When a pen may be as mighty as the scalpel

Doc­tors face life-and-death de­ci­sions daily, but we rarely think dis­abil­ity grants are one of them

Mail & Guardian - - Health - Koot Kotze

The door slams open, knock­ing the han­dle into the wall so hard I hear the plas­ter crack. A hag­gard man struts into the room, a blue jacket trail­ing his slight build, made slighter still by mal­nu­tri­tion. He reaches out a cal­loused hand, rapidly drags the plas­tic chair to­wards him, and flops down.

Nei­ther the nurse nor I look suf­fi­ciently in­tim­i­dated by what was prob­a­bly meant as a show of force from a man on the edge.

Wait­ing times are long and many peo­ple are un­der­stand­ably up­set by the time they make it in­side the con­sult­ing room, but it is only 10am and we are more cu­ri­ous than any­thing else about what has led to this early-morn­ing erup­tion.

“Molo, tata. Yin­toni in­gxati namh­lanje,” I ven­ture, know­ing that the re­sponse may be­come dif­fi­cult to fol­low. Ex­hausted, he be­gins to mum­ble. Nurse Fik­ile* has of­fered to help me this morn­ing and she as­sists in prob­ing a bit more, as I fold open the school ex­er­cise book that serves as his clinic record.

I catch most of the fa­mil­iar phrases but one grabs my at­ten­tion: “Fu­man’ipay ...”

I am sit­ting in a small clinic in the ru­ral Eastern Cape. We are in the most spa­cious con­sult­ing room. Out­side, in a dark, un­lit cor­ri­dor, both walls are lined with peo­ple wait­ing to be seen.

“What was tata ask­ing about a grant?” I in­ter­ject.

The nurse catches my scep­ti­cal ex­pres­sion and cal­cu­lates the best way to re­lay a rather trans­par­ent at­tempt to ma­nip­u­late us.

“He says that he has been hav­ing this prob­lem since he was two years old and that the doc­tors in Mthatha said that he must come here for a grant.”

Sis­ter Fik­ile is kind and pa­tient. I am be­com­ing deeply sus­pi­cious.

“At the age of 45? Where is the let­ter from the Mthatha doc­tors?”

“He says it was de­stroyed in a fire,” she says. Al­though the sce­nario is plau­si­ble, I am not sure whether this is more or less con­ve­nient for him if the story were true.

“What is the prob­lem, then?”

The ques­tion is re­layed and I think I see some­thing break in him. He half-heart­edly points to­ward his left cheek. I put on some la­tex gloves and he protests a bit. He was hop­ing to se­cure the grant without an ex­am­i­na­tion.

In the brief mo­ments I am al­lowed to look into his mouth, I see rot­ten teeth, re­ced­ing gums and decades-old plaque.

“You def­i­nitely have some prob­lems, but I don’t see any grounds for a dis­abil­ity grant at this mo­ment, tata,” I try to re­lay the news as gently as pos­si­ble.

He is not in­ter­ested in see­ing the den­tist for fur­ther as­sess­ment. He shakes his head, takes his clinic card and trun­dles to­wards the door.

I have sim­i­lar con­ver­sa­tions with pa­tients hop­ing to qual­ify for a dis­abil­ity grant al­most daily. Most of the time, I am left fight­ing the same vexed feel­ing.

I tell my­self that it is my an­noy­ance with be­ing ma­nip­u­lated or be­cause these kinds of con­sul­ta­tions take time away from se­ri­ously ill pa­tients.

Of­ten, I am not sure my col­leagues would all agree on who does and doesn’t qual­ify for a dis­abil­ity grant.

As health work­ers, we hear many sto­ries of fraud­u­lent dis­abil­ity grant claims but the truth is far more de­press­ing and much less sat­is­fy­ing.

Na­tion­ally, more than four out of ev­ery 10 house­holds re­ceive a grant, ac­cord­ing to Sta­tis­tics South Africa’s lat­est house­hold sur­vey. In prov­inces such as the Eastern Cape, the North­ern Cape and North West, grants make up more than a quar­ter of house­hold in­come on av­er­age.

In a coun­try like this, most grant ap­pli­cants are just des­per­ately try­ing to sur­vive and we doc­tors make it harder for them in some ways.

On the same day, a mother brought in her daugh­ter, who suf­fers from epilepsy, in­sist­ing that she needed a dis­abil­ity grant be­cause of the fre­quent seizures. They were strug­gling to get by.

