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.

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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?

But…

We

Never

Drop

The

Ball.

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.

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DOC-U-MENTALLY: The Film [Review]

Breaking this unintentional hiatus to tell you (read: shout from the rooftops) that I have watched Doc-u-mentally and

IT.

IS.

AMAZING!

Continue reading “DOC-U-MENTALLY: The Film [Review]”

Working in the Land of Milk and Honey

I recently realised that some of my posts have disappeared into thin air. I’m not sure how, but I’m reposting them courtesy of the web archive.

By some kind of dumb luck, I am doing my Community Service posting at an incredible children’s hospital in Cape Town, rather than the archetypal middle-of-nowhere clinic post we all expect for ComServe.

And it’s incredible.

This hospital is just something else. It’s public, but has so much private funding that it might as well be a private hospital. It gets a lot of private patients so clearly I’m not alone in my perception.

Some things that continue to blow my mind: Continue reading “Working in the Land of Milk and Honey”

Doctors and Piercings: Part 3

It’s been nearly five years since I decided to get a nose piercing. I mused about the decision on the blog both before and after the fact.

Since becoming a “real” doctor, I’ve never had a patient refer to my piercing. As mentioned before, it really isn’t that conspicuous. I’ve also noticed more and more doctors who have nose piercings, so it probably isn’t so strange in South African healthcare workers as it was in 2011.

This year, after working with a certain doctor for three months, he finally noticed the piercing. His response was, “Well that’s atypical,” then he laughed and we moved on with our ward round.

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You can see it, but just barely.

I removed my nose jewellery recently, and in many ways that decision was as difficult as getting it in the first place. Continue reading “Doctors and Piercings: Part 3”