Monday, March 26, 2007


for those who have been following my blog, you might understand my feelings about what is happening here in mpumalanga public health. due to a number of reasons, i felt the need to write a letter to the head of surgery in pretoria. that letter follows:-

Dear Professor B

I feel it necessary to bring you up to date with events in R F hospital because you have always shown a keen interest in our hospital and I view our department as a subsidiary of the department of surgery Pretoria, of which you are head.

Firstly, some background in brief:-
As you know, with the initial recruitment of myself, Dr KS and Dr C, certain financial promises were made, which the province of Mpumalanga did not keep. As you know, both Dr C and Dr KS (who had already moved to Nelspruit in order to take up his position) therefore did not commence work here. I, however did start working in Witbank. This was mainly due to my desire to work in the state sector but also because of my desire to be involved with student education, which I could do in Witbank. I started there despite the knowledge that I would be getting considerably less than originally promised. Despite frustrations there I threw myself headlong into my work and specifically student education.

However, even though they weren’t going to pay me what was initially agreed to, they took 4 months to pay me my salary at all and another 2 months thereafter to pay me my overtime. (They only paid me overtime for 4 of the 6 months I worked there. I have accepted the loss of 2 months overtime money as bad debt but it does show a certain amount of bad faith on the part of Mpumalanga.)

During my time in Witbank, there was talk of moving me to Nelspruit. This made good sense because there were already two surgeons at Witbank, namely K and M (m is a cuban doctor and does not actually have registration as a surgeon in south africa. he is, however an excellent surgeon) and a very competent medical officer (T) who could function as a surgeon, but Nelspruit had only one surgeon (Ki). I immediately expressed interest in it, believing I would be of more use to the province in Nelspruit, but also because, once again there was talk of the initial salary that was offered at the first interview. What I did not know at the time was that K M (the guy whose job it is to ensure delivery of health care in the province) and the CEO of Witbank (Ma) had a disagreement. This translated into K M not getting back to me about the offer for about 3 months. He was therefore willing to allow the province to suffer because of his own personal agenda.

Finally he did get back to me and once again offered a higher salary if I was willing to move to Nelspruit. I expressed interest. As soon as I said I was willing to move to Nelspruit, the higher salary offer was removed from the table. I telephonically informed him that the increased distance to Pretoria in my case translated into an increased financial need. He assured me that we could look into forms of boosting my income when I get to Nelspruit. He mentioned extra overtime and private work.

Having established contact with the Nelspruit surgery department and gaged the need, I decided to take the chance and accept the transfer. I did this despite being lied to twice by K M and being treated with extreme disrespect. I refer to the abovementioned fact that he strung me along for 3 months, keeping me in the dark while he and Ma sorted out their differences. I have reason to believe that, had Ma not resigned from witbank he would not have gotten back to me at all.

When I arrived in Nelspruit, I found a very disgruntled Dr Ki. He was owed a substantial amount of money by the province for overtime performed when he was the only surgeon here. He told me he is not interested in doing overtime at all but would do the contractual 80 hours to support myself and Dr Se (the new recruit from pretoria). It is interesting to note that, when I approached the private surgeon G about the possibility of helping us with calls, he informed me that he also is owed money by the province for calls done in Rob Ferreira hospital and therefore knows he will not be paid if he does offer his services. He understandably declined. Even Dr KS expressed willingness to do calls but how could I even ask him to when I knew he wouldn’t get paid and we would therefore burn our bridges for the future when there is another administration in power.

The extra overtime became an issue. The province was offering 25% of normal fees for extra overtime. This would be unrelated to call outs or time spent in the hospital. I hoped Se would be willing to take the offer, but, like me, he refused. His feeling was that you should get paid for services rendered. I agreed and we set up a call roster accordingly. K M then phoned you. I suspect he bent the truth to his advantage but I was grateful and impressed by how you handled the situation. You phoned me and stated how overtime works in the rest of the country for specialists. I thanked you for that call when you phoned but I’m not sure you realise quite how much I appreciated it, so thank you once more.

The very next day I wrote a letter to K M, stating that we would be willing to be on standby at 25% and claim 100% for actual call outs to the hospital. Witbank was demanding 70% standby and 100% call out which I thought unreasonable. Our offer, Dr Mo (the ceo of Rob Ferreira hospital) assured me, was in line with K M’s initial proposition. However, be that as it may, he still did not accept our proposition. In fact he didn’t even reply to my letter. I couldn’t help wondering about some political agenda. Why would he refuse to correct the problem even though the solution was in his grasp?

During this time, with Se’s input, I totally revamped the department. We divided the department into 3 firms to ensure continuity of care, clear delegation of responsibility and direct consultant input. We also increased the academic level of the morning hand over meetings. We started a Wednesday morning academic meeting, the level of which is of a high standard for a peripheral hospital with direct consultant involvement. We trebled theater time as well as the gastroscopy lists. All clinics were directly run by consultants. We initiated a morbidity and mortality meeting to both improve service delivery as well as to further develop our doctors.

