Right now I’m halfway through the sixth month of my South African community service year, working in a small district hospital in the rural north of KwaZulu-Natal.
The lesson is very clear: Resource constraints are not an excuse for treating staff badly; they are another good reason to treat people well.
Coming back to medicine was a difficult decision. Last year I began a career as a bioinformatics researcher and I absolutely loved it. I worked in an amazing team, participated in fascinating, cutting-edge work and travelled almost monthly to international conferences and meetings. Even though I was just starting out, my involvement was valued in a way that it never had been in medicine.
But I also came under a lot of pressure to complete my community service, including from one of my academic supervisors. It will keep my options open, allowing me to work in research roles that require a registered professional, if I ever feel the need. I’ll be able to volunteer in a clinic for a few hours a week, or locum to pay for unfashionable projects. And I believe it is a morally good and important thing to do.
This year has been hard. The Department of Health’s budget shortfall means we’ve had less than half the number of doctors as last year. People who loved working out here were forced to leave when their contracts ended, and posts have been left vacant, or dissolved. It puts enormous pressure on those who remain. We don’t want to make our patients submit to lower standards of care, and our management has desperately resisted doing so. But there’s little we can do when there’s no money to repair or replace basic equipment. Without an ultrasound machine, some babies die. And this is after all the usual rural problems of electricity and water shortages and long, rough roads that destroy ambulance services.
But I have also had an incredibly positive experience of institutional medicine. I am managed by people who care deeply about sustaining an institution that provides holistic care for both staff and patients. The threat of complete collapse has only sharpened the need to treat staff well. Because if a single person doesn’t pull their weight with enthusiasm, that weight falls on the next person, who may already be stumbling. And we cannot afford to lose more doctors. The lesson is very clear: Resource constraints are not an excuse for treating staff badly; they are another good reason to treat people well.
So what about next year? Our unusually long hours mean that I’ve fallen behind on a lot of my research commitments. But I’m still planning to go back to full-time as soon as I can. It’s just so much fun. And I think it’s a space where I have more to contribute. There are many excellent, good-hearted doctors who can take my place here. If the posts get unfrozen.