All in A dAy’s

work

Dr Thandeka Mazibuko works at Durban’s King Edward VIII Hospital.

22 september 09 feminA

feminA september 09 23

HonourIng woMEn

All in A dAy’s

workstate doctors have

been in the news in recent months

because of national strike action.

we spent the day with a state doctor

to see what a typical working day in a

government hospital is like.

by JAne CowAn

your life

fFinding a 35+ state doctor for this story wasn’t easy: once they’ve qualified (in their late 20s) most doctors leave state hospitals to go into private practice or work overseas.

Last year an independent study commissioned by the South African Medical Association (Sama) showed that doctors are underpaid by up to 200% compared with other public service professionals. Yet they are treating more patients than ever, with limited resources and in increasingly difficult conditions that in June prompted some to strike.

Dr Thandeka Mazibuko is unusual because after qualifying she left to work in the private sector (earning R20 000 a month more than she is currently getting) but chose to resign and return to the state sector when the government issued an appeal for doctors to return to state hospitals.

‘I’m committed to working in the state sector – I don’t want to go overseas, I want to stay and help people here.’ w

24 september 09 feminA

3am Wake up to study for two hours. I want to specialise in

oncology in the future.

5am Check Sphume’s homework, which he leaves out for me every

night, make his porridge, do ironing and housework.

7am Drop Sphume at school in Pinetown, and battle traffic to

reach King Edward VIII Hospital by 7.45am. Change quickly into hospital greens in a toilet with a door too warped to close.

8am First ward round of the day, with a consultant (supervising

doctor), a registrar (a doctor studying to be a specialist), an intern and a dozen medical students who we are expected to teach as we work. This team is responsible for

‘All we wAnt is A living wAge’

Dr Thandeka Mazibuko, 35, is a medical officer in the department of Obstetrics and Gynaecology at Durban’s King Edward VIII Hospital – a position she has worked hard and passionately to achieve. She grew up in the rural settlement of KwaNyuswa near Botha’s Hill, the daughter of a single domestic worker. Maths and science teaching was poor so she largely educated herself, and was accepted into the Nelson R Mandela School of Medicine at the University of KwaZulu-Natal. Fighting for loans and eventually a bursary, Thandeka graduated seven years later.

She worked as an intern and community service doctor at Prince Mshiyeni Hospital until the government froze posts, then as a medical officer on the mines in Johannesburg, earning R20 000 a month more than she does today and enjoying far better conditions. Friends thought her crazy when she was one of a handful of doctors to heed a call to return to state hospitals, and took a post in obstetrics at King Edward VIII. ‘But I felt a commitment – I’d been given a bursary here, and I wanted to serve the people I grew up with, who had prayed for me to become a doctor.’

It’s commitment that keeps Thandeka at the hospital today: ‘All

doctors want is a living wage and decent working conditions. I think the doctors at King Edward are among the best in the country.’

She earns R14 000 a month after tax which she stretches to R20 000 with four ‘overtime calls’ a month, when she works from 4pm to 8am, giving her a six-day week. Thandeka’s normal working day is officially 8am to 4pm, ‘but no one gets out until the last ward round is done at around 5.30pm.’ She struggles to square her earnings and hours with meeting her student-loan repayments and the bond on a modest duplex, and supporting herself and Sphume, her 14-year-old son.

Thandeka gets up at 3am to study.Below right Thandeka irons her son’s school uniform.

‘i still CAn’t Afford to free my mom from Her Job As A domestiC worker.’

your life

a 30-bed labour ward, where women must be monitored and assisted through childbirth (though few of the foetal monitors work). The beds are always full and women occasionally have to give birth on rickety stretchers.

8.30am Break away early from rounds to start

doing one of three Caesarean sections left over from night shift (there are usually more). All show foetal distress, but must wait their turn – there’s only me and the registrar to operate. While I wait for the anaesthetist, I rush to the crowded admissions area to check on a pregnant woman being dropped

off by ambulance. Referrals arrive all day from clinics and hospitals surrounding Durban, and there are numerous walk-ins.

9am Deliver the first of my C-section babies for the day,

and hurry on to the next. I learned to operate by watching and assisting, but wish the training had been better. Most specialists have left for the private sector or jobs abroad, and those remaining have little or no time to teach.

