Before coming to Afica I was troubled by this point. If I was prepared to donate 6 months of my time to the cause then how should it best be spent when looked at from the point of view of the patients. In short, should I go to Africa and do the work there or alternatively should I stay in the UK, live in a tent in field whilst working extra hours in a UK hospital but sending all the money to someone I trusted in Africa. The thinking was that although the former would be something I would prefer to do for myself perhaps the potential receipients of my 6 months labour would prefer the latter and maybe that was what I should actually do.
While it hasn't taken me all year to work this out I now realise that without a shaddow of doubt the right thing to do is to come and do the work here. As I have eluded to before in these posts it is the shortage of human rather than financial resources that is the biggest problem most of the time.
I'm therefore left wondering if there shouldn't be a shift in thinking regarding the financial needs of hospitals like ours. I will stick to the doctor situation for now although the same could be applied to most other groups. There are 8 doctors working here of whom 5 are foreign, 1 is here as a part of compulsary service and only 2 are South Africans who are here by clear choice. There are 140,000 patients under our care and we are in the middle of an HIV/TB pandemic so the ratios are in no-ones favour. The bottom line is that rural African hospitals can't rely on do-gooder foreign doctors like me in the long-term . I'm personnally very happy with the terms and conditions here (except the lack of hot water!) but I'm not talking about me. For sure a limited amount could be done by tightening compulsary service rules for South African doctors but the reality is that large numbers of staff will only want to come here if the living conditions are excellent and to put it bluntly the salaries are very high.
Significant funds have indeed been chanelled towards improving staff living standards but I can imagine that it would be extremely controversial to direct extra resources towards higher salaries. What I would say is 'look at it from the patients' perpective'- would they rather have a bunch of extra doctors and nurses and rehab. staff etc. or more expensive pieces of equipment that no-one knows how to use or get fixed when they are broken? I think the answer is clear but I suspect the change is very unlikely to happen. Perhaps I should go back to the UK and live in my tent and use the money to fund extra salaries after all!
Wednesday 30 July 2008
Saturday 19 July 2008
Cleaner hospitals
Before I left the UK I remember that 'Cleaner Hospitals' had become a new political catch phrase, along with 'tougher on crime' and 'small class sizes' etc. I also remember when the previous government privatised hospital cleaning in the UK. As I recall they basically sacked all the cleaners on Friday and by Monday same people were hired by the new cleaning companies but were paid less money, it was one of those great advertisements for the motivational attributes of the open market.
Well, the Eastern Cape government can now claim to be ahead of the UK government on both counts. Until recently the hospital was cleaned by a group of generally older women who mopped the floors with various degrees of enthusiasm and kept it reasonably clean. However, someone somewhere decided to contract out the hospital cleaning to a private firm. So one day a whole new army of cleaning staff clad in heavy grey uniforms weilding yellow signs with flashing lights on top started patrolling the corridors. There are so many of them that it can be an obstacle course getting from one ward to another but the place is looking pretty spick and span. I don't think people have to worry too much about hospital super-bugs around here anymore- so one up for the Eastern Cape.
The killer move however is that instead of sacking the old ladies or making them carry yellow signs with flashing lights they just continued to employ them. They have been farmed out to some of the peripheral wards in droves, they now seem to have even more time for gossip and seem to be loving it. This means that since privatisation we effectively now have two complete teams of hospital cleaners working on the same hospital at the same time and no-one has been sacked or had their pay cut. Now why didn't the UK government think of that?
Well, the Eastern Cape government can now claim to be ahead of the UK government on both counts. Until recently the hospital was cleaned by a group of generally older women who mopped the floors with various degrees of enthusiasm and kept it reasonably clean. However, someone somewhere decided to contract out the hospital cleaning to a private firm. So one day a whole new army of cleaning staff clad in heavy grey uniforms weilding yellow signs with flashing lights on top started patrolling the corridors. There are so many of them that it can be an obstacle course getting from one ward to another but the place is looking pretty spick and span. I don't think people have to worry too much about hospital super-bugs around here anymore- so one up for the Eastern Cape.
The killer move however is that instead of sacking the old ladies or making them carry yellow signs with flashing lights they just continued to employ them. They have been farmed out to some of the peripheral wards in droves, they now seem to have even more time for gossip and seem to be loving it. This means that since privatisation we effectively now have two complete teams of hospital cleaners working on the same hospital at the same time and no-one has been sacked or had their pay cut. Now why didn't the UK government think of that?
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