Marion Edmunds
Health Department Director General Olive Shisana has personally petitioned outgoing British high commissioner Sir Anthony Reeve more than once this year in a bid to stop South African doctors finding employment in British state hospitals.
While there are rumours of diplomatic agitation behind the scenes at Shisana’s forthrightness, British diplomats say there was no anguish in the latest meeting where they were able to express sympathy with her problems.
Representative of the British High Commission, Andrew Noble, said the British government was unable to tell the National Health System (NHS) who to employ, but it had sent a message to the NHS to go “softly, softly” on employing South African doctors.
“It’s a subject we have been discussing with the department all year … and we have drawn the attention of Dr Shisana to organisations such as the British Experts’ Service Organisation and the Voluntary Service Organisation to provide volunteer doctors for the rural areas. However, we genuinely believe that a free flow of doctors internationally is good,” said Noble.
It is this flow that Shisana and Health Minister Nkosazana Zuma wish to stem. However, Deputy President Thabo Mbeki said this week that the most popular destinations for emigrating doctors were Australia and New Zealand, followed by the Americas and Europe. Six more doctors immigrated to South Africa than emigrated last year. Mbeki said 23% fewer doctors emigrated last year than the year before. Shisana was abroad, and could not be reached for comment.
And this week the Parliamentary Portfolio Committee on Health instructed the Interim Medical and Dental Council of South Africa (IMDCSA) to research its own proposal that medical graduates do two extra years of vocational training, saying there was a need for deeper investigation.
During a day of public hearings, speaker after speaker said that there had not been sufficient consultation on the proposal and criticised the assumptions that underpinned it.
The vocational training issue and the doctors’ brain- drain have become twinned in the minds of many, who see the training as a mechanism to stop young graduates from leaving South Africa before giving something back.
But there was almost unanimous agreement that the medical curriculum needed to be revised to suit South African needs and community service was sorely needed in some areas.
Anti-conscription activist Dr Ivan Toms recommended compulsory community service at the meeting, on behalf of the National Progressive Primary Health Care Network:
“I was not one of those doctors who went abroad to escape conscription. I stayed at home and went to jail … but at least with the old system of conscription young doctors were conscripted into military hospitals and even though the system was wrong, at least they were able to provide some sort of service to the poor in rural areas. This is not happening anymore. We have to get doctors into those areas and community service can help us do this,” Toms said.
Ironically it was British-trained Dr David McCoy, working in rural Kwazulu-Natal, who gave the most vivid description of how bad the situation was in rural South Africa:
“At the end of 1992, I came from England to work in a 400-bed rural hospital. I joined six other foreign doctors. Together with a local, non-medical staff, we were charged with looking after the health of about 180 000 people. In England, it is normal for 180 000 people to have access to well over 300 doctors.
“Several patients died in theatre or in the wards due to clinical mistakes or misjudgments, not because of negligence, but because of inexperience. I often performed surgical operations on patients with an open textbook in front of me,” he said.