Chris Hani Baragwanath Academic Hospital.
Having worked in the public health service for 15 years, in two provinces and nine government health institutions ranging from community health centres to quaternary level service, I know well the inner workings of the machinery that is our public health service.
In one moment of desperation more than a decade ago, confronted in my daily practice with the nexus of corruption, incompetence and the resultant effect on service delivery, I approached the public protector for help.
In another, I reached out to a lawyer to find out if it was possible to go to the press or if it would be breaking my employment contract. In both instances I was left disappointed. Use internal avenues of reporting within the department of health and your contract forbids you from going to the press, I was told.
When I read Dr Tim de Maayer’s open letter about the appalling conditions at Rahima Moosa Hospital in Johannesburg in May, I was not surprised by the content. The public, however, appeared to be titillated. People spoke with hushed voices and that knowing glint in their eyes. “Things in the government hospitals are so tough these days,” they enthused. Like they always knew it and this incident had somehow validated their opinion.
I may not have been surprised by the content, but I was certainly surprised by his action of going to the press because I knew how great a risk he had taken. But as things played out, I was heartened. The subsequent open letter signed by the who’s who in the medical field calling for change garnered less attention publicly, but to me it was an exciting moment for public health in the country.
I believe passionately in the ideal enshrined in the Constitution that access to quality healthcare is a basic human right. I have worked closely with scores of healthcare workers; doctors, nurses, social workers, physiotherapists, speech therapists and many more to provide quality service in the fulfilment of this right. I have watched colleagues extend themselves time and time again to help their patients in ways that go beyond a script being filled. I have seen patients transformed. I have watched the district health system work.
Following one particular patient’s care from regional to tertiary and ultimately to quaternary care and having him greet me like his hero in the halls of all three institutions, even years later, has been especially heartening for me.
I also once cried on the phone with a doctor I had never met. She was phoning the paediatric intensive care unit (ICU) where I was working, wanting to transfer one of her patients for ICU care. We both knew that without ICU care her patient would not survive but the ICU was full. I called her a few hours later to try and give her some advice to help the baby where she was. She cried as she recounted her attempts at resuscitation which had ultimately not been successful. She cried as she told me she had failed her patient. I cried as I reassured her the system had failed us all. This is our shared pain. This is our moral injury.
We, the doctors, nurses, social workers, physiotherapists, speech therapists, social workers and many others. We, the ones tasked with carrying out the government’s noble goal of providing equal access to adequate civil services. We, the end point of the taxes paid by citizens. We are the ones daily faced with the vast challenge of making the ends of need and available resources meet. We are at the end of ourselves and we need help. That is what Dr De Maayer’s letter told the South African public. That’s what the open letter signed by 130 of the country’s top medical professionals confirmed.
If you are looking for an individual head to roll, you won’t find one. I have watched many public service leaders be dismissed and replaced with no appreciable change at implementation level. The problem is far more elusive and pervasive than that.
The proposal outlined in the “I am” open letter is what is needed. The establishment of a standing Public Health Administration Review Commission to reconfigure provincial health departments.. This requires two key things. Firstly, independent, skilled and capable hospital boards that are accountable to the facility and its staff and patients and that report regularly to the provincial legislature. Secondly, chief executives with operational and financial management skills must be appointed by these boards, in conjunction with joint staff protocols of relevant academic medical faculties and the provincial administration.
To achieve this will require every ounce of public and political will available. Let us, as South African society not allow dust to gather on this public moment. Let us not sit back, satisfied that our curiosities have been met but overwhelmed by what’s required. Equal access to quality healthcare service is certainly an audacious dream. I have seen what our public health system is capable of and I believe that with the right support and change we can achieve it.
Perhaps what it looks like is sharing far and wide the “I am” open letter so that the public becomes aware of what health care professionals are proposing. Perhaps it’s lobbying within your circles of influence that these proposals be actioned. Perhaps it’s reading the National Health Act 61 of 2003 and the National Health Insurance Policy so that you may understand what systems are needed to enact the noble vision and policy contained therein.
Perhaps, as an interested and affected stakeholder, it’s gathering around yourself other like-minded individuals with an array of skills and forming a “friends of the local hospital” group. Then with this group engaging both hospital management and implementers to find out what support is needed.
Not only do I believe the public health system is up for the challenge, I also believe the South African public can bring about the change. We need it. We the implementers are at the end of ourselves and we need your help.
The views expressed are those of the author and do not necessarily reflect the official policy or position of the Mail & Guardian.