Fancy gadgets can't replace well-paid human care
April 30, 2009
By Pat Sidley
As the first two suspected cases of swine flu are reported here, I wonder how those angry young doctors who were on strike are going to cope. And how will the struggling public health system cope?
Kill those already in isolation from other diseases, to free up beds for those with swine flu? No, a machine at the airports will save us all. It is a thermal detector - like a thermometer, only it costs millions. Somebody has to make a living - not the doctors, though
Their strike prompted a memory of giving a lecture to public hospital chief executives taking advanced degrees. I referred to the luxury cars driven by private medical sector types, prompting one of the doctors to ask jocularly how long it would take before he could own a Porsche.
I said never. As a communications type in part of the government's health establishment and with no degrees behind my name, I was earning more than that doctor with two medical degrees and on his way to getting a business one.
Doctors, you see, are fair game in the public sector. Every sanctimonious word said about them, while more than 400 went on strike recently, has relied on the notion that "earning a few bucks more at the expense of lives" was immoral.
Put like that, it is hard to disagree. But it is very far from the full picture.
For one thing, the entire labour spectrum, including the National Education Health and Allied Workers Union (Nehawu), the labour minister and Cosatu had all called for the doctors to return to work.
This was strikingly, so to speak, different from Nehawu's backing of nurses on strike. A reason for this is the funny belief that the person in the white coat charged with saving your child's life will be able to survive on the certain knowledge - but uncertain income - that the labour is valued in a new currency: love.
The striking doctors were hugely aggrieved by having had promises broken for about 18 months. They defied both the belief, entrenched in law, that doctors cannot strike; and a court order stopping it. They were all threatened with dismissal - and then dismissed. This was then reversed and they got a final warning instead.
There is an argument that other means of protest could have been used - such as working to rule (no 48-hour shifts for a while) and going to court to get the agreement enforced. Having been failed by bodies that purported to represent doctors' interests, nobody gave them good advice. Labour lawyers charge a bit more than the average striking junior doctor could afford.
But what happened in Pretoria? Did they lose touch with reality? Do they think the human beings in the white coats are in some way less human than the garbage collectors or bus drivers, who strike quite often? Perhaps they did not realise doctors were as stretched as everybody and everything else in the public health system.
Having for years castigated the immense rewards of the private health care sector, did those in government really believe junior doctors did not realise they were badly done by and that without a very loud scream, they would never be heard?
There was room for different tactics, and the timing left a bit to be desired. It all happened as the world faced yet another pandemic, swine flu, which is likely to be worse than the fears that surrounded severe acute respiratory syndrome (Sars).
Should this dreaded disease strike our shores, exhausted and underpaid doctors will be the least of our problems.
If provinces can run out of antiretroviral (ARV) treatment for Aids patients and tuberculosis (TB) can be allowed to develop into an extremely drug resistant epidemic, why would anybody believe we could cope with swine flu?
Antivirals are very expensive. Those for this virus are no exception. Supposing the good folk in Pretoria are able to focus their minds on the task at hand, will they declare a public health emergency? This could ensure the drugs could be produced locally as cheap copies, without the normal expensive licensing and patent protection.
About 10 years back, the drug companies and western governments would not give way on this point for the cash cows that antiretrovirals promised to be. That was until bird flu or Sars or whatever threatened North America. Canada found itself remarkably adept at ensuring it did what was required in terms of World Trade Organisation agreements to produce the drugs in large quantities, and cheaply, by local generics manufacturers. The US did the same when Washington thought it was dealing with anthrax.
We, however, are introducing a temperature detector at airports. Perhaps I have missed something here? But the World Health Organisation stressed early this week that measures for prevention were doomed to failure and that the emphasis ought to be on dealing with it when it arrives. But why stop a good kickback for some new technology?
The news on e.tv's satellite service showed people wearing gowns and masks at airports while steering worried people into examination rooms. Hopefully the personnel on duty had had enough sleep and were not underpaid or angry.
In the Sars outbreak, the few cases that did arrive here were not dealt with by the public health system, but by the private sector. This sector could do it while the public sector could not.
Those doctors who specialised, became virologists (or gained expertise in other fields to assist), tasted the working conditions in the public sector and left it - either for different countries or the comforts, if not morality, of the private sector.
A couple of badly paid public health doctors will assist, with tired bags under their eyes, while their private sector counterparts give their free time with love - just as they did in the cholera outbreak. They could afford to, and countless lives were saved by that generosity - a generosity of spirit that cannot be forced out of an unwilling abused worker, even if it is a doctor.
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