May 24, 2009
South Africa’s state hospitals are in crisis — and will be at risk of collapse if hundreds of underpaid and demoralised doctors flee their shocking working conditions and pay. Underpaid doctors are working up to 36-hour shifts without pay, operating theatres and trauma units are summarily shut down because of a lack of basic supplies, and patients are routinely turned away because of a lack of ventilators, beds and medicine.
The shocking state of the country’s public health sector was revealed this week by doctors who are at loggerheads with the government over their paltry pay.
And the situation will deteriorate further if the 10% to 15% of junior and mid-level doctors carry out their threat to quit unless their pay improves.
South Africa currently has just over 18000 doctors in the public sector, which works out at one doctor to every 3800 citizens without medical aid.
The World Health Organisation recommends an average ratio of eight doctors to every 10000 people — about three times more doctors than we currently have.
Doctors and health experts blame the shambles of public health on mismanagement. But the minister of health, Dr Aaron Motsoaledi, says : “I would not use the word crisis; I would say very serious challenges.”
Dr Tina Ingratta, a senior doctor at Johannesburg’s major hospitals, lists poor management and misallocation of resources among the primary reasons why the healthcare system is in disarray.
“Besides this, lack of incentives for people working in the health sector is a contributing factor. Government doesn’t seem to prioritise our health-care system,” she said.
Dr Clarence Mini, who headed a committee to test the standards of Gauteng’s 33 public hospitals, said only 11 met basic standards when they were first measured in 2005.
Since then, even some of the successful hospitals had dropped their standards, chiefly “owing to staff shortages and management issues”.
As the doctors prepare to take to the streets on Friday and threaten to down tools during next month’s Confederations Cup soccer showpiece, they revealed that:
All surgery was cancelled at Boitumelo Hospital in the Free State from Thursday this week because there was no life-saving oxygen and no surgical gloves that fitted surgeons’ hands;
A patient died of renal failure while stuck in a lift at Charlotte Maxeke Johannesburg Hospital ( Joburg hospital ). A “colony of flies” lived inside the hospital’s Caesarean-section operating theatre and some patients had to be carried up stairs from operating theatres to ICU on stretchers or in wheelchairs owing to lifts that have been defective for more than a year;
All life-saving equipment was defective in the emergency room at South Rand Hospital in Rosettenville, Johannesburg, since Thursday this week — including ventilators and a basic heart-restarting “defibrillator” machine that even many gyms stock for their members;
Chris Hani Baragwanath Hospital in Soweto is regularly forced to “close” on weekends when it runs out of ventilators and space in its trauma wards and experiences frequent critical shortages of life-saving drugs ;
Only three “or a maximum of four” of Ngwelezane Hospital’s six operating theatres were working owing to a “chronic staff shortage”, with doctors working shifts of up to 36 hours without pay. The hospital is the major trauma centre for northern KwaZulu-Natal ;
Staff at Tara Hospital in Johannesburg were forced to use petty cash to buy bread and milk this week when “essential foodstuffs” ran out, while food was also not delivered to Sterkfontein Hospital in the past month;
There were no diagnostic services (procedures used to determine the cause of an illness) “at all” in the critical Nuclear Medicine departments at Bara-gwanath or Charlotte Maxeke hospitals “because the supplier has not been paid”;
Charlotte Maxeke has adopted a “first 500” rule whereby all patients are turned away after the first 500 have drawn their medicines from the pharmacy, because 15 of the pharmacy’s 20 posts have been “frozen”; and
East London Hospital Complex, one of the Eastern Cape’s referral hospitals, has only two full-time psychiatrists attending to about 12455 outpatients a year, excluding in-patients, outreach and community services.
The province has only 14 state-employed psychiatrists.
Dr June Fabian, a senior specialist at Charlotte Maxeke, said there was sufficient money in the health system for functional hospitals, but “poor leadership and mismanagement of funds” had created “a crisis of care”.
She said the Western Cape was the only province in which state hospital care was not yet in crisis. “The Western Cape health (department) has focused on developing their primary and secondary health-care systems and has a very tight referral system to the academic centres. This reduces the influx of primary-level care patients to big centres. The chaos at Bara exists because the primary-care centres in Soweto are poorly functional (and) there is no intermediate care facility in Soweto,” she said.
An audit commissioned in 2007 by the Association of Surgeons shows that mid-level public-sector doctors earned 65% of equivalent-level magistrates and engineers in government employment.