10am Want to start my next C-section but the over-

burdened lab is taking two hours to return blood results that should take 15 minutes, and anaesthetists can’t risk taking patients to theatre if they may be anaemic (which many are because of HIV, ARVs or bleeding) or have low platelets. Respond to a call to attend to 10 walk-ins in admissions.

11am Emergency C-section on a 14-year-old.

12am Another teen delivers a stillborn child. ‘It can’t be

dead,’ she cries. ‘I thought this baby would put food on the table!’ She’s been counting on getting a state grant. Another pregnant woman is brought by the ambulance for preterm labour, but there’s no spare ventilator available here or in the whole province. I have to suppress this labour until one of our three becomes available. While still talking to this patient, Chesterville clinic calls – a sister is requesting that we take a patient with uncontrollable bleeding.

1pm Have an uncontrollable bleeding case of my own,

prepare and counsel her for a possible hysterectomy.

2pm Difficult delivery for a woman who clearly doesn’t

want this child. No time to sit and ask her about it, just hope she takes my advice to see a psychologist later. Another call, this time from Wentworth Hospital, where a patient is not responding to blood-pressure treatment – she too will be sent to us. Meanwhile two patients are brought in from Addington Hospital, one having uncontrollable fits, the other bleeding badly – hope my poor-quality gloves don’t tear as they sometimes do, exposing us to patients’ blood. These women must join the emergency C-section queue.

3pm Call from theatre: ‘The spinal is in.’ I rush to do another

foetal distress C-section, knowing there are other unstable patients who desperately need to be in theatre. There are two theatres, but only one is operational because we have only one anaesthetist instead of three, which also means labour-ward patients can’t get the epidurals many need.

4pm The consultant and others are here for the last round of the

day. I look as if I haven’t done my work because there are still many Caesareans pending, and no blood results for the patient having fits and the one who is bleeding. The consultant starts shouting at me, asking what we were doing all day. I’m tired, I’m hungry, my phone is ringing. It’s my son’s school, asking me when I am picking him up. No-one cares, the work must be done.

6pm I’ve seen around 40 patients today and delivered around

15 babies! Leave at last, shoulders and feet aching, to fetch Sphume. He’s waiting on a bench outside the school, which is closed.

7pm Fix Sphume a dinner frozen on my one day off each week –

too tired to eat myself. While he watches TV, I go upstairs to bath.

Hoped to see my fiancé, but he’s a senior registrar at another state hospital and regularly pulls 30-hour shifts. You’ve got to love someone to date in these conditions! The cost of lobolo and a wedding are out of our reach. And I still can’t afford to free my mom from her job as a domestic worker.

Before Sphume goes to bed I have to give him an injection. He has a rare condition called anterior pituitary hypoplasia (the front part of his brain isn’t working) and has to have a lot of medication.

8pm To bed, alarm set for 3am. I’ve earned a good night’s sleep.

feminA september 09 25

‘i felt A Commitment – i’d been given A bUrsAry Here, And i wAnted to serve tHe people i grew Up witH, wHo HAd prAyed for me to beCome A doCtor.’

¢F

‘I can make a difference’dr rACHel moore, 36

Rachel Moore is a Senior Surgical Registrar working at a State hospital in Johannesburg. Married to Dean Donaldson, she has two sons Joshua (4) and Gabriel (2). Having completed her six year primary undergraduate degree followed by a one year internship and a year’s community service in Nelspruit, she’s now training to be a general surgeon – usually a five year course (2 years as a junior registrar; 3 as a senior registrar).

She started in January 2005 but chose not to put up with the long 80-100 hour working week that was required. While surgery is her passion, she felt that her job had become her life: there was no time to see her husband or her friends. When she told her professor she was going to resign she was offered a lifeline, and became the first doctor countrywide on an extended registrar programme. This means she works 40 hours a week (normally it’s between 80 and 100) with no expected overtime, and although she’s regularly on 24 hour call, her working hours are adjusted accordingly if she is called out. The flexibility fits in well with being a mom but also means that she’ll only qualify as a general surgeon at the age of 40! With a monthly take-home salary of R18 000 (medical aid is deducted) 11 years after qualifying as a doctor, money is tight.

‘We’re not saying we’re not making enough to live on but that compared to other professionals in the public sector with similar qualifications (SA Medical Association’s independent market research on magistrates and pilots nationally and internationally) we’re earning 50% less. Dean works fulltime for the church as a pastor so there’s a lot of financial juggling. If he