#Whatsitlike: Essential workers in the kitchen at Pholosong Hospital

Lunch preparations in Pholosong Hospital's kitchen. PHOTO: Denvor De Wee/Spotlight

People don’t go to hospital for the cuisine. Many would rather avoid a hospital stay altogether. But when people end up in these health facilities as patients, bland hospital food is often among the things that get a “bad rap”. Nutrition, however, is an important part of healing for the sick and the people preparing food for patients are rightly classified as essential workers.

Thobeka Bavuma is one of them. She is the food services manager at Pholosong Hospital in Tsakane, Brakpan.

Even before COVID-19 Bavuma was a stickler for hygiene in the kitchen, stressing it with all the staff daily. “Even on the things they know, we must remind them every day,” she says.

These reminders include wearing protective clothing and that no make-up is allowed – which explains why Bavuma isn’t dressed up for a photo shoot with Spotlight’s visit to the hospital in March.

An army of food soldiers

The kitchen is buzzing with the sounds of pots and pans reaching a crescendo as it is almost time for lunch. The smell of stew and cabbage hang in the air. Beef stew with pap, cabbage, beans and samp are among the items on the lunch menu. Food trollies are being stacked to go out to the wards. In the kitchen there is the usual banter among staff. There are busy hands and feet all over the kitchen – everyone knowing exactly what they’re supposed to do –like a kitchen filled with an army of food soldiers.

Bavuma says she started working as a food services manager in 2007 at Tygerberg Hospital in the Western Cape. “For this type of job, you need a food services qualification, hospitality or something related to it,” she explains.

From a young age she wanted to have a career in the food industry because she enjoyed cooking. Now, years later, she is managing a team who makes sure that patients have a meal before they get their medical treatment. This team includes three supervisors, nine food services aids who do cooking in the kitchen and eight food services aids delivering food per shift.

Bavuma has been managing the kitchen at Pholosong Hospital for four years.

“It’s the patient’s health we’re taking care of. If there is no plate, how will they (the patients) take pills on an empty stomach? If the plate is not there, they (the patients) cannot recover quickly. Also, the plate is supposed to be balanced – we make sure the vegetables and fruit is there.”

Bavuma says because she wants to create a home away from home for the patients, she has introduced something special for patients who celebrate their birthdays in the hospital. She allows them to have a special meal. “When they make an order, we make sure a special meal is being prepared for that particular patient. This is so that the person can feel we are celebrating with him or her in here,” she explains.

Cooking with love

Mavis Nkosi, a food services aid at Pholosong Hospital, says she’s been at the hospital for five years. “My job is important. I come in early – at six o’clock in the morning – then we prepare soft porridge and bread with cheese or fish fingers,” she says.
“When the doctor arrives to see the patient, they (the patients) have eaten already, they can then receive their treatment. That is my job, to make sure the patients do not get treated on an empty stomach,” Nkosi says.

“I like to make sure everything is okay. I try to make sure they enjoy the food. I improvise to make sure it’s tasty. I cook with love.”
Sometimes, says Nkosi, the groceries delivery does not come on time. That’s when she must improvise, especially if there isn’t a certain spice for the food.

And if she has patients who doesn’t want to eat anything? When they do not want to eat, Nkosi persuades them to eat at least two or three spoons. “I try to talk to the patients, especially the ones that don’t want to eat, to make sure they get something in. I talk to them about, for example, how was their night, their experience…”

She says she sometimes has patients who makes her life difficult when they change their minds. “Some patients lie. They say they don’t want tea when I ask them. Then, when I come back with the trolley, they say ‘you didn’t bring me tea.’”

She chuckles.

But Nkosi says listening to patients is an important part of the job. “It is important to listen to the patient, to make them feel [at]home. I feel like I can make them well because they have families to go home to,” she says. “Sometimes you see their anger or the pain, you must calm down, because you don’t know how he or she is feeling. I’m here for the patient.”

Precaution measures for COVID-19

The COVID-19 pandemic has affected how health facilities across the world operate. So, what does that mean for food services in these facilities?
According to Bavuma, they have tried to improve the menu to respond to COVID-19 on advice of the dieticians. “We have increased the food intake and instead of one fruit a day they (the patients) get three fruits,” she says. “We have also put in jugs with lemon water for every patient for them to improve hydration. We are looking at adding yogurt to the menu to increase the probiotics. All these changes are aimed at improving the immunity of all admitted patients, so that they are not vulnerable to any kind of infections including COVID-19,” she explains.

“The other addition is that of the personal protective equipment (PPE). Food services aids going to the wards must at all times ensure that they are fully protected and wear a mask all the time according to the COVID-19 regulations.”
Bavuma herself wears a mop cap to cover her hair, a chef jacket and chef pants, surgical mask, gloves and safety boots every day.

