Health in Crisis
| Shortages are forcing junior doctors to run entire hospital units despite their lack of experience
MEDICAL graduates with one or two years of practical experience are holding South Africa’s public healthcare system together — but are falling apart themselves.
With workloads estimated to have tripled over the past few years, interns are often left running entire hospital units. They are supervised by seniors — equally burdened registrars with three to five years’ experience — while consultants are available for off-site telephone consultation.
In December the Sunday Times spent a 26-hour shift at the paediatric unit of Rahima Moosa Mother and Child Hospital, and paid a shorter visit to Chris Hani Baragwanath Academic Hospital, both in Johannesburg.
Speaking confidentially, the doctors admitted to:
Momentarily falling while performing surgery; asleep IN AT THE DEEP END: Intern doctors doing the rounds in the neonatal wards at Rahima Moosa Mother and Child Hospital AT 2am in the lift of Rahima Moosa hospital in Johannesburg, Dr Kartik Naidoo wonders why he chose his profession.
Slumped against the cold steel, he talks about the responsibility, reward and quality of life for those who choose to save lives.
It is a privilege: he loves it and hates it. He recalls the first shifts. “Seniors are meant to train, the registrar and consultant should be by your side, but there is no time.”
He thumbs a book with guidelines for emergencies.
He can phone consultants, but in a do-or-die situation only. They don’t appreciate being woken.
“There are nights that I think if I had known, I would not have studied medicine. But I still can’t see myself doing anything else. You always feel you won’t cope.
“In paediatrics the culture is different. Everyone gets their hands dirty when it comes to children. [Putting a drip] in a baby can humble you. People are softer. It is not the same in other areas.”
Rahima Moosa at least has beds; Baragwanath has only couches where doctors can sleep.
“They think it is normal to work like this but it is not stable,” said an intern at Bara.
Babies with cerebral palsy are common. They aren’t attended to on time because the doctors can’t get there fast enough.
“Once I was alone for 27 hours, I wanted to curl into a ball and quit,” said another intern. “You are continually working.
“In stressful situations you make mistakes. Then you take ages because you triple-check so you don’t make a mistake.”
The system requires interns to spend about 10 years in the system to specialise.
“The way things are run is archaic and inefficient. There is no ongoing patient care because the doctors leave,” said a senior doctor.
”The entire system needs to be relooked at, to make it more efficient. There are ways and places where it works; it just needs an overhaul.
“Community service, internship, it is so important. We know we get good experience. But the system is flawed. It should encourage people to stay in medicine, not leave.”
You take ages so you don’t make a mistake