Covid-19: foreign doctors and local heroes
There is no payment, insurances are tricky, and the formal education process is under pressure
Healthcare workers are, without doubt, one of the hardesthit groups since the start of the coronavirus outbreak in SA, with more than 4,000 in SA having tested positive for Covid-19 to date.
But for foreign doctor William Adams*, who works at a Cape Town public hospital, exposure to the pandemic is even more complex.
Despite working on the Covid-19 frontline, the young doctor, an international registrar at one of Cape Town’s medical schools, neither gets paid nor adequately covered by the government’s occupational and health insurance. Added to this, his private health insurance will not cover intensive care cost should he get infected and have Covid-19 complications, as it is a cheaper option and offers minimal benefits.
An added blow is that Adams, who planned to leave SA by the end of this year when he completed his four-year training programme, could be spending more time in SA thanks to the lockdown, which saw his training programme screech to a halt and his speciality exams postponed. Adams is one of the “supernumerary registrars” in the country who feel neglected by the country’s government, despite their contribution to the country’s under-capacity healthcare system.
Though they do similar duties to that of their SA counterparts, many of the supernumeraries are struggling financially as they are not remunerated and depend mainly on stipends from private donors or their home governments, who sponsor their studies.
In an article in the SA Medical Journal, fifth-year medical students from Stellenbosch University’s Centre for Medical Ethics and Law raised concerns about the “neglect” of foreign registrars amid their duty to SA during the pandemic – a situation the authors described as an “ethical quandary”.
Authors AJ Arendse, JF Coelho and SH Gebers have argued that though the SA government has no legal obligations regarding the health insurance and financial wellbeing of supernumerary registrars, there were ethical considerations at play.
“We question whether the government and universities are ethically fulfilling their duty towards those who are working on the frontline of the pandemic in SA.
“Utilitarian and virtue ethics would support putting measures in place to support these registrars during this extraordinary time, as their safety and wellbeing will aid the SA healthcare system. Supernumerary doctors have been the unsung heroes in the undercapacity SA healthcare system for almost 25 years,” they said.
Though supernumerary programmes are in place to provide training to these doctors, the trio said the country’s healthcare system benefited substantially from supernumerary doctors.
They also questioned the government’s decision to spend millions of rand on the recruitment of Cuban doctors to fight the pandemic.
“The vast amount of money spent on Cuban doctors recruited to aid SA during the pandemic – in contrast to the lack of health insurance and financial support provided to the supernumerary registrars – raises a contentious point. In light of this neglect, their duty to SA during the pandemic remains an ethical quandary,” they said.
While some of the country ’ s medical schools – such as Wits University – have encouraged their registrars to go back to their home countries, others, such as the University of Cape Town, have asked their supernumerary registrars to remain in SA.
Dean of health sciences at UCT Lionel Green-Thompson said all 126 registrars remained in the Western Cape and were on the frontline of the Covid-19 battle.
“The vast majority remained to continue with their training on the clinical platform. Those who opted to leave did so with the commitment that they would return into their training positions. Some have now indicated that they would like to return, and we endeavour to assist them in this regard,” he said.
Green-Thompson said just like their peers, international registrars were “part of teams responding to Covid-19”.
UCT has negotiated with the Western Cape health department “to allow our registrars access to government health services should they contract Covid-19 during the pandemic if they continued working”.
“Registrars from outside SA are on a study visa that does not allow remuneration. They are not staff and are given access to the clinical platform for their training by virtue of being clinical students of the institution. As foreign students according to their visa requirements, they normally have to get their own health insurance that covers them during their stay in SA,” he said.
Prof Martin Veller, dean of the faculty of health sciences at Wits, said while international registrars were not remunerated as they were self-funded, the Gauteng health department had agreed to assist them during the pandemic.
They would be given “the same levels of health care and other forms of risk coverage that is available to their counterparts who are in a contractual employment relationship with the provincial health authority”, he said.
Veller said some self-funded registrars who wished to return to their home countries had been allowed to do so even though they could not be guaranteed training on their return.
“The primary reason for not being able to guarantee such a return to training is the limited training facilities available,” he said.
As most specialist registrar training is experiential in nature, and all registrars must be exposed to the same patient population, the “exposure to the pandemic is no different”.
“They [supernumerary registrars] are also not treated differently in terms of access to suitable protection,” he said.
Apart from his financial woes Adams believes the pandemic has put him in a more disadvantaged position than his SA counterparts and delays of the registrar programme may have far-reaching implications for foreign trainees.
“The Colleges of Medicine of SA has postponed speciality examinations, and state hospitals nationwide will need to extend contracts for SA trainees to ensure training requirements are met.” he said.
“The question remains, if we are not being paid to serve during this time, who is responsible to fund the extension of training programme? Can universities and the SA governments help curb the financial impact on us?”
* Name changed to protect his identity