[Photos: David Harrison and Darren Taylor]
The cold gusts of a harsh Eastern Cape winter fill the colossal wards of the Nelson Mandela Academic Hospital in Mthatha. Outside, queues of despairing, restless patients mount rapidly — people uncertain of receiving the help some have journeyed for days on foot from rural mountain settlements to find. But doctors and nurses are scarce commodities.
They do not wish to work in a poorly equipped, grossly understaffed hospital in a city with an unappealing social life — especially when they’re able to find well-paid employment in fully equipped, pristine private clinics or in public hospitals in provinces far more tempting than the Eastern Cape with its desperate poverty and icy isolation.
Doctors who end up in Mthatha often have had no choice — they’re either foreign with restricted work permits or the state has placed them there for their compulsory community service. They rarely stay for longer than they’re forced to. Consequently, services in facilities such as this in the Eastern Cape are frequently substandard and the health personnel almost always disgruntled and unmotivated.
Last month, the media reported that 181 babies had died in the Nelson Mandela Academic’s neonatal ward between January and April this year, and many staff members threatened to quit when Phumulo Masualle, the health MEC, blamed the fatalities on their negligence. But it emerged that oxygen compressors — which could have saved many of the babies’ lives — had been malfunctioning for more than a year. ‘Babies die one after the other,” one nurse told a local newspaper. ‘More than five babies have died in my hands. I can’t even sleep or eat properly as I always think of them. I’m thinking of quitting.”
But for Dr Pumza Ghu, working at the chaotic facility in depressing circumstances such as this was a ‘calling”. She asked to be placed in her hometown for her two-year internship, in stark contrast to other students she knew who ‘prayed” to be deployed ‘anywhere but” Mthatha. ‘I know what it feels like to arrive here at 6am in the morning and at two o’clock they tell you, ‘sorry, but the doctor is not going to take any more people. Come back tomorrow’,” she said. ‘I chose this hospital because I know what service here feels like. I’ve been dreaming of working here as a doctor my entire life.”
But she very nearly didn’t. A product of bad township schooling with its constant education boycotts, Ghu barely passed maths and science in matric. ‘I had a terrible maths teacher,” she said. ‘She was always absent and lazy. We [pupils] had the responsibility of doing things for ourselves and no one was really guiding us. We would try to do sums and try to practice, but we never knew if we were on the right track.”
But through it all Ghu aspired to attend university to study medicine. She knew she had the potential, but her bad grades threatened to dissolve her dream — Stellenbosch University dismissed her application to study medicine, but accepted her for a BSc focusing on food science.
Ghu was grateful, yet arrived at the university ‘miserable and directionless” because she knew she wasn’t following her heart. ‘I didn’t even have a place to stay,” she said, ‘but what could I do?” But hope came during a conversation with a sympathetic university recruitment officer.
Ghu was told about the science and mathematics at Stellenbosch University programme (SciMathUS), designed to help matriculants from previously disadvantaged backgrounds who had fared badly but had shown potential in these disciplines to improve their marks radically. For one year, experienced tutors drill SciMathUS pupils.
‘They made sure that if you don’t understand, they explain problems to you until you do. It was something I had never experienced before. I didn’t know that type of schooling,” Ghu said. She and the other SciMathUS entrants then rewrote their matric exams and, based on their new results, reapplied for admission to their chosen courses.
In Ghu’s case, she almost doubled her marks. It was an ‘amazing result” that finally allowed her to be accepted into the university’s medicine faculty. Today, she’s occupying a position the state would probably have had to import a foreign doctor to fill. What’s more, once she has completed her internship and community service, she wants to continue working in the public sector.
‘It means I would go where most of the population is. It’s going where the action is and that’s what I want. My job is to help those people who are too poor to afford private doctors,” she said. Since its inception in 2001, the Sci-MathUS programme has prepared 11 students like Ghu for medicine and six for physiotherapy. Not one of these students has dropped out.
Many other SciMathUS students have become health professionals in other fields. In 2008, the programme accepted 62 students who had an average of 42% for maths in matric. When they rewrote their exams at the end of the year, they averaged 73%.
Gerald Maarman (26) is one of the project’s greatest success stories. At the East River Secondary School on the Cape Flats, Maarman failed maths in the higher grade and got 45% for science. After his SciMathUS year, he got 75% for maths higher grade and 80% for science, results good enough for him to be accepted for a BSc in functional human biology. ‘SciMathUS taught me how to think critically, something our education system dismally failed in,” Maarman said. ‘At school, it was like the blind leading the blind and I thought my dream of going to university was going to die. But the programme improved me phenomenally.”
At East River, he and his fellow learners had to share textbooks and opportunities to take them home to study. ‘No one seemed to care,” Maarman said. ‘There was just this attitude that people coming from my background were simply not going to end up at university, let alone study in a medical direction.”
