I’m starting with the man in the mirror…

It is a commonly-held sentiment that South Africa is the best place to train to become a medical Doctor. Apparently a month spent in SA is the equivalent to 6 – 12 months’ practical experience in the UK – and in South Africa Doctors and Medical Students have the ‘luxury’ of burying their mistakes. Ouch. It’s not difficult to see now why so many foreigners dream of studying or practicing medicine here – albeit sadly a feat riddled with bureaucracy.

For a UK Doctor to apply as a foreign Doctor in SA, it takes 6 months on average. Some wait 2 years and more. Applications are left unanswered, lost or ignored on the desks of the picky, power-hungry public works officials, who are shockingly-pedantic about whose applications they accept, despite the current [questionable] quality of our public health system. When we take into light the fact that – as of 2013 – the ratio of Doctors to patients in SA was 25 state and 92 private Doctors per 100 000 patients [0.00117 Doctor per patient, or roughly 855 patients per Doctor], the picture suddenly become bone-chilling.  It becomes laughable to add how South African medical schools aren’t providing enough doctors to attend to the burden of disease in SA, despite how over 100 interns [freshly-qualified Doctors] sat without government-appointed posts in state hospitals this year due to ‘funds drying up’. It’s not as if we have a line of foreign specialists begging at our door to practice in SA. Oh wait, we do.

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An obvious solution would be to increase medical school intakes to train more local Doctors, increase foreign Doctor intakes, and increase the healthcare budget so that more posts can be made available for freshly-qualified Doctors to work in our over-burdened state hospitals. Maybe if there were more hands on board, the glaringly-obvious challenges of terrible working conditions, corruption in the system [think R500k a pop at UKZN to get your child a spot in medical school] and bad morale of staff [we all know the consequences of coming across a grumpy sister in the ward] could be overlooked. But this is where healing clashes with the ills of humanity.

When you struggle to find equipment, are exploited by Senior Doctors and are forced to deal with stubborn, ill-tempered sisters every day, it doesn’t predispose a student Doctor [or any Doctor] to be self-sacrificing and unconditional to the system. When amazing patients are treated without dignity, when there’s a risk of being raped by a patient, when you are forced to separate from your support system upon being given an internship post across the country, one tends not to feel motivated to do what we entered medicine to do in the first place: to serve. In an ideal world, judging a person’s worth by their integrity and kindness – especially when in a position of power – will heal many ills of society we currently face – especially in medicine where kindness is kinda the name of the game, isn’t it?

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I can’t blame the 17% of Doctors [fresh from comserv] who are inclined to emigrate, or the 80% who don’t want to work in the state system. At least in the private sector by standing up for what is right won’t showcase so starkly what some sisters are doing so wrong. Hospitals are supposed to be places of healing – where you family members can sit beside the bed without being scared of being chased away by a tired sister, and where you can find solace to heal emotionally and mentally, in addition to physically. How can one even begin to focus on these ideals when each layer of the healthcare system – from government level to ward management – seems so primordial and abrasive?

It’s a privilege to be able to observe the system from grass roots’ level. It surely changes you. Some students become arrogant – especially when SIC comes around – which is another manifestation of the same process governing the fragmented healthcare system as we know it. But a few will get out really knowing how to heal their patients. Like the private GP who charged R250 for a consultation AND medication, when just a consultation alone had cost me R800 a month before at a different Doctor.

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It’s easy to see the cracks in the health-care system – from med school right up into the days one starts working in the state hospitals as a fully-fledged Doctor [that’s if you get a post]. It’s difficult, however, to determine where one would even start in trying to ‘change the system’, because the power lies with the politicians at the end of the day. I am of the opinion that a true healer is one who can maintain their kindness in a system which is setting them up for everything but kindness; the change really can only come from looking in the mirror first.

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“History is a vast early warning system” – Norman Cousins

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