A bitter pill to swallow

In his first press interview new Health Minister Aaron Motsoaledi chides doctors for planning to strike and warns that the government cannot meet their 50%-70% increase demands. He spoke to Mia Malan and Nosimilo Ndlovu

Doctors are demanding a 50% to 70% increase. Is that fair?
It might be fair, but I don’t think it’s viable. We’re not England; we’re a Third World country. I don’t think there’s any way that I’m going to wake up one morning and say ‘Here’s is a 70% increment’. But we may be able to do it in steps. I have not yet spoken to the minister of treasury, but I’ve been in government long enough to know that such increases are impossible.

How fair is the government’s 2% offer?
Please allow me not to answer that question. All I can say is that I’ve been around in government for long enough to know 50% to 70% is impossible.

Do you condemn doctors’ strikes?
I’m not condemning; I’m saying they’re inappropriate. They provide an essential service — it’s illegal to strike. I don’t think there are any conditions in which doctors should strike if it’s going to lead to someone’s death. I was a doctor in a public hospital under apartheid and wanted to boycott. A sister said an old man was in trouble , and I said: ‘No, I’m not going to help him because the government doesn’t appreciate me.” She told me: ‘This old man — what does he know? How did he contribute to the government doing that to you? Why punish him? It’s not his fault!” I felt very guilty and realised that as a doctor there are certain things I can’t do.

So what should they do?
They should sit down with us and talk. They should engage with us.

What has made doctors so militant, and are you worried?
Of course I’m worried. I don’t mind them being militant, but I’m worried that the militancy affects patients. In all spheres of life workers have become more militant. The fact that it’s moving over to medicine shows that society is changing. What worries me is that society must never change to an extent that we no longer care about people’s lives.

Doctors have threatened to strike, legally or illegally, by the end of May if their demands aren’t met. How will you react?
I was part of the ANC health committee that engaged doctors in April, when they signed a document stating that they won’t engage in illegal strikes over the next six months. We believe and hope they will respect that. I don’t want to pre-empt what I will do, but I’m warning striking is illegal in this. My impression is that a small number of doctors don’t want to adhere to such basic rules.

What will happen to doctors who don’t stick to the agreement?
There are many actions — dismissal or suspension is possible.

Sama has lost members to a new association, the United Doctors’ Forum. How will this affect negotiations?
I’m very sad about it. A few weeks ago I tried to bring them together, and now they’ve broken up again. Sama has focused mainly on private sector doctors and the forum on public sector doctors, who feel they’re not taken care of. I’ve told them a new union is not child’s play. It’s going to make negotiations even more tedious — because they’re going to disagree. When an employer negotiates with you while you’re divided, one half agrees, and they may get weakened. It’s going to cause us problems, but it may also destroy their cause.

Doctors are also demanding better working conditions and hours. What will you do?
I will sit down with them, listen to them and tell them what’s possible. I know what it feels like to work until 3.30am — I’ve done that myself as a public sector doctor. Bad working conditions are caused by a shortage of doctors and nurses. Part of relieving doctors is to get more nurses, and we blundered in a big way when we closed down many nursing colleges. The biggest trainer of nurses is the private sector — while producing skilled people is the work of government! I’m going to reopen the government nursing colleges so that nurses can study while they’re getting paid. I think it will start alle-viating some of the unbearable working conditions.

Why do we also have such a shortage of public sector doctors?
I trace the problem back to Bantu education, when black children were no longer taught maths and science. When I was the Limpopo education MEC I got many offers for bursaries for medical students, but few passed maths and science [at matric] and qualified to study medicine.

People say the problem should have been fixed 15 years after democracy, but 15 years is just the period between grade R and matric for one child. I believe the country won’t survive some of these things unless it gets a massive dose of outside help. It’s not only doctors that are lacking.

When I worked in rural areas I only once met a trained pharmacist in a hospital. In one hospital I used to prescribe a common drug that was simply never in stock. One day I went to the pharmacy and found the drug was there. I was using a scientific name which the assistant could not understand. I found some of the packets of this drug had even expired! This lack of trained staff in the country is quite problematic and adversely affecting the health sector. We need to solve it very fast, with the education department — it’s not only a health department problem.

How will you find the money to fix the healthcare system?
It’s a challenge. It doesn’t depend on me alone; it depends on the minister of finance, so we’ll have to meet. It also depends on the public service minister. It’s a major challenge — and all of this during the global [economic] meltdown!

What doctors say they earn

Why have South Africa’s doctors become so militant? Mail & Guardian reporters Nosimilo Ndlovu, Qudsiya Karrim and Ilham Rawoot took snapshots of doctors’ working conditions in public hospitals.

Sharan Rambarran: general surgeon, Addington Hospital, Durban
Earns: R19 000 after deductions (including overtime)
Working hours: On average 90 per week

Sharan Rambarran, with 15 years’ experience as a state doctor, feels his days never end. ”As I speak to you now, at 2pm, I’ve been at the hospital since my shift started yesterday at 7:30am,” he said.

”We just don’t have enough hands to say okay, you’ve been here since last night, you can go home.”

Rambarran said some doctors are involved in car accidents because they fall asleep at the wheel after long shifts.

He complains of a lack of basic equipment. ”We don’t have abdominal swabs, face masks for theatre or proper gloves. We also don’t have access to an endoscopic machine, a diagnostic microscope digital camera for looking into a person’s stomach for ulcers and other problems. We have to use X-rays to find out what’s wrong.”

The X-ray department is understaffed, often forcing him to treat patients ”on an assumption” of what ails them.

Rambarran would like to start a family, but says his salary rules that out.

He is still paid as a registrar, despite being a qualified consultant surgeon, as the government has frozen all posts and promotions in KwaZulu-Natal because of budget constraints.

Tsebo Mphahlele: intern, Helen Joseph Memorial and Coronation hospitals
Earns: about R7 000 a month after deductions (without overtime)
Working hours: Often 80 per week

Tsebo Mphahlele, who has worked at Helen Joseph and Coronation for two years, says her basic salary does not cover her expenses or enable her to rent her own flat.

She often works shifts of between 24 and 27 hours.

”We are on our feet all the time because of the increase in patients. We’re lucky if we get time to eat, and usually survive on two hours’ sleep,” she said. ”When you’re that exhausted, accidents can happen.”

Compounding the difficulties is the fact that medicines she prescribes are often not available at the dispensary. Mphahlele believes the government has a duty to increase doctors’ salaries, given the volume of work. ”We’re asking for a 70% -75% increase. If they don’t give us that, we won’t settle for less than 50%,” she said.

Janine Webber: chief physiotherapist and head of the physiotherapy department at Helen Joseph Hospital
Earns: R9 200 after deductions
Working hours: 40 per week

Janine Webber says that while staffing in the hospital’s physiotherapy department has improved, her unit faces a shortage of equipment. Equipment ordered in October last year and January this year has not arrived. ”We order it and it doesn’t come,” Webber said. Outstanding equipment includes walking aids such as frames and elbow crutches. ”We can’t teach people to walk without them. Sometimes we have to use the trolleys next to the beds.”

This leads to patients staying in hospital for longer, which, in turn, costs the hospital more money. ”It’s very frustrating.”

Orders are placed through the hospital’s stores department, which then needs approval from the Gauteng Shared Services Centre (GSSC).”When I ask the stores department about the orders,” said Webber, ”they say the GSSC has lost it. Once they said the GSSC had thrown the orders in the bin.”