The heart of public health needs defibrillation - Business Day

1 October 2018 - The real answer lies in merit-based appointments, strict accountability for poor performance, and effective action against corruption and wasteful spending, coupled with easing the burden on the public system by increasing access to private health care.

Michael Morris

One of the Christmas season routines that marked my and my brother’s early childhood was tagging along to choral performances at Kimberley’s hospitals — public ones only, in those days — by a matronly ensemble of retired Galeshewe nurses. The performances were part of a Red Cross project to make the most of the experience and knowledge of retired but still active township nurses, which at the time fell under the care of my late mother, then a district office bearer in the organisation.

Nursing, as a life of service, had long been a feature of our domestic atmosphere. We always enjoyed the story of our maternal grandmother, bound for the Balkans front on a troop train in 1917 with a contingent of Queen Alexandra’s Imperial Military Nursing Service, dashing for the hissing locomotive at every halt to fill her teapot, the catering staff’s tepid offering having fallen short of the essentials for properly made tea.

The teapot spectacle caught the eye of a young officer of the Gloucester Regiment embarked on the same journey. Officer and nurse later married in Calcutta (now Kolkata), where their units took them after the war, my mother being born in 1922 at the hill station of Murree in the Punjab. Like her own mother, she became a nurse, serving first at the Gloucestershire Royal Infirmary then in London during World War 2 and, ultimately, in the years immediately preceding my arrival, at the TB isolation hospital that served Galeshewe in Kimberley. She later joined the Red Cross.

I don’t know if it’s true of everyone brought up in a nursing household, but it’s certainly true of me and my brother that anything to do with sickness and health was approached in a spirit of stern attention to fundamentals, the scope for moping and self-pity narrowed sharply by basic procedures considered unimprovable by their curative effects. The same, I remember, seemed as true of that quite daunting assembly of elderly Galeshewe nurses beneath whose kindly demeanour was the same no-nonsense rigour we knew in our mother.

What’s happened to all that? Of course, such a question deservingly attracts suspicion; nostalgia can be deceiving in a world that changes mostly for the better, and anyone who has been to hospital recently will know there are many nurses — and doctors, surgeons and all the rest — who are every bit as selfless, stern and caring as Florence Nightingale herself. Equally, in the old days, the chronic racial disparity in health spend was itself a risk to the majority and a token of profound neglect.

But we do have a problem. As my Institute of Race Relations (IRR) colleague and head of policy research Dr Anthea Jeffery has pointed out, a staggering 85% of public clinics and hospitals cannot comply with basic standards, even on hygiene and availability of medicines. Mounting medical negligence shows in compensation claims totalling R56bn — more than a quarter of the entire R201bn current public health-care budget.

The IRR report collating more than 100 media reports on negligence, corruption and mismanagement in public health between April 2017 and August 2018 provides tragic insights.

There is the 13-year-old boy losing both feet, his left hand and four fingers on his right hand following complications after appendix surgery — a broken lift meant that he wasn’t taken to a high-care ward after the operation, and the amputations followed an infection that affected his circulation.

There is the toddler left brain damaged allegedly because of nursing staff responding too late to her choking on vomit after surgery, and a baby losing an arm to amputation when infection set in after an intravenous drip was incorrectly inserted. Those who can afford it can mostly avoid these risks by paying for private health care. But, here, the looming tragedy is twofold; the government’s dogged commitment to National Health Insurance will not stop the rot in public health care but will erode excellence in private health care.

The real answer lies in merit-based appointments, strict accountability for poor performance, and effective action against corruption and wasteful spending, coupled with easing the burden on the public system by increasing access to private health care.

We don’t need a new, vast and expensive bureaucracy; what we need are basic procedures whose curative effects are unimprovable.

Any good nurse could tell you that.

• Morris is head of media at the IRR.

https://www.businesslive.co.za/bd/opinion/columnists/2018-10-01-michael-morris-the-heart-of-public-health-needs-defibrillation/

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