Family medicine

Revealed: the living hell of rural doctors

Rural doctors operating on limited budgets, often alone on duty, working more than 60 hours a week, seeing as many as 150 patients a day - are suffering. Up to one-third say they are considering throwing in the towel. The first comprehensive research into the challenges facing rural doctors in the Western Cape, undertaken by Stellenbosch University's department of family medicine and primary care, in co-operation with the Western Cape provincial administration points to an even bigger challenge for health authorities to provide top-level care, especially to people living in the rural areas so that they do not leave for abroad. Researchers, led by Professor Marietjie de Villiers, head of Stellenbosch University's school of public and primary health sciences, canvassed full-time, part-time and community service doctors at 27 district, or level one, hospitals, across the province - and the picture that emerged is not one that inspires confidence. The district hospitals, took care of more than 91 000 in-patients, only 18 000 less than Cape Town's three tertiary hospitals combined, but with only 147 medical practitioners, including community service doctors and out of 141 community service doctors allocated to the Western Cape, only 20 have ended up working at these hospitals. However, Western Cape is still much better staffed with rural doctors than the other provinces. Only a few foreign-qualified doctors work in this province's district hospitals, whereas in KwaZulu-Natal, you can hardly find a South African doctor in rural hospitals. Doctors at rural hospitals are strongly committed to working for the benefit of these communities, but the stress of keeping up with the patient load and other challenges of rural medicine leaves little time for personal advancement or skills development that would be useful in guiding the development of rural health resources. Whereas permanent staff relied heavily on community service doctors as a buffer to deal with primary healthcare patients who arrived for treatment at rural hospitals, their inappropriate training pushed up costs. Almost 21 percent said they needed supervision to undertake neo-natal resuscitation: about 20 percent wanted help dealing with HIV/AIDS; nearly a third felt ill-equipped to deal alone with family violence; to deal with severe childhood asthma, 23 percent said they needed supervision; when it came to abortions, 42 percent of doctors who responded said they would not perform abortions for moral and ethical reasons, although they were capable of performing the procedure. The research showed the most common operation done in rural hospitals was caesarean section, followed by female sterilisation. Statistically younger, less experienced, doctors, particularly women, carried this burden, the research results showed. Although some universities, including Stellenbosch, had started exposing doctors to rural conditions while they were undergraduates, this was limited and insufficient as preparation. Appropriate experience during the intern year was crucial in preparing doctors for rural practice. Dr Joey Cupido, the provincial head of rural regions, has now asked De Villiers to develop educational programmes to help fill the gaps identified. It's essential that the role of district hospitals in the health system be examined, particularly its interaction with primary healthcare services.One of the big problems is that clinics in these areas shut up shop at 4pm and then the doctors at district hospitals find themselves working long, frustrating hours having to deal with relatively minor complaints, De Villiers said. For permanent, experienced doctors too, career paths needed to be defined to make them feel valued. Doctors said they had been working in the same hospital for ten years and longer, but had no chance of a rank increase. Although many doctors saw rural work as a wonderful opportunity and had a real sense of benefiting the community, ways needed to be found of training them and supporting them so they progressed. Ways must also be found to cut down their after-hours duties. That's what is making them leave, she said. (Source: Cape Argus, 17 September 2002)