NHI: A tale of two hospitals
OPINION: The South African health system has been described as a two-tiered system divided along socio-economic and geographic lines. Almost half of total health expenditure is on 16% of the population covered by medical schemes whilst the other half is spent on 84 % of the population in the public sector.
Public health users complain of many challenges including long wait times, rushed consultations, old facilities, poor infection control and prevention practices, as well as stockouts of essential medicines. This is the complete opposite to the private health system. The private health system is also better resourced, it has about double the number of medical specialists and triple the number of dental specialists and practitioners. However, the private health sector remains under-regulated often with exploitative and high prices.
This stands in contradiction to our Constitution and our fundamental principle of equality.
One of the ways the state seeks to remedy this is through the establishment of National Health Insurance (NHI). It is hoped that NHI will create a unified health system by making good quality health care more affordable and accessible for those living in South Africa. The health minister claims that NHI will ensure equity and address the inequalities presented by the current private and public health system. While this is a noble goal, it is widely accepted that for NHI to work, the public health system must be drastically improved and the private health system properly regulated.
A few months ago, two of my colleagues were attacked by a mob for trying to stop a beating of someone suspected of stealing. After their attack, Themba was taken to Netcare’s Pholoso* hospital because he had medical aid and Chris*, who didn’t, was taken to Limpopo Provincial Hospital, the nearest public hospital to where the incident occurred.
Myself and other colleagues were driving to Polokwane when we were informed of this incident we rushed to both hospitals to check on our colleagues and it was on this rare occasion that we had an opportunity to visit what we experienced as polar opposite health systems – one for the haves and the other for the have nots who happen to be the majority of our people.
We started at Netcare Pholoso in Polokwane. Driving into the parking lot we were greeted by security guards who assisted us with directions to the reception area. At the entrance of the hospital was a gift shop with flowers and balloons sticking out. The lobby looked almost, unused in its clinical state. We approached the reception desk and asked where we could find Themba. The lady behind the desk quickly typed his details into a computer and informed us that he was still at the emergency ward. On our arrival at the emergency ward we were informed that he was being examined by the doctor and thereafter he would be going for x-rays. It is then that they would be able to determine if he was to be admitted. In the meantime we were directed to a waiting area where we could get snacks and something to drink.
Two of my colleagues stayed behind while myself and another drove to Limpopo Provincial Hospital to check on Chris.
We walked into the hospital and enquired about the reception desk from the security guards. Once there, we asked the lady at reception if Chris was in the hospital. The response was that he could be at the emergency ward or in general admission. Naturally we asked if their system could tell us which ward he was in and in response the lady behind the desk just shot me a blank stare.
At a loss, we walked back to the security guard by the door to direct us to the emergency ward. As we walked through the hospital, a strong urine smell permeated through most of the corridors. We finally found the emergency ward and a local paramedic took us in to speak to the nurses. Unfortunately for us, we arrived during the change of shift and so most of the nurses ignored our request for assistance. After a while, almost annoyed at our presence, one of the nurses asked us what we wanted. We explained that a colleague was transported a few hours ago to the hospital and we needed to check on him. She looked through a book and told us that he had not been captured and that we should check if he wasn’t on one of the stretchers lining the corridor. One can only imagine how difficult it is to walk through a passage littered with stretchers of ill and injured people trying to find your loved one. We could not find him. Another nurse exclaimed “Ooooh, I think he might have been sent for an x-ray” and instructed us to follow the signs to the Radiology Section.
When we arrived at Radiology, there was no one to ask if he was in that section. Eventually we decided to call his phone, and perhaps through that we would be able to locate him. Luckily his phone rang and he was in one of the passages waiting for someone to take him in for an x-ray. A nurse came and asked us to sit in the waiting area.
We waited for about an hour and then the nurse pushed his stretcher to the corridor where we were sitting. After a few minutes the nurse turned to us and said that he had been trying to reach the emergency ward to come collect him, but that no one was answering. He then told us that if we wanted him to see the doctor, we should push his stretcher to the emergency ward ourselves because no one was coming to fetch him. We stared back in shock at his suggestions. He then said “Just make sure you push it straight so that you don’t make him fall”.
With those words of caution, we pushed Chris back to the emergency ward. When we arrived there, we asked where he should go. A nurse told us to find a cubicle and put him there. Looking around the for a cubicle we could see nothing – it looked nothing like how I had imagined an emergency ward cubicle would look like. All the signs for various machines and supplies were placed on the wall but none of those items was actually in the room. I kept looking at a sign of the wall written oxygen thinking – if he suddenly needed oxygen, would someone have to run and find some or does it even exist?
After further waiting, we approached a nurse to ask if she knew what needed to happen for him to get attention and all she said was “the doctor will come when he comes”.
After more waiting a disheveled looking man approached us and asked who we were with. He studied us and after a thorough look turned to Chris and said “how many wives do you have? Earlier you showed me the skinny one and now here you have the voluptuous one and the one with interesting hairstyles to see you”. Chris kept quiet while we stared at him shock. He walked right up to me and moved close to my face, I stepped back against the wall and held my hands up to show that he was too close. It was only then that he stepped away and walked towards Chris to take the x-rays, it turned out that he was the dpctor.
The next minute a nurse asked us to leave the area, telling us that family members were to wait in the waiting room. While waiting there, we witnessed a nurse telling a group of men that their colleague – who was in a car accident earlier – would not be admitted. They explained to the nurse that he was in no condition to walk and that they had no other means of getting to the area where they lived. The nurse told them that there were no beds and he had no sheets and that if he were to stay, he would sleep in the waiting room with newspapers for blankets. After an hour, the nurse told us that Chris would not be admitted because nothing was broken and that they would give him a prescription.
We left the hospital and Chris’ family picked him while my other colleagues took Themba to the hotel we were staying at.
While Chris’ experience is unfortunately not unique, his and others’ stories need not only to be told but to be given centre stage and consideration today when health activists, practitioners and public servants alike convene at the two-day Presidential Health Summit. The summit aims to bring together key stakeholders from various constituencies in the health sector, to “deliberate and propose solutions to address the challenges facing the South African health system”. It is with this in mind that I guess our plea is this; to focus on health system reforms and strengthening and less on coming up with more legislative interventions. Our public health system needs a firm commitment for adequate human resourcing including integration of community health workers; for facilities to be fixed and properly maintained and proper monitoring and evaluation of health services.