Doctors forced to play God
Part two of a three-part series

Article 2 of a three part series

While some improvements have taken place at Johannesburg Hospital, doctors are concerned that they are being forced to play God, while Government refuses to take political responsibility for those decisions involving limiting care.

Chairperson of the medical advisory committee and chief of paediatrics, Professor Peter Cooper, says the Department of Health has not adequately addressed the issue of budgets and services.

“National and provincial health policy states that the primary health care system needs to be strengthened and that this would in turn reduce the demand for tertiary services.

“This may make a difference in the medium term (10 to 15 years), but not in the short term.”

Cooper says while there is agreement that some tertiary services are not appropriate for a country such as South Africa, nobody is prepared to take political responsibility for deciding what should or should not be provided. “Nobody is prepared to state for example whether we should be doing heart transplants or resuscitating premature babies (under 1 000g). Instead it is left up to clinicians to make these impossible decisions.

“The policy of not ventilating babies weighing less than 1 000g is our policy, we had no option. But although the Gauteng health department is quite supportive, they won’€™t accept it as their official policy. No one is prepared to take the political flack.

On the issue of budgets, Cooper believes equipment was in poor condition, with many items of equipment either very old, not functioning or condemned. There was also a constant, critical shortage of beds forcing doctors and nurses to juggle beds and patients to make space.

HIV/AIDS, Cooper said, was almost overwhelming hospital services, especially the paediatric and adult medical wards where at least 40% of admissions were related to HIV.

He said the epidemic had increased the workload and frustrations of personnel and had a significant impact on how people viewed their profession.

“When I was a junior doctor you thought you had a good shot at curing most patients. Now, whatever you do, the eventual outcome will usually be the same with respect to HIV/AIDS patients.

“I think that does lead to people being less aggressive in treating patients.”

On a more positive note, Cooper says there have been major improvements in appointing junior staff at medical officer and registrar (specialists in training) level.

“Over the past five years many posts were cut. At least now we are able to fill those posts that are currently filled when they are vacated.”

Nursing, however, was still suffering from huge shortages, that impacted on all aspects of hospital care. There are also shortages in the allied professions such as occupational therapy, physiotherapy and social work.

When the Commission of Inquiry into Hospital Care Practices tabled its report in 1999, they pointed out that low morale ran as a common thread throughout their interviews with staff.

But Cooper says the recent appointment of hospital chief executive officer Saggi Pillay has made a big difference to morale.

“It is the first time we have a non-medical person running this hospital and his influence at the top has made a huge difference to morale.”

He says although Pillay did not enjoy as much autonomy yet as a CEO should, it was coming about slowly.

“Things are not ideal, but in the end we would like to see Johannesburg becoming a major referral centre for complex cases, while the regional hospitals absorbed most of the primary and secondary level patients.”

Professor Yosuf Veriava, acting head of the School of Medicine at the University of the Witwatersrand, said hospitals were still struggling, but that he detected a change in the approach of the authorities.

“In 1994 hospitals had to cope with people from all over. The peripheries were poorly developed, overloading the big hospitals. There was AIDS and, of course, budgetary problems. But we are still able to teach at the hospitals and I think quality has not been compromised,” Veriava says.- www.health-e.org.za

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