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.
Wow! This could be one particular of the most useful blogs We have ever arrive across on this subject. Basically Great. I’m also a specialist in this topic therefore I can understand your effort.
I believe that avoiding refined foods is the first step to be able to lose weight. They can taste fine, but prepared foods include very little vitamins and minerals, making you consume more simply to have enough electricity to get with the day. For anyone who is constantly feeding on these foods, switching to grain and other complex carbohydrates will help you have more power while taking in less. Great blog post.
It’s truly very complex in this full of activity life to listen news
on Television, therefore I only use internet for
that reason, and obtain the newest information.
Hi there to all, how is the whole thing, I think every one is getting more
from this web page, and your views are nice in support of new viewers.
I am actually pleased to read this blog posts which includes tons of valuable
facts, thanks for providing such statistics.
I am actually thankful to the owner of this web page who has shared this
great piece of writing at at this place.
Hmm is anyone else having problems with the images on this blog loading?
I’m trying to figure out if its a problem on my
end or if it’s the blog. Any feedback would be greatly appreciated.
Greetings from Idaho! I’m bored at work so I decided to browse your website on my iphone during lunch
break. I love the information you present here and can’t
wait to take a look when I get home. I’m shocked at how fast your blog
loaded on my mobile .. I’m not even using WIFI, just 3G ..
Anyways, great blog!
You’re so cool! I don’t believe I’ve read something like that before.
So wonderful to find another person with unique thoughts on this subject matter.
Really.. many thanks for starting this up. This web site is one thing that’s needed on the
web, someone with some originality!
Post writing is also a excitement, if you know then you can write otherwise it is
difficult to write.
Terrific article! That is the type of information that are meant to be
shared around the web. Shame on Google for no longer positioning this put
up higher! Come on over and seek advice from my web site .
Thank you =)
The attention to detail in recreating famous scenes and
characters is what truly sets Lego apart. You can have a little piece of
your favorite stories at your fingertips. LEGOS prime set This guide
is a testament to the endless possibilities with Lego.
Lego can be used for a variety of creative projects, from recreating iconic stadiums like FC Barcelona’s Camp Nou or creating intricate stories.
This set allows aspiring architects the opportunity
to explore their design and creativity.
Pretty nice post. I just stumbled upon your weblog and wanted to say that I’ve really enjoyed
browsing your blog posts. After all I will be subscribing to your rss feed and I
hope you write again soon!
Pretty section of content. I just stumbled upon your weblog and in accession capital
to assert that I acquire in fact enjoyed account your blog posts.
Any way I’ll be subscribing to your augment and even I achievement
you access consistently fast.
I am regular reader, how are you everybody? This post posted at this web site is in fact pleasant.
Fantastic beat ! I would like to apprentice while you amend your website, how can i subscribe for a
blog web site? The account aided me a acceptable deal.
I had been tiny bit acquainted of this your broadcast offered bright
clear idea
This is the right web site for anybody who really wants
to understand this topic. You know so much its almost tough to argue
with you (not that I personally would want to…HaHa).
You definitely put a brand new spin on a topic that has been written about for many years.
Great stuff, just wonderful!
What’s up, for all time i used to check web site
posts here in the early hours in the dawn, for the reason that i love to learn more and
more.
Full full bets are most generally bet by higher rollers
as maximum bets.
Also visit my page :: http://www.pakkretcity.go.th
Keep this going please, great job!
Stunning quest there. What happened after? Good luck!
Hello There. I discovered your weblog using msn. That
is a really neatly written article. I’ll be sure to bookmark it and return to read
extra of your useful info. Thanks for the post.
I will certainly comeback.
I love your blog.. very nice colors & theme.
Did you create this website yourself or did you hire someone to do it for you?
Plz reply as I’m looking to construct my own blog and would
like to know where u got this from. thanks
We absolutely love your blog and find a lot of your post’s to be
just what I’m looking for. Do you offer guest writers
to write content in your case? I wouldn’t mind creating a post or elaborating on many of the subjects you write related
to here. Again, awesome blog!
Hi there, I discovered your blog by the use of Google even as searching
for a comparable subject, your web site got here up, it seems
good. I’ve bookmarked it in my google bookmarks.
Hi there, simply became alert to your blog via Google, and
located that it’s really informative. I am going to be careful for brussels.
I’ll appreciate should you proceed this in future.
Numerous other folks will probably be benefited from
your writing. Cheers!
