Michael Nurok
It is 3am on Sunday and “Dr Davis”, an intern at a Western Cape hospital, has not stopped working since 8am the previous day. He is trying to resuscitate a child who has lost so much blood from an open fracture he is unconscious.
Save the overburdened nursing staff, there is no one available to help revive the child on the brink of death. This is Davis’s first unsupervised resuscitation. The more senior registrar is attending to another critically ill child.
When this child has been seen to, Davis must go back to the paediatrics ward to see another child the nursing staff is concerned about. His shift will end sometime on Sunday afternoon when all the patients in the ward have been checked.
Work starts again at 8am on Monday. Davis has worked like this, spending between one in three and one in four nights at the hospital, since his internship began at 7.30am on New Year’s day.
What he has to look forward to is a full year of between 70-hour and 90-hour weeks.
If he wants to register to practise in South Africa, he will have to perform an additional year of community service, working similar hours, with much less supervision.
This, in addition to six years’ studying (which included unpaid student work in the hospital), would bring the total number of years spent before being able to practise medicine to eight. He is one of hundreds of other interns working under similar conditions.
“You can’t function like this,” states an intern at Davis’s hospital. “With this workload I am learning and practising bad medicine.”
Through a peculiar inversion, the most inexperienced doctors in the hospital system are being given the largest burden.
Internship has traditionally been the year that doctors fresh from medical school learn to apply the theory and skills they were taught.
It is easy to spot interns at the beginning of the year. They are the doctors with their white coat pockets overfilled with books. Inside are drug dosages, problem- oriented management plans, emergency phone numbers — effectively a DIY doctor kit.
As the year progresses and the new doctors cruise up the learning curve, the white coats become lighter and lighter. Unfortunately, the hours do not.
Even more alarming is that the fatigue of the gruelling year often leads to complacency about the inability to practise good medicine under such stressed conditions.
Why is this? The Western Cape health budget is under immense constraints. This translates into staff posts being cut. Problematically, the same does not happen to patient numbers.
The only solution is for the existing staff to work harder.
Given the regimented hierarchy of medical practice, the interns, as low persons on the totem pole, end up shouldering much of the workload.
Granted, salaries have gone up substantially in comparison to wages previous generations of starting doctors earned, but the salaries being paid are calculated for a 40-hour week and 16 hours of commuted overtime.
Fifty-six hours does not begin to compare with the 70-hour to 90-hour weeks actually worked.
At the beginning of this year interns were informed they would not be able to claim for any more than the 16 hours of commuted overtime, even though they will be working far beyond hours claimed.
“I worked out my salary for the number of hours I put in,” says an intern. “I could easily be making more money waitering, and not have any of the responsibility.”
“I’m happy with my salary, I just think it is crazy to be working these hours,” adds his colleague.
Many senior staff reject such complaints, recalling how hard they worked during their training as junior doctors. They also point out that other doctors in state hospitals put in many more hours than they are paid for.
This, however, misses the interns’ point. The fact that a previous generation worked in a ridiculous system is no justification for the perpetuation of the process.
More posts are out of the question, and decreasing the patient load seems similarly unfeasible. “If the hours keep going up, there will come a point where I am not prepared to work,” says an intern. “I can’t be held personally responsible for a system that isn’t functioning. I am committed to patient care, but I also have my own life.”
“I’m not thinking and I am making mistakes,” complains his colleague.
A doctor who just completed his internship put the situation more bluntly: “I was worried I was going to kill someone.”