It came as no surprise that a group of South African medical students have fled Cuba to escape the horrendous conditions they were being subjected to in that country.
In 1996, the Department of Health dreamt up a programme to train doctors in Cuba to reduce the chronic shortage of skilled doctors in SA and avoid the supposedly high cost of training them here. Students, keen to study medicine but unable to get into any of SA’s eight government-run medical schools went along with the plan.
Why should we not be surprised that they want to flee the country? Cuba is one of the world’s most repressed countries with an economic freedom score of 28.5 out of 100 according to the Heritage Foundation’s 2013 Index of Economic Freedom. It is second to last in the world ranking, one place better than North Korea. Cuba’s socialist command economy lurches from one crisis to the next under a resolutely Communist economic policy. The average worker earns less than USD25 (R228) a month. Any move towards genuine political or economic freedom is rejected by the Castro regime.
According to SA’s Minister of Health, Aaron Motsoaledi, “It costs R750,000 to train a South African medical student in Cuba, but double that to train them here.” The problem that South African students going to Cuba have to study in Spanish, and on their return to South Africa have to relearn medical vocabulary in English seemed to be of minor importance.
But our healthcare problem is urgent, so Dr Motsoaledi says, “With the shortage we have got we want to send (them) to any part of the world. It’s an advantage, of course, to send them to a country where the language is the same.” So now the Minister is contemplating sending SA students to Russiawhere training is provided in English.
How soon will our students be fleeing from Russia? It also ranks poorly (139th) on the Heritage Foundation’s Index of Economic Freedom, amongst the likes of Guinea-Bissau (138th) and Vietnam (140th) and slightly ahead of the Central African Republic, which is ranked 142nd.
What Minister Motsoaledi intentionally overlooks in his quest to send our students off to economically and politically repressed destinations is that our very own private sector has already shown a keen interest in training doctors right here in this country. A few years ago, when a private institution applied to establish a medical school in Midrand, Gauteng, it was turned down by government. This naturally quashed any interest by others contemplating the same move.
Apart from the language barrier, are foreign trained returning doctors adequately equipped to handle problems unique to SA? According to the economics consultancy group Econex, SA has a “quadruple burden of disease”. As a result Econex states, “The types of in and out-patient treatment, medication, primary and other care needed in South Africa, are not like that of other countries. One implication is, for instance, that more hospital beds, and therefore medical as well as other staff, will be required in a country where there is such a high prevalence of HIV/AIDS, communicable diseases and also injuries”.
It is not only more staff we require but also medical personnel. Personnel who gain an acute in-depth knowledge of prevailing local conditions that can be acquired only by obtaining training in this country.
The HIV/AIDS prevalence rate in Russia is 1 per cent. In Cuba, it is 0.1 per cent. In South Africa, it is 17.8 per cent. From this it should be obvious that we require local solutions to heal local problems.
In SA every year, thousands of potential candidates, even those who achieve distinctions in their matric examinations, are turned away because the number of positions available at SA’s eight government run medical schools is limited to around 2,000 positions. This number is only fractionally higher than that which was set in the early 1970s, despite our rising disease burden and a population that has more than doubled.
An obvious short-term solution to the chronic shortage of skilled healthcare personnel in SA would be to allow foreign skilled healthcare personnel to practice here, without any restrictions on where they are allowed to work and for whom. A longer term solution would be for the Department of Education to relax the restrictions and allow the private sector to establish private medical schools so that thousands of SA’s brightest students can pursue their dream of studying medicine. Whether these schools operate on a for-profit or non-profit basis, their establishment can only alleviate the burden.
South African private hospitals are well-established centres of excellence and world-renowned for their high levels of care. Privately run education facilities, if conducted in co-operation with private hospitals, have the potential to attract internationally recognised lecturers, which, in turn, will increase the available pool of knowledge as well as international students, who quite possibly will continue to work in SA.
Unlike government, the private sector has an immediate economic incentive to ensure that doctors who qualify at their institutions measure up to SA’s high standards. Fears that they will not are unfounded.
Privately run medical schools will not solve the chronic doctor shortage overnight, but they will definitely assist the government’s long-term efforts to increase the number of doctors practicing in SA.
This article was first published in the May edition of the Medical Chronicle.