Tuesday, May 18, 2010

EC Syndrome

I'm not sure if you're aware that there is a plague invading the Western Cape.

It is not the recent measles outbreak that has caused so much anxiety.


Far more severe than that.

Far more frightening.

This disease is a conglomeration of the most purulent, macerated, chronic and cancerous iniquities of pathology.

To diagnose it is easy.

To cure it, an impossibility.

It is what we in the Western Cape call: Eastern Cape Syndrome.

Something is not happening in the Eastern Cape.

Something is not happening a lot in the Eastern Cape.

And that something is health care.

Patients, on death's door, are making the arduous journey all the way down to Cape Town in droves, in the hope of better treatment.

Like the bastard child you forgot to tell your wife about, these poor patients from the Eastern Cape rock up, unwanted, at the holy doorstep of the nationally renowned Western Cape Health Department.

I have had three such patients in the last two locum shifts in casualty, who literally arrived in Cape Town on the morning train from somewhere East of the Hinterland, and were on a stretcher in casualty before the noon gun had a chance to blast them back to where they came from.

At medical school they talked to us about the "heart sink" patient - ie the patients that literally make your heart sink...

These are they...

I don't even write notes on them anymore. I just document: "Arrived from Eastern Cape today..."
and then hand them over to the medical registrar....Who will then write down what we all know to be wrong, a combination of, or variation of one of the following

  • HIV stage four, and all of the complications that come with it
  • disseminated extremely drug-resistant TB
  • some fungating cancerous metastasised mass with superadded infection and no hope of cure
  • septic and gangrenous legs, unsalvageable and ripe for amputation
  • spinal pathology that if treated early could have prevented the total lower limb paralysis of some poor teenager...
  • etc
  • etc
  • blah
  • blah
  • blah
You will forgive me for being so dismissive...

It's just that I cannot expend any more energy cursing the Eastern Cape Health Department for not getting their act together...and after months of being faced with the embarrassment of having nothing to offer these dying guests from another province...I've kind of just given up on ever being the brilliant host they hoped for...if only they had presented earlier...or if something had been done for them in their home towns...

Welcome to the Eastern Cape, enjoy South Africa's finest beaches where dolphins play in warm waters, game reserves full of wildlife, where people greet with smiles and enjoy the holiday adventure of a lifetime. Explore the Eastern Cape and experience the best South Africa has to offer, absolute tranquillity and relaxation...

This is a description of the Eastern Cape as promoted by the Eastern Cape's tourism website

However, in terms of health care, the Eastern Cape can only be described as a big black hole of disease.

p.s. Any Dr's out there working in the EC who want to disagree with me please go right ahead and prove to me that I'm just spouting my mouth off when I know nothing of the true state of affairs... My opinion on this matter is of course entirely biased and based only on first hand experience with the patients, not a gold standard randomised control trial.
But I think I know what you're going to tell me...that the fault lies not with the staff, or the facilities, but at the feet of the administrators and managers who are supposed to use their provinicial health budgets to enhance their health service, not drive their patients to seek help in other provinces...


Alia said...

brilliant writing Dr S. Sad but true.

Rabiah said...


Do you know that a VAST number of these patients and their families are uneducated/illiterate too?

Ethra was saying that there is a VERY strong belief in PE/surrounds that you go to Livingstone to die. The patients and their families will try EVERYTHING first before they present there for the first time.

Primary Health is more of a delusion/illusion there. Despite patients usually keeping a note book/record of their illness and medication, if you ask them to tell you exactly what is making them ill, they will simply tell you, "i dont know" or my favourite (whether its true or not) "the doctor didnt tell me". So if you're dealing with a vast population who cant read, have no concept of basic physiology and how your body works other than what you've been told by your family/local sangoma, how can one expect them to be compliant with meds?

i guess its chicken and egg - only a healthy and well fed child can learn and flourish, but you can only stay healthy if you've been educated. and with all the mixed messages the media feeds them, is it any wonder they are all in search of the wonderful wizard of Oz, here in WC.

ultimately, this is just another gleaming reflection of the legacy of apartheid. the old elite has been replaced by another. you have Julius Malema driving around in his R750K Land Rover saying he is poor, and the only thing young black men should be concerned with is killing white farmers, because for him, CLEARLY education is/was irrelevant, and all you need to become successful is arrogance, hate speech and, of course, a brainectomy.

the real diseases are not HIV and TB, they're elitism, greed and denial. we dont need to cure disease we need to cure lack of education, true empowerment and illusions of freedom. HIV and TB are only symptoms, the cause is deception and avarice.

Zain said...

Very interesting.
The problem with the health care system is quite rightly that the 'legacy' of apartheid has continued. There were only a few centres around the country that had any significant investment during the bad old days and Cape Town was at the forefront of such investment. Its got very little to do with ongoing management of health resources, historically as well as curently health care resources have always been disproportinately distributed.
Durban has had the same tertiary institute for over 80 years. The word 'same' can be replaced by 'unchanged'. Kind Edward Hospital has had alsmot no significant investment since it was built. Hence the fact that 90% of the hospital wouldnt pass a building inspection and ward have started to literally collapse over the last few years.
KZN also services the Eastern Cape and that is no indictment on their health body but rather evidence that certain parts of the country have been almost completely ignored by the government.
Out of sight out of mind so they say. At least they are now making themselves seen.

Anonymous said...

I agree completely. I was with the NSRI at a station in the EC. We were not allowed to hand over patients to the ambulance crews as we were higher qualified than them... with a level 3 1st aid!!! Another time we picked someone out the water (indeterminate length of time) did CPR for 45 min at the scene, then in the vehicle all the way to the hospital, only to have to carry on there for over an hour as there was no doctor to call it.

Anonymous said...

I think it's partly to blame on patient beliefs - That "Ikapa" brings you good health. Obviously the Eastern Cape health department could do with some major infrastructure remodelling, but rural health education and patient belief systems would also need to be looked into. And if "Ikapa" brings you good health - Through the grapevine it spreads...and EC syndrome kicks in:)

Anonymous said...

that passage describes natal not the eastern cape!! cry the beloved country is set in ixopo

Dr S. said...

Well, I'm quite flattered by the debate this post has sparked. I'm also pretty embarrassed that Ixopo is actually in Natal. (Thanks anonymous! I'm gong to change it immediately!)


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