A classic case of economic ill health

Posted on November 3, 2018


In the wake of South Africa’s dismal outlook presented in the medium term budget statement and the hype surrounding what much of the labour movement sees — justifiably — as the rather light-on-substance investment summit, who noticed shocking figures announced by health minister Aaron Motsoaledi? He stated in an interview that while the health contribution for 84% of the population had declined by R9 billion, the 16% dealt with by the private sector had benefitted to the tune of R11 billion: a R20 billion welfare gap.

In major urban areas the situation is exacerbated by the huge and continuing influx of population. At the same time, service provision has not kept pace and, in many cases, has declined.

Then there is the massive shortage of skilled health workers and the shambles that sometimes passes for administration in various public sector hospitals and clinics. This results in many unpublicised and unnecessary casualties along the way, resulting in workers being crippled and forced out of work, becoming burdens to their families and the state.

The stories of three women workers in the Western Cape seem to epitomise this problem. Zodwa is a freelance domestic worker, Venitia an admin office assistant and Kate a landscape gardener who employs two assistants. All live in the greater Cape Town area which is generally regarded as providing better levels of public health care than most other centres.

What these women have in common, apart from the fact that they have to sell their labour in order that they and their families survive, is that they live with constant pain and have difficulty walking. As matters now stand, they also have no hope of undergoing the operations that could liberate them.

Venitia, as an office worker, is at least able to spend most of her working day sitting down. But she has to get to work from a far-flung suburb. She needs to travel by train on a service that is notoriously unreliable and unsafe. So she leaves in the early hours to catch the first available train to get to her office in the Salt River suburb on time, putting up with an often 14-hour day nearly half of it travelling on or waiting for trains.

Venitia’s problem is exacerbated by the fact that she can no longer cope with stairs — and the Salt River station has two flights, up and down from the platforms. So she travels all the way into Cape Town where she can hobble on level paving to get to a bus to take her back to her workplace, repeating the same process to get home.

It adds additional cost to an already stretched budget, but this mother of two has managed — “with the help of pain killers” to keep her job. Zodwa, also still manages, with the aid of clinic supplied pain killers, to keep some of her work.

She has similar problems with transport and mobility using both trains and taxies, but also having to hobble along suburban streets for considerable distances. She has lost jobs over the past year either for being “too often late” or because she could no longer complete the demanded work in time.

“It’s my hip,” she says. “I just can’t do some of that work any more.” The same applies to Kate, the landscape gardener although it is her knees that need replacing. All three agree that, sooner, rather than later, the pain will become too much and they will no longer be able to do any work.

But this is just one aspect of a public health system that seems to be on a steady, downward spiral that punishes the poor, whether employed or unemployed. Ten years ago, had they been on a waiting list, the three women stood a reasonable chance of being treated within two to three years.

Now there is no chance and it is small consolation that their affliction will result in painful disability and not death. In KZN there are reported cases of cancer patients put on six-month waiting lists who have died before they got to see a specialist.

In all cases, the stock answer from officialdom is that the situation results from “a resource restrained environment” and one in which there is “too much trauma”. Trauma simply means physical injury sustained, usually through an accident and, throughout the world, trauma cases are prioritised. Yet the greater the population, the greater the incidence of trauma.

In centres such as Johannesburg, Cape Town and Durban, this means that operating theatres are overwhelmed although, in some cases, they are under-utilised. “Elective”orthopaedic cases — those just as debilitating, but caused by arthritis — stand no chance of treatment for those who do not have nearly R200 000 to pay to “go private”.

Against this background, it should come as no surprise that there is increasing resentment about health care that relies on the contents of bank accounts rather than the seriousness of illness or disability. Or that R9 billion can be cut from public health care when multi-billion rand bailouts go to apparently pillaged state-owned enterprises such as SA Airways and Air Express.