Medical graduates with one or two years of practical experience are holding South Africa’s public healthcare system together – but are falling apart themselves, says a Sunday Times report.
With workloads estimated to have tripled over the past few years, interns are often left running entire hospital units. They are supervised by seniors – equally burdened registrars with three to five years’ experience – while consultants are available for off-site telephone consultation.
According to the report, speaking confidentially, doctors at the paediatric unit of Rahima Moosa Mother and Child Hospital and the Chris Hani Baragwanath Academic Hospital, both in Johannesburg, admitted to: momentarily falling asleep while performing surgery; taking prescription medication for anxiety, depression and to manage their irregular sleep patterns; due to fatigue being unable to give patients adequate care, which resulted in complications, or death in worst cases; deferring “difficult” emergencies and miscalculating medication and feeds for premature babies because they “cannot cope”; putting their lives at risk of fatigue-induced accidents, such as exposure to infected needle sticks; and falling asleep at the wheel upon returning from a call.
“Sometimes I feel if I had walked faster, I could have saved that baby. But I am so tired. I have not slept for 24 hours and there are another 12 to go. I feel guilty to take a nap for 20 minutes, or even to eat,” said a registrar at Baragwanath’s neonatal unit. There are 50 to 60 babies to attend to per shift, plus emergencies. “There are many, many cases of cerebral palsy, which is from not delivering babies on time. Despite working so hard, I am not proud of the outcomes. It is the impossible workload,” she said.
Dr Kartik Naidoo says he loves his job, but conditions are unmanageable – slumped against the cold steel, he talks about the responsibility, reward and quality of life for those who choose to save lives. It is a privilege: he loves it and hates it. “There are nights that I think if I had known, I would not have studied medicine. But I still can’t see myself doing anything else. You always feel you won’t cope…”
“They think it is normal to work like this but it is not stable,” said an intern at Bara. “Once I was alone for 27 hours, I wanted to curl into a ball and quit,” said another intern. “You are continually working. In stressful situations you make mistakes. Then you take ages because you triple-check so you don’t make a mistake.”
The report says the system requires interns to spend about 10 years in the system to specialise.
“The way things are run is archaic and inefficient. There is no ongoing patient care because the doctors leave,” said a senior doctor. “The entire system needs to be relooked at, to make it more efficient. There are ways and places where it works; it just needs an overhaul. Community service, internship, it is so important. We know we get good experience. But the system is flawed. It should encourage people to stay in medicine, not leave.”
Professor Ashraf Coovadia, who manages interns at Rahima Moosa, said: “In the old days, we worked the long shifts but were much less busy. There are just far more patients now than there are staff to meet this need. It is the case for senior doctors, and it occurs in private hospitals also.”
Doctors should rest between duties, and be “called” in emergencies, but this rarely happens.
Last year, after a Western Cape intern died in a post-call car crash after reportedly falling asleep at the wheel, the Health Professions Council of South Africa responded to protests from young doctors to restructure shifts. It recommended shifts of 26 hours. The previous recommendation was 30 hours, which often ran in 36.
But Dr Lucinda Singh, who is eight months pregnant, said: “The reduced hours do not apply. I did 27 hours [the other day] and we still do up to 30 hours. Our overtime is capped, so we are not paid for working those hours, but we do it because we are dedicated to the patients. The training in South Africa is unparalleled, we become quite confident, but these conditions can break a person. It would not happen in any other profession.”
Health Department spokesperson Joe Maila said is quoted in the report as saying: “We have resolved with the HPCSA to cap the doctors’ working hours at 26 hours . . . because we are a caring government. But we shall keep on talking about this matter.”
Dr Khanani Mathonsi, chairman of the Junior Doctors Association of South Africa, said: “The biggest issue is that one person carries the workload of at least two to three people, so to fill those gaps unfortunately people are forced to put in those extra hours.”
[link url="http://www.timeslive.co.za/sundaytimes/stnews/2017/01/29/Health-crisis-Shortages-are-forcing-junior-doctors-to-run-entire-hospital-units"]Sunday Times report (subscription needed)[/link]