Working in our ailing public healthcare system

After an interesting conversation I had with a stranger recently, I decided to take his advice and put my thoughts and feelings down on paper. After mulling over a few topic ideas it soon became obvious what I wanted to talk about. The hard part was to choose the angle from which to approach it. The result is my frank and honest take on this county’s healthcare system and what it is like to be a small but integral part of this ailing machine.

You can’t look at this country’s healthcare system without appreciating the contrasts that exist within. South Africa is a third world country trying to practise first world medicine. It is trying to provide a quality public healthcare service that is on par with that in the private sector without a budget to match. The system is neither friendly to the people it is meant to serve, nor to the healthcare workers operating it. . It serves the larger part of the population but is allocated a chunk of the budget that is inadequate for what it is attempting to achieve. For the millions who cannot afford health insurance, public hospitals are their only hope. They have to rely on a system that simply cannot support them.

My brief stint as a community healthcare worker in the rural outskirts of North West Province has given me a glimpse of just how deep the problems really go. The feeling amongst most healthcare workers is that we are being expected to perform miracles with the little scraps we are given. We have a mammoth task of fighting HIV and TB, and, as if that isn’t enough, we have to battle growing social issues like poverty, unemployment and alcohol abuse which all come with their own complications. The ever-growing queues in our clinics and hospitals are a testament of how much sickness and disease is in our communities. I have found that most doctors in the state sector do not mind the increased workload and have come to accept it as a normal part of the job. What we do mind, however, is being expected to do a good job under the most difficult conditions and without being given the proper tools to do so. What’s extremely frustrating is that all our pleas for change seem to fall on deaf ears.

Instead of the hopeful anticipation usually associated with the announcement of the annual budget speech, it is now met with anger as we know that the huge sums of money promised by the ever smiling, big-bellied politicians, will never trickle down and reach us. If so much money is being allocated to HIV, why do our pharmacies constantly run out of life saving ARV’s? Why are HIV babies going hungry because there is no baby formula in the clinics? I would like the powers that be to justify why my Hypertensive/Diabetic patients have to go for months without HCTZ and Aspirin. How can I be expected to offer emergency procedures like caesarean section when the autoclave machine hasn’t worked for months? Of course, these are just isolated incidents, but these and many more horror stories are becoming the norm in hospitals around the country.

I was and still am a supporter of the recent strikes by doctors. I believed in what we were fighting for and was proud to be amongst the crowds picketing daily. However, I am concerned about the negative image of us portrayed in the media. We were made to appear as if we were money hungry, ruthless and had no respect for the lives of our patients. South Africans purposefully were not given a chance to see that the strike was not only a demand for a decent wage but more a cry of despair over the appalling condition of our healthcare system.

The DOH dragged the wage negotiations on for months but failed to tackle the core issues. They still cannot justify the supply of substandard equipment like latex gloves and syringes – be it all in the name of BEE and cost cutting? How can we make life and death decisions when we are exhausted from pulling long shifts because essential posts have been frozen? Who is the enemy here when all we are doing is advocating for our patients, the voters? Doctors in this country have little interest in filling their pockets, owning big expensive cars and enjoying lavish lifestyles. That’s for the politicians to do!

I’ve grown tired of the promise of a better health system because I don’t think it will ever come, at least not in my lifetime. And for those who are being fooled into thinking that an NHI is the answer to all of our problems, I hope they are prepared for disappointment. You cannot build on a pile of rubble. Would it not be more logical to focus all energy and money on fixing the current system, to make it work efficiently before we restructure? Call me a sceptic but even my limited experience has taught me to be wary. It’s a fact that not all that shines is gold! The most painful part of all of this is that while the policy makers and the politicians sit in their air-conditioned offices pretending to bring positive change for the people, babies will die of malnutrition and more communities will succumb to disease and poverty.

So my decision to leave the country to work overseas is an easy one to make. I cannot stand by and watch these atrocities happen in my own country, these blatant acts of genocide! People can call me a sell-out, non-patriotic, and even a traitor, but, as much as I love my country and its people, I would rather work somewhere else than be a slave in my own country.

Author: Dr Bongiwe Ngcobo (not her real name) gives her views on SA healthcare after having worked in a rural hospital. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the authors.

Note: Doctors’ Diary
The Health Policy Unit has opened a new section on its website called Doctors’ Diary, in which doctors can report on the travails and joys of working as a doctor in South Africa. Pseudonyms should be supplied (as in the case of “Dr Ncobo”) if views expressed in the article could make life awkward for the author.

Notwithstanding the mention of pseudonyms, Doctor’s Diary is not intended as a “grievance column”. We hope the Diary will provide a balanced view of the lives of South African doctors.

Eustace Davie, Director, Health Policy Unit.

FMF Feature Article / 07 May 2010