Five years ago I had the misfortune to experience a series of rather long and recurring visits to my local hospital. This week I had the opportunity to again become acquainted with my local doctors, nurses and other clinicians. I was astounded by how much things had changed in five years.
First off some context for my non-South African readers. Due to our very unfortunate history, South Africa has developed parallel systems in almost all spheres of life. We have the private systems (healthcare, education, security etc) that are often first class and on a par with (or better than) what you would expect to see in the ‘western world’. These systems are used by the upper middle classes and are paid for out of your private funds. The government systems are used by the rest of society and whilst not free (they are means tested) are cheaper (but not always significantly cheaper) than the private systems. The government systems are in truth beset by many problems, poor funding, poor training, a lack of resources, poorly motivated staff, political interference, poor management and people who reflect the underlying issues within our society all combine to create systems that are often not user friendly, can be prejudiced and lack a clear purpose.
Being relatively well off and the beneficiary of significant historical and institutional privilege I am lucky enough to be able to make use of the private systems. Thus five years ago I went to hospital and was truly impressed by how well things worked. The staff (nursing, administrative and support) were friendly, caring and well trained and motivated. Nurses were attentive and capable. The doctors were efficient and made sure you were well cared for. South Africa is a very cosmopolitan society with all sorts of different races, ethnic groups and religious beliefs co-existing. There were also a number of foreign patients from the rest of Africa who had come to seek treatment as their hospitals lacked the facilities to help them. Everyone seemed to get the same treatment and a high standard of care.
My most recent stay was rather different. I was in a ward next to a man from Cameroon. He spoke English well, but with a central African-French accent. He was on an international medical aid and there was some difficulty getting them to approve an investigative procedure. I noticed that the nurses treated him with a slightly more cavalier attitude than the other patients. My first thought was that this was because he was younger than the rest of us (possibly more attractive) and that they were flirting with him. But then they started saying things like ‘Oh he is an African man so he eats everything.’ Or, ‘He is African he can’t be allergic to anything.’ As they were second language English speakers I could not be sure whether they were being sarcastic, ironic, flirtatious, friendly or what. But it was certainly not bland professional language. And it was being said in English rather than isiZulu (or another local language) so it was obviously being said for our or his benefit.
Then his doctor arrived. She was clearly upset that the medical aid had refused her request for the investigative procedure, but the patient said that he was actually feeling better and was wondering if he could go home. She replied very curtly that she had not seen the blood tests or the x-rays yet. He then asked when she thought she may see them. She got very angry and said that she was not in charge of these departments and that she would see them when she saw them. He asked if he could perhaps be discharged and that if the tests showed something that needed treatment he could come back. This angered her even more and she said that if he wanted to discharge himself he could and stormed off. I was surprised. Clearly he was trying to understand a system that he was not familiar with. He was feeling better and did not think he needed to stay there but she was unwilling to assist him. When I left that ward nearly 24 hours later she had still not returned to review his results or examine him again and I wonder if he is still not lying there.
I was moved to another ward for my last few hours and here I found myself next to a Nigerian man who needed a surgical procedure. He returned from the operation and was clearly not well. His wife was very concerned and contacted the nurses a few times. They said that he needed to eat and drink and then could go home. He was clearly (to me anyway) not capable of eating or drinking let alone going home. After some time the nurses came to do their routine tests and then they realised that he was not well and called for the doctor. The doctor spent quite a lot of time working on him and ordered that an intravenous line be set up and that he should receive antibiotics, pain medication and oxygen and that if his position did not improve shortly they were to call him again. Clearly all was not well. Forty five minutes later the man’s wife was still trying to get a nurse to set up the intravenous line and start administering the medication. She finally contacted the head nurse for the section who came to assist.
Now obviously this is anecdotal evidence and based on my subjective observations, but it seemed to me that these interactions were at least partially fueled by the fact that these people were foreign nationals. Please remember (not that it should matter) that these are private individuals in a private facility paying for treatment. They can not be accused of being benefits scroungers, they can not be accused of taking beds meant for locals or any such spurious allegation. They seemed to get sub-standard care simply because they were not South African.
The care they received was to my mind different to that received by the South African patients. It is true that I felt a discernible diminishing of skills of the nursing staff in the five years since I was there. The supposedly senior nurse had difficulty establishing my intravenous line earlier in the week and she managed to hurt me quite badly. I was also struck by the lack of knowledge regarding some of the medication that they had to administer. They did not always know how to administer the medication.
I was truly shocked to see how an institution can change so quickly for the worse. It seems that many of the problems affecting the government health care system are starting to impact the private system as well. If doctors display xenophobic traits then nurses and other staff are sure to follow. If senior nurses are incapable of doing their jobs how do junior nurses learn anything? If managerial staff find it easier to do the work themselves than to insist that junior nurses do the work how will the junior nurses ever progress and the hospital will sink ever lower in terms of its ability to service patients. I wonder how much the various problems that play themselves out at senior levels of government have direct impacts on the lives of ordinary South Africans. Much needs to change if we are to progress and achieve our potential.
Sadly I am also given cause to wonder if this is how people are discriminated against in the private sector where they are paying clients, how do they manage in the government system and perhaps far worse, what do people who do not ‘fit the mould’ (LGBT, people with disabilities etc) experience everyday?