Surviving public healthcare in South Africa

You learn very quickly at Charlotte Maxeke hospital. Progress through the system depends on tyrannical doormen/women and cleaners. Disobeying a doorman can cause your file to mysteriously slip to the bottom of the pile. Inadvertently disrespect a cleaner and the foul smelling surgical waste bag is left in your ward. Any mention of the puddle of urine on the floor outside the toilet ensures the cleaning trolley and wet floor signs block your meal from being delivered. You quickly learn that outright obsequiousness is more likely to smooth your path.

Equally quickly you learn that no amount of being nice, threatening or begging can penetrate the armor of the nursing staff. They are overburdened and not well paid. They are working in dire conditions, with erratic supplies, no visible signs of maintenance and no incentive to try to make a difference. It is as if they wear a barrier of disinterest to protect themselves from caring or even trying. Any attempt to engage is met with a blank stare. You are told blankly that there are no blankets. No clean sheets. No additional pillows. The one centimetre thick thing on your bed is actually a mattress. After sitting on a chair in the passage for two nights, you manage to steal a blanket from the linen closet and use that as a mattress.

As a patient in South Africa’s public health system, you are in a giant sausage machine. How well you adjust to the lower level tyrants can help things along. However, by being a bit demanding – waking up the night shift nurses to help a bed-ridden patient, recalling the junior nurse to replace the fabricated numbers she wrote on your chart with an actual blood pressure reading, going into the linen closet and taking a blanket/pillow/clean sheet – any assertive actions that challenge the established way of things can prompt the nursing staff to ‘promote’ you up the ‘emergency surgery list’. And pop you out of the sausage machine relatively quickly.
I was operated on a mere six days after admission. I met kinder, gentler souls with equally broken bones, who had waited a month for surgery on the emergency list. Longer-term patients seem to have two pillows, a blanket and a real mattress on their bed. Does a modicum of comfort compensate for showers encrusted with black mold, blocked air vents, paint falling off the ceiling, frayed linen that looks less than clean, disinterested nurses?


Our health care is exhausted and straining at the seams. Throughout, there is a sense of lack. Lack of resources. Lack of capacity. Lack of belief that anything can ever improve. The sign at the door of the orthopedic x-ray clinic advises that waiting times can be up to ‘3 hours and 20 minutes’. A nerve function test takes the entire day, so please bring something to eat. The sign outside occupational therapy advises the waiting time is up to 2 hours.

Clinics open at 7 am. At 7 am you are number 80 or higher on the list of people who arrived earlier. If you are sent for x-ray by 10 am, you are lucky. After waiting for the x-ray, another wait. To see a doctor, who opens your x-ray on screen, and then waits for the consultant. This consultant is reviewing 6 – 10 cases simultaneously. Clearly, the 30 seconds, perhaps 1 minute time the consultant spends with you covers the bare minimum. The doctor schedules the next clinic visit. At the booking counter, they move the date of that appointment out by a week because date requested is full. But you can’t get a nerve function test appointment for a month, so again the clinic doctor’s appointment must move.

Trying to negotiate this health care system is desperate and desolate. The National Health Insurance (NHI) proposal seems to aim at leveling all health care to a similar bare minimum. Everyone will have to pay for it – probably by means of a tax. The wealthy can have private medical aid but will not get a tax rebate and will have to pay the NHI tax as well. The stated objective of NHI is to get the rich to pay for the poor and the healthy to subsidize the sick.

By Lee Maddeux

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