military precision

i have been in the priveledged position to observe the systematic destruction of health care in the beautiful province of mpumalanga first hand. a military operation i doubt could have been planned and executed so well.
the first thing they did was to appoint a man who had been fired by a previous province for missmanagement as the head of department of health to the position of head of department of health in our province. i suppose it seemed he had the ideal qualification. once he was in power, he made a few changes. firstly he could not be contacted by mere mortals like superintendents or lesser doctors. only a select few were granted the priveledge of being allowed to speak to him and even fewer were granted the honour of gazing upon his countenance. the next thing he did was to decree that he and he alone had the power to sign for payment of extra overtime. in our country all state doctors are contractually oblidged to work 80 hours overtime per month. however the system requires that almost everyone must work more than that. any extra hours worked are claimed for separately. it's these hours i refer to. this would not have been a problem, but for the fact that the man simply did not sign any forms. quite soon people were a few months behind on overtime payment. by people i mean nurses, doctors, radiographers, porters and even some cleaners. actually the doctors were not the hardest hit, because the other groups don't work the 80 hours contractual overtime that we work, so any overtime by them at all was not paid.

once the overtime payments were about 4 to 6 months behind, people started refusing to do extra overtime. doctors continued to work to keep the call lists full.

the next step was to cut specialists extra overtime to only 25%. this works out to about $1 per hour. so they were asking us to do our overtime at next to nothing. the specialists stopped doing extra overtime. the administration did not see this as a problem. soon the medical officers stopped doing extra overtime too. the reasons given were that they weren't getting paid and they felt unsafe, especially in surgery to work without the backing of a senior.

the administration replied that they had now approved payment of overtime up to the month of september. no word on october or november or december.

during all this the single general surgeon (registered only for state service) in the capital of the province, nelspruit, left. the administration responded by doing nothing again. they had no surgical service in the capital and only cover for about ten days in the other center(witbank). during this time the plan was to send patients to private to be operated there. the costs to the state would far outweigh the costs of just paying their doctors for services rendered.

the administration has now decided to respond by downgrading witbank hospital from a regional hospital to a local hospital. the problem with this is certain appointments at our hospital are joint appointments, meaning they work partly for the university of pretoria and partly for mpumalanga. they would all be withdrawn. there would be almost no specialists of any kind.

the next problem they decided to address is the question of interns and community service officers, both of which are not supposed to work without supervision. suggestions have already been made to stop them coming to this hospital because there are seldom specialists on call after hours. that would destroy about half of the working force of doctors here. the remaining doctors would then be expected to handle everything that comes their way. the old true generalist would emerge from the flames once again. one wonders how long they will last.

meanwhile the sisters are jumping ship and resigning in droves. who can blame them? theater time is already bare minimum, so the next step would be to only do emergency operations. i think that's not too far off.

anyway, i will be moving to nelspruit to replace their lost surgeon, so i won't be here to see the total destruction of this hospital. i however have no doubt that nelspruit is also on their to do list of things to destroy. we'll see what the new year holds.

we as south africa have a northern neighbour to remind us what rock bottom is. because of them i know we are not yet there, but it should be exciting to see how close we get.