Strike Update

As you may know, there is a national strike going on in South Africa at the minute, which originated with government employees but seems to be spreading to take in workers from every sector. From my point of view the most significant aspect is that healthcare workers are also on strike – as I work in a government hospital, almost everyone here is a government employee and hence on strike. Today (Thursday) has been declared a day of ‘total shutdown’ by the unions and the vast majority of hospitals in our region have already been forced to close, many by rioting mobs. This week, the closest hospital to ours was attacked, forced to close and one nurse was badly beaten by a mob (which included workers from the Department of Health, no less) who believe that if anyone is working it weakens the strike.

Our staff here are understandably very scared and many left work without authorisation yesterday. We have had several staff meetings to try and determine a response to the crisis, which is affecting us on several levels. The hospital manager has received anonymous threats over the telephone this week as word has got out that we are still working here. Many of our staff are on strike and levels of care are consequently suffering. Furthermore, our supply lines have been cut since the beginning of the strike (over a week now) and we are running out of food and medicines.

It is very difficult to formulate an appropriate response. I wholeheartedly support my colleagues in their quest for more adequate remuneration for the job they do, which is often far from well rewarded. Especially as, if the union members here can be believed, the government and President have awarded themselves around a 50% pay rise this year. However, how can I support a strike that is violently and forcibly closing government hospitals, which are the only source of medical treatment for the poorest members of this society? There is no doubt that people are dying as a result, and more are likely to suffer in the long term from, among other things, the consequences of being unable to get their antiretroviral or anti-TB medicines. Similarly, the public health consequences in the future are hard to quantify but are unlikely to be insignificant.

We were informed this morning that the hospital only had food supplies for another 2 days to feed the current number of inpatients, which has already been substantially reduced. Only those who are critically ill or requiring daily injections have been kept in the hospital. The really difficult thing is that it seems to me to be a choice between allowing extremely sick people either to take their chances without medicine if we discharge them prematurely, or else allowing them to starve in the hospital – patients who are almost all malnourished already. The obvious solution is to buy food ourselves to feed those who must stay. However even this suggestion was met with limited approval, as our transport manager is reluctant to send any of his drivers to town to get food, and our hospital manager is happy for the foreign doctors to spend our money on food for patients if we wish but does not wish to contribute on the grounds that it is “not sustainable.” I can’t believe that we were talking of the sustainability of feeding people who are entirely dependent on us – it seems supremely callous.

The compromise solution was to discharge every patient who could walk, take oral medicines, had a home with food to go to, and could understand the situation. It breaks every principle we’ve ever been taught to send someone home who has not completed a course of antibiotics (for some TB treatment patients need to complete 2 months of daily Streptomycin injections). But if you can’t feed your patient…? And if they want to go home because they are aware that the hospital is unable to provide adequate care or even security? You let them go home with the best possible treatment you can organise and as much good advice as you can offer. We will buy food for the rest.

The whole situation is wholly unsatisfactory. My South African colleagues seem divided – those who are frustrated that they cannot fulfil their duty of care to patients, those who feel strongly that this is the only way to get through to an irresponsible government, and those who are terrified of the wrath of the trade unions. We all have to walk a fine line in trying to fulfil our legal, professional, and moral obligations whilst also striving for equality in this country of stark inequality. I feel my own frustration with the system failures here is only probably a filtered product of the intense frustration felt by people here for years which has boiled over into this strike. And who knows what you could be driven to if those who are supposed to be your allies – for me, the health service, and for ordinary working South Africans, the government – seem so woefully incapable of doing their job in supporting you. In 1995, they went on strike for 3 months…

So we were expecting my first shift on-call to be quiet, as even the taxis are on strike today. However that hasn’t proved to be the case, starting with having to discharge half the hospital this morning. Since then, I’ve had a 4 year old in status epilepticus, a man who had been stabbed through his hand, a malnourished and dehydrated baby, possible cryptococcal meningitis, jaundice/hepatomegaly and 5 ladies in labour to deal with (one stillbirth, one Caesarean, and three still going, hence being up at this late hour.) Plus: parents demanding to take their extremely sick son home against medical advice (apparently, legally, I cannot prevent them from doing this – very frustrating); a ward sister with severe back pain; and another of our nurses going into labour (she is number 5).

Anyway I wanted to let you know what the situation was like on the ground here. Thanks for your support and your prayers – I really appreciate it. My internet credit is running out so bear with me if it takes a while for me to get more – once I get some money in my bank account I should be able to top it up via my mobile but the likelihood of me receiving a salary this month is diminishing by the day!