We wanted to change the world, now we don't know what we are doing
An in depth look at SA's Doctor shortage crisis
By Mamaponya Motsai
It's about 3:00 pm on a Thursday afternoon,*Kgomotso and her friend are having lunch at one of the food caravans outside Jubilee Hospital in Hammanskraal , North of Pretoria.
Both women are heavily pregnant, Kgomotso in her eighth months and her friend, seventh. The two women quickly finish off their lunch and head back inside the hospital to re-join the queue to see a doctor.
"I have been here since 6:00 am, but these women in front of me have been longer. Some arrived here before 5:00 am," says Kgomotso, pointing to a queue of pregnant women. The queue starts inside the ward and extents to the benches outside.
Women, like Kgomotso, have been referred to the Jubilee Hospital from their local clinics because their situation is more serious than what a clinic could handle. But the shortage of doctors at the hospital and the large number of patients it serves means that they often have to wait for hours or days to see a doctor.
As the clock approaches 4:00 pm, Kgomotso says she is becoming anxious, because the doctors knock off at that time and she is so far behind in the queue that her chances of making it are very slim. She has been turned back three times before without being able to see a doctor. Because of this, she says she has not even had a scan yet, which means she does not yet know if her baby has any structural abnormalities.
After 4:00 pm the doctor on duty comes out from her office and closes the door. The women began to murmur among themselves. As the doctor disappears from view, the murmuring dies down. The women, about 50 of them, start to make their way home. The doctor will not see them on this particular day.
“I’ll come back next week. Hopefully I won’t give birth before then,” says Kgomotso as she walks off.
After the women left, SABC approached a staff member at the hospital who explains that shortage of doctors is the reason these women had to wait all day, some from as early as 5:00 am but still unable to see a doctor.
“There were only two doctors available today. We had 116 pregnant women today and two doctors. When one of them is called for a caesarean section, it leaves us with only one doctor,” says the staff member.
This situation is not unique to Jubilee hospital. According to a report by Econex commissioned by Hospitals Association SA, South Africa has far fewer doctors per 100,000 citizens than other countries, and has a much heavier disease burden than many other developing countries.
According to the report, South Africa had just under 32 000 doctors in 2013, at that time the South African population was 53.31 million.
Making matters worse is the uneven distribution of doctors between public and private sector. For example in the private sector there are 86.5 medical specialists per 100,000 patients in the private sector, whereas the ratio is 14.5 GPs per 100 000 patients in the public sector. Majority of South Africans, 84%, is dependent on the public health sector which employ only 30% of the country’s doctors.
The distribution of doctors is also skewed across provinces. Western Cape has the highest amount of ration of medical specialist to patient at 33.1: 100 000 patients, Limpopo has the lowest ratio at 1,8 medical specialist for 100 000 patients.
The infograph below gives details on doctor shortages in South Africa.
Sohayl Essa, intern doctor at Charlotte Maxeke Academic Hospital says shortage of other medical staffers is also a big factor in the service they are able to give.
"Staff shortages affect everyone at every level. For example, there is a shortage of potters. If there is no potters, who becomes the potter? The doctors become the potters. We now have to take from our duties of diagnosing patients, booking them for scans and taking them to theatre for operations, we become the people that push patient," says Essa.
Essa says this is only one example that shows how everyone is affected by staff shortages.
In the video below, Essa and Leonard Muhango, a 6th year medical student at Wits University share how doctor shortages affect them as they do their work and how it can lead to deadly results.
The Econex report lists limited training capacity along with immigration of doctors, restrictions on hiring foreign doctors as one of the reasons for shortage of doctors.
South Africa currently produces about 1 300 medical graduates every year, the number is 1 100 less than the Department of Health's target.
According to students at the Wits University health faculty, the output of doctors and other medical professions will continue to be low if government and training institutions continue to turn a blind eye on the hardships students go through.
"Student morale is low. You go through a lot, physically and emotionally," says Sofia Poultney, a third year Clinical Associate student at Wits University. Poultney says it is difficult for students to balance the academic, practical and personal aspects of being in the medical field and they receive little to no help to help them cope.
“Then you see a patient dying. You ask yourself - did I do something wrong? But you don't have time to deal with it. You’re on to the next patient. There is so much to deal with and you can't even think but you have to be playing doctor and live out to that kind of responsibility while under so much stress,” says Poultney.
"We came into health science to help change the world, we had big dreams. Once in second year, third year, you're like, why am I even doing this?”
Tshegofatso Ubisi, third year medical student and president of the Wits Medical Students' Council, agrees with Poultney. She says if the government and training facilities are serious about increasing the number of medical graduates, they must give more support to students.
Ubisi says the difference between the number of medical students in first year and those in the final year should concern authorities.
She says although it is normal for people to decide to want to change careers, some medical students do so because they do not have the support they need.
“Students are exposed to a lot of trauma but they don't receive any counselling or any help. Female student doctors also get sexually harassed by male doctors at the hospitals they works at, when they report it nothing gets done. People are being exploited by senior doctors. They are not getting much needed academic support. At the end of the day, those things get to you,” says Ubisi.
"We came into health science to help change the world, we had big dreams. Once in second year, third year, you're like, why am I even doing this?"- Sofia Poultney, 3rd Year Clinical Assistant Student at Wits University.
Minister Aaron Motsoeledi has promised an increase in doctor output through increasing funds to training faculties and through partnering with Cuba and China.
Doctor Shortages is one of the big issues that has been pointed out as an obstacle to successfully implementing the National Health Insurance (NHI).
The NHI aims to provide free quality to all South Africans regardless of their class or level of income. Many say the lack of financial and human resources will make it difficult to equalise the quality of health care in South Africa.
In the meantime, millions of South Africans like Kgomotso continue to struggle and hope that plans by the minister will translate into changes, even at the lowest levels of health care.