The state of a nation must be judged by many indices. When considering a safe haven, wise people look at such indicators as stable government, abundant natural resources, safety and security and, most of all, good health policies and services – at some point or the other we will all have the experience of having to visit a hospital – and then one realises just how important a good health service is.
It is in this context that South Africans need to seriously focus on what is important to a healthy nation in a caring society.
Recently, our doctors and nurses in Durban were forced to abandon their patients and take to the streets to draw attention to a litany of problems they face on a daily basis.
Their grievances range from a lack of or inadequate equipment, long working hours, staff and medicine shortages, frozen posts for registrars and so forth.
One senior specialist informed told me that she had no access to a CT scan machine in her hospital as it had been in a state of disrepair for years. Her patients have to be transported to another hospital for a scan which delayed her treatment process considerably.
Others complained of a lack of medicines.
Doctors have to work long hours without tea or lunch breaks as their patient loads are so heavy. Their grievances were listed in a five-page memorandum and handed to a rather surprised Sifiso Mtshali, the KwaZulu-Natal Department of Health head.
For management to plead ignorance over such widespread issues reflects poorly on the competence and goodwill of the department. He is quoted as having said: “The last time we met Sama (SA Medical Association) was on commuted overtime in December, then they came in April requesting an urgent meeting about the march.”
Well, what did he think a lapse of four months means after years of unattended complaints? What does one day mean to an overworked doctor or a tired and sick patient who has to wait in long queues to see a doctor? What does it mean to poor and indigent patients who after waiting all day are only to be told in some cases to come the next day? Stories abound of some patients even dying waiting in a never-ending queue.
No, Dr Mtshali, the poor state of public health in the province is a widely expressed concern among, particularly, the poorer strata of society.
It is of deep concern to our medical professionals who are thwarted in their efforts to practice their noble profession with some nobility. In taking the Hippocratic Oath, each doctor faces the ethical dilemma of serving patients and saving lives over all other economic and politi- cal issues.
It would seem that over the years the state of our health services in South Africa has become more of a political than a health issue.
In this regard, the question of Libyan and Cuban doctors seeping into our health system is of some concern.
Why are they here when we are freezing the posts of registrars? There are apparently many qualified doctors without a job when the hospitals are crying out for them. Surely they would be more in tune to understanding our local disease patterns, and the cultural expression of patient symptoms, than complete outsiders? Why are we favouring foreign doctors over our local people?
An eminent cardiologist expressed his concerns about keeping South African-born, super bright students out of the profession on the basis of race.
If such talent were allowed to blossom we would be able to create a reservoir of academics, researchers and medical specialists from all communities to address the demands of private and public health-care, hospitals and university research and training centres.
Medical health care is a global issue that warrants the intervention of doctors of all races working together in a spirit of true patriotism for a common humanity.
Concern is also being articulated from various quarters about the perceived dropping of standards in our once highly regarded medical schools. All these concerns would warrant a special investigation into the state of our nation’s health system.
How have we arrived at this untenable situation? Who is to blame?
Professor Hoosen Coovadia writes in a journal article on Health in South Africa that the roots of a dysfunctional health system in South Africa can be found in policies of the country’s history, from colonial subjugation, apartheid dispossession, to the post-apartheid period.
Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa’s troubled past, and all have inexorably affected health and health services.
In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macro-economic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants.
The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies.
Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV pandemic has contributed to and accelerated these challenges.
All of these factors would need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.
Perhaps protests have their advantages after all.