Major disruptions in the state health sector — including a possible national strike — are looming after the South African Medical Association (Sama) rejected the government’s proposed pay rise for doctors last week.
In the occupation-specific negotiations dispensation forum the government offered an increase of between 0.28% and 2%, which doctors described as ”a severe insult”. They have demanded between 50% and 70%.
Angry medical practitioners staged daily lunch-hour pickets outside hospitals across the country last week.
”If there are no satisfactory results by the end of the month government might face a situation that they’re not able to control. Legal or illegal, we will strike — nationwide,” Sama’s Bandile Hadebe told the Mail & Guardian.
”We have little hope anything will improve,” Hadebe said. ”In fact, it’s no longer clear government even knows what the negotiations are about … I hope the new health minister knows how to sort this out.”
Three weeks ago, after an illegal week-long strike, doctors and the health department seemed to have reached a deal on the way forward. But Hadebe claimed the understanding had been ”deliberately ignored or actively distorted”.
Sama is pressing for parity between doctors’ salaries and working conditions and those of other public servants, such as teachers. An entry-level teacher earns R10 800 a month, while medical interns — who do two years of practical service in state hospitals after graduating — earn R9 000.
At last week’s lunchtime demonstrations doctors held up placards reading ”Plumbers earn more than us!” and ”We want an increase, not an insult!”. The protests are expected to continue until the end of the month.
Marinus van der Westhuizen, an intern at Johannesburg’s Helen Joseph Hospital, said he often works 36-hour shifts, leading to ”severe lack of concentration”.
”Internationally, shifts of up to 13 hours are acceptable,” Van der Westhuizen said. ”After that, studies have found one’s cognitive function goes down to that of someone with a blood-alcohol level of 0.1%. You’re not allowed to drive on South Africa’s roads with that level of alcohol in your blood.”
Van der Westhuizen said he and his colleagues are often ”left alone” to look after as many as 40 patients each during shifts.
”I get moody — all of us do,” the doctor said. ”If someone comes to the hospital at 3am with a minor backache, and you’ve been there since 7am the previous morning, you naturally get rude and intolerant.”
Patient loads have become ”insufferable”, said Ashraf Coovadia, an HIV paediatrician from the Rahina Moosa Mother and Child Hospital in Johannesburg.
”I’m dealing with twice as many patients as five years ago because of the influx of refugees, particularly Zimbabweans,” Coovadia said. ”While I’m glad we’ve opened our doors to foreigners, there are budget constraints we can’t ignore.”
He said his department was severely understaffed. ”We now hear government wants to delete all the vacant positions instead of filling them. That way they think they can claim that they have a full complement of staff!”
Health department spokesperson Fidel Hadebe refused to comment on the negotiations.
Meanwhile, hostilities between Sama and the newly formed United Doctors’ Forum have resumed after a two-week truce.
The forum said it ”doesn’t trust” Sama, accusing it of being ”too sympathetic” to government. ”We’ve decided Sama is not honest — they only represent their own interests,” said forum spokesperson Rapitse Malatji.
Sama hit back that the forum was ”disorganised, propagandistic and irresponsible”.
The forum has now lost its representation in the bargaining chamber, as Sama and the nursing union, Denosa, had earlier agreed to accommodate it by giving it seats.
In another development the trade union Solidarity has published a report which finds that up to 40% of jobs for registered nurses in the public sector are vacant. ”South Africa’s ratio of health workers per 100 000 people is almost 23% lower than the global average,” the report says.
Marion Stevens, of the Health Systems Trust monitoring group, said this adds to doctors’ burdens.
”Nurses often end up being porters, cooks or security guards, because there’s just no one else to do this,” Stevens said. ”If they can’t do their jobs doctors end up doing nurses’ jobs and the vicious cycle continues.”