While the Cuban brigade doctors earn handsome salaries on the COVID-19 frontlines, there is a small group of doctors from the African continent who are battling the pandemic daily without pay – the so-called “supernumerary” registrars.
Daily Maverick reports that following the death of a Libyan colleague, they say they are at breaking point.
The Daily Maverick report says the supernumerary registrar programme was created to give doctors from other African countries specialised training in South Africa in order to allow them to take those skills home. But during the COVID-19 pandemic, some of these foreign doctors have found themselves effectively stranded in South Africa, working the same gruelling shifts as local medics to treat COVID-19 without pay.
Because they are technically registered as foreign students, they have no access to the benefits or salary of their local colleagues. But like them, they have been putting themselves at risk daily for close to a year to treat patients hit by the first and second wave of the pandemic.
Dr X is a supernumerary registrar from a SADC country whose identity is known to Daily Maverick. None of the doctors was comfortable being identified for this article because they feared recriminations, as their course examiners work closely with them.
He is a University of Cape Town (UCT) student seconded to work at Groote Schuur Hospital, and he says he is reaching out to the media in desperation. Dr X says that the situation for medical registrars treating COVID-19 in the second wave of the pandemic is significantly more difficult than the first.
“We now have more patients on high-flow nasal oxygen who need close monitoring,” Dr X explained. “One medical registrar is expected to man three wards and still expected to do intubations and also do admissions and supervise interns at night. One person is not enough. It’s just torture.”
Medical registrars get 21 days’ leave a year, of which only 14 days can be taken at a time. Dr X says most leave was cancelled in 2020. But for the foreign supernumeraries, going home and returning to South Africa within that time frame was, in any event, virtually impossible – due both to closed borders and quarantine requirements.
Ordinarily, Daily Maverick reports, the studies of supernumerary registrars are sponsored by their home countries. But because the pandemic saw teaching and learning suspended, a number of sponsors have pulled the plug. This means that not only are some of the supernumeraries not receiving a salary – they are being actively financially disadvantaged through their work.
“Many of us are getting threatening letters of fees owing. We are getting letters of rent owing,” says Dr X. He says the doctors are not asking for salaries, but some understanding and acknowledgement when it comes to UCT fees and rent “for those who stayed behind and helped out”.
The report says the situation is doubly galling given the fact that the 187 health workers brought in from Cuba by the national government to treat the pandemic were reportedly earning monthly salaries of more than R130,000.
Daily Maverick reports that part of the problem seems to be that responsibility for the supernumeraries is shared by UCT and the Western Cape government, under which Groote Schuur Hospital falls. Groote Schuur CEO Dr Bhavna Patel is quoted as saying: “The (foreign supernumeraries) are not appointed as staff by the province, but register with the university as students. The province only provides a platform to facilitate their learning.”
Dr X has heard this before, the report says. “When we came here we were told we are students, but nobody knows where we fall,” he says. “UCT only wants us when it comes to fees. Groote Schuur only wants us when it comes to work. When there’s a problem, we are stuck in the middle.”
Daily Maverick reports that it is not just the supernumerary registrars at UCT raising these concerns. In a letter to the South African Medical Journal in August 2020, three Stellenbosch University medics described supernumerary doctors as “the unsung heroes in the under-capacitated South African healthcare system for almost 25 years”.
In the past, these foreign doctors have battled xenophobia and significant financial hardship. But, the COVID-19 pandemic has “exposed the vulnerability of their health and financial well-being,” the doctors wrote. The letter’s authors acknowledged that the state has no legal obligations towards the foreign doctors, but questioned “whether the government and universities are ethically fulfilling their duty towards those who are currently working on the frontline of the pandemic in South Africa”. A moral approach, they suggest, might see measures put in place to support the doctors financially and medically at this time.
Dr X and his colleagues say that although they are constantly told they are on a par with their local colleagues, the reality is very different. They have to pay for their own medical aid, and if they can’t afford it, seek assistance from public clinics. If they contract COVID-19 on duty, they receive no occupational compensation, unlike their colleagues.
Groote Schuur’s Patel is quoted by Daily Maverick as saying: “Since (the supernumeraries) do not earn any salary, they are categorised as those receiving a free service from the public sector. None of the students at the university (is) covered by any insurance and there are student health clinics at the university that can be used.”
The issue of the health risks that Dr X and his colleagues are facing by serving on the frontline of the pandemic for so many months came to a head earlier in January, the report says. A Libyan supernumerary seconded to Groote Schuur, Dr Abdulraouf Mohamed Kdaish, died of COVID-19 on 18 January 2021.
The report says for Dr X and his colleagues, though, Dr Kdaish’s death might be the straw that breaks the camel’s back. “We are suffering here,” Dr X says.
A recording of a meeting held last week between Groote Schuur management and UCT postgraduate students, seen by Daily Maverick, makes it clear that treating the pandemic is exhausting and traumatic work for all healthcare workers.
A hospital administrator acknowledges the extraordinary toll placed on Groote Schuur’s doctors, with 7,874 patients coming through the doors since March 2020. “The kind of pressure that you have had to face with the number of people coming through the doors, and how sick they were, and the numbers of deaths that you had to deal with… You know, it was just a very difficult time for those of you that worked, we absolutely recognise that, we acknowledge that,” she says.
Then the administrator asks: “How do we pick up those pieces now? At the time when you needed it most, were we able to meet your needs? I’m not so sure.”
Responding to questions posed by Daily Maverick, UCT spokesperson Elijah Moholola said: “UCT recognises that all frontline healthcare workers, and a number of workers in other fields too have had to work hard during a very challenging period and under very demanding conditions. Confirming that there are cases of supernumeraries whose funders have stopped paying for their studies at this time, Moholola said: “Support has been offered to these students – personally through staff members, through the department itself and through the UCT postgraduate office”.
Dr X disputes this. He showed Daily Maverick an email sent from the UCT Department of Health Sciences’ admin office on 27 January 2021 informing one of the foreign supernumeraries that they were not eligible to apply for a bursary for fees.
UCT spokesperson Moholola also said: “The Deanery has been sourcing private funding to assist international registrars with costs relating to COVID-19 challenges. The faculty leadership is in the process of addressing these issues.”
[link url="https://www.dailymaverick.co.za/article/2021-01-27-at-risk-and-unpaid-the-foreign-doctors-treating-covid-19-in-sa/"]Full Daily Maverick report (Open access)[/link]
[link url="http://www.scielo.org.za/pdf/samj/v110n8/03.pdf"]SAMJ letter[/link]