During my second year, I almost lost my thumb due to an unfortunate oatmeal incident (yes, really). Because I have medical aid, my friends rushed me to the nearest private hospital, a fifteen minute drive. Upon arrival, the hospital would not accept my completely legit medical aid number: they insisted on having the card. Which I had forgotten. They refused to tend to my wound unless I paid upfront.
Eventually my wound was taken care of. I was lucky not to have any apparent nerve damage, because I definitely could not pay for microsurgery up front, and medical aid clearance would take a while. Only later, when I had my sutures and pain killers, did I wonder why I had not simply walked across to the training hospital: a ten minute walk, a two minute drive. Why didn’t I? Because it is a public hospital, that’s why.
My recent post about public hospitals was factually accurate, but may have lacked some context to new readers. I hope to provide some of that here.
If I had walked into a public hospital with my bleeding hand (which was going to clot long before it could kill me), I would have been triaged as orange – maybe. So I would probably have had to wait an hour or two (or three; it was a Saturday) while all the GSWs and stab wounds and MVAs and ODs were seen to – as they should be.
I would have sat in an overcrowded makeshift waiting area where the nurses would have been too overwhelmed to bring a hyperventilating medical student a blanket and sugar water. And appropriately so, because they would have had lives to save. When I collected my antibiotics, I would have stood in another very long line. My treatment would have been a lot cheaper, though.
My hand would have been seen to eventually, but it would have been a markedly more arduous process. And so people who can afford to put their families on medical aid do so – for the speed and the knowledge that they won’t have to wait for hours to be seen, for the knowledge that if their child needed an emergency appendectomy it would happen in three hours and not thirteen. So we pay for the little extra comfort, as is our right, and we tell ourselves that we are contributing to the economy and at least there will now be one less patient at the overcrowded hospital, which is also true.
But this does mean that by far the majority of patients at public hospitals are non-paying patients, so are we really surprised that the hospitals are improving slowly, if at all?
I have stated before that the government “doesn’t give two craps”. Well, that may have been a little harsh and presumptuous. It is fair to mention that we have had a democracy for nearly twenty years and that the government should have done more in that time. But it is also fair to say that they really did walk into a disaster zone. The Apartheid Regime left behind some really good public hospitals… the only problem is that they were by no means equipped to deal with the entire South African population.
In 1994, the new government walked in on a situation where millions of South Africans still did not have a clinic within accessible limits. Many still had to walk hours if not days to reach PRIMARY healthcare. So instead of trying to improve tertiary healthcare, the government tried to address the inequalities of primary healthcare. And I really can’t blame them for that.
It is correct that there is a lot of fraud in our country. It is correct that many politicians build pretty homes and drive snazzy cars and fly luxury jets to luxury destinations. But it is also true that a large portion of the government really does try to do right by the people, and I think their good intentions get obstructed by just a handful of useless people.
Our national health minister is an example of someone who tries really hard. Dr Aaron Motsoaledi only makes use of public hospitals. Because he has a medical aid, that means that the hospital gets paid for serving him, so he does not get free healthcare. He admits that the conditions (the bad food, the paint peeling from the walls) are uncomfortable, but he says that he gets excellent care. Tertiary public hospitals are, after all, the only place in South Africa where a PROFESSOR is going to treat you.
Motsoaledi even told his daughter (also a medical student) that if she wants to use his medical aid, she will make use of public hospitals only.
This, I think, is a worthy move. How can he improve healthcare if he does not know what the situation is like on the ground? And, as a medical doctor, how can he shun the very centre of medical innovation in the country?
I blame the government’s mismanagement for many of our problems, but they are not the only ones to blame. When the country’s economy is falling to pieces, it is difficult to keep public service afloat. And when nurses are striking it is difficult to run a good hospital. When paramedics strike and vandalise hospitals and ambulance call-centres, lives won’t be saved. When members of the community put our doctors at risk, either through violence or by absconding from TB-treatment, doctors will want to leave. When the power cables are stolen from clinics, patients will die. When pharmaceutical and equipment companies are making unprecedented fortunes by capitalizing on our healthcare needs, healthcare can only drain the country.
When our country has a shortage of healthcare professionals because so many are leaving for greener pastures and better salaries, we are going to circle the drain.
You could probably say that most of these problems can be traced back to government inefficiency – for example, probably people would not steal power cables if they had enough money to feed their families. But the blame game isn’t bringing our country anywhere.
Some South Africans shared their experiences with me after said post. Stories of lives saved after private hospitals could not help them. Stories of incredibly kind hospital staff who take the time to smile even though they are overworked. And yes, stories of chaos too.
So, I guess what I’m saying is that the problem is a lot more complex than what it appears, but also that there is hope. I would not be in this profession if I did not think that there was hope. It is easy to lose hope and not everyone gets it back.
