South African doctors on strike on May 29, 2009.

We live in country that has made me proud and sad all in one breath.

Been talking to a doctor friend of mine and came to the realisation that I along with half the country does not actually know nor under stand why the doctors across the country are striking. I convinced the kind soul to enlighten me and along with that the rest of the nation.

His response is below. I suggest reading it completely before judging the doctors and health care professionals who are striking presently. Who we conveniently condemn for leaving their patients unattended.

Have a heart to read the pleas of the doctors, for they are the heart that our nation needs to survive with.

Why Doctors feel the need to strike.

27/06/2009

The current strike happening by government employed doctors gained momentum yesterday when doctors in the Western Cape decided to join the strike action following a meeting at Groote Schuur Hospital. As a doctor at the above institution I had mixed feelings about striking and abandoning our patients in what is seen by the general public as just a dispute over salaries. The protest action is in fact a culmination of years of abuse that medical professionals have endured at the hands of the government.

Let’s start with working conditions. The hospitals are over-capacity, and the doctors are overworked. In my ward, we officially have place for 65 patients. We had more than 85 for the best part of last week. Doctors work 30 hour shifts when they do overtime, working a minimum of 60 hours a week in my hospital, but it’s not like this everywhere. Usually it’s worse. Although, this certainly is an improvement since 2002 when as an intern, I worked 100 hours a week and 30 hour shifts every third day. We are expected to do procedures with needles potentially putting ourselves and others at risk of contracting HIV by needlestick injuries, this even after having been awake and on our feet for 24 hours and more. Yes, just call us Jack Bauer.

If that was all there was to contend with, then it would be bad. But add to that, unsafe working conditions. Doctors and nurses literally put their lives at risk to save others in busy casualties by working late nights, trying to save gunshot victims of gang warfare, knowing full well that someone might just overpower the lone security guard at the door and come in to finish the job. I kid you not. Many of my colleagues have had to dodge a flying bullet.
Supplies. You’d think hospitals wouldn’t run of supplies right? Nope. Gloves. Needles. Syringes. IV fluids. Linen. Antibiotics. Incubators. Two nights ago, on call, I had to place two babies into one incubator, because we just did not have enough. As an Intern and a Community Service doctor, I had to treat patients on the floor. They had to sleep on the floor, because we didn’t have enough beds! Not that there was anymore place to put any beds in the ward. It’s frustrating having to work in a SA hospital. You have nothing to work with, yet are asked to perform miracles. Often the doctor on call, has to decide whether to refuse one patient life-saving treatment, in the hope of saving another with a slightly better chance of survival. This is Africa after all.

All this, in the face of dwindling staff. Nobody wants to work for the state. It’s too difficult. Too stressful. Dying patients you can do nothing for, in overcrowded hospitals, with nothing to help them with.

It’s no wonder so many of my colleagues have decided to jump ship. Go to any hospital in the UK, Australia, Canada, The Netherlands, Ireland, New Zealand, and you’ll be sure to find at least one South African. This brain drain is going to continue, unless the government starts making amends. It’s a one-way ticket out of South African Medical Schools and into European hospitals. And it’s spiraling out of control. The less doctors in government service, the rosier it looks overseas, the more doctors will leave the government service. And if you think it’s just whites, think again. Blacks, whites, indian, coloured doctors….all leaving in droves. Ironically, I know of many European and Canadian doctors wanting to work in South Africa, in SA hospitals, for experience not money, and the government and HPCSA have them jumping beaurocratic hurdles for years.

Add to that, the government recently doubled the internship time from 1 year to 2 years, and are now looking to increase mandatory community service from 1 year to 2 years. Effectively, if you’re 18 when you enter Medical School, you’ll be 28 when you’d be free to make independent choices about your career. Until then, you’ll be told where you must work and live. This is going to force medical graduates to do internship overseas, never to come back.

Now coming to the salaries…after having spent 6 years studying, and at least R30 000 on tuition alone yearly , one can look forward to taking home around R9000 (after tax) a month as an intern. If you ask me, I think this was an incentive for doubling the internship time and community service time. Where do you get skilled workers to perform life-saving procedures locked into a 4 year contract to earn R9000 a month?

To do the job I do in the hospital I have three degrees in the medical field, but earn less than a gym personal trainer. If you compare my job requirements and qualification to any other professional in the government sector, I am being underpaid by at least 50%. In private practice I would be earning at least 300% of my current salary.
So why do I work in government and not private practice? For most people in my position, it’s a lot more about the job than the money. It’s about the patients. It’s about advancing healthcare in this country, and advancing the field of medicine as a whole, by academic work and delivery of professional service. Medical professionals are amongst the most skilled people in society, as it is almost a process of natural selection that produces these individuals.

But they’re being walked all over.

When the Minister held that press conference on Wednesday, it was a sneaky political move. When has any employer presented a wage offer to the public without first taking it the bargaining chamber? It was a move that they knew would be highly publicized and designed to remove public support for the strike action. In it they announced massive increases for Interns and Principle and Chief Specialist. But it was the grades in the middle that basically got nothing. To use an Army analogy, it would be giving the new recruits and the Generals something to keep them happy but everyone in between got shit. The generals were happy, so they didn’t support the action, and the New recruits were happy so they, who are usually the youngest, most militant, out the group, would go back to work.

But they left out the people that really count. The one’s doing the real work. Medical Officers, Junior and Senior Specialists. The Interns, registrars aren’t going to be around forever, they have finite contracts. But the Medical officers and specialists working in the government have made it long-term career choices. This is not the first time that we are being duped either. We were promised that this OSD would come into effect July 2008. It’s now one year later, and we’re still waiting. We want what we were promised.

And those that ask is it worth it? Is it worth patients dying for higher salaries? That’s a difficult one for us, but in the end, it comes down to what’ll happen if we don’t do anything. And the simple answer is this: Our health system is at breakpoint. It’s close to crumbling, and the government has chosen to ignore and put band-aids on it. It’s as if they don’t care. When Manto got her new liver, she didn’t lie in a government hospital.

So, since most of us don’t have the heart or inclination to abandon our sickest patients, doctors in the Western Cape have decided to continue running emergency services, critical care and theatres only. All outpatients and elective surgery will have to close. We’re not doing medical teaching either. Sorry students, we’re fighting for your future too.

If we don’t do something now…it’s going to cost much more lives in the future.

We humbly ask that the public support us in our endeavors. In the end it affects all of us.

Dr Y.J.