Doctors in revolt

Furious doctors are planning to march on parliament, and may even go on strike, over what they say is a crisis in South African medicine.

They have: hit out at chronic under-funding by the government and the halving of budgets; claimed that the department of health is spending more on bureaucracy than patients; complained of appalling pay and working conditions; and, threatened to emigrate in their hundreds.

The doctors' dissatisfaction has grown to such a degree that the SA Medical Association has become an affiliate of Cosatu.

A weekend conference in Johannesburg to discuss strategies for doctors' survival was peppered with war talk. Dr Kgosi Letlape, head of the Medical Association, said although doctors were essential personnel and may not strike, this drastic action was still a possibility. But first we need to raise public awareness about our plight.

Letlape said it was time for doctors to join forces and stand up and fight.

We have been at the bottom of the food chain for too long. We are not going back. We will negotiate with the government. But if deafness ensues, we will resort to sign language, he warned.

The doctors' anger was fuelled by the last-minute pull-out from the conference by the minister of public service and administration, Geraldine Fraser-Moleketi. She said she wasn't able to address the pay and working conditions of public sector doctors.

Letlape said the association had tried desperately to create dialogue with the government but doors had been slammed in its face. If there is anyone out there with other remedies, herbal or otherwise, please try to help us, he said.

Dr Mark Sonderup, chairman of the SA Registrars' Association, who works at Groote Schuur Hospital, said a sore point was the chasm between administrators and clinicians, as well as expensive top-heavy administrations.

Groote Schuur, for example, had appointed a new chief executive officer and seven or eight medical superintendents since 1996, along with healthcare and nursing managers.

There is a huge bureaucracy running a hospital that has lost half its beds in the past seven years. They seem to be spending less money on care and more money on administration systems, he said.

The joint budget for Groote Schuur and Red Cross Children's hospitals was R1,1 billion in 1996. That had been halved to R525 million this year, but hospitals in the area were seeing one million more patients a year.

Money is falling down the pyramid, allegedly to primary healthcare, but it's definitely not reaching those people who really need it. Is it going into administration and bloating the bureaucracy? Sonderup asked.

Dr Timothy Berlyn, of the Junior Doctors' Association, said: As many as 60% to 70% of my friends in the medical sector plan to emigrate. Another 20% will stay to specialise and then they will leave. The majority of the rest of them will migrate internally - to the private sector.

He said the migration was having an avalanche effect. As doctors left, those left behind picked up a bigger burden and became stressed. Then they left. It's a never-ending cycle.

Professor Denise White, chair of the Medical Association's committee on public sector doctors, said she wasn't working in the public health sector for the money. We just want a fair deal to serve the people of this nation.

White said the association had made many submissions to the department, but was stonewalled - something it would no longer tolerate.

White said problems with working conditions included: understaffing, lack of essential medicine and equipment; inadequate support and supervision of junior doctors in rural areas; declining capacity for supervision and training of registrars; poor living conditions for community service doctors; lack of security at work; burgeoning patient loads; and the burden of diseases like HIV/AIDS and TB. (Di Caelers: The Cape Argus, 22 September 2003)