On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.100 n.7 Cape Town Jul. 2010
Surviving in the public sector
To the Editor: I have read the latest Med-e-Mails from SAMA with increasing distress. The apparent failure of our new Minister of Health to solve the problem of enabling doctors to negotiate just salary increases, because of labour legislation, is sad indeed. The obvious anger that this has evoked among members of the profession is very serious. It is awful to hear threats of resorting to strike action once more in this essential service. We can expect that the brain drain will again accelerate. Medical and nursing staff who decide to stay in the service for love of our people will be increasingly open to burn-out and discouragement.
My experience of 48 years in the public health structures of this nation suggests that those who stay will not find help in coping from the Department of Health. Those sensitive to their neighbours' pain then often find the situation intolerable - they have to opt out for their own well-being. My own experience of that, as a gynaecologist in a rural KZN town, came in 2001. Dealing with as many as 120 child rapes per annum over a period of 10 years upset me so much that I had to pass this important and difficult work on to more junior staff with less experience. Now, with more time to consider the problem, I realise that medical staff in public hospitals must take care to structure their own support, which can be done in several ways.
Those of us who are members of faith communities will usually be able to find a mentoring individual or group to provide a secure place where we can off-load and find objective insights to help deal with our own pain.
In the 60s and 70s, in a deep rural mission hospital, our weekly journal club was run in such a way that we could give one another mutual support. That sometimes included insisting that someone take time off. We were a small group of 5 doctors looking after 550 inpatients. But there is no reason why like-minded doctors should not form small support groups even in the largest hospital. That is better than always taking flight from a difficult situation without helping one another to make it more bearable.
Any person who becomes aware that they are suffering from significant burn-out (illogical rage reactions, sleep disturbances, depression, etc.) should seriously consider seeking the help of a psychologist. That decision has significant financial implications, but if one chooses the right colleague, it will be well worth the expense.
These and other similar solutions should be sought in good time by all who feel strong enough and who desire to stay and work for our people. It is often too late to begin when one is actually in crisis. In that situation, the only sensible way to cope may be to leave!
J V Larsen
Private Bag X010