Many kind people wished me and my colleagues well – thank you. Many kind people called me a saint, but I really am not. I’m just a girl who admires the resilience of the human body and the tenderness of the spirit. I believe in health and I believe that it is a joint effort.
And I do not believe in a hopeless case.
Please note that I welcome comments even if they are in disagreement with my views. However, flaming will not be welcomed.
This is so well put from the inner workings of our Hospitals… who would know better than you the problems faced on a day to day basis.. I still say that it is because of Doctors like you that a total collapse has not happened… yet I remain full of confidence in the Government to improve healthcare for all in the country… when you take the bold steps made in the Environmental Act, the OHS act as well as a few others, I have faith, that with time, things will improve… This type health care, throughout Africa is not of the best, but I would stick my neck out and say I think ours is pretty darn good in relationship to others in Africa… sure it needs a lot of refinement .. but like all things in Africa, time is not really that important…
I remain indebted to people like yourself for remaining here to aid with the improvements, far too many Doctors, because of their wealth have left our shores to what they think is greener pastures, and it is that which worries me…
Love this post… a straight shooter.. love it…
Thank you! I definitely think the government should pull its socks up a bit, but you’re right, we are way ahead of most of Africa. I’ve only been to a few other African countries, but from what I can gather we are very, very lucky. Good to remember that for sure 🙂
One thing I love about blogging is the ability to be able to learn about the problems in the world and the problems within different countries etc, from people who are actually living and breathing those problems. It’s one thing to read about them in the newspaper and quite another to hear from personal experience. Your posts have been a real eye opener for me. I have always had a great interest in South Africa due to Nelson Mandela’s global presence, but apart from reading his biography I don’t know much more. South Africa sounds like such a beautiful but complex country and I’m looking forward to learning more through your beautifully written posts.
Thank you 🙂 I’m glad this could provide some context for you. You should visit our country some day! Having read Long Walk to Freedom you’ll already know more about the country than many other tourists who come here 🙂
I’m glad you also highlight some of the positives of public healthcare. Two years ago I did a counselling course through Hospivision at Steve Biko hospital in Pretoria and I was impressed. Yes, they still had long lines and the wards didn’t look like much, but you could see the staff were doing their best to help the patients.
What I do find sad, aside from all the other things you mention, is the number of state-of-the-art government hospitals that were closed after 1994. In my town there stands a huge hospital complex which is slowly being overgrown with weeds. I understand the need to build hospitals in the townships where the biggest need is, but how many more people could have been helped had the other one also been kept open?
I did not know this about the minister. He’s clearly a step up from the previous two 😉
That’s nuts – I didn’t realise so many hospitals had been closed down (I was very young at the time) so I don’t really have an answer… will be interesting to investigate that though. We need MORE hospitals, not fewer. Now they want to build new ones when others are standing empty? It doesn’t really make sense…
I’ve sadly only ever had appalling service at a public hospital; that being said I myself waited over 2hrs to be seen in a private casualty unit (I was classified as ‘orange’) 2 months ago. But I will not go to a public hospital; there is no perfect hospital, but in what I pay for my medical aid every month, I will go straight to a private hospital. Yes, I agree that it’s ridiculous that they won’t see to you without the relevant ID, medical cards etc, but that is there policy. I had to wait 6hrs in 2009 for my medical file to be pulled from the filing at the Ladysmith Government Hospital – 6hrs before I could even go and see a doctor. I’m really glad that our current minister only uses public hospitals; good for him, but you won’t catch me near one every again.
And I have huge respect for those working at public hospitals; your previous post about working in a South African public hospital really opened my eyes.
I’m sorry you had negative experiences – you’re certainly not the only one. It drives me nuts when it takes hours to get a patient’s file. It happens here too. Sometimes I’ve had to go pull a file myself because I’m tired of waiting for people to do their jobs – even though they’re paid to do it. Sigh. Now we have it electronically but that doesn’t work half the time either.
You’re completely entitled to make use of private hospitals, especially with the bad runs that you’ve had. I hope that one day the hospitals will improve such that nobody will have to experience what you experienced!
Well written. Ur article touched a nerve. I am a medical student from a developing country . And I know the kind of situations u are put through everyday. It takes a lot of guts to do the right thing when there is a lot of wrong going on around you. It is easy to get swayed and say that’s how things go on around here. You gotta be the change you wanna see. And I agree with your last paragraph. Medicine runs on hope far more than ppl would like to believe.
Good luck and keep those articles coming.
Thank you! It’s great to meet you. You’re right: it’s so easy to be complacent and just go with the flow… but our countries will never improve if we do that. Thanks for highlighting that for me!