Dr Zakhele Zitha is the medical manager responsible for the COVID-19 committee at the Pholosong Hospital. “The kitchen has always been adhering to safety and hygiene processes to ensure that we give quality and nutritious food to our patients,” Zitha says.
“Staff on a quarterly basis attend training in various areas around food handling. The COVID-19 pandemic has therefore not impacted operations in any way. This is because all food service personnel understand what is required from them in order to ensure that we adhere to procedure when cooking and distributing food.”

Zitha says there have been collaborations between the Nurses Services Department, in particular the newly established isolation ward that is earmarked and prepared for COVID-19 cases. “In such cases, trained nursing managers work together to ensure that everyone entering the ward has the appropriate personnel protection equipment to be able to give food to our patients.”

A typical week in Pholosong’s kitchen

Every week Bavuma does her meal planning for the week. There are normal or special diets, she says, and that is why she involves dieticians in her meal planning.
“We check the orders of the wards; we prepare according to the number of the patients. We receive orders (a diet list) daily,” she explains. “The special diets are prescribed by the dieticians, and then we make sure the food is available,” she says. “The special diet is called therapeutic diets. These diets are for certain patients like the diabetic patients, or those who are on high-protein diets, low salt, salt-free, et cetera.”

Bavuma says she places orders according to the item on the menu. “Most of the time we use items that are already on the contract. The head office sends us the list of suppliers to order from.” According to her, they do a master order for all food supply. “We calculate it for the whole month, then we cost it, then order based on calculations.”

Her day typically starts with a visit to the food storage areas to check the temperatures. “We record the temperature every morning and midday – we don’t want the stock to go off.” There are also generators in case a power outage happens, she says.

Planning the menu

Bavuma says the food choices of patients are mostly based on a community’s culture. “Meat and pap are a favourite here. We cannot do Pilchards (canned fish). The patients don’t like it. I find that some communities do like it, but here they do not like it. They also don’t like spaghetti.”
She tells Spotlight her staff conduct surveys on a monthly basis or when a new dish is introduced. “We ask what do the patients like or want, and if they don’t like it, then we can change that particular dish.”
We train the food services aids – they listen to the patients and tell us after they have listened to them. We don’t say ‘no’ to a request; sometimes you do get patients who say ‘this food make me vomit.’”

Dieticians are responsible for giving supplements to patients. “We do have a tube feed or fluid diets that are readily prepared for that,” says Bavuma. “We also have a blender for the food of those who can’t chew.”
Children get different (and soft) meals, according to their age, and these diets are prescribed by dieticians.
So, what are the regular dishes on the menu? In winter, Bavuma says, they prepare soup because it’s cold. They do ‘night tea’ as well. “We give choices when it comes to snacks, according to what is available, bread or biscuits with tea, juice or water,” says Bavuma.

Bavuma tells Spotlight they have “emergency” food stocked in case unexpected incidents come up like a strike or a protest (which could hinder the delivery of food). This include foodstuffs such as canned food, like meatballs or flour.
On a daily basis, Bavuma says, they serve between 300 to 450 patients in the hospital. This excludes the moms who come to visit their children who are sick. “Some moms are here during the day, we serve them in a separate area. We don’t know who comes, so we count them in – whoever is here on the day.”

On the day of Spotlight’s visit, there were 264 normal diets and 80 to 90 special diets.

The food budget

According to Bavuma, they get an annual budget from the Gauteng Department of Health (GDoH). “I’ve never had [a situation] where I exceeded the budget. We make sure we buy within the budget unless there are unforeseen circumstances,” she says.
Kwara Kekana, spokesperson of the Gauteng Department of Health (GDoH), explains there are facilities where food services are in-sourced and outsourced. “Masakhane Cook Freeze is an entity of GDoH, we prepare food for 23 facilities – that is six hospitals and 17 CHC (community health centers) – without charging any cost. It is our responsibility,” Kekana says.
“Some facilities do not prepare meals, but they are being serviced by Masakhane. In other facilities meals are prepared internally.” Kekana says the province’s position is to “not outsource”.
At the Pholosong Hospital food is prepared in-house.

Kekana notes the department budgeted R 307,7 million for the 2016/17 financial year, R342 million in the 2017/18 financial year and R 447,9 million for 2019/20 for food in health facilities.
“The allocation for food is informed by service delivery needs as per each facility’s needs,” she says. “The central office allocates an overall budget to each facility which then proportionally allocates budget per items that are procured,” says Kekana.

The food items procured through the different tenders include fresh meat, frozen products, fresh vegetables, fresh fruit, bread and groceries.
Bavuma tells Spotlight the hospitals’ food services department get audited. “We got 86% or 87% in the national audit in 2017. They chose four hospitals to audit. You have to be ready for an audit at any time.” Bavuma says she considers it a good score given staff shortages in that financial year.

*Read more on articles in our #WHATSITLIKE series here, here and here.

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