Are We Secretly Our Own Worst Enemies?

If you’ve been reading South African news, you’ll know that at least 300 interns and community service doctors stand to be unemployed next year, due to a lack of funded posts at accredited institutions.

Perhaps you read about our inhumane working hours last year.

Perhaps you have read about the overflowing hospitals where patients pile up in the corridors.

These are not new problems, we just hear about them more because doctors and patients have phones with cameras, and social media accounts.


When I was ill recently (appendicitis) there was a shift of mine that nobody could cover. The hospital should have paid a locum to do it. Instead, people cancelled their plans and shifted around and, with great cost to themselves, made it work.

South African doctors are really good at “making it work”. Maybe that’s why we’re so well-loved in other countries. In a natural disaster, South African doctors will be the ones who work day and night among the injured and ill. They’ll find sleeping space for the destitute, but not for themselves. They’ll jerry rig drip stands. They’ll crack open chests with minimal tools. They’ve seen horror in their own practice, and they won’t be overwhelmed by this horror. Or at the very least, they won’t show it.

We “make it work” every day in state hospitals. And our employers know that we will make it work, and maybe that is why nothing changes.

Our nurses – bless them – have indomitable unions. When they speak, the administration listens, lest they suffer the wrath of a union inciting its members to protest. And they get results.

At my hospital, nursing staff have two 30-minute tea breaks as well as an hour lunch break during their twelve-hour shift. The doctors have no guaranteed break(s). I have eaten my lunch at 01h00 in the morning. I have arrived home after a 26 hour shift and realised that I did not pee my entire shift (and then I wonder why I have a post-call headache).

I have worn surgical gloves two sizes too big because my size had not been in stock at a certain hospital for over two years. I learned how to adjust my technique to avoid slipping. I still ended up with a needle stick injury that year.

I know of people who have worked shifts while hooked up to an IV line, because they knew that their patients would not be seen otherwise.

When we are short-staffed, we make it work. We cut team sizes to the minimum so that everything is covered. We come to work earlier, and finish later. We skip teaching meetings and training and courses because patients are dying, and further education is really a just a privilege, right?







And maybe that’s the problem.

We stretch our muscles to breaking point to catch all those balls. We become weary and strained, but we hold on.

Maybe if we dropped some of those balls – dropped them so they clattered across the floors, and people stepped on them and tripped over them and they became a real nuisance – maybe then something would change.

Because we say that we are overworked, but all our employers see is patients who are saved at the witching hour.

We say that we are short-staffed, but all they see is that the shifts are covered and the work is done.

We say that we are under-resourced, but then we find private funders for our new ICUs, and to paint our hospitals, and to provide the medication our government will not provide.

Where is the impetus for change? It is not there, because we make it work.

Perhaps we are too proud to let the ball drop. We’re too proud to say, we can’t: we need help. Because isn’t that how we got ourselves through medical school in the first place – by convincing ourselves that we were invincible?

dbf8e6f859df16669b4d3d302c86a486There is a story about an oncology department at a KwaZulu-Natal hospital that had its medical officer program shut down. The remaining doctors left, because they could not run a service without medical officers. Very quickly, the Department of Health funded the MO posts, and the service was up and running again.

Sometimes I think that may be the only way we ever achieve anything.


  1. ackeldatter says:

    😦 ❤

  2. Promise Nomonde Mafuya says:

    Unfortunately, you’re not in the same category as nurses (them being seen as the life-force of health care). I say this as a paramedic myself. Being overworked and making it work is part of us, daily. Improvisation is normal.
    But I tip my hat to you and your colleagues for putting patients first. Do remember to take care of YOU.
    Much love and respect

    1. barefootmegz says:

      Thank you, Nomonde. I have a great respect for the importance of nurses’ in healthcare, but the discrepancies drive me mad. Best wishes to you, too.

  3. Robyn says:

    One more time for the legislators in the back.
    Same problems over here in Jamaica, Meg. Nurses go on strike and we bend over backward to make sure nothing goes amiss. Short-staffed? Everyone does double and triple shifts, works overtime, gets burnt out and comes right back. I absolutely believe that nothing will change until the system breaks first. Unfortunately in our culture doctors are not taken seriously when we complain because our lifestyles are regarded as “privileged”.

    1. barefootmegz says:

      Right?! So because we get paid more than nurses, we should somehow be able to survive the abuse. The system is breaking. I just worry that it’s breaking so slowly that it’s causing a “frog in boiling water” effect. Will the legislators even realise when it is broken?

      1. Robyn says:

        Frog in the water is exactly how I would describe it. Even the doctors are experiencing that. The conditions will slowly worsen until the system totally collapses, but that will be much too late.

  4. GovtHospReg says:

    Had the most awful gastroenteritis last month – my GP wanted to admit me for 24 hours of IV fluid but instead I forced down liquids and did two weekend shifts because I knew trying to get someone to replace me would be difficult if not impossible… you can only miss a call if you are basically in ICU when you are a state doctor…

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