Most of the doctors who completed their community service year at the end of 1999 intended remaining in the public service, while a large percentage were planning to go overseas.

This and other findings have been published in the 1999 SA Health Review, launched in Cape Town earlier this week.

Co-author of the chapter dealing with community service, Dr Steve Reid said the majority of the doctors found the experience worthwhile and that they had contributed and made a difference.

“Although they were positive, community service had not altered their plans.

About 43% of the doctors intended to remain in the public service, 34% planned to go overseas, 13% were going into private practice and 11% were unsure.

“Those going overseas were mainly doing so to pay off their study debt as soon as possible and then return at some stage. They are concerned over crime and other problems, but not more that any other average South African,” Reid said.

“My perspective has totally changed from the Stellenbosch Afrikaans way of understanding things,” one doctor said.

Another community service doctor, alone in the Eastern Cape with eight Cuban colleagues, chose to make the most of the year’€™s experience: “This is a life experience which I’€™m not in a hurry to repeat. But at least I’€™ve learnt how to do a Caesar ‘€“ in Spanish.”

According to Reid the realisation of many community service doctors that they were actually making a difference was a huge motivation for them. This was particularly so for those who visited outlying clinics, some which had never been visited by a doctor.

Most community service doctors reported that they had learned to make independent decisions for the first time. Most learning was in the area of gaining confidence and insight into themselves as practitioners, as opposed to formal learning of clinical skills from supervisors.

Many felt that the supervision and support was poor. In isolated rural hospitals community service doctors were often the only full time medical staff. In some hospitals other doctors were hesitant to supervise the community service doctors, as they did not feel sufficiently qualified themselves.

But most reported that they could at least get help over the telephone. This was, however, a problem in the more remote hospitals of the Eastern Cape, where telephone access was limited.

The allocation process was widely felt to be grossly unfair. The allocations of doctors according to their five choices left a minority whose choices could not be accommodated.

Those allocated to urban hospitals raised no objections to their placements, whereas those in isolated rural situations felt resentful of their colleagues in central hospitals who were able to proceed with specialties of their choice.

Reid said nothing had changed for the second intake of community service doctors and that the problems were expected to be similar.

However, there would be regional rotation whereby doctors would not be assigned to one hospital, but a complex of hospitals. ‘€“ Health-e News Service