abnormal pathology - or serious heart disease - because many patients, because of poverty or ignorance, allow symptoms to develop and do not go for check-ups. By the time they get to the unit, they are often seriously ill.
It is twice as big as the cardiac unit at Johannesburg Hospital and its cardiologists are among South Africa's top publishers of medical research, but resources often lag.
But the new MEC for Health for Gauteng, Qedani Mahlangu, is taking a keen interest in assisting it; on the day I was there she paid a surprise visit with an entourage of staff.
A good deal of the research staff do at the cardiac unit is to raise funds for new equipment. Because the quality of the research is so good, some of the equipment they have on loan is among the most advanced in the world.
An example is the non-invasive assessment of the heart using stenography done in the echo lab under the supervision of Dr Feranda Peters.
Philips has loaned them a machine that can only be described as beautiful. It shows the heart in three dimensions in bright, awe-inspiring colour. Here visuals of the heart can be spun, zoomed in upon and examined in all their magnificence while a patient lies comfortably on a bed.
The machine improves diagnosis by 75 percent, doctors say, and cuts down on unnecessary tests.
Patients experiencing these examinations are getting the best expertise South Africa has to offer.
The unit has begun training stenographers on the machine, modelling their expertise on the US Mayo Clinic and Britain's prestigious Hammersmith Hospital. But although this machine is extraordinary, the unit needs five more, perhaps not as advanced. The price tag is R1 million for a hi-tech machine and R350 000 for entry-level machines.
Chris Hani Baragwanath may not have pioneered the heart transplant, but it has consistently produced many of South Africa's top heart surgeons.
The present unit owes much to the passion of the cardiologists who man it and a hospital leadership that backs their ongoing fundraising and research efforts.
In a health system buckling under the demands placed on it, the cardiac unit led by Professor Rafiq Essop, his brother Rashid and cardiologists Chris Zambikidis, Anthony Becker, Feranda Peters and Anthony Yip is an example of remarkable innovation and attracts some of the most prestigious research funding in the world.
In the late 1980's, under the command of world-renowned Professor Rob Kingsley, the unit performed more than a thousand open-heart operations a year. But a falling-out with the authorities at that time saw Kingsley and his team leave and the cardiac unit all but collapse.
Then, in 1988, Rafiq Essop, then working at Hammersmith Hospital in London, returned home to get married and was persuaded by Professor John Barlow, then chief of cardiology at the University of the Witwatersrand, to accept a consultant position.
He and Dr Pinky Sareli, who is now in private practice, began channelling research funds to develop the cardiac unit at Chris Hani Baragwanath. It was the first dedicated black cardiac care unit in the country and the first led by black doctors.
Rafiq persuaded his brother, Rashid, who began studying medicine at the age of 15 and was the youngest cardiologist to qualify in South Africa, to return from exile in Scotland in 1992, where he headed the chair of cardiology at Edinburgh University.
On clinic days, the waiting rooms are jammed with hundreds of patients of all races, some elderly, some children.
Doctors sit with them in 11 tiny examination rooms. The cardiac intensive care unit has space for only 10 beds. It lacks the sophistication of private hospitals - there are four nurses for the 10 patients instead of the one a patient found in the private sector - but it has new hi-tech monitors and two precious ventilators.
"Up to the end of last year we had only one ventilator," Rashid Essop notes. "And then we were lucky enough to get the two new ones.
"We see a lot of valve disease and rheumatic fever. If a person is poor they won't seek help when their legs start swelling, and then experience gross or severe heart failure."
Space is at a premium. Nine technicians are crammed into a tiny office. There is no rest area for nurses or doctors, but the unit boasts a fine auditorium. The doctors have a small patch of ground next to the unit that they are eyeing covetously; it is here that they want to extend the unit - every metre of additional space counts.
In a twist from the norm, they are trying to recruit top nursing staff from private hospitals using the funding the doctors are pleading for from major financial institutions.
Two new doctors will soon join the unit from Oxford University in England and St George's Hospital in London. It is hoped that one will set up a new electro physiology unit and the other a cardiac MRI unit, which will push the unit to the fore of cardiac research and expertise in South Africa.
But their challenges are numerous and the doctors used Mandela Week to launch a fundraising drive. They have only one dedicated radiographer and only three catheter lab assistants.
When The Sunday Independent visited, the computer monitoring an angioplasty (a catheter is inserted in the patient's leg and moved to their heart to try to locate the cause of a problem) stopped while a patient lay on the operating table. Medical staff swore, then began pushing and cajoling the ancient computer - the only one.
"It does this every few months," one muttered.
The unit was allotted R400m for the year, but half of that has already been spent and more is needed to meet the demand. Each Monday, the cardiac team discusses every angiogram and each pacemaker, seeking ways to improve them.
Rashid Essop divides his time between a busy private practice and the cardiac unit at Chris Hani Bara.
"My private care patients" - and some of the most famous people in the country are seen in his waiting room - "help fund this unit", he says. "But we need much more money to be truly successful."