Community Service

Community service in an urban hospital

Dr Anthony Zaborowski

I regard my own community service year as being most successful on the whole. I can look back with satisfaction on a wonderful first six months spent in the top notch Paediatric Unit at Durban's Addington hospital, and a second six months gaining experience in trauma and casualty medicine. The knowledge and skills that I've gained will be invaluable in my career. I have seen a lifetime of pathology in one year and I've gained confidence in myself and my abilities. I have come out of this year a stronger doctor and, indeed, a richer person.

Addington is a professionally run hospital with nothing being left to chance. Supervision during my year was almost universal, with specialist advice never more than a phone call away, if not actually on the premises in the form of a registrar.

However, my experience is by no means the norm amongst the community service doctors of 2000. I was fortunate that I was awarded my first choice of hospital, in a Department of Health run application process that required me to list five South African hospitals in order of preference. I received the post that I wanted in a major national city, my home town, in a hospital that must rank as one of the best public hospitals in the country. I have had exposure to academics, first world medicine and first class teaching.

Others were not so fortunate however. Many community service doctors did not get anything near their hospital of choice, some going into second and third rounds of application in a dubious and often confusing system which does not seem to be blind to factors of colour or gender. Many doctors have spent a year far away from their families and friends, in rural areas with poorly managed and poorly equipped hospitals, sometimes devoid of any meaningful supervision at all. Some of these doctors no doubt loved every minute of being in the bush, whilst others did not, and many have regrettably left South African shores forever, purely to avoid this.

The crux of the matter is that a year of community service has been high-handedly thrust upon a group of highly educated and hard working professionals, and the terms are often less than ideal. Community service doctors often work up to 32 hours at a stretch, with little or no sleep, under the most stressful and trying of circumstances. One can only question the morality, if not the legality, of allowing young employees to work under such conditions, putting them, their patients and their professional reputations at risk. A feeling has arisen that if such a year can be enforced now, then why not again later? Will our community service obligation ever end?

Surprisingly, most community service doctors are positive about their year of service to their country. Perhaps it is the personality type a group of people who really want to make this a better world. Unlike our peers in many other professions, we work the hours and get our hands dirty without too many complaints and for this reason, for the most part, things have gone smoothly.

There is a dire need for well trained doctors in South Africa, particularly in the periphery, and there is merit in the idea that state trained doctors owe the country a service. However, we are taking a backward step with the existing system of community service. We need to make it more attractive to work in the periphery and we need to improve the archaic conditions of service. The answer to improving health care in South Africa is not to exploit your human resources to the point of losing them completely.