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The Public Sector is a Public Affair

Lily Zhou, Public Health and Development in South Africa, Spring 2013

South Africa’s health care system is quite simple to explain but emotionally difficult to observe. To give some background information to our excursions, the healthcare system is two-tiered: the public sector is basic, state-funded health care that is free to those who qualify, while the private sector is specialized and caters to a middle-to-upper class population. Despite the private sector only serving 20% of the population, it receives 80% of the nation’s doctors, making the public sector—which serves the remaining 80% of the population—severely understaffed and underfunded. These ratios mean little until you see what operates on a grassroots level at South Africa’s public and private clinics.

During one of our public health excursions, we visited Macassar Community Health Center, a public sector primary level center serving a mainly coloured population. In an already crowded waiting room filled with mothers and the elderly sitting in plastic chairs, the twenty of us only exacerbated the bottleneck in the busy hallways. A high-pitched beep would sound every few minutes in the overhead speakers to signal for the next patient in line to be seen by one of the few nurses. Lining the walls were posters conveying information that would seem superfluous or unnecessary in the context of a typical American hospital.

A poster outlining home-made oral rehydration therapy procedures to counteract dehydration caused by diarrhea

Here, however, the simple messages transmitted through these posters are essential. Fetal alcohol syndrome (FAS), for example, is a very common developmental defect children are born with in South Africa. Within the beautiful grapevines and wine farms in Stellenbosch’s valleys, we learned that a few of the less ethical farms pay their workers in wine instead of money. Drinking is so normalized and ubiquitous within some townships that children as young as 7 start experimenting with alcohol. Apparently, it is a common phenomenon in some communities for expecting mothers to purposefully consume alcohol in order to increase the chances that their children will be born with FAS—all because the government will provide these families with more social grants along with food/clothing passes. Initially, these seemingly reckless actions would have been morally inexcusable for me to fathom. Now, I’ve come to understand more about the volatile environments these women live in that drive them to such acts of desperation. Absent fathers, a lack of male role models, poverty, and inequality are at the crux of why these acts occur.

Our tour of Macassar’s Center quickly elucidated just how literal the “public” in “public sector” is. The building’s infrastructure simply did not support or have room for individual check-up or treatment rooms. For more severe cases, patients would be separated from the others with a privacy drape. During our tour, our doctor guide disappeared behind a drape and came back out several seconds later telling us that he got the permission from a patient for us to observe his condition. When the drapes were pulled back, we were greeted with an unsettling sight of an extremely thin black man twitching and groaning in severe pain on a bed. This man was suffering from a supposed kidney stone. I say supposed because the clinic did not have available technologies—X-rays, lab tests—to properly diagnose him, so the doctors could only make educated guesses on his diagnosis. Treatment was also limited, as surgery was out of the question. Such is the high level of medical uncertainty in a field with limited resources.

While the conditions in the Macassar clinic weren’t ideal, they surpassed my expectations. The facilities seemed adequate and care was comprehensive, covering TB, HIV, maternal and child health, etc. It was only upon walking into the private hospital MediClinic that I became shocked at the heavy contrast between the two, both in facility quality and patient demographic. MediClinic—a ten minute drive from Macassar—was as well-off, if not more luxurious, than American hospitals I’ve visited: patient care was private, there were no visible waiting lines, and the hospital even seemed somewhat empty. Private rooms were equipped with comfortable electronically-adjustable beds and flat screen TVs. There were surgical rooms for heart and knee-cap surgery. Hallways weren’t filled with wrinkled posters outlining TB prevention or hygienic practices, but rather with aesthetic framed paintings of flowers and children. Never had I thought about potted plants, elevator music, and small coffee shops within a hospital as signifiers of privilege.

Privilege truly is defined by relativity and invisible to those who have it.

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