Reflections on our Healthcare System

I have been on both sides of the South African health care system since the lockdown was enacted – I volunteered and assisted for a couple of months at a Clinic in Orange Farm, and unfortunately had a family member spend a few weeks at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) due to a terminal cancer diagnosis. My experiences as such have been contrasting and have shown both the best and the worst that our health care system has to offer.

The best aspects have come from doctors and nurses showing unbelievable courage, determination, empathy, work ethic, and ingenuity in running a clinic safely and smoothly in the light of a pandemic. Doctors and nurses who see literally hundreds of patients every day, and yet manage to give empathetic and personalized care to people. Doctors and nurses who take the time (despite the unimaginable patient burden) to teach and encourage students in every little aspect of patient care, from examining chest x-rays to dispensing medication, to taking adequate histories and communicating effectively with patients across all spectrums. Watching team leaders develop new plans to safely manage patient-load and to design systems to triage an entire community has been beyond awe-inspiring and incredibly motivating.

However, the one thing I feel I can take away from both scenarios is to say without a shadow of a doubt the kind of doctor I don’t want to become, and I hope to one day run a ward in the way it absolutely should be.

At the other end of the spectrum, we interacted with doctors who were scared to interact with their patients, who would shout at their patients in front of others, who would disregard a patients pain or time completely, and who would say constantly in front of patients that they should have become an accountant instead. There were instances when patient care was neglected completely because it was a Friday afternoon approaching 1pm, and if that patient had to open their file it would mean the doctor had to oversee their care past their knock-off time at 3pm; instead, the patient was sent home, in obvious pain, and told to come back on Monday. I had a patient turn to me in tears literally begging for help after this doctor dismissed him because it was nearing the end of his shift.

At CMJAH, my gran was subjected to every possible humiliation with little regard from the nursing staff in the ward – she was berated for not having her pensioners card (even though she was transferred from Donald Gordon for emergency vascular surgery due to a thrombus in her thigh following a first surgery) and was denied admittance to the ward (despite the surgeons direct orders). She was left naked in a bed, shivering and begging for help, for more than six hours following her surgery with staff members ignoring her pleas until the surgeon came to check on her that night. She was forced to lay in a blood-filled and soiled bed the next day for more than 10 hours because the nurses refused to change her sheets after her colostomy bag malfunctioned. She was told to change the bed herself because she has two hands. She eventually slept naked in a chair in the ward because they would not provide her with a change of sheets or a fresh gown. There were times when other patients in the ward would help each other change their sheets or walk to the bathroom because the staff would simply outright refuse.

As it was lockdown and family members could not visit, we were given the number of the lead surgeon at CMJAH who would be performing a separate procedure to attempt to remove some of the cancer. When phoning for an update, after we hadn’t heard from my gran in over a day and the nursing staff could not locate her in the wards, the surgeon told my family that if we wanted any information from her we should join the ward rounds in the morning and to never phone her on that number again. There was absolutely zero regard for patient care and for simple human empathy. There was no information given to a family who could not visit a loved one, let alone even locate her in a hospital. We were told over the phone by a nurse that because they could not locate her in the ward or in the theatre, that she was likely in the morgue. The nurses refused to change and clean her despite orders from surgeons. The doctors refused to communicate with family members by any means. The psychological toll this took on both patient and family, in the midst of a terminal diagnosis, was a damning indictment on a health care system that has little regard for patient care despite our constant teachings in class. The divide between what we are taught and the reality of our system is unimaginable.

The worst part for me as a medical student is that I have been in that very surgical ward at CMJAH this year as a student as part of our surgery rotations. I have practiced history taking and learning new skills on a patient in the same ward who happened to be in the very same bed that my gran was later in. And the patient we helped during our rotation was in the EXACT same situation – she was being discharged without being told that she had inoperable terminal breast cancer. She literally had no idea what was wrong with her; she assumed she had an infection. Not one doctor or nurse had informed her of her diagnosis or prognosis despite being in the ward for over a week, and she was being discharged that day to be sent home to die. At the time I assumed it was an irregularity, a massive oversight that never happens. However, having a family member go through similar experiences in the same ward shows that this appears to be norm instead.

I know that this essay could appear to come from a higher-than-thou attitude and stance, from someone who does not understand the burden, demands, or realities of working in the public healthcare sector in a system devoid of resources. However, this is not the case. My disappointment comes from someone who idolizes the notion of becoming a doctor and serving our people in the public sector, and perhaps whose naiveté and rose-tinted glasses have been cracked a little. Patient care should be about the patient, and unfortunately, I witnessed too often a complete lack of empathy for far too many people in the clinic and at CMJAH. I can only hope that I don’t become jaded by the system and overworked and burdened to the point where I dismiss an entire human being because I am worrying about my own wellbeing instead of the patients I am supposed to be helping.