Meanwhile Se was not receiving his salary here. He was luckily still receiving his registrar salary but had incurred expenses related to moving across the country, making his financial situation difficult. Se had an advantage which I did not have when I started in the province. That is he somehow had direct access to someone high up in the provincial administration who quickly got his appointment letter sorted out. (Interesting to note at this stage that I still have not seen my appointment letter and wonder if it actually exists). Despite this they still didn’t sort out his salary. I was informed that the fault didn’t lie with the province, but with Se himself because he apparently did not resign in Pretoria. This is a lie as I was in the same position when I first went to Witbank. He came over as a transfer and didn’t need to resign. On the contrary, resigning would have left him with no form of income while the province dragged their feet. Se, during this time also asked the hospital for a loan car temporarily because he had problems with his car and didn’t have money to fix it. They said no because it was “an irregular request”. Se then informed me he was taking 3 weeks leave in March, as he said, “to give the province time to sort out the appointment”. I suspected that he was going to look for work elsewhere. Who could blame him? Let me just also say that while Se was here he worked hard and contributed constructively to the department and the hospital.
I recently heard that he handed in his resignation. This is somewhat comical because he is still not on the system here. He essentially resigned from a job he doesn’t have. The superintendent here told the heads of department in my presence that she would have reported him to the HPCSA for absconding if he had been on the system. To me this added insult to injury. He worked well here while he was here. He was not paid. He slept on the floor of his place the first few nights he was here. The hospital was not willing to help with a very reasonable request for transport, a need which arose from the province not paying him. And after all of this, in an act of vindictiveness there is a threat to report him? It is true he was not entirely forthright in his dealings with the province, but the province has proven that forthrightness is not their strong suit.

With all these things in mind and bearing in mind Keith Michael’s promise to explore other forms of financial augmentation I wrote a letter to the medical manager expressing my wish to change to a 5/8th post. I however clearly delineated extensive involvement in the hospital. (See enclosed letter). I also expressed my considered opinion that there is no desire from admin to develop a surgical service here. I also described my financial need to free up some time.
The medical manager called me to her office. I was told that there is a view that I am a disruptive element and intentionally being obstructive, therefore punishing the normal man in the street with my agenda. She basically said that people higher up come down on her head when they receive a letter from me and they don’t take the letters very seriously. That means they respond but not to me and not constructively but rather in irritation. I was also told that there was a suspicion that I had instigated Se to resign. I defended myself on both points. Luckily I had written that original letter to K M which proves that we were willing to do overtime. As far as instigating Se to resign, what possible gain could I get from that? I also pointed out that I was the only one of 4 surgeons recruited from Pretoria still here. I therefore am the least disruptive. On the contrary, the province has successfully chased 3 surgeons away and I am still here. She also told me that the request for a 5/8th post would not necessarily be granted and it would take some time to organise.

I came to the realization that my desire to work in the state puts me at a severe disadvantage. They feel they can abuse me and I will not leave. I therefore, with a heavy heart have decided to resign. This province so far has seen every concession I’ve made as a sign of weakness and license to further abuse me. There is no desire to fix the situation. On the contrary, as is shown in this letter, one must wonder if K M is working towards collapse of services. I can’t, with a clear conscious, be a party to that.
I therefore plan on handing my letter of resignation in on Monday. I will however consider a 5/8th post. This is because I feel a responsibility to both the people of the province and the doctors trying to do their best in the hospital. If the hospital does not accept this, I may consider doing a list on Tuesdays to help the doctors and to try to work down the substantial waiting list. This I will do for the people and doctors, not the administration. Therefore I will not ask for remuneration for this initially.

I truly feel bad for the necessity to write this letter because I dreamed big dreams for this hospital, but as I said to Dr N (the medical superintendent), surgeons are ready for R F hospital, but R F hospital is not yet ready for surgeons.

I wanted you to hear this from me first because I have no doubt that the story relayed to you from other sources will be creatively tuned to their personal agendas.

As always an advocate of surgery


note, some names abbreviated.

so in some senses this represents a failure to do what is truly in my heart. however, as is shown in the letter, i will not totally abandon them, even if they totally abandon the people.

there are a few interesting extra bits of information that have subsequently come out. the administration had actively decided to ignore my letters pleading for a service (there were many) reasoning that i would tire of writing them. they actively planned to do nothing. they also did not see my actions as trying to fix the situation but rather as something that made their day slightly more uncomfortable and therefore no more than an irritation. i have also learned that there is resistance to giving me a 5/8th post, even if the alternative is that i resign. they would rather not have a surgeon than compromise. there are no replacements lined up nor likely to be in the foreseeable future.

so keep watching for more developments.

maybe not failure but a necessary step to put things right.


Sid Schwab said...

This is terribly sad and frustrating. Clearly there's no realization of what a gift they have in you. You've tolerated more than most would, already. Clearly they feel they can take advantage of your sense of purpose. If it makes me want to scream (it does) it must make you want to commit crimes!

Anonymous said...

I have recently been appointed at Rob Ferreira hosp and let me tell you..apart from the department I work in,the rest is pretty dismal.It seems that the moral of us young docters have at least lifted slightly,maybe it was just the world cup win..Luckily you are already a spesialist..something I guess I can only dream of reaching "one day",if the system pervails.
But in the mean,it's good experience,although at numerous times you feel a bit out of your depth,especially working in the surgery dept with no consultant
I have myself not been paid any overtime yet and I'm sure Absa morgage will come knocking soon.
Seems there's so many empty promises,a lot of talk among the Administration,but no real hurry (well except 4 the new superindendant who is really trying to come up with solutions),and in the mean time so many innocent people's lives are being put in jeopardy