There is a new doctor in town who provides his clients with an unusual leverage of determining how much they want to pay after being seen. The patients also receive basic medication and it seems the idea is slowly catching on as the six-week old private medical practice is seeing more patients. The Weekly’s Martin Makoni spoke to Dr Paulo de Valdoleiros whose approach to work is yet to be fully understood and appreciated, about his unique practice. Makoni also asked De Valdoleiros who is based in Westdene, Bloemfontein, about the motivation behind the idea and how he hopes to sustain it. Excerpts:
You don’t have a set fee for your consultation and the medication you provide, you leave it to the client to decide. It sounds unreal or there could be a catch to it given the high cost of medical care, what motivated you to take this approach?
I believe that we are on the planet for other people, not for ourselves. That’s the first thing. And I also believe this is God’s idea. I believe God impressed it upon me because it’s not normal human logic to do things like this. You know, if you go into business or if you have a job, you always try to get as much as you can. In other words, the money side of things is almost the motivating factor. And, I believe we should all serve others. You know, if everybody went and did their jobs, it doesn’t matter what it is… if you make coffee, then you should go to work and make coffee as a service. You are serving other people, so you make the best coffee you can make. The money will follow. You will have your salary. The issue is, if we work primarily for money instead of serving, it’s not the best thing. That’s why I call it God’s idea. I believe in God and I believe God impressed it upon me. That’s the motivation. We are here for others.
But medical practice is complicated and expensive, why not at least put some kind of price tag to your work, even if it means lower than the standard fees?
Yes, if you look at healthcare, it is a very complex field and it has become a very expensive field. One can debate a number of things… the Bill of Rights says you have a right to basic healthcare. But I believe healthcare is not just a right. I believe healthcare is more of a need. In other words, food is a basic human need. We don’t call food a right. It’s a human need and healthcare goes hand in hand with food because it affects your body… We have to do things for other people. We are here to serve. It’s a God principle.
Your practice is about six weeks old now, having started on June 10, how has it been like over this period?
We are very busy now. But in the first week it was a bit quiet. We started without telling anybody about it… We never asked anybody to come. So, in the first week, the whole week, I saw 10 patients. Today I have seen 29. I am sure that tells you we are taking care of more and more people.
So, when people come through and you don’t tell them what to pay, what sort of amounts do they eventually pay?
What happens, I don’t check what each patient pays. At the end of the day we just cash up so that we know how much money came in and how many patients we saw. My brain works out the average, I have a mathematical brain. I know from my staff that we have had payments as little as R10 and we have had people paying R500. There aren’t many people paying R500 obviously and there aren’t many people paying R10. But payments of R20-R50 are pretty common. The important thing is the average, because you can have 20 patients today and you can receive more than tomorrow with 30 patients, depending on how much they pay. So, the averages last week were pretty low, relatively speaking. We were doing about 20 percent of what a normal doctor would have done. Today (Tuesday) was a bit better. We did about 30 percent. That’s how things look. The majority of our patients are people that seem to be financially challenged in one way or another. Essentially, it’s between the patient and their conscience. It’s got nothing to do with us. I’m doing this in good faith. It’s sort of a good will gesture and we expect people to react the same way to us. If the last time they went to a doctor they paid R300, they should pay the same when they come here, unless if they don’t have… because I have done the same work. In fact, I believe, and I am not bragging, I believe I have done better work. I believe I am an excellent doctor. I take care of the people, not just the physical ailment that they come in with, but I take care of their emotions and I take time to understand them.
And how exactly do you do that, what’s so different about the way you deal with your patients?
Look, you can sum up a person very quickly. You can see where they are going and where they are not going. You know there are a lot of unwanted pregnancies out there. People have a lot of issues, a lot of stress, a lot of depression, a lot of people in toxic relationships, and I can have a positive input into their lives. It’s not just a question of saying to a patient you have a sore throat, I’ll give you some antibiotics. Good bye, Next patient… You know anybody can do that. You don’t need to be a doctor to do that. I believe that to be a doctor, you have to touch the entire person, the body, the soul, the spirit, I have got to have an impact. I have a privileged position as a doctor that I am allowed to say anything, practically to the patient. And you as a patient, are allowed to tell me anything. You know patients will tell me things that they don’t even tell their husbands or wives because I am the doctor. So, my position is very privileged in that I have access to information that people don’t normally have, in terms of the patients’ lives. And I can communicate things that patients will listen to. You know if a friend says to somebody who smokes that smoking is bad, the other one will just say ‘keep quiet’ I have heard about it before. But if I start speaking and explain what happens to your lungs when you smoke… you’ll listen to me. You don’t tell me to keep quiet, which means I have an opportunity to plant a seed in your life.
And what sort of people are you seeing in terms of their social standing?
We are getting a cross section of people from the low socio-economic group – such as people who have never been to school, people who have jobs that don’t require any education at all, to candidate attorneys, advocates, sales people, receptionists, managers, supervisors, welders and students. I would say that maybe just over half are from the lower socio-economic groups. It’s a mix. Remember, this is not a practice for poor people as such. If you have a medical aid and it is depleted, it means you have to pay out of your pocket the next time you visit a doctor. And even if you have a big salary, you may be short this month for some reason. So, you come to me and pay less, if you wish. There is also a perception out there that this is a place for poor people. For example, we have had some employers bringing their employees here or telling them to come here. I think the idea was this is a dirty place in the middle of nowhere. Some employers have been surprised and have even remarked that the place looks much better than the practices they go to. It’s a misconception by the more affluent that this a place for poor people as if there is medicine for poor people. I treat everybody the same and health is health. I hope that will change with time. I want people to come here because of the doctor. A doctor who gets things done and not because you pay what you can afford. Doctors are usually known to keep a distance from their patients. I don’t, and I talk straight. If I have got something to say, I say it. If you don’t like it, you don’t like it.