Great beat ! I would like to apprentice whilst you amend your site, how
can i subscribe for a weblog website? The account helped me a appropriate deal.
I have been tiny bit familiar of this your broadcast provided bright transparent concept
Oh my goodness! Amazing article dude! Many thanks, However I am experiencing issues with your RSS.
I don’t know the reason why I cannot subscribe to it. Is there
anybody else getting the same RSS issues? Anyone that knows the answer can you kindly respond?
Thanx!!
My brother recommended I would possibly like this website.
He used to be totally right. This submit truly made my day.
You cann’t believe simply how a lot time I had spent for this information! Thanks!
My brother recommended I might like this
website. He used to be entirely right. This post actually made
my day. You cann’t believe simply how a lot time I
had spent for this information! Thanks!
It’s great that you are getting ideas from this post
as well as from our dialogue made at this place.
I enjoy reading through an article that can make people think.
Also, thanks for allowing for me to comment!
Great blog here! Also your website loads up fast! What web host are you using?
Can I get your affiliate link to your host?
I wish my site loaded up as fast as yours lol
Very good write-up. I certainly appreciate this site.
Thanks!
As the admin of this web page is working, no hesitation very rapidly it will be
renowned, due to its feature contents.
Hello, I enjoy reading all of your article post.
I wanted to write a little comment to support you.
You are so interesting! I do not suppose I’ve read through anything like this before.
So nice to find another person with a few unique thoughts on this issue.
Really.. thank you for starting this up. This site is one
thing that is required on the internet, someone with some originality!
Pretty great post. I simply stumbled upon your weblog and wanted to
say that I have really loved surfing around your blog posts.
In any case I will be subscribing on your feed and I hope you write
once more soon!
I wanted to thank you for this fantastic read!!
I definitely enjoyed every bit of it. I have you bookmarked to check out new things you post…
I’m very pleased to find this page. I wanted to thank you for your time for this particularly wonderful read!!
I definitely enjoyed every little bit of it and I have you book marked to check out
new information in your website.
Hey! I know this is somewhat off topic but I was wondering which blog platform are
you using for this website? I’m getting tired of WordPress because I’ve had issues
with hackers and I’m looking at options for another platform.
I would be awesome if you could point me in the direction of a good platform.
Your style is so unique compared to other folks I have read
stuff from. I appreciate you for posting when you have the opportunity, Guess I’ll just book mark this blog.
My brother recommended I would possibly like this website.
He used to be entirely right. This submit actually made my day.
You cann’t consider just how much time I had spent for this information! Thank you!
Truly no matter if someone doesn’t understand then its up to other people that they will
assist, so here it takes place.
I want to to thank you for this very good read!!
I absolutely loved every little bit of it.
I’ve got you book-marked to check out new stuff you post…
It’s hard to come by experienced people for this topic, however,
you sound like you know what you’re talking about! Thanks
Today, I went to the beach front with my kids. I found
a sea shell and gave it to my 4 year old daughter and said “You can hear the ocean if you put this to your ear.” She put the shell to her ear and screamed.
There was a hermit crab inside and it pinched her ear. She never
wants to go back! LoL I know this is completely off topic but I had to tell someone!
You are so awesome! I do not think I have read anything like this before.
So wonderful to find someone with some genuine thoughts on this issue.
Really.. thanks for starting this up. This website is something that is required on the web, someone with
a bit of originality!
Hello mates, its enormous paragraph on the topic of educationand completely explained,
keep it up all the time.
Very nice blog post. I absolutely love this site.
Stick with it!
I am really loving the theme/design of your weblog.
Do you ever run into any browser compatibility problems?
A couple of my blog readers have complained about my blog not
working correctly in Explorer but looks great in Safari.
Do you have any recommendations to help fix this problem?
Hello! I know this is kinda off topic but I’d figured I’d ask.
Would you be interested in exchanging links or maybe guest writing a blog
article or vice-versa? My blog addresses a lot of the same subjects
as yours and I think we could greatly benefit from each other.
If you are interested feel free to shoot me an email. I
look forward to hearing from you! Wonderful blog by the way!
Excellent article. Keep writing such kind of info on your blog.
Im really impressed by your blog.
Hey there, You’ve performed an excellent job. I’ll definitely digg it and individually suggest to my friends.
I am confident they’ll be benefited from this site.
I think the admin of this site is genuinely working hard in favor of his web site,
since here every data is quality based data.