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]”

Mental Health Begins With Medical Students

Every few months, the mental health of doctors/medical students makes it to popular media. It seems like these spikes in attention occur, and everyone shouts YOU SHOULD CARE FOR YOUR DOCTORS! and then we write blogs and we tweet and we make youtube videos and eventually we go back to work, and nothing has changed.

I think we are the missing link. And by “we”, I mean qualified doctors. And also, you, the older doctors. Continue reading “Mental Health Begins With Medical Students”

[Book Review] Incarceration Nations

dreisinger_incarcerationnationsI don’t know how much time the average person spends thinking about prisons. It usually crosses my mind when I have a patient who is brought from prison – which happens a lot less now that I’m working only with kids. Every once in a while there will be a report of a jail break, and in high school we had a few debate topics around prisons (This House Supports The Right To Vote For Prisoners, etc). Every year at the anniversary of my aunt’s murder I think about prison, and wonder whether her murderer is still incarcerated.

Besides that, prison doesn’t cross my mind too often, and I’d wager it’s the same for those who don’t work with inmates, or don’t have a close relative currently imprisoned.

Baz Dreisinger’s Incarceration Nations dares to coax us from this comfort in a multi-national exposé of prisons around the world, and the justice/punitive systems within which they function. Continue reading “[Book Review] Incarceration Nations”

The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why

If you’ve been paying attention, working hours of doctors (especially junior doctors) have been getting some good airtime over the past few months. The Province of the Western Cape has committed to actively reducing maximum continuous working hours for doctors to twenty-four, the HPCSA has promised to “look into it” (not that we have too much confidence there), and our biggest representative, SAMA (South African Medical Association) has come out in our support.

One of the things to come from all this is the launching of an armband campaign. This has its origins, I believe, from a similar campaign in the UK – although I have not been able to find any source to this link.

608772084 Continue reading “The Safe Working Hours Wristband Campaign is Missing the Point – Here’s Why”

What If Slavery Never Fell: Underground Airlines [Book Review]

I’ve been on a bit of an alternate-history kick recently, which has led me to believe that it is possibly one of the most challenging genres an author might tackle. Call it the Butterfly Effect or Domino Effect or just plain Jenga, but changing a single event in history causes a cascade of changes, and if the author misses even one of those, the book loses its believability.

23208397Underground Airlines by Ben H. Winters is an alternate reality in the present day where slavery was never outlawed in the USA, and is still practiced in four major states. It is a horrifying thought and an important topic in light of current race-relations in the USA and much of the world.

World-building is important in alternative-history fiction, but must be subtle. If the world is different to the way we know it, the reader must be able to understand why that is. Winters did this fairly well, in referring to trading sanctions which, for example, result in CDs not yet reaching American markets. Continue reading “What If Slavery Never Fell: Underground Airlines [Book Review]”

My Evolving Opinions About Doctors’ Working Hours

I started working on this post two days ago. Since then, I have received news of a colleague who died in an accident while driving post-call. She went to my alma mater and graduated last year, and though I did not know her personally, my heart breaks. A country with a shortage of doctors has lost a young doctor who was just starting in her career. She was well-loved, and we will all feel her absence.

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 * * * Continue reading “My Evolving Opinions About Doctors’ Working Hours”