After working in the United States, healthcare in South Africa is vastly different to that in the US. In South Africa there are two sectors of hospitals, the private and the public sectors. The private hospitals are typically for those who have insurance, and are entirely dependent on your ability to pay for the services required. These hospitals, which have many more resources, only tend to approximately twenty percent of the country’s population. Public hospitals are run by the government, and provide everyone with access to healthcare, regardless of their ability to pay. These hospitals are divided into primary day clinics, secondary hospitals, and tertiary referral hospitals. Day clinics provide obstetrics units for normal deliveries, regular doctor visits, and follow-up visits. I am working at Eersteriver Hospital, a secondary hospital. The hospital has five departments, internal medicine, pediatrics, casualty, surgery, and psychiatry as well as an eye clinic; while many patients are completely taken care of at this level, and then eventually discharged, those that need more specialized care will be sent to a tertiary hospital. Despite the fact that everyone has the ability to be seen at the hospital, there are significant challenges that both patients and physicians alike face.
Due to the large amount of people that they serve, the government hospitals are always overcrowded, leading to a constant shortage of beds. Some of the patients who came to Eersteriver during my time there waited as long as three days in casualty before they were able to attain a bed and be admitted to the hospital. To further the problem, there are also scarce financial resources, which leads to a lack of equipment, including an onsite laboratory. Specimens must therefore be sent to an off site facility, significantly lengthening the time frame for test results to be received. It is also common to have to refer patients to tertiary facilities for tests, including CT scans, which increases the time it takes to diagnose the patient. This also restricts the care that can be offered to patients. For example, it is difficult for people to get on the list for dialysis, and there are a limited number of available ventilators in the tertiary hospitals intensive care units. Last this financial challenge leaves the hospitals significantly understaffed, which leaves the physicians very overworked and underpaid. This overcrowding of the wards, lack of equipment, and understaffing of the wards significantly limits the interactions that the physicians have with the patients and lowers the quality of care that hospitals like Eersteriver are able to offer.
Another problem that some of the individuals of lower socioeconomic class face is the lack of proper sanitation and hygiene in some of the townships. This increases the spread of diseases between individuals due to close quarters, lack of proper plumbing, and poor ventilation in the housing situations, which heightens exposure to diseases, especially over long periods of time.
This situation is exacerbated by a lack of education in these areas, regarding hygiene, proper diet, proper body care, and proper disease management. Even with access to healthcare, life expectancy in the country remains lower. Many people do not end up in the hospital until they have incredibly severe health issues, including heart failure, COPD, kidney failure, uncontrolled diabetes, and serious infections that often require the need for amputations. Furthermore, those who do receive it early enough to encourage preventative measures do not seem to understand the severity of their illnesses. People go home and do not remain on their ARVs, Tuberculosis medication, or insulin, leading to serious complications from uncontrolled HIV, Tuberculosis, and diabetes.
Cultural beliefs and practices also pose a sizable issue when it comes to changing these habits and situations to decrease the spread of diseases. For example, the Xhosa circumcision ritual, which is performed on boys during their transition from boyhood to manhood, leads to cases of dehydration, hypothermia, infection, and deaths every year. Although it is inappropriate to discuss the intricate details of this ritual out of respect for the Xhosa culture, some of the issues come from the lack of sterilization of tools and proper wound care for the circumcision, as well as the harsh living conditions that the boys face during their seclusion. Despite the risks, the Xhosa people are very hesitant to alter their cultural traditions because of the rich history that underlies them.
All of these things affect and are affected by the current healthcare system in South Africa, which is a direct result of the changes that have occurred in their government over the past century. The quality of care that hospitals are able to offer patients is relative to the state of the country’s healthcare system. As a result, our expectations for quality care should be based on the resources that are available to the hospitals. Rather than finding someone or something to blame for the challenges that the healthcare systems face in both the United States and South Africa, it is crucial that physicians, nurses, and staff work to offer patients the highest quality of care that can be achieved within the current situation. We simply cannot expect that the quality of care in the United States should be the same as that in South Africa; as the state of the healthcare systems are entirely different, the care available, especially in the public sector is different. Nevertheless, by recognizing the problems and the merits in both systems we can learn from each other and continue to work to offer patients the best quality of care available.