Students were ‘vandals of soul’
Operating theatre like aircraft cockpit with no safety measures
#Fees Must Fall students “vandalised the soul” of University of Cape Town health sciences dean Professor Bongani Mayosi, his sister told mourners at his funeral yesterday.
And the cardiologist’s wife, Professor Nonhlanhla Khumalo, said of her husband: “You cared so deeply for people who now treated you as the enemy.”
Mayosi suffered from depression and committed suicide. This week, doctors and medical students spoke to the Sunday Times about their journey through a “black hole”. Dr Alastair McAlpine said: “We work ridiculously long hours, our goodwill is exploited by our employers, and we are unsupported by our regulatory bodies.”
Anaesthetists have the highest suicide rate. South African Society of Anaesthesiologists CEO Natalie Zimmelman said the culture was to be strong, “but the narrative must change”.
● Anaesthesiologist Caroline Lee had her ideal job and a beautiful family — but was battling a silent killer.
The Johannesburg doctor was so burnt out from work that she became numb.
Lee said she lost the ability to feel emotion, but couldn’t explain why.
“I said to my therapist, I know I love my children so much but I don’t feel it. In fact, I can’t feel anything. I was not coping, but I didn’t know it. She diagnosed burnout but I had no idea what it was or that I had been working despite it,” she said.
Following the suicide of top cardiologist Dr Bongani Mayosi, doctors have raised the issue of depression in their profession, as doctors tend to ignore their own health.
This is also the case of many clinicians who work in anaesthesia, said Lee, adding that this field of medicine had the highest suicide rate among doctors. Natalie Zimmelman, CEO of the South African Society of Anaesthesiologists, said there were at least three suicides a year.
“There is unquestionably a problem of wellness and clinician suicide in the industry. In 2013/2014, nine South Africa anaesthesiologists committed suicide in just 18 months, including the vice-president of our association,” said Zimmelman.
The profession created a mental health awareness campaign, offering drug and alcohol abuse therapy and support systems.
Academic studies on the issue showed the suicide rate “constitutes a massive human disaster and is reflective of the great seriousness of the problem”, said Zimmelman.
Analogies were drawn between the operating theatre and an aircraft cockpit, without the safety measures being adhered to or the physical and psychological fitness of clinicians to perform their work being considered, she said.
One of the reasons for suicide and depression was a high incidence of drug abuse, linked to the high-pressure role in medicine. Another was “horrendous working conditions in public and private care”.
Zimmelman added: “Also, they will never fail at suicide because of their access to drugs, and their training means they know very well how to harm themselves.”
There are just more than 1,300 anaesthesiologists in the country, about 2.5 for every 100,000 people. This is against the minimum recommended by the World Federation of Societies of Anaesthesiology is five.
“Even this number, though, is badly maldistributed, with almost none in small towns and rural areas and only about 0.9 per
I know I love my children so much but I don’t feel it. In fact, I can’t feel anything
Dr Caroline Lee
Anaesthesiologist
100,000 in the public sector,” she said.
While there are worldwide shortages of clinicians in anaesthesia, a comparable rate in the UK is 14 per 100,000 people and in the US 20 per 100,000.
A 2015 report found burnout among local anaesthetists was unreasonably high.
“When they can’t save lives, or if medicine isn’t available, they feel ineffectual,” said Zimmelman.
“Overwork leads to burnout and stress, which leads to depression, which leads to suicide. It is a continuum which is worsening because of the workforce diminishing.”
Lee has since become the convener of a support group for anaesthesiologists.
She said mental illness and depressive symptoms in the medical fraternity were at about 60%, according to a US study.
“That is four times the rate of equivalent professionals with similar education, age and income groups,” she said.
“In anaesthesia, although we don’t have statistics locally, we know it is worse. Patients are getting sicker, there are new and different drugs all the time. Never mind being on top of your game, every minute of the day, you may have family or personal issues yet you are not allowed to make a single mistake, whether your shift was 48 hours, 36 hours … Who can stay awake, let alone function at 100%, in those conditions?” she said.
Lee said the stress could be greater than for other clinicians because of the risk factors. “You have to make sure the patient goes to sleep, the vitals are stable while they are asleep and that they wake up in decent function.”
Doctors also find it difficult to admit they are not managing well, or need help coping.
“This is common to all physicians. They don’t look after themselves, they look after you,” she said.
Zimmelman said the culture in medicine was to be strong, “but the narrative must change. That mental illness is not a weakness.”
She added: “What in their training makes anyone think doctors can diagnose their own incapacity? They have to have the answers and when they don’t, it is a problem. It takes strength to ask for help.”