Positive Hospital: Public is not the Devil

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.

Via Zapiro, click image for source

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.

Via Jerm, click image for source

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.