The Taung district hospital in the North West province serves a population of nearly 250 000 people, spread across 84 villages and three townships (Reivilo, Pudumong and Pampierstad). It has just six doctors — and three of them are leaving next month. The hospital will be left with one senior doctor and two doctors performing their community service.
”There are nights when there is one doctor on call for the whole hospital. With 200 inpatients as well as casualty and outpatients, it is an impossible task,” said a medical doctor at the hospital who did not wish to be named.
Doctors, he said, are ”frustrated and demoralised by dealing with a huge patient load and not being able to do their best for each person”.
He says there are currently 15 vacant doctors’ posts at the Taung hospital. Emergencies have to be referred to Klerksdorp hospital, 300km away.
According to the Rural Doctors Association of Southern Africa (Rudasa), the situation at Taung is not unique. ”There are hospitals in the Eastern Cape and KwaZulu-Natal that have no full-time doctors at all,” says Dr Elma de Vries, chairperson of Rudasa. ”At present both Hlabisa hospital in KwaZulu-Natal and the Alice hospital in the Eastern Cape have a severe shortage of doctors.”
The organisation is concerned that community-service doctors are filling urban posts and avoiding rural areas. Rudasa claims that only a quarter of community-service doctors are allocated to rural hospitals. This goes against the objectives of the system, which aimed to address such imbalances.
Staff shortages mean that even those community-service doctors who do get posted to rural hospitals lack supervision at the appropriate level, while already over-worked senior doctors battle with the added burden of training them.
De Vries said that while incentives are necessary to retain senior doctors at rural hospitals, Rudasa’s main concern is for patients: ”We are really concerned that patients are going to die.”
The situation is exacerbated by delays in rolling out the rural allowance that aims to provide doctors with an incentive to stay at rural hospitals. In March this year the Department of Health allocated R500-million for this purpose, but the process has stalled as nurses demand an allowance, too.
Thembi Mngomezulu of the Democratic Nurses Organisation of South Africa says nurses were promised a rural allowance in April, but it has not materialised.
According to the Department of Health, the payment of the rural allowance to nurses is still being negotiated in the Public Service Coordinating Bargaining Council.
Mngomezulu said rural hospitals are being ”used as a springboard for newly qualified staff who work for short periods in these facilities while waiting for better employment opportunities elsewhere”.
Rudasa proposes that more medical students be recruited from rural areas, and that training be done in rural communities and hospitals rather than urban areas. It suggests that academic institutions be given incentives to implement distance-learning courses for health-care professionals, as well as financial incentives for doctors and nurses to stay in rural hospitals.