The State of South African “Health” Care

I am writing this post call, post an exhausting 30 hours of being awake, 25 of which I spent seeing countless numbers of patients in a busy hospital in Pietermaritzburg, KwaZulu Natal, South Africa. Thankfully, as I write this, I am sitting in a warm bed with a cup of coffee following a warm shower; all of which I took for granted until I spent 3 days without electricity due to a municipal workers’ illegal strike in which they sabotaged the electricity substations in my area. I am not ashamed to say that it made me angry – don’t undermine my rights because you’re frustrated at a government that you vote for, especially when every day I work to provide you with one of yours… health. But I digress.

 

As I sit here reflecting on another call, I have much for which to be grateful, but I also have a deep sadness in my heart. What is happening to the state of our “health” care? Actually, what is happening to our state? Is the degradation of our public hospital systems a metaphor for the crumbling of our beautiful country? The anger and frustration is suffocating us, muting us to solutions, molding us into apathy and resentment.

 

Last night I was called to certify my first death as a doctor: fifty year old with cervical cancer. She was awaiting surgery, and a CT scan to determine how far it had spread. She never got those. She was a victim of lack of resources in KZN healthcare. I mean disease care. Fixed and dilated pupils – I won’t forget.

That same hour and in that same ward I ordered three units of blood for a stage 4 cervical cancer. She had already received 4 units and her haemoglobin (that marker of oxygen carrying capacity in the blood) was still 3.9. It should be 12. Every unit that went in her came out the other end. The nurse told me her sheets were soaked the previous night. I didn’t mention… she is 28 years old.

But there is no time to reflect, to empathise, to shed a tear for the fragility of human life and injustice of life itself. There is another Caesarean section to be booked for a patient screaming on her back in labour, clutching at your scrubs in pain while you take consent and put up a drip for theatre. She will give birth to her fourth child. Alone. She is unemployed. She requests a grant. You tell her the government doesn’t have money. She will vote for them in 2019. She now also declines to tie her tubes, and when you ask what she wants to use for “family planning” (the irony of the term acknowledged), she says Depo, the 3-month injection. Your next patient comes in stomach round and full, and when you ask about her last period, she says she doesn’t know because she was on Depo… she forgot to keep going for her injections… oddly, she got pregnant.

And just when you begin to count the hours you have left until you pack your lunch box containers and the sleeping bag you never use but bring optimistically anyway, two emergencies arrive simultaneously: a ruptured ectopic pregnancy and a prematurely detached placenta. Both are bleeding, one on the inside and the other through her vagina. And now you’re the only doctor that will prep these patients for theatre. The senior doctors have been sleeping all night, and on the occasion that they pop their head in, they will be on their phones and watch you wade through the queue of patients. The sisters will be there though… eating greasy chicken, playing videos on iPads, and then looking appalled when you ask them to get you a green jelco needle for the patient. If their seat is really comfortable, they’ll just tell you “O/S doctor”. Out of stock. Which either means too lazy to look, or the department of health hasn’t paid the supplier again.

 

Another call draws to a close, and my fellow intern who has become like family brings me a cup of coffee as she takes over the patients I have been seeing all night. I am grateful for my job, that I have one in this country, that I am not one of the many doctors who graduated last year and now sit at home because they weren’t placed and don’t know what to do with their degrees, while the Minister of Health denies the situation and his contribution to the crippling state of disease care in this country. I am grateful for the interns I work with, the incredible friendships I have made, and the unique bonds I have with people who have seen me at my worst. I am grateful for the experience I am able to gain in this environment, and the skills that will serve me going forward. And I am grateful for the fortitude I have had to develop this year – I am a stronger person for it.

 

But I am sad. I am overworked. I am exhausted. And after these two years of internship, I will find a way out. To practice the type of medicine for which I studied to be a doctor, to give people what they deserve – health care.

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