It took one ques­tion to ver­ify that she did not qual­ify for a grant: “How are you tak­ing this med­i­ca­tion to pre­vent the seizures?”

When she said “one tablet once in the morn­ing”, my heart sank. She was sup­posed to be tak­ing three tablets twice daily.

It must have felt like I was dan­gling the keys to a mea­gre eco­nomic sal­va­tion in front of them and then pass­ing her some pills through the bars in­stead. I coun­selled her on the cor­rect use of her med­i­ca­tion and made a fol­lowup ap­point­ment, but their dis­ap­point­ment was ap­par­ent. I was left feel­ing ashamed at my in­flex­i­bil­ity.

In­di­ca­tions for so­cial as­sis­tance grants are rigidly de­lin­eated, un­der­stand­ably so. The So­cial As­sis­tance Act de­fines a dis­abled per­son as some­one who is un­able to work be­cause of a phys­i­cal or men­tal dis­abil­ity.

Mean­while, the South African Bill of Rights says every­one has the right to “so­cial se­cu­rity” and that the state must take rea­son­able mea­sures, within avail­able re­sources, to achieve the pro­gres­sive re­al­i­sa­tion of this right.

But what counts as so­cial se­cu­rity?

The So­cial Se­cu­rity Agency of South Africa dis­bursed 17-mil­lion so­cial grants in 2016 and pay­ments such as these have “played an in­stru­men­tal role” in re­duc­ing poverty, a Stat­sSA 2017 re­port shows.

But many peo­ple are too old for a child grant, too young for a pen­sion and don’t qual­ify for a dis­abil­ity grant. It is un­de­ni­able, how­ever, that many of these peo­ple en­dure an ex­is­tence of bare sub­sis­tence when one in four South Africans reg­u­larly don’t get enough to eat.

What are peo­ples’ al­ter­na­tives? It is dif­fi­cult to live without money and it is al­most as dif­fi­cult to come by it in some parts of South Africa. Even sub­sis­tence farm­ing is ex­pen­sive to start.

As a doc­tor, I can of­fer no treat­ment be­yond a par­tial di­ag­no­sis. I just never ex­pected my­self to be po­si­tioned as the petty bu­reau­crat, block­ing re­quests by peo­ple des­per­ate to be deemed dis­abled to ease the strain of their ex­is­tence.

My feel­ings of guilt are am­pli­fied when I re­call the story of Aris­tides de Sousa Men­des. Sousa Men­des was the Por­tuguese con­sul in France in the 1930s. Against or­ders, he is­sued thou­sands of visas to refugees flee­ing oc­cu­pied Europe.

He was one of hun­dreds of diplo­mats, most of whom car­ried on deny­ing visas as per pro­to­col.

Ev­ery des­per­ately poor, but the­o­ret­i­cally able, adult one de­nies as­sis­tance to is an­other per­son who stays on the low­est rung of the lad­der, strug­gling to sur­vive and far more likely to fall off with the next sud­den gust of mis­for­tune.

Even if you’re not starv­ing, a lack of trans­port money can be the dif­fer­ence be­tween life and death in ru­ral ar­eas.

Should one fol­low Sousa Men­des’ ex­am­ple and is­sue dis­abil­ity grants for all ap­pli­cants, re­gard­less of qual­i­fi­ca­tion?

Sousa Men­des had half his salary docked for a year but then went straight back to work. If a doc­tor sim­i­larly doled out dis­abil­ity grants, this would be fraud and could re­sult in im­pris­on­ment or be­ing struck off the med­i­cal reg­is­ter.

And all the grant ap­pli­ca­tions would likely be re­jected. This is clearly not a vi­able so­lu­tion and def­i­nitely not what I am rec­om­mend­ing. How­ever, if peo­ple are slowly starv­ing why are we not look­ing at al­ter­na­tives and be­gin­ning to con­sider ex­pand­ing South Africa’s so­cial se­cu­rity safety net?

Hav­ing the abil­ity to rec­om­mend fi­nan­cial as­sis­tance to dis­abled or dis­tressed pa­tients is a sign of liv­ing in a func­tional state with a so­cial safety net and this is heart­en­ing. It is dispir­it­ing, though, to watch peo­ple pass through our con­sult­ing rooms as they fall through the gaps.

Money mat­ters: In ru­ral ar­eas, be­ing able to af­ford trans­port in an emer­gency can mean the dif­fer­ence be­tween life and death — some­thing that a ba­sic in­come grant could sup­port. Photo: Del­wyn Verasamy

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.