Monday, June 29, 2009


I never ever thought this day would come...

But if one examines the history of state health service in this country, the current strike was a long time coming.

I have two days left at the Community Health Centre I work at - but I did not go to work there today.

A decision was taken at a meeting on Friday to strike for a better future in state health care, for patients and doctors. The meeting occurred at our tertiary referral centre, and we decided that all day hospitals would close down, and that the state doctors from those centre's would go and help out at their secondary and tertiary referral centres. We decided to keep only the essential services running at these hospitals.

Thus, the Western Cape Province is only running emergency services, like casualties and trauma units, labour wards and ICU, for life-threatening emergencies. All non-essential clinics and elective surgeries have ben cancelled.

Of course, defining what actually constitutes a life-threatening emergency is difficult. Do we stop giving chronic disease patients their antihypertensives? They are not technically an emergency case, but not having their meds might result in an emergency. Do we continue running the anti-retroviral clinics for the HIV patients? It's really hard having to deny patients care in this way. But we are completely fed up, and have no other recourse. The government has exploited our humanity for too long. They know that we will always put ourselves above our patients. But who puts us first?

Why are we actually striking?

We are fed up with the current pathetic state that our Health Care System is in. We are shocked by the government's lack of urgent action to remedy the situation. All of their children and relatives must be using private hospitals. Nobody in a position to change things could just stand by if they knew exactly what was going on at the state hospitals.

We are saddened that we cannot provide the quality of health care we know we are capable of due to the fact that our resources are so limited. Some hospitals do not have sterile gowns in the operating theatre. I have often had to man the trauma unit without an ECG machine or an oxygen saturation monitor. I have colleagues, at my level, working up-country who have to do three jobs at once. And by that I mean: Putting the spinal anaesthetic into the pregnant patient themselves and making sure she is stable - then scrubbing up and performing the caesarian section themselves - then resuscitating the child after delivery - then rescrubbing to close up the wound from the caesar-then monitoring the patient in the recovery room. They're supposed to be working as COSMO's ( community service medical officers) like me - instead they are the anesthetist, paediatrician and obstetrician all at the same time! IT'S RIDICULOUS! And dangerous. And unfair to the patients.

Furthemore - we are insulted by our current salaries. Compared to other government employees - Dr's are undepaid by up to 50 percent. This is not a comparison between South Africa and other countries - this is a comparison with our OWN government employees. A judge at the highest level gets paid 50 percent more than a chief medical specialist. Despite that medical specialist having worked longer hours, and trained for longer. A bus driver's basic salary is the same as an medical intern's basic salary without overtime. How does this make any sense?

We are striking for an increase in our wages to ensure that our doctor's stay in this country we love, and not be forced to move overseas due to better working conditions there and greater financial reward.

The government was supposed to implement the wage increase last year in June 2008. But since then, nothing has been done about it. The strike, started in Kwazulu-Natal Province, forced the Government to begin talking about our wages again, and begin implementing them. Recently the government thought they were clever, and presented us with an offer - claiming that they had increased our salary by 30 percent. But it was nonsense.All that they did was collapse our rural allowances, scarce skills pay and overtime into our basic salary. The actual increase worked out, for some of us - in the region of an extra R300 a month.

I was one of only two doctor's from our community health centre who decided to strike today. The rest don't seem to be interested. And my clinic ran as usual today with no change. Perhaps they feel that things are running smoothly. Perhaps they have been suffering too long to stand up for change. I'm not sure. Perhaps they just can't leave the patients. All I know is what I've experienced and what I've experienced has been shocking.
I might get into a lot of trouble for staying away, I might not. I don't know. But someone has to do something.

So today about 300 of us from hospitals around the city, toyi-toyi'd and marched and sang. All the media were there. It was hectic.

I am seriously frightened for the future of health care in this country - it's stressing me out.

I start as a medical officer in the trauma/casualty department of a secondary hospital on the flats on Wednesday. As this falls under emergency services I will definitely be going to work then....

We'll see what the future brings...the bargaining chamber is still hot with discussions as to what the Department of Health should offer us... so far what they've offered has been akin to a slap in the face.


Ketan said...

Hi Dr. S,

Sorry for the delayed response to this post. Actually, I'd typed my comment (which I do using my cell phone), and somehow I couldn't submit it. I was irritated 'cuz as it is typing comments through a cell phone is such a pain in the thumb.

But anyway, I got over my inertia (more respectable term for laziness), and am commenting :)

Thanks for incorporating my suggestions on your blog. But more important, I'm happy, you joined the strike, and even more important, wrote about it. This is the type of post I wanted to read on your blog--dealing with something having your own opinions. For instance, your pointing out how antihypertensives and ART, though not emergency medications, are very essential provisions.

Each time I read your posts, I feel how similarly is medical profession poised both in South Africa and India. I used to get Rs. 1700/month as stipend, which is about one-fifth of what an ambulance driver would get (and unlike in SA, these won't be adept at basic life support or even first aid! Their only qualification would be to drive well!). But then they also have to support a family, so maybe their salaries are justified.

Don't you have provision of casual leave--not reposting to work without notice?

All the best!


Dr S. said...

Well, I'm so frustrated by everything that is happening in our Public System, that on principal I refused to take sick leave. I made sure they knew that I would be at the strike.

I couldn't strike today as I started in the emergency unit of the secondary hospitals. Which was wonderful. I loved it there.

Our strike is all over the news. Has anything filtered overseas?

Also - do you still work in clinical practice?

Ketan said...

Happy to know you loved your new workplace. :)

Well, I've not been following much of news, so don't know, but will let you know if any news trickles.

I'd got my degree and permanent license to practice in mid 2008, but since then have only been preparing for postgraduate (PG) entrance exams. Couldn't get any seat (position/residency--I don't know what you call it in South Africa) last year, so trying again. In India, simply trying to practice on the basis of MBBS degree that I possess is not practicable, though legally, I'm permitted to perform even neurosurgery, as because of factors like patient perception, etc., not even those suffering from simple URTI will come to me for treatment unless and until I get a postgraduation degree, and for some of the fields like MS general surgery and MD General (Internal) Medicine (both of which take 3 years to complete), one can't get patients even with those degrees.

So, as of now an unemployed and just studying for these exams, where the easiest selection ratio is 1:40. My preferences in order are MD Radiodiagnosis (selection ratio~1:5000) and MD Pharmacology (1:100 to 1:50).

Actually, I've always been interested in research involving molecular biology like immunology, but don't see good scope for research in India, and going abroad anywhere would prove very costly.

Just if you find time, you may gloss over this Wikipedia article written entirely by me, and also a few of the images were made by me. It's a 'good article'--meaning quality-wise it's around 1 in over 1000 articles on Wikipedia:

Polyclonal B cell response.



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