I’m still trying to understand your practice, how do you pay your staff and your bills?
I employ two people and we pay rent here. The income that’s coming in, even though it’s a low percent of what a normal practice would get, is sufficient to run this practice. We also buy medication because we give basic medication, but that is not a fixed cost because I don’t know who we are going to see and their medical needs. We buy what we can. I stand at the end of the queue. The income we have received in the last couple of weeks doesn’t cover my personal needs in full. There is a shortfall. I do a television show at times but that’s not regular income. It also helps. At times I am invited to talks or presentations that are paid. We will see what happens. At the moment, we are taking it day by day. If I believe that this is God’s idea, then He owns the practice. I’m just a doctor doing the work. He will sort it out one way or the other. You may have heard of the Uber taxi driver in Cape Town who read about the practice and was so touched that he has set up a R1 million crowd funding for us. He is doing it with back-a-buddy. I didn’t know about such funding but we will see how it goes. I have given them my consent and when they reach the amount, they will divide it by 12 and pay us one twelfth every month. That will obviously allow us to do a lot more for the practice, such as offering services we don’t currently offer.
But are you funded in any way at the moment?
No, there is no funding. We are operating just from the money that people leave here.
You only enrolled into medical school at the University of the Free State (UFS) at the age of 46 because you couldn’t afford it, you qualified as a medical doctor at the age of 51, you are now 56, surely one would expect you to be wanting to have everything you never had, what were you doing before opening this practice?
I have tried different things on my own and I was never successful, the way people measure success in terms of expensive cars, millions of rands and all that. I worked for a bank a long time ago around 1982/83. The thing in life is we live life forward. We can only see what happened backwards once we have been forward. I wanted to be a doctor since I was a little boy but my family couldn’t afford it when I left high school. The things I tried worked a little bit until, at the age of 45, I said to myself, I’m not going to carry on like this. I’m going to try and study medicine, and the rest is history.
And within the medical field, what else have you done besides your current practice?
I graduated in 2011 and in 2012/13, I did my internship. In 2014 I did community service, working for the government. I then opened a practice in 2015 here in Bloemfontein. Then in 2016 I moved the practice to Bryanston in Sandton, Johannesburg. I moved back here last year in August. I spent three months this year at the Chemical Pathology Department at the UFS and Universitas Hospital. I was going to specialise in Chemical Pathology but I decided to leave at the end of March to start this practice.
But one would have thought you were making money in Bryanston and still you closed the practice, why make such a decision?
Look, making money is a relative concept. For some, making money is getting R20 000 a month, for others, it’s making R500 000 a month. The practice was going fine. I wasn’t busy all the time. It was a different type of practice. It wasn’t GP (General Practice) work. I was doing functional medicine. But looking back, I wasn’t entirely satisfied. I believe everybody is created for a specific purpose. If you are supposed to be a violin, you must not sound like a piano. I now feel deep down that I am now doing what I have always wanted to do. You know, there is a certain type of freedom that I cannot really explain. I just call it freedom because I don’t know any other word. The freedom about this is what I earn is not dependent on me in the sense that I don’t stipulate it. If you have a job, you negotiate your salary, if you work for yourself, you have specific fees that you charge… the system here is different. I don’t charge anything. The client decides what to pay. My accountant refuses to call it a business model. We will not close down, God will take care of everything.
How have your colleagues in the medical field responded to your practice, are they encouraging you keep pushing on, are they laughing at you?
There is nothing happening. If they are laughing, I wouldn’t know. I have had one message from a colleague who studied two years behind me, saying, ‘well done, God bless you.’ Another colleague that I worked with also sent a message saying, ‘wow, fantastic.’ But said it’s something they wouldn’t mind doing but would need a guaranteed salary. Now, if there is a salary, that’s a job and that’s not what I’m doing. I have had nothing else from other doctors. Nothing. It’s surprising. I find it a little strange. The only medical contact I have had in terms of institutions is from Medscape, a medical platform for information on health and medicine on the internet. They have about 3.6 million doctors from across the world registered on that platform. They interviewed me from Lisbon, Portugal.
I want this question to talk to your inner self because I asked a question earlier, what really told you to start this practice, was there a situation that you came across, what is it that told you serve people and let them pay whatever they can afford?
It’s difficult to say. There is no specific point that I can pin-point. I can’t put my finger on a day or time. It’s almost as if it was something that there and I knew it but I wasn’t quite aware of it. If I really think hard about it, we are all chasing money because it’s survival. Long ago, you would have to go and kill a springbok to eat, now we have to go out and get money to buy the springbok in the shop. I believe that we should live dependent on the creator. But nobody does that today. We trust ourselves until we can’t trust ourselves anymore and we cry out to God. Human beings are very arrogant creatures. We study medicine and the universe and we think we know everything. We are just observers. All the laws of physics and chemistry, they were always there. We didn’t create them. I believe that if one is made for a purpose, then whoever designed me, will provide everything I need to fulfill that purpose.