Senior surgeons and specialists earn almost half (52%) that of judges and senior pilots of state-owned airlines.
Intern doctors this week showed the Sunday Times pay slips that indicated that they took home less than R10000 a month, although some earned up to R14500 with 80 hours of monthly overtime pay.
said that, as of Thursday this week, there was no life-saving oxygen at all in the hospital and no surgical gloves that fit surgeons hands, causing all surgery to be cancelled;
Dr Tina Ingratta, a senior doctor at Johannesburg’s major hospitals, told the Sunday Times that one of her patients died of renal failure while stuck inside one of the many faulty lifts at the hospital Charlotte Maxeke Johannesburg Hospital (“Joburg General”) as doctors waited to receive him at the renal unit on the 9th floor. A panel of 33 junior doctors here said that “a colony of flies” lived inside the hospital’s caesarean section operating theatre, and that some patients had to be carried up stairs from operating theatres to ICU on stretchers or in wheelchairs due to lifts which have been defective for over a year;
Dr Jack Thomson, an intern at various Johannesburg hospitals, said all life saving equipment was defective in the emergency room at South Rand Hospital in Rosettenville as of Thursday this week -including both ventilators and a basic, heart-restarting “defibrulator” machine which even many gyms stock for their members. Thomson said premature babies died “very, very often” at Joburg General because there were only 8 to 10 ICU beds for babies;
The panel of junior doctors confirmed that Chris Hani Baragwanath Hospital in Soweto is regularly forced to “close” on weekends when it runs out of ventilators and space in its trauma wards; that it is so short of equipment that some doctors have been forced to use Biohazard Waste boxes as desks to write their scripts; and that it has frequent critical shortages of life-saving drugs like adrenaline and heparin;
Dr Thomas Hilton, a senior medical officer at Ngwelezane Hospital -the major trauma centre for northern KwaZuluNatal -said only three “or maximum four” of the hospital’s six operating theatres were working due to a “chronic staff shortage”. He said some foreign doctors worked shifts of up to 36 hours without pay -treating over 100 patients per shift -to keep the institution open, because the provincial Department of Health refused to appoint the needed more doctors;
Professor Chris Szabo, head of clinical psychiatry at Wits, said staff at Tara Hospital were forced to use petty cash to buy bread and milk this week when "essential foodstuffs" ran out, while food was also not delivered to Sterkfontein Hospital in the past month;
Motsoaledi told the Sunday Times yesterday that he would “not try to dispute what doctors have been telling you. Unfortunately, I know those serious problems are possible.”
He said he had listed “financial management” as the first of his department’s four priority areas for urgent action.
He said there was no need for some doctors to strike or leave the service because “we acknowledge their remuneration is not satisfactory. I apologise for the delay of almost 12 months with this problem, and there is a willingness and a determination on government’s part to resolve this issue as speedily as possible.”
Fidel Hadebe, a spokesman for the department, said an offer of improved pay and conditions was currently “on the table” with the SA Medical Association, but refused to discuss the details.
However, Ingratta said: “Ten to 15% of my fellow registrars will definitely leave the sector this year if anything like that deal is accepted. It’s a total joke — it actually represents a net cut in our salary.”
The government is offering doctors a on e-off payment and to phase in increases over a period of time. But, in essence, what government is offering would still be far less then what the SA Medical Association is demanding — an effective 50% increase.
Professor Mac Luhkele, chief negotiator for the Sama, said independent studies showed that there were “big differences” between the two parties.
He warned that conditions were not improving and “we are going to lo se a lot of doctors if this isn’t solved soon”.
The Sama and other unions are now hoping for political intervention in the negotiations and, together with Cosatu, will meet with the ministers of health, public service and administration and the treasury on Wednesday to come up with a proposal that will hopefully resolve the matter.
Lukhele said industrial action was a last resort, as government would not be the ones suffering, but the poor and sick who cannot afford medical aid.
“We are not unreasonable. Legally or not legally, what do we do when we are being ignored? ” said Lukhele.
The CEO of National Hospital Network, Otto Wypkema, said: “Unless we have more doctors, both the private sector and the public-sector health services will crumble to the point of no return.
“It is appalling that doctors, dentists and Emergency Medical Services (EMS) personnel should be kept waiting for nine months since June 2008 for promised salary adjustments.
“The future of health services in South Africa depends on the fair treatment, remuneration and teaching facilities in the public sector.”