Special Hearings — Health Sector Hearings — 1997-06-18

<UNKNOWN>: .
 There were to our knowledge no Zulu doctors working in rural hospitals in KwaZulu between 1986 and 1994.  The University of Natal have been graduating Zulu doctors for about 40 years, so how did the situation come about?  The reasons are complex but one important one I've singled out was the KwaZulu Pledge.  This is a law requiring all KwaZulu public servants to sign an oath of allegiance to the KwaZulu government and its leaders. If a person refused to sign the pledge they could not be employed as a public servant in KwaZulu. We ourselves were not required to sign it as we are employed in State health posts.  This pledge deters Zulu doctors from working in rural areas.
The lack of academic support for rural medicine.
 Doctors need training, professional support in the field of ongoing continuing medical education in order to be motivated to do a good job and to provide a good quality of service.  The University of Natal showed very little interest in rural medicine.  While there may have been political and situational reasons for failing to provide academic support for rural health were they truly adequate excuses for neglecting to support the doctors and health service that attempted to provide health care for a few million under-served poor and marginalised rural South Africans?   We do not believe the excuses were adequate.
 It is our firm recommendation that specific attention and resources be given to rural health and rural medicine by the country's medical academic institutions, a kind of affirmative action towards rural areas without which the situation is likely to remain unchanged in the future.
Very few South African doctors and the difficulty of registering foreign doctors.
 There are very few South African doctors who are willing to work in rural hospitals.  Many were leaving the country for personal as well as political reasons.  These included the problem of conscription for White male doctors, the general level of violence and unrest in the country and perceived unsatisfactory working conditions.
 In contrast to this was the situation of doctors from other countries wanting to work in South Africa, often specifically in rural areas. It is not an exaggeration to say that in the majority of rural hospitals, foreign doctors were the life-blood of the service. Without them there would have been no service.  The problem was that the procedure for registration was difficult and got worse from the mid-1980's.  We were very frustrated by corresponding with interested doctors from countries with a good standard of medical training to see them lose interest because of the problem of registering with the South African Medical and Dental Council. The burden of an understaffed health service which could have been lightened continued. Ultimately he suffered with the disadvantaged rural communities.

THE CONSEQUENCE OF LACK OF DRS: .
 If doctors left and there was no one to replace them it created enormous stress and overwork for those who remained.  No one wanted to go and work in a hospital that was badly staffed because they knew it would be very stressful, so more left and a vicious cycle developed.  Some hospitals were down to one or two doctors for two or three hundred bed hospitals and there were some hospitals that had no doctors for a few years.
 The next part looks at doctors who do not respect the human rights of their patients. This is what the TRC apparently most wanted to hear about.  There were a number of GP's in the area who provided curative health care on a private basis.  On a few occasions I did locums for them and was thus able to experience aspects of their practice which undermined the dignity of the people who were unethical in some way. 
 Firstly separate facilities.    
 Black patients were treated differently to White patients. Doctors' surgeries were divided up and had separate waiting areas as well as consulting areas. Whites had a waiting room which was comfortable while the Black patients waiting room was uncomfortable and inadequate.  It might have just been a verandah or just sitting outside on hard benches or on the ground.  
 The consulting areas were also different. The White patients were seen in a room where there is privacy, a desk where the doctor sat, an examination couch and curtains around the bed for the patient to undress with dignity.  
 The Black patients were examined in a room which had been divided up with partitions to create three of four kinds of stalls which is a narrow space which scarcely fit an examination couch.  The doctor stood and hurried from one stall to the other and they lined the patients up.  There was no privacy as the partitions did not prevent patients from hearing what the doctors said to others.  There was no linen on the couches.  It was very uncomfortable. The situation was undignified and created a feeling of a depersonalised production line.
The abuse of the jova(?)
Black patients were treated differently to White patients.  They paid a standard fee for which they got a consultation and medication as part of a package deal. Medication had to include an injection, the Zulu word for which is the jova as well as two or three different kinds of pills or medication in syrup form.  When doing a locum I was told in no uncertain terms that this practice was non-negotiable.  Every patient must have a jova.  When I asked what to give a baby withe diarrhoea, which is a common primary health care problem which requires a detailed enquiry into feeding practices, use of enemas and then advice about oral rehydration but no medication. The doctor said, oh just give them anything, penicillin, streptomycin, gentomycin, sterile water, vitamin E, anything you like but just make sure they get the jova.
 The practice was defended on the grounds that the patients demanded it and were not satisfied with the consultation if they did not get it as well as a few other pills. Clearly the GP's felt they would lose patients if they did not continue this well established practice.  For medical and ethical reasons this is a very problematic thing.  I won't go into it now but if people want to know at questions... 
 I was told stories by nurses about GP's re-using needles until they were blunt. This was something they had observed while attending GP's as patients.  This practice is purely unethical and dangerous and spreads infections such as hepatitis B and HIV.
Failure to provide primary health care.
 GP's are in an excellent position to provide primary health care, the minimum being to give routine immunisation to children.  They do not do it.  This results many missed opportunities.  I would add that I know that none of these circumstances are any different now to the period under discussion.
 The third point was police violence.
 We were expected to do medical examinations to determine if minors were medically fit to be whipped by the police. This was degrading and humiliating for all concerned. We saw patients who had been assaulted or tortured by the police.  I won't talk about this because people have talked about that a lot.