allAfrica.com: South Africa: Rural Doctor Speaks Out On KZN Events (Page 1 of 2)

A rural doctor who recently returned to the country reflects on the events at Manguzi Hospital and shares his own personal experiences and incidents while working at a rural hospital in KwaZulu-Natal's Umkhanyakunde district.

His name has been withheld for fear of persecution.

I am deeply troubled by the KwaZulu-Natal health department's recent actions involving Mark (Blaylock) and Colin (Pfaff) from Manguzi.

I do not know Mark, so of course cannot make any comments about his actions, but I do know that he is well-respected and would find it hard to believe that he is a racist or anarchist (although there may be other rural doctors who are).

Overall, I found the reaction to an insignificant act of throwing a picture in a bin, especially when compared to the seriousness of the work that rural doctors do each day, to be insulting and disillusioning.

Having worked in the Umkhanyakunde district for a year I can relate to much of what has happened at Manguzi. There are many stories and incidents from that experience which were wonderful and often enraging.

Following are some relevant examples from my time at the hospital and hopefully some helpful insight:

1. Shortage of doctors

Our hospital serves a population of around 110 000 people. Last year we had 11 full time doctors, which equates to a ratio of 1 doctor to 10 000 people.

This is clearly well short of the World Health Organisation recommendation. Because of the huge demand for health care created by HIV and poverty, doctors in rural areas have to work extra hard in often suboptimal conditions.

On Mondays for example, the five doctors in the out-patient clinic were seeing between 120 and 170 patients between them (not counting emergencies or theatre cases).

The x-ray department and pharmacy close at 4pm, and this left us with less than 5 minutes per patient. Of course this stress occasionally leads to anger, especially when there are no translators or the pharmacy runs out of an essential drug or management is sitting in another two day meeting session (yes, every week there is a two day-long 'extended management meeting').

I can see how these frustrations may be perceived as racist by those trying to deflect attention from their own incompetence.

Of the 13 doctors employed last year at my hospital, only one was non-white (coloured), and only seven were South African. This demographic immediately creates a division between the doctors and other staff, who are almost entirely Zulu and local. The question must be asked: why is the health department unable to attract more local doctors to work in rural areas? Well, one answer is simply because of the insensitive and inflammatory statements made by the minister and her local deputy. Another is the difficulty working in a restrictive bureaucratic system without acknowledgement from superiors.

And so, without an effective (actually non-existent) recruitment strategy, the health department makes last ditch efforts to retain doctors who are already there by bumping up salary scales. This often results in sub-standard doctors staying on and taking senior positions with disproportionate salaries - another factor which pushes away young potential doctors.

2. Limited support/involvement/acknowledgement by administrators

Despite a widely held perception that we are forced by government to do service in rural hospitals, the vast majority of rural doctors have actively chosen to work in those environments.

I personally went with the best intentions of contributing my skills (even as a junior doctor) and somehow finding a way to make positive systemic changes. I see the practice of rural medicine mainly as a means of enhancing individual lives, but also to strengthen democracy in South Africa by improving access and therefore choice.

Sadly, from the very beginning of the year and throughout, my efforts were largely blocked by management on all levels. There is an intense bureaucratic ethos where decrees from superiors are not challenged and procedure becomes debilitating.

It feels like the (provincial) health department loses sight of its main directive - to provide effective, accessible health care - and has become a victim of small-time politicking and power struggles (and surely also corruption).

At my small, deep-rural hospital, the hospital manager never once introduced himself personally to the new doctors. It is not possible to simply phone him and arrange a meeting - there is a protective secretary and a week-long wait for an appointment.

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