A chronic shortage of staff is mainly responsible for the deterioration of patient care in a number of state health facilities, particularly in rural areas and small towns, according to Dr Elma de Vries, newly elected chairperson of the Rural Doctors’ Association of SA.

“Many hospitals in rural areas are dependent on foreign doctors,” said De Vries. “But the government has made it very difficult for foreign doctors to work in state hospitals.”

First, government imposed a moratorium on the registration of foreign doctors, making it impossible to recruit new doctors. This was lifted officially on 28 November 2000, but authorities have taken months to finalise regulations governing foreign doctors’ employment.

The Rural Doctors’ Association of SA (Rudasa), which held its congress over the past weekend, described the treatment of foreign doctors by the Departments of Health and Home Affairs as “disgraceful”.

“The actions of these two departments have been the main reason for many of these foreign-qualified doctors leaving our country. We believe that these two departments are morally responsible for the collapse of medical services in many rural areas and the resultant suffering and unnecessary deaths that have occurred,” resolved the congress.

Foreign doctors wanting to work in public health now have to write a test. The first of these has been set for next month, and thereafter will be held twice a year.

De Vries said that foreign doctors often acted as senior staff in hospitals in rural areas and small towns, as the Department of Health had done very little to attract experienced South African doctors to such hospitals.

Inexperienced community service doctors were now forced to work unsupervised in a number of places. Some had made serious mistakes, according to case studies collected by Rudasa.

Examples included:

A community service doctor cutting through a patient’s bladder while conducting a Caesarian section. The repair operation took over three hours.

A Caesarian being delayed for a hypertensive pregnant woman with malaria because of the doctor on duty lacked experience. By the time she was prepared for theatre, the foetal heart had stopped.

A patient with a dislocated hip was left for three days as his doctor had misinterpreted his injury as a fracture instead of trying to put the hip back in place.

Government’s recent decision to tax the fringe benefits of rural doctors – particularly their housing benefits – had driven even more senior doctors away, said De Vries.

Rudasa noted that “doctors have left rural health service because of the substantial decreases in salary they experienced as a result of the fringe benefit taxation,” and that the Department of health had not consulted them about the new taxation.

The Department of Health recently established a rural health unit under Dr Tim Wilson in an attempt to address the rural health crisis.

According to Wilson, Home Affairs has agreed to fast track the permanent residence permits of foreign doctors, provided that they provide the health department with the appropriate documentation.

“We’ve got a lot of the work into the Health Department where we can say, yes, this person qualifies in terms of the agreement, and then Home Affairs will go ahead and issue permanent residence quite quickly,” said Wilson.

Wilson added that while community service doctors were inexperienced, he believed that the service was working as it had brought doctors to areas were previously there were none.

Health department spokesperson Jo-Anne Collinge added that her department had appointed a group to deal with the taxation of rural doctors’ housing benefits and they “hope to resolve the matter within the next two months”.