By the time I walked away from a promising career in medicine I felt that I had not only abandoned my dream of being a doctor but that I had lost my love for medicine. It was when I was writing my memoir, Postmortem – The Doctor Who Walked Away, that I realised that my experience was not unique. When I spoke to other medical professionals who had either gone into private practice or had left the profession entirely, their stories mirrored my experience of working in the public health sector. I saw the impact that our dysfunctional health system has on its most valuable resource – the healthcare workers.
Diagnosing the Problem
The challenges facing our health system are well-known: a shortage of healthcare workers, chronic shortages of medical supplies and frequent stock outs of essential medicines. But what is less spoken about is the devastating consequences of the dysfunction – healthcare workers who are overworked, often traumatised and ultimately disillusioned. Is it any wonder that so many skilled doctors, nurses and other healthcare professionals are leaving the country?
South African medical training is amongst the best in the world, but that investment is potentially lost when medical graduates are plunged into a broken public health system. There is a mismatch between what we are taught at medical school and what we end up doing at the coalface. The end result is a detrimental impact on the motivation and well-being of the doctors, which ultimately has a negative impact on the well-being of their patients.
Better Systems for Better Healthcare
There are several reasons that contributed to my decision to leave medicine, one being frustration at the lack of efficient systems. For example, many of my patients at the Site B Community Health Centre in Khayelitsha lived between the township and the rural Eastern Cape, which posed a challenge in terms of continuity of care. It would have made a difference to have had a system to track their care across facilities and provinces, and enable all treating clinicians access to the patients’ complete medical records.
These gaps in their health records resulted in gaps as well as inefficiencies in their management. The result was often that I had to resort to starting the process of investigations all over again, possibly repeating what was done in other clinics or provinces and thereby duplicating efforts and wasting valuable, limited resources.
Other system failures included stock outs of essential medicines and shortages of medical supplies. In a country with an enormous burden of disease, I felt frustrated at not being able to truly help my patients. It was demoralising and left me with numerous questions about how effective I could really be as a healthcare professional.
I’m aware that significant strides are being made in improving the internal systems. However, it’s important to note that, whilst technology is a great enabler, it isn’t the solution to our healthcare woes. Throwing something high-tech at our public health system and expecting dramatic improvements in health outcomes is unrealistic; we need to get the basics right first. And that responsibility lies at the doorstep of the system’s leadership.
Getting the Basics Right
We are fortunate that our current Health Minister is both competent as well as committed to delivering a health system that works for all. However, he can’t heal the health system on his own. More people are required further down the chain of command who are both proficient in their jobs and passionate about change, in order to realise the vision for a reformed health system.
Improving the health and well-being of South Africans is not just about healthcare, so it is also essential that there is better collaboration with other ministries and the private sector to address the many challenges – such as housing, sanitation and education – which impact on health.
It’s a sad reality that patients who use the public system are poor and desperate. They don’t have access to information, they don’t know that they can demand better, and they are solely dependent on a dysfunctional health system for their basic healthcare needs. It is precisely for this reason that the system needs to work, not only for the patients but for the healthcare workers at the centre of the machinery.
We’ve got excellent people working across the public health system, but because they work in a less than excellent system they either go into the private sector or go overseas. We shouldn’t be losing as many skilled doctors and nurses as we do. We need to appreciate that the level of expertise that exists in our healthcare system, particularly our academic hospitals, is outstanding. But we also need to prioritise the people with those expertise and enable them to do their jobs well, safely and not to their detriment.