Default to silence

2014-07-01 00:00

“SILENCE like a cancer grows” — a line from Simon and Garfunkel’s classic song Sounds of Silence, frequently comes to mind these days thanks to the increasing frustration of trying to get information from provincial government departments.

Silence has become the default option for the majority of government departments, despite the fact they all employ sizeable communication departments.

Ironically, the growing cancer of silence has become particularly evident in the KwaZulu-Natal Health Department. This department is facing a crisis thanks to having blown its budget. There have been squabbles about the R3 billion it owes or doesn’t owe the state laboratory service. But that’s only 10% of its budget. Where’s the rest going? Well, part of it on servicing payments for expensive machinery bought in U.S. dollars. The rand sank — but the monthly payments continue in dollars. Do the maths.

The budget crisis has played out most dramatically in the public arena with the cutback in registrar posts. A registrar is a medical doctor receiving advanced training in a specialist field, ranging from anaesthetics to urology. Training has to be completed within a four-year period.

There are two intakes of registrars: one in January and another mid-year. Last November, the Health Department decided to reduce the January intake of registrars to the University of KwaZulu-Natal’s Nelson R. Mandela School of Medicine in January from 93 to 40.

Twenty disciplines were affected by the reduced intake, including anaesthetics, cardiothoracic surgery, family medicine, general surgery, obstetrics and gynaecology, oncology, paediatrics and psychiatry. The largest reduction was in general surgery from 16 to four, followed by paediatrics from 11 to six, and psychiatry from four to one.

The mid-year registrar intake has been cancelled entirely.

The blame for this situation falls squarely on the shoulders of the Health Department as, according to a spokesperson from the university, “the registrar establishment falls within the area of responsibility of the DOH”.

The reduced intake of registrars will further reduce the number of doctors available in the public sector and thus impact on service delivery. Already natural attrition — people leaving, people dying — has reduced existing registrar numbers.

The cancelled registrar intake will see specialists in training being pulled back from what are perceived as less critical areas of health-service provision to concentrate on areas of acute need. That might seem sensible, but it means the registrars in training will get restricted exposure to their area of speciality and end up experientially deficient in key areas of their speciality.

Bottom line: fewer specialist doctors will be trained in the province, which is already experiencing a shortage of specialists, and those who are trained will be lacking experience.

Despite the precarious position this places our provincial health services in, the Health Department has made no formal announcement of the fact that there will be no mid-year intake of registrars to the University of KwaZulu-Natal Medical School. It is a silence the department has resolutely maintained since early May, when The Witness first approached the department with questions regarding the mid-year intake, having established it was not to take place. These questions included a request for information on the effect of the reduction on health provision in the province.

No response was received, despite repeated e-mails and telephone calls. After an e-mail was sent to the head of the Health Department, Sibongile Zungu, complaining about the lack of communication, The Witness was contacted by the department’s general manager: corporate communication, Samuel Mkhwanazi. Incidentally, copied into a previous e-mail. In a subsequent e-mail, Mkhwanazi indicated that at the “appropriate time” The Witness “will be provided with a comprehensive response set within a correct perspective which will be beneficial to your readership”.

Given the gravity of the situation, such a response from a government department in charge of key public institutions is totally unacceptable. The reduced intake of registrars in January and no intake mid-year will have a major impact on the services the KZN Department of Health can offer the public. By any yardstick, this means the KZN Health Department and the UKZN medical school are in a crisis situation. The public interest in matters pertaining to their health should be acknowledged and demands a detailed response from the department.

At the very least, we should be told, given the reduction in registrars, which clinical services will be reduced and which clinical services will be terminated. The department has this information at its fingertips.

The departmental silence does not bode well for the future or for an answer to the next question: will there be a registrar intake in January?

• Stephen.Coan@witness.co.za

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