South Africa’s health sector is faced with a set of daily challenges including a shortage of critical staff, drugs and surgical equipment as well as limited theatre time for those needing surgery, among others. The Free State province is not immune to these challenges. The Weekly’s Martin Makoni asked the Head of the Free State Department of Health Dr David Motau why the situation had persisted for several years and what was being done to address it. Makoni also asked Motau how bad the situation was in the province. Excerpts:
There have been recent reports of some doctors not being employed yet the country is faced with a serious shortage of doctors and other key health staff, how would you explain this?
It’s a multi-factoral problem. One reason could be that one will be facing personal problems or reason, another one could be system issues, that is the system now that has to absorb these doctors. Let’s start with the personal problems; a doctor that I spoke to said to me that I had decided to sit at home because I had personal problems. Now, if somebody says to you they are resigning because of personal problems, there is nothing much we can do. So, they will add to the list of unemployed doctors.
Would you know how many such doctors we have out there?
My guess is as good as yours as to how many of those we have out there. But then it means the system would have failed in making sure that it addresses the challenges faced by these doctors in terms of employer assisted programmes in order to understand their problems and be able to support them so that they come to work happy and they don’t make mistakes and all that. But the second thing is that you have somebody who gets fade-up, for lack of a better term, because the system is not making it easy for them to do their job.
Let’s talk about the system, how effectively is it in addressing issues?
While the system is expected to address these issues, it is also faced by a host of challenges. One such factor could be there won’t be any funded posts advertised. The second one would be the fact that we frustrate these colleagues in terms of them not having enough equipment to use, or that the equipment is broken or they are unable to do their work because of a shortage of other support staff such as cleaners, porters, nurses, radiographers and others. Now, you should understand that medicine is a profession which requires a holistic approach, so you need everybody around you to be a good doctor. If you don’t have those people, it can be a major challenge. Some people would tell you that instead of jeopardising my career through negligence and all that, let me rather stay at home or go into the private sector.
But is there something tangible being done right now to address these problems because this can’t be allowed to go on, what’s being done?
We are certainly trying to address all those issues faced by the system. You would remember President Cyril Ramaphosa called a Presidential Summit where one of the biggest discussions was around human resources. It was agreed that we need to fill positions. But that means that there has to be enough funding to allow departments to deal with the ever increasing burden of diseases. Now, if you don’t have the money, it means these doctors will be out there on the streets.
How has the issue of geographical local affected your efforts to recruit, because there have been cases of some professionals preferring certain areas only, how is it here?
We do face the issue of geographical challenges in terms of doctors that would have qualified out the country that have to go through the system of the Health Professions Council for us to appoint them. Also, if you look at the Free State as a rural province, the other problem will be that somebody, for personal reasons, feels I can’t go to the Free State. I would rather remain unemployed because the Free State is rural, and it’s a fact. For example, if one comes here and there are no schools to take their children, or you find the accommodation that we offer not habitable, that will make you not want to come to the province. So, issues of recruitment and retention of these doctors is highly important, but largely, the system is what needs to be corrected.
Does the country’s health system have the capacity to assist these doctors facing personal issues?
We do have the capacity but not to the extent the demand detects. I don’t want us to make it like doctors are the only important people in as far as healthcare provision is concerned. Everybody is important. Even in my office, if my PA (Personal Assistant) is not well, I have to subject her to a wellness programme for her to be able to discharge her duties of management for me otherwise the department will fail because I won’t be doing things correctly through her. I have a staff establishment of almost 17 000 and I can guarantee you that almost three quarters of those people have one form of anxiety or depression or another.
It’s clear the challenges are known, why then is it taking long for them to be addressed or is it a question of priorities?
Those are the things we need to look at. Some of them, for instance, your EMS (Emergency Medical Service) personnel, which by the way is also a very important area, we don’t debrief them. They get to accident scenes where they find people that are decapitated, some of them debowled and all that, nobody ever says, let’s take this group of people and debrief them. So, those people gather all those issues in their sub-conscious and the day they burst, it becomes a problem. We need to deal with our employees historically and give them all the support they may need. But the main thing I want to emphasise on is that, if there could be adequate funding for us to be able to appoint, I would take a doctor from the street and appoint them and then deal with the rest.
But the health department used to have this key support staff in charge of the wellness programmes, where are they now, or did you, as a department, frustrate them out of the system?
No, we did not frustrate them. Remember, we have a system which determines how much staff we can have at a given time. Now, these people get old and retire, some of them leave due to attrition processes and then we fail to appoint because we don’t have money.
But these are key people given the role they play to ensure those charged with responsibilities in the health sector are able to discharge their duties well, why not prioritise their recruitment too?
They are key, yes. But somebody will say let me prioritise this money that I have to your critical skills which will be your doctor, and they will be wrong. They forget that these are people also getting affected by all these things. And they are also a critical skill, so it’s quite important that we look into that, but the issue of funding is very important.
At the end of last year, I heard a Registrar Dermatologist in the Free State remark jokingly that ‘I might not be employed in January, my contract ends at the end of December’, how does that happen given the shortage for specialists, and why can’t the contracts be renewed in advance?
We don’t simply renew. Let me take you through what it means to have a registrar. A registrar is a student that is studying to specialise in a particular field of medicine. Now, this one was studying to qualify as a dermatologist. That person was taught by other dermatologists. As we train, we don’t train for ourselves only. We train for South Africa as a whole. Now, at the end of that contract, depending on the need, we appoint on a full-time basis if it’s a South African citizen. So, they were supposed to explain to you how they got into that contract and what the expectations were at the end of that contract. So, it’s normal for the contract to come to an end, but whether the need was there or not, in-terms of appointing, is another question. We obviously would want to appoint everyone that comes through the system but we have limited resources.
But there is a shortage of specialists in almost every area in the country’s health system. Patients have to wait for months to see a dermatologist, surely there is need to hire, why the long processes?
Remember you are talking to the HOD of the health department. There’s a shortage in almost every department, you are correct. But there is no dire shortage because patients are still being seen and registrars are still being taught. So, maybe you want to ask me, where do I want to take the provincial health department. Where I want to go is strengthen my regional hospitals for all of them to have their own specialists so that other health centres don’t bring all cases up here to the major referral hospitals. In that case I would have won because I will be able to keep the load down. District hospitals should be able to refer to those regional hospitals and from there, they should be able to down-refer. That means, only specialised cases can be brought up here. It’s very expensive to treat a patient up here. It actually depletes our money.
In terms of theatre how is the situation the province, let’s say one needs to undergo some orthopedic procedure, how long can they expect to wait?
It depends on the type of injury that you have. If it’s a life threatening injury where it’s a fracture of a long bone, which tends to bleed much quick than a small bone, and may lead to cardiac shock, it becomes an emergency and you will be operated on, quickly. But if you have somebody with a degenerated joint to the point of needing a replacement, we will then consider those cases and put the patient on a waiting list and advise them on when to come for the operation.
So, where does that leave the Free State, is the situation dire or it’s manageable?
It’s not that dire, but I am not happy with it. I think we can improve. That’s why now we are doing blitzes where we call all the doctors on a weekend, open all the theatres at Pelonomi Hospital and deal with all these cases. We are also opening an extra theatre in collaboration with one of our partners to deal with some of the cold cases of scoliosis. This is where your spin has sort of changed and assumed a certain curvature. In other words, the spin is not straight, it has curved and therefore it impacts on your lungs, your breathing, your heart and others. We are dealing with such cases. We presently have about 64 of them which we are dealing with.