Inhuman hours, overflowing emergency rooms, poor resources and little support – this is the daily reality of most staff in our public hospitals. Maria Phalime was once a bright-eyed young medical student with high expectations of how she would make a difference. But then during her tenure at hospitals in Mitchells Plain and Khayelitsha she was overwhelmed by the conditions and the needs of her patients. Medical school had not prepared her for the ethical dilemmas she had to face. Now she has written a book about why she left.
When my memoir, Postmortem – The Doctor Who Walked Away, was published in April 2014 I had no idea it would break open a wound, one that has been festering for years. Postmortem chronicles my years as a medical doctor and the challenges I faced working in public hospitals in the Western Cape, and my decision to leave medical practice altogether.
When I was writing the book I had an intuitive sense that the challenges I faced were not unique to me. As I interrogated my own story and interviewed other doctors who had chosen to walk away, it became apparent that many doctors felt disillusioned about the dysfunction in the health system. “For Nina*, it was the sense of helplessness that bothered her most, the feeling that in spite of her world-class education she was often unable to provide what her patients really needed.” (Postmortem, pg. 139)
But I knew better than to make a claim of widespread disillusionment in the book; my scientific training told me that I simply didn’t have enough evidence to make such a generalisation.
“…festering wounds can’t heal. The low-grade infection lingers on, feeding off itself and threatening to engulf all around it in its toxicity. It is only when the rot is released and dead tissue is cleared away that new growth can begin.”
– Postmortem: The doctor who walked away by Maria Phalime, NB Publishers (2014)
The feedback I have received from doctors and other healthcare professionals who have read the book has however confirmed my suspicions. And though it doesn’t lend statistical significance to any claim that the challenges in the health sector are widespread, it does give merit to the assertion that the challenges in the health sector and their impact on healthcare professionals are significant.
In conversations and emails the same sentiments are expressed – frustration, disillusionment, and in some cases outright anger towards a system that does not seem to appreciate those who have devoted so much of themselves to it.
Doctors no longer care
Vinesh* wrote: “Doctors are worked to the point where we no longer care. I don’t think we can really look after the numbers of patients we have to see and do justice to anyone.” His frustration led him to take his considerable skills elsewhere and he is now practising medicine in Canada, one of many thousands of South African doctors who have emigrated.
Nkuli’s* anger was palpable in the lengthy email she sent me, detailing the many ways she feels unappreciated by the system: “There is just no justice in our profession when a young doctor seeks help when confronted with challenges such as the ones you have pointed out in the book.”
Many more doctors simply wrote to thank me. “I wanted to thank you for giving my feelings a voice. A way for my family to understand, and a way for me to realise that I am not alone.” – Victoria*, community service doctor.
As disheartening as these messages are I think they also signal an important – and necessary – shift. This is a shift away from the culture of coping which is so deeply entrenched in the profession. A psychiatrist I interviewed when I was writing Postmortem described it thus:
An illusion of coping
“We don’t reflect on our experiences. There is fear that introspection might lead to questions which we are often too scared to ask ourselves. Have I wasted all this time? Was I foolish to do this? Am I naïve and idealistic, a hopeless romantic? Can I do anything else? Instead we create this illusion of coping when in fact we are shutting down the critical faculties of questioning and reflection.” (Postmortem, pg. 167)
So at last we are talking and being honest about what it’s really like. This conversation is scratching the surface of a deep-seated wound, and it is critical that the conversation is kept alive so that we can start to heal the system.
I can’t help thinking we need a Truth Commission of sorts, a space to air out the wounds that extend so deeply into our profession and the health system as a whole. By talking and sharing our stories we will not only give a voice to our experiences, we will also move closer to finding ways to address the challenges. And, crucially, we will also give a voice to the millions of voiceless and desperate patients whose very survival depends on the system working.
*Names have been changed.
Postmortem: The Doctor who walked away by Maria Phalime, NB Publishers (2014)
Havana’s Latin American Medical School is the largest in the world, graduating 23 000 young doctors since its first class of 2005. There are nearly 10 000 more in the pipeline. Its mission is to train physicians for the people who need them the most: the over one billion who have never seen a doctor, the people who live and die under every poverty line ever invented. Its students defy all norms. American journalist and Havana resident Gail Reed gave a Ted Talk on this remarkable Cuban medical school that trains doctors from low-income countries who pledge to serve communities like their own and that has sent professionals all over the globe including Southern Africa.