Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

06 July 2012

State doctors: their real, everyday world

via Daily Maverick, by Karen Milford

I am a doctor working in the state sector, and this is my response to the article entitled ‘Baragwanath’s Shame: A good man dies’.

Firstly, I want to give you an idea of what a typical weekend morning is like in the trauma unit of a South African tertiary hospital. It’s 8am on a Sunday, and the morning handover round is just starting in the unit. The weekend’s carnage is plain for all to see. The resuscitation unit is over-full, serving as temporary home to seven ventilated patients. These are people so critically ill that they need what lay-people call ‘life support machines’ to keep them breathing: ventilators that push breaths in and out of their bodies because they can’t take those breaths themselves. In the passage is an eighth patient on a stretcher, being manually ventilated by a paramedic. They have been there for three hours, waiting patiently for a space to open up in the resus area for them.

Down the passage are more patients, wedged as closely together as possible. They’ve all suffered some sort of trauma: they’ve been stabbed or shot, hit by cars or thumped by thugs, throttled by their boyfriends or beaten by community members. Some of them are elderly people who fell and broke their hips whilst on the way to the bathroom, others are teenaged boys who broke their legs playing soccer. They’ve filled up all the stretchers in the unit, and have flowed over to the chairs, wheelchairs and benches. One has made a nest of blankets on the floor. They’re asking for water and bedpans and receivers to vomit into. They’re asking for help and pain medication.

Mandy de Waal’s article made me angry, not because I don’t want the horrors of state hospitals reported on, but because of her failure to put the opportunity she was given to good use. She scratched the surface and told us one thing: that doctors sometimes act without compassion and don’t properly communicate to patients and families what is happening. But she could have dug deeper and pulled out the evil root at the base of this ugly tree to show us. The public healthcare system is appalling. It is not equipped to deal with the burden of disease in this country. Whether this is due to a lack of funds or simply mismanagement and wasting of available funds is a question worth asking. Whether or not it can be fixed by changing the people running the system is another.

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