powerless

some things make me feel so powerless (yes, even i can be powerless in the face of incompetence)

i have previously mentioned a thing or two about my opinion of where medical training is going in this country. basically the powers that be are not-so-gradually degrading the degree. to them somehow it seems like a good idea. ideas i suppose can easily seem good when you are safely hidden away in your nice air conditioned office far from the reality of the consequences of essentially negligent doctors released into the community. well i get to see the consequences up close.

he was referred from an outlying hospital on a friday. the peripheral hospitals so like to empty their wards for the weekend. after all there is some good fishing in these parts. thank goodness for good fishing. otherwise many more would die unnecessarily.
anyway the patient had free air in his abdomen. this is a sign of a ruptured stomach or intestine and requires immediate operation. in fact the longer you wait the higher the chance of death. what i found interesting is the x-rays that they sent with the patient dated four days before the transfer (but admittedly not just before the weekend) clearly showed the free air.

now not all that long ago, to miss free air on an x-ray even as a student was a mistake that would fail you. these days you can easily get through medical school without worrying about trivialities like free air on x-rays. also, to have perforated bowel causes intense almost unbearable pain. even a street sweeper would be able to pick this up in the patient. yet the doctor at the referring hospital did not miss this easy clinical diagnosis only on one day or two days or three days, but on four days. that is if he even ever examined the patient. then fortunately a weekend turned up and the patient was referred, well on his way to the great hereafter.

as can be expected, when he turned up he was extremely ill and was already in kidney failure. the catheter bag remained empty. after a few hours of aggressive fluid resuscitation there was at least a bit of urine in the bag. then it was time to operate.

the abdomen was in a bad condition. to say it was rotten would be somewhat of an understatement. but the interesting thing i noticed was the full bladder. the peripheral hospital had kindly inserted a catheter not into the bladder but only into the urethra. there they had blown up the balloon, just to make sure they did the maximum amount of damage.

so not only did his treating doctors totally miss a very obvious diagnosis that any 4th year medical student should be able to make and thereby neglect to treat him appropriately, but the one necessary thing they tried to do , because they didn't know how to do it properly, caused further damage to the poor man.

i cast my mind back to when i was still in academic circles. i remember the professors complaining about pressure from the powers that be to pass students even when they felt the students were not suitably prepared. i myself was asked to examine a student in a practical exam. i failed her because she was simply a danger to any person unlucky enough to become her patient. and yet the powers that be had so changed the system from when i was a pregrad that she could not be failed and was released into the community.

i'm sure the people who have orchestrated the new system that is so student friendly (but not patient friendly) don't get to see the disasters out in the periphery that are a result of their hard work. quite frankly even if they did see them i doubt they would care. after all it doesn't directly affect them.

mpumalanga health

this is a riot. i can't help loving my government. such ineptitude is difficult to fake.

mpumalamga is burning

the capital of our province is a beautiful town called nelspruit in the lowveld (subtropical region in the east). actually i should give it it's dues and call it a city, because that's what it has become over the last few years. at independence roughly twelve years ago, witbank was the bookie's favorite for the capital, but the politicians had other plans. i suspet nelspruit was chosen because of it's beauty, which is a far cry from the dusty wind swept plains of the highveld upon which witbank situated. witbank is also the source of most of the country's coal, a large proportion of which is burned in many nearby power stations supplying the country with electricity. the pollution is therefore quite something.
having said all this, there is one thing that witbank does have and that is proximity to pretoria, the capital. witbank is merely one hour's drive away. nelspruit is about three and a half hours away.

for some reason this proximity to pretoria makes witbank with it's pollution and grasslands a more attractive option for many professionals, including surgeons. but despite this there is an absolute shortage of surgeons in the state sector in the entire province. there are only two with full registration in the whole province and both of them are in witbank. therefore i wasn't surprised when the state approached me about 4 months ago and offered me a post in the capital, nelspruit. brimming with enthusiasm, i rushed to nelspruit the next day to scout the place out. it is quite a drive and the toll gates add exponentially to the irritation thereof. but still the beauty of the place seemed to get under my skin and i was quite keen, especially that they mentioned a significant increase in salary.
i waited for the official offer. and i waited. and waited. nothing happened. i knew from a friend in nelspruit that they only had one surgeon with limited registration and he was only covering half the month's calls. that meant they were referring most of their serious cases to witbank after hours. this didn't seem to bother the administration. not only did this not bother them, but they decided to further sabbotage services by no longer paying the by now severely overstretched surgeon for after hours services rendered (actually they said they'd pay 25% which ammounts to about R300 for a night's work probably in the region of $40). he cut his overtime by half. now nelspruit, the capital only has surgical cover for 4 days every month.

during this time, surgical services in the entire province collapsed, partly due to the 25% after hours policy by the government, but also due to the fact that the overtime owed to the medical officers was three months behind. they felt that they could no longer go on working in excess of 80 hours overtime per month with no renumeration.

with this as a backdrop, the province once again engaged me in dialogue about a move to nelspruit. they were also canvassing a recently qualified surgeon from pretoria, who was soon to be unemployed because his time at the academic hospital had come to an end. the head of the depatrment of health for the province was however reluctant to ok the ammount initially offered to us. he seemed not at all phased by the total lack of surgical cover in his own city. he clearly has medical aid, and would never have to receive treatment from one of the hospitals he administrates, so he doesn't care.

the last i heard was that they would take at least a month or two to simply organise a transfer for me and between 4 to 6 months to appoint the new surgeon. the question of a higher salary has totally fallen by the wayside. apparently desperate times do not in fact call for desperate measures. the fact that they don't consider what the new surgeon is going to do to make ends meet in that time is absolutely typical. what he will most likely do is find a cushy post in private and earn three times what they are offering. once he is settled, why would he then move.

from my side, possibly because i'm foolhardy, i'm still thinking about the nelspruit offer, but i have slowly come to the sobering realisation that this province does not care for the health of it's people.
last weekend, the administration was forced to send a gunshot abdomen patient to be operated in private because there was not one single state surgeon on call in the entire province. the costs of that alone could start approaching the amount they would be required to pay for an entire month's overtime of one surgeon in the state. the money is there, it's the will on the part of the administration to make it work that is lacking.

every day i find my resolve to stay in the state more difficult to maintain. i still feel that evil prospers where good men do nothing, but in a system that simply does not care about the lives of it's people it is very difficult to not be seen as part of that system by the casual observer. most people that hear i work for the province of mpumalanga assume i'm on some form of remedial community service imposed by the council for some or other medical misdemeaner. maybe it is time to consider another avenue of employment and allow the ship to finally sink as the administration so badly wants it to do.