Thanks for linking this post with Medical Mondays. Very informative, and interesting to note that politicians don’t change much regardless of what country they serve, there are good ones and bad ones everywhere. It was nice to hear about your national health minister. Great post!
Good observation – politicians will be politicians!
Fascinating post. When a patient of mine complains about wait times, I should direct them to blogs such as yours. We live a very privileged life in Canada with our Universal health care.
Very privileged indeed, but I think we will always complain and try to improve things even more. It’s the way we progress, but it does have the potential to be destructive (and annoying!).
In italy there isn’t this problem fortunately.
Oatmeal accident eh? Pray tell!
I have an unrelated medical observation. Why is it that when you bang your humerus it’s not in the least funny! I cried out in pain the other day to my husband “I banged my funny bone!” He laughed! I didn’t.
It was kind of silly. I was making oatmeal in the microwave in a porcelain bowl. It was too hot when I took it out, so I dropped it. It bounced on the counter top and I caught it, not knowing that it had split cleanly in the middle. So I ended up catching the sharp side with my palm.
As for the funny bone, apparently it might have referred to “strange” – i.e. the strange buzzing sensation. Also, the funny bone not actually a bone – it’s just the connection between the humerus (which IS a bone) and the ulnar nerve.
I tried to figure out why the upper arm bone is called the humerus, and it seems that the Latin word was “umerus” and was then misspelled. Mmmh…
Sorry ’bout your funny bone 🙂
My in-laws have to go without medical aid. As my mother-in-law is a diabetic, she visits our local government hospital every month, sometimes twice a month, in order to get her medication and check-ups. Her care and the attention she receives can only be applauded – there have not been a single mishap.
Yes, she has to be there extremely early every month if she wishes to miss the long cues, but I figure that is a small price to pay.
When it comes to emergencies (we went through a heat attack as well as a triple-bypass in recent years) the government-run hospitals stand back for nobody. It may not be pretty – the food may be bad – you even have to take your own pillows and bedding – but the care received was excellent.
Thank you for your blog – I love it!
Thank you for sharing your experience. Also, I love it when patients arrive early, because that means we can start at 8 instead of having to hang around until everybody arrives en masse, so kudos to her. It’s a pity about the waiting times though.
Government hospitals are really good with emergencies and I’m glad you’ve experienced that too. I always feel sorry about the food and the lack of pillows, but I agree, it is a small price to pay.
Hope I can contribute to giving people such positive experiences too.
Thanks again for stopping by!
Really encouraging stuff as always. I really appreciated the remarks about remaining involved in public care to be able to work out better policies. What would patient advocacy be if one didn’t first know their patients!
Reblogged this on me and my life.
Another M2 and I are curious if yourself (and/or med students outside the US) have curricula which give more time to learning about parasitic diseases? We are flying through nematodes like ascaris and hookworm which are endemic in other parts of the world. Do you get more exposure to such while we spend more time on atherosclerosis or whatever other chronic “Western” diseases?
Mh, well we probably spend more time on it than you guys do, but we also spend a lot of time on chronic disease, because South Africa has what we call the quadruple burden of disease, namely
1. HIV and TB
2. child and maternal mortality
3. non-communicable disease
We didn’t spend too much time in theory classes on nematodes and such, but we spend more concerted time on them in rotations such as paediatrics and family medicine (and somewhat in internal). Because we’re being trained as GPs (specialisation is another day’s worries), they’re not really too concerned with having us recognise the microscopy of parasites, more being able to recognise and treat the disease conditions caused by them.
One thing we probably get more exposure to in terms of microscopy is schistosomiasis and hydatid disease, for some reason. And malaria, even though it isn’t very prominent in South Africa, because we get a lot of tourists/refugees with the illness. We just rush through things like yellow fever and such, though, because we hardly ever see them. Similarly we spend very little time learning about Kawasaki Disease, because it too is very rare here. (Hypertension, Atherosclerosis, Cancers and Hypercholesterolaemia are unfortunately very common here.)
Does that make sense/ answer your question?
Most certainly, it’s fun being trained to know everything in medical school, but what your everything takes on different forms than ours. And I know medicine varies within the US from countryside to cities to suburbs, but haven’t quite been exposed to such. I am looking forward to that as well as a possible rotation abroad (fingers crossed… plus that’s forever away!)
Really appreciate these bits of knowledge and will email to my friend 🙂
Rotations abroad can be an excellent experience – try your best to do one, you’re not likely to regret it.
My dad died in a public hospital, the service there was unpalatable. It took me some time to forgive the negligent personnel. Your blog is going a long way in helping me heal those wounds…..now I get to hear “the other side” of the story
I’m so sorry to hear that. I think I would also be very angry in such a situation, and those situations DO happen. I hope that they will be reduced into oblivion soon, because such events are unacceptable.