The idea of doctors going on strike is anathema, perhaps most of all to doctors themselves, who have until now found it impossible to compromise the care of their patients to protest against the increasingly disastrous management of the public health system.
There can be little disputing that doctors working in the state sector are more committed to their vocation of care than they are to dreams of fat salaries and flexible hours.
They are prepared to accept miserable pay and depressing working conditions because they believe decent health services should be available to everyone and because they believe in academic medicine. As our reporting this week suggests, they have not taken the decision to strike lightly.
It is a harder choice, a braver choice, and indeed a more optimistic choice than the one that leads to the arrivals halls at Heathrow and Toronto, or the gleaming foyer of a Netcare facility.
The fact is that it is precisely the striking doctors who are staying with their patients and using the only tool they have left to ensure better healthcare outcomes.
Perhaps that is a proposition that requires explanation. Is the strike not, after all, about money, and the botched implementation of an occupation specific dispensation (OSD) that just about no one really understands?
Salaries, which by any measure are inadequate, are certainly the proximate cause of the strike, and the crisp issue under negotiation, but the OSD debacle plays a large role for two reasons.
First, the bargaining process provides a ready point at which to apply leverage. Second, and more important, it caps a decade of health policy failure under former president Thabo Mbeki, his health minister Manto Tshabalala-Msimang and Director General Thami Mseleku.
The HIV/Aids denialism at the apex of the state had an immensely damaging effect on doctors’ morale and convinced many of them that their employer cared little for the lives of their patients.
Chronic failure of management occasioned by incoherence, corruption and incompetence that gutted service provision in state hospitals and clinics deepened the rift, and the apparent contempt of Tshabalala-Msimang and provincial ministers such as KwaZulu-Natal’s Peggy Nkoyeni for health professionals turned the atmosphere from disappointment to violent hostility.
When doctors complain of poor working conditions they are speaking not as office workers might, who have to sit in cramped and drafty premises, or even as factory workers might, when exposed to dangerous machinery.
They are speaking about the unavailability of drugs, machinery and expertise, even beds. In short, they are speaking about the circumstances under which the vast majority of gravely ill or injured South Africans will get to live or die.
The mess around the OSD is simply a symptom of the fact that the departmental culture of the Tshabalala-Msimang era persists, in the form of Mseleku, and in an institutional mind-set that continues to see relations with medical staff as a winner-take-all battle.
Even amid the budget crunch, this problem can be solved. It is not so much a question of money, but of political choices. There are grandiose and wasteful projects that should be cut, starting with the Pebble Bed Modular Reactor, the purchase of Airbus military jets and Broadband Infraco.
Minister Aaron Motsoaledi needs to fire his DG and sit down with the profession to chart a healing course for our public health system.
The strike is an awful choice, but if it begins that process it will save many more lives than it puts at risk.
Something is rotten in Bloem
The Mail & Guardian received an extremely troubling response from a senior police officer this week in answer to basic questions about our lead article about Free State Premier Ace Magashule last week.
The question: are the Free State police investigating claims of corruption made by a businessman under oath against the premier of the province? The response came from senior superintendent Motantsi Makhele who heads the police’s communication department in that province.
His response was: “Please take note that as part of our protocol in the government, enquiries related to the political leaders, especially those on the level of the one you mentioned, can only be dealt with by the office of the MEC for police and transport, or the spokesperson of the premier himself.”
When challenged by our reporter over his complete disregard for a separation of powers, Makhele insisted: “If it’s a Free State politician you’re asking about, go to the minister of police and premier for answers.”
Something is rotten in the state of the free.
We wish we could say that this was an isolated incident and that the police were generally doing a good job of following up claims of corruption and other white-collar crimes that come out into the public arena. This is unfortunately not the case. President Jacob Zuma’s constant anti-corruption rhetoric will stay just that if not translated into action.
This should of course not come as a surprise. The ANC’s decision to disband the Scorpions never had anything to do with fighting crime, but was the party’s way of punishing a successful unit for probing right to the top.
The Directorate for Priority Crimes Investigation (DPCI), which replaced the Scorpions, was supposed to start working this week, but has been delayed. Zuma and his Cabinet must assure the nation without delay that the DPCI will immediately start probing corruption, even when politicians are involved, without fear or favour. The Magashule case is a good place to start.