Rampant racism and corruption, inadequate communication with patients, maldistribution between rural and urban areas and a Eurocentric medical profession are some the ingredients creating barriers to success in South Africa, a senior specialist at Chris Hani Baragwanath Hospital told a top-level gathering of doctors in Johannesburg recently.    

Dr Richard Nethononda, a cardiologist at the largest hospital in the southern hemisphere, said that South Africa had all the attributes necessary for success. “We just have to get things right,” Nethononda said at the SA Medical Association summit.

He said reasons for poor care in the public sector included maldistribution of human and material resources, poor infrastructure, bad management, understaffing, lack of commitment to the public sector and lack of monitoring mechanisms both in the public and private sectors.

Nethononda said corruption was rampant in both the public and private sectors, while professional misconduct saw doctors consulting privately during office hours, taking leave without completing leave forms, tendering for unnecessary equipment, on duty absenteeism and theft of hospital medicines and property.  

He accused the private sector of unnecessary and prolonged hospital admissions as well as unnecessary tests and inappropriate interventions to obtain kickbacks and more money, issuing generics while charging for brand names and involvement in the theft of state property.

Ethnic imbalances, were further challenges facing the profession, Nethononda said.

He said small numbers of African doctors and specialists resulted in a discomforting environment for minorities.

He listed a range of factors that reflected ethnic imbalances:  

•  rampant racism  
•  skewed power relations
•  poor appreciation and insight of cultural beliefs and traditions by the profession
•  inadequate communication with patients
•  maldistribution between rural and urban areas (67% of all medical  
•  professions in the Western Cape, Gauteng and KwaZulu-Natal)  
•  A Eurocentric approach to the profession

“Why so few African academics? This is mainly due to poor family background, poor primary and high school education, few African students at undergraduate level, a hostile (racist) postgraduate environment and the lack of role models,” Nethononda said.

Looking towards the future, Nethononda said society needed a “mode switch”.  

“A change from taking, which is bleeding our country dry, to giving mode. Doctors and dentists are heavily subsidised by the people of this country while the private sector and medical aids take no part in the training of doctors.”

Nethononda said political leaders should lead from the front and go to public sector hospitals for treatment while sending their children to public schools.

Nethononda, who takes home a R7 000 per month pay packet, said sincerity was also needed from government with better pay to retain doctors and nurses.

He urged medical schools to develop practical methods of dealing with internal racism and medical aids to become accountable.  

“The public health sector should contribute to the training of doctors and dentists.”

South Africa currently has close to 30 000 medical practitioners and 4 000 dental practitioners. Only 10% of medical practitioners are Africans and there are a minute number of specialists.

Sixty percent of medical and 85% of dental practitioners are in private practice. This is in stark contrast to the fact that 80% of South Africans rely on public healthcare.