Five years after the SciMathUS course, Maarman is about to finish his masters in medical physiology cum laude. His research evaluates the effects of drugs designed to prevent heart disease. University authorities regard his work as being so advanced that they’ve given him the option to upgrade his dissertation to a doctoral degree without his first having to obtain a master’s.
In Limpopo, one of Ghu’s fellow Sci-MathUS students, Dr Bongiwe Tyhala, has been working at the Mokopane Regional Hospital since January. Like Ghu, she has chosen to be here. ‘Students who are not from a background like mine don’t understand what it’s like to serve in an impoverished area. They obviously don’t want to go to rural areas. I think, because we come from rural areas, Phumza and I wanted to return to these areas. It’s because we understand the suffering here,” she said.
Aaron Motsoaledi, the health minister who was the education MEC in Limpopo, said he had often had bursaries for matriculants from the province to study medicine. ‘But their marks were never good enough. I had no one to give them to,” he said.
‘You can go to Limpopo now and you will find that 90% of the doctors are foreign because South African doctors don’t want to work there. And those who come from Limpopo and who might have wanted to go back there and serve the people they know so well don’t have good enough science and mathematics marks to get accepted into medicine programmes.”
Besides the SciMathUS programme, both Ghu and Tyhala attended a bridging course for medical studies and did their first-year course over two years. ‘It was a huge jump when we had to join everyone else in our second year and, all of a sudden, do seven instead of two modules per semester. But when you’re determined and know where you’re going, you don’t allow anything to knock you back,” Tyhala said. ‘It’s a good feeling once you get through it.”
The two young women even had lectures in Afrikaans. ‘We used to struggle to understand what oxygen is, what is nitrogen and things like that, because all the words were just confusing. You think today you have it, and tomorrow you forgot it all — but somehow we managed,” Tyhala said.
She is at a hospital in one of country’s poorest areas, where doctors have previously reported that patients who suffer from conditions such as acute appendicitis often wait for 10 days to see a doctor. ‘People won’t wake up at five in the morning to go to the clinic if they don’t have to. We understand those people more than anyone else because, once upon a time, we were those people,” Tyhala said.
All three former SciMathUS students also want to remain in South Africa to improve public sector health. ‘I don’t want to contribute to the doctor shortage in my country and I want to work in a place that gives me hands-on experience,” Tyhala said. ‘I prefer a place without fancy equipment to make diagnoses, because I believe this will make me a better doctor.”
Her advice to Motsoaledi is to recruit potential medical students from impoverished areas, because she thinks the chances of them returning to work there are high. ‘There are plenty of learners in such places who have the potential to become doctors, but the circumstances in which they grow up and under which they study are not conducive. They just need a bit of extra help — like the help I got.”
Maarman believes the problem is not finding doctors or medical researchers but rather ‘developing” them. ‘This is not going to happen unless South Africa’s education system is totally revamped and we seriously reassess teaching methods in this country,” he said.
‘We have to educate our teachers first. If we did this, and the teachers passed their knowledge on to the kids like they’re supposed to, there would be no need for a programme like SciMathUS.” Ghu said: ‘Everything needs to start from primary level. They have to groom the kids from a very young age.” Back at Mokopane Hospital, the arduous work hours, lack of equipment and generally low staff morale aren’t enough to discourage Tyhala. Rather, such a bleak scenario ‘inspires” her.
‘I want to work in the public sector because that’s where the people are who need help most. There are too few doctors at state hospitals, so they are burning out. Even though they try their best, they are just overworked. The more doctors we get into the public sector, the better chance we have of ending this situation,” she said.
Early in the morning when Tyhala reports to work, or late at night when far more patients than she can physically cope with wait in the emergency room, she remembers what her great-grandmother used to tell her: ‘If you want to make life easier
for yourself, you must understand people — understand how they think and why they do the things they do.
‘She used to say: ‘Don’t seek to be understood, seek to understand’. And I live by that when I serve our patients.” The intern doctor spends most of her time attending to HIV-infected patients and malnourished babies from surrounding townships and former homeland settlements where food and health information are equally scarce.
‘In the end, education makes all the difference. I am lucky because I have experienced both sides of the schooling system — the very bad side that leads to promising students ending up on the streets, and the very good side that gives people like me a second chance to achieve our dreams.”
When pleading mothers arrive with weak, ‘half-starved” children who Tyhala has to treat, knowing the little ones will return to homes without food and unemployed parents, no matter what she does, she is grateful for the opportunities she’s had.
‘I understand what it’s like to sit in a class and feel totally ignorant. And I know what it feels like to feel as if I have knowledge. The lives of my patients, especially the young ones, could also change if they get such a chance. I would like to make that happen for them. ”