Crumbs from Your Table

2017-03-19 10:28

Picture: JeffBlock

Human Rights

Thanks to a new democratic South Africa; citizens of all shapes, shades and sizes can enjoy the benefits of basic human rights that were once privileges in our very own country. Although some still cannot taste the full benefits of equality, human dignity, security and privacy because of where they live, we have come a long way and are hopeful for a better future. While people have been given the freedom of expression, association and political rights, the disadvantaged still seem to get manipulated into voting out of loyalty and fear of a dark past repeat. On human rights day, 21 March 2017, what will you celebrate? The right to call yourself South African? Freedom of movement and residence? Freedom of occupation and profession? It’s hard to see those “luxuries” when poor housing structures, water supply, healthcare and education still threaten the very solid right to life.

Money Money Money

If you can afford medical aid, a hospital plan or cover, you are amongst the most fortunate of citizens. If you have a family doctor that knows your pet’s name, be thankful. Some people have to start queuing at 4 am at hospitals just to see a doctor. You are probably tired of hearing this, but that is unfortunately the reality in our country. You have worked hard for your money, and you probably have ideas of how the poor can improve their situation. In the meantime, while we wait for others to join medical aid, let’s look at some general challenges that state patients face relating to different hospital departments. Without looking at what other people do with their money or why they don’t prioritize joining medical aid schemes, I would like to address some issues that could be fixed in state healthcare centres.

Paediatrics

This was once my specialty of choice when I was a medical doctor for the state. At first I was drawn to it for the experience. I had to polish my fine skills of putting up drips in babies as small as 900 grams. Reason? Government medical doctors are expected to work in all hospital departments in small hospitals, so one needs to be clued up with everything. I also needed to be prepared for the worst. We still get babies who come in with hypovolaemic shock (systemic manifestation of loss of blood or water) after having severe diarrhoea and putting up drips on them is a matter of life and death. Other hectic cases involve babies born before their time (pre-term) or babies who have suffered severe oxygen deprivation while still in the mother’s womb. These babies need meticulous attention to detail and one to have updated knowledge on how to resuscitate them.

Even if our department of health (DOH) can claim to have all the necessary equipment and trained personnel for dealing with childhood conditions, we still have a long way to go. Compared to private hospitals, our paediatric departments in state hospitals are very behind. We are not talking about Red Cross Hospital or its cousin tertiary hospitals in a few provinces. Everyone has a right to life according to our constitution, but some children don’t have access to the best paediatric units in the country.

Obstetrics and Gynaecology

I have a lot of respect for doctors that choose to work in this field. It is not because they deal with conditions that gross the general public out or see a lot of “things”. Simply because the Obstetric part of it deals with 2 lives at a time, the mother and the baby.  It is both scary and rewarding at the same time. Things are also getting more complicated in Obstetrics because litigation cases have risen over the few years and specialists in private institutions have to pay a lot for indemnity cover. In state hospitals, things are no better as the DOH has to review and deal with cases that involve maternal and neonatal deaths. All doctors working at district hospital level are expected to know how to manage difficult deliveries and perform a lifesaving caesarean section.

There are still obstacles affecting Obstetric care relating to patients, healthcare professionals, healthcare centres, resources and general policies. Patients who present to hospital late with complications are still expected to be saved. Health professionals are sometimes managing complex cases that ideally need specialist review. With procurement and tender processes, some resources take a while to reach hospitals where they are most needed. Poor maintenance of equipment can also lead to delays in care.

General Medicine

If you ever get bad kidney failure or are in need of dialysis, you will learn of the long waiting list and special conditions around dialysis. In private hospitals, with money, you can easily get dialysis. Have you ever experienced the nightmare of getting a scan date 3 or more weeks away because you have to compete with other patients? How about having a relative that was told to wait for months to see a specialist? Have you heard of essential medication shortages that affect people who don’t even have a cent for taxi fare? It pains health professionals being the bearer of such bad news. You won’t understand the daily burden of watching one’s patients lose hope because it seems you have failed them.

The ideal world of grand ward rounds with consultants and professors ended for most doctors when they left medical school. Patients living next to teaching hospitals have some of the best hospital experiences ever. Although some of them still complain about students and student doctors constantly bugging them, they should take a short left for a different perspective.

General Surgery

Surgical specialties are often misunderstood by our superiors in the department of health. They believe that outsourcing surgeons from Cuba will solve our shortage crisis. A surgeon should be able to prepare a patient for an operation and post-surgical care is just as important. My experience in the surgical department taught me that we have well-qualified South Africa surgeons that are displaced to private hospitals because of unnecessary politics. What is better than allowing a home-grown specialist to give back to their people? Cuban surgeons can learn a lot from South African specialists as their training programs differ from ours, hence our responsibilities and expectations in the ward, ICU, theatre and clinics are unique.

Anaesthesia

The art of switching off a patient’s mind to their surroundings, numbing the pain and paralyzing them for an operation will always fascinate me. The experience as a patient is equally mind-blowing. You just have no idea what happened, yet the surgical operation will be done when u wake up. For the doctors performing the anaesthesia, the anxiety grows with slight changes when monitoring the patient during the operation. How I wish peripheral hospitals could get tertiary hospital level technology in theatre and more skilled supervisors. There’s usually one guy at small hospitals that everyone depends on. In his absence, complicated cases can't be done.

Orthopaedics and Emergency Medicine

I dream of well-equipped rural hospital emergency centres that will be trusted enough by big government officials to have their own lives saved there. I also hope to see specialized Orthopaedic departments that are accessible and available to state patients in all provinces. The waiting list for Orthopaedic operations is depressing in some rural areas.

Psychiatry

This neglected department is still experiencing horrors one only expects to see in movies. The great stigma attached to it is quite appalling. If only we could get to a point where mental health is also considered crucial. One wonders how different it would be if the powers that be (or were) could understand that delusions, grandiosity and pathological lying are classified under this discipline. Maybe then some attention would be paid to psychiatric patients.

General OPD

It still remains a burden for doctors to have an outpatient’s department that sees all sorts of patients under the same roof. With staff shortages and other general challenges, it is sad that some of our people are still getting sub-standard care. With limited resources and a health budget that does not address all medical problems equitably, state patients will continue to receive crumbs of quality healthcare.

U2- Crumbs from your table

“You speak of signs and wonders

But I need something other

I would believe if I was able

But I'm waiting on the crumbs from your table

Where you live should not decide

Whether you live or whether you die Three to a bed Sister Ann, she said Dignity passes by”  

Picture: Redbubble

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