Doctor shortage forces leading African children's hospital to refuse emergencies
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《英国医生杂志》
An acute shortage of doctors at Africa抯 largest children抯 hospital, the Red Cross Children抯 Hospital in Cape Town, has forced the hospital to begin refusing emergency admissions.
The hospital had to close its emergency intake wards at night because it had only five doctors doing the work of 14, as vacant posts lie unfilled. In South Africa graduating doctors must undergo a community service programme for two years before they can practise on their own, but the hospital says the Department of Health has failed to place any graduating doctors at the hospital this year.
The hospital抯 decision has also galvanised the health authorities to make emergency plans to fill some of the shortages at the Red Cross Children抯 Hospital, a process that can only be temporary, as more than half of places for doctors are unfilled in several large public hospitals in the country.
At the heart of the problem of the shortage of doctors both at the Red Cross hospital and throughout the country抯 public hospitals are bad working conditions, long hours, and poor pay. The situation has been exacerbated by the continuing exodus of doctors from the country.
Several new pieces of legislation place new restrictions on doctors in practice, for instance: around 10,000 doctors in private practice dispense medication, but the law now states that only in certain areas will this be possible, and doctors who want to dispense will have to pass examinations in the field and have appropriate premises. Laws governing medical insurance have also placed added administrative burdens on doctors.
The Red Cross Children抯 Hospital has a crucial role among the impoverished community of the Western Cape. It takes in an unusually large number of children who have been seriously burned in shack fires or who have other injuries such as gunshot wounds.
But it is far from the only hospital in this situation. The neighbouring academic hospital, Tygerberg, is short of almost as many doctors.
The head of the South African Medical Association, Dr Kgosi Letlape, lays the blame for the shortage at the door of national and provincial health authorities and more specifically at the underfunding of the public hospital sector.
Short term measures, such as recruiting doctors from overseas, have brought their own problems. Foreign doctors face a long and difficult process of written examinations before they can register locally. It also seems that they are subject to unexplained delays.
In recent weeks the statutory registration body, the Health Professions Council of South Africa, has agreed to fast-track the registration process to relieve pressure, and authorities have agreed to advertise the vacant posts in journals abroad as well as locally.
However, pay is low. Junior doctors, for example, earn 180 000 rand (?6 000; $30 000; $24 000) a year, similar to what a fairly junior clerk in the health department would earn.
Health staff generally face shortages, with AIDS taking its toll both on morale and on the health of nursing staff, who are dying at such a rate that their jobs cannot be filled by trained staff.(Johannesburg Pat Sidley)
The hospital had to close its emergency intake wards at night because it had only five doctors doing the work of 14, as vacant posts lie unfilled. In South Africa graduating doctors must undergo a community service programme for two years before they can practise on their own, but the hospital says the Department of Health has failed to place any graduating doctors at the hospital this year.
The hospital抯 decision has also galvanised the health authorities to make emergency plans to fill some of the shortages at the Red Cross Children抯 Hospital, a process that can only be temporary, as more than half of places for doctors are unfilled in several large public hospitals in the country.
At the heart of the problem of the shortage of doctors both at the Red Cross hospital and throughout the country抯 public hospitals are bad working conditions, long hours, and poor pay. The situation has been exacerbated by the continuing exodus of doctors from the country.
Several new pieces of legislation place new restrictions on doctors in practice, for instance: around 10,000 doctors in private practice dispense medication, but the law now states that only in certain areas will this be possible, and doctors who want to dispense will have to pass examinations in the field and have appropriate premises. Laws governing medical insurance have also placed added administrative burdens on doctors.
The Red Cross Children抯 Hospital has a crucial role among the impoverished community of the Western Cape. It takes in an unusually large number of children who have been seriously burned in shack fires or who have other injuries such as gunshot wounds.
But it is far from the only hospital in this situation. The neighbouring academic hospital, Tygerberg, is short of almost as many doctors.
The head of the South African Medical Association, Dr Kgosi Letlape, lays the blame for the shortage at the door of national and provincial health authorities and more specifically at the underfunding of the public hospital sector.
Short term measures, such as recruiting doctors from overseas, have brought their own problems. Foreign doctors face a long and difficult process of written examinations before they can register locally. It also seems that they are subject to unexplained delays.
In recent weeks the statutory registration body, the Health Professions Council of South Africa, has agreed to fast-track the registration process to relieve pressure, and authorities have agreed to advertise the vacant posts in journals abroad as well as locally.
However, pay is low. Junior doctors, for example, earn 180 000 rand (?6 000; $30 000; $24 000) a year, similar to what a fairly junior clerk in the health department would earn.
Health staff generally face shortages, with AIDS taking its toll both on morale and on the health of nursing staff, who are dying at such a rate that their jobs cannot be filled by trained staff.(Johannesburg Pat Sidley)