My Experience at Victoria Hospital and Thoughts on The South African Healthcare System

I had an extremely humbling experience at Victoria Hospital. It was nothing that I expected or had pictured before and it totally opened up my eyes to what another healthcare system was like firsthand.

Me and two other students were given an official tour with CIEE at Victoria Hospital. We would be meeting with two doctors in their office to learn about the hospital and the healthcare system and then be taken on a walking tour through the hospital.

The first doctor we met was a gentleman named Dr. Nasief who is considered a specialized physician. He was an interesting person, in the sense that he was all about the hard facts and was not afraid to tell things as they are. This is some of what I took from our conversation:

Victoria Hospital is considered the best public hospital in all of South Africa. There are two levels of care: the public and the private. South Africa has the highest gap of the rich in poor in all of Africa and this makes it especially hard when entering the healthcare system. South Africa also is considered the most unequal society in the entire world (!!?) The rich are richer and the poor are poorer. I have seen income inequality firsthand living in Los Angeles, but here its just as present. This, naturally, creates HUGE implications on health.

2/3 of the healthcare money from the [corrupt] government system is spent on the private sector, that means 60% are in the private and only 40% is in the public. 18% of the people in the country use the private sector and 80% use the public sector, but only 40% of the money is actually there. This means there is SUCH a need in the public sector, but there is not appropriate funding given in that direction.

The private hospitals are extremely nice compared to the public hospitals. Thankfully, I have not been so sick that I need to go to one of them, but the general understanding it they are cleaner, have more staff and have way shorter wait times than at the public hospitals.

In the public sector there are three levels of care. Primary, is considered more family medicine/community based health care. There are no specializations, in it- more so holistic care. Secondary, are hospitals where people get referred to after being at a primary care doctor. Victoria Hospital is considered a secondary level of care because there are doctors with varying levels of skills and specialties with many different departments. Then there is Tertiary, which are extremely specialized centers for specific needs. If you could believe it, in the public hospitals, each doctor must see AT LEAST 50 patients a day. That means about 5 minutes each per patient. It’s like a factory. The quality of care is horrific compared to what we are used to in the states.

I learned some about life expectancy as well, some of which I already knew. The white females have the greatest life expectancy, then white men, then Indian females, then Indian men, then black women and then black men with the lowest life expectancy. Life expectancy is really low in Cape Town. Dr. Nasief seemed to be just throwing out numbers so I need to research the exact value, but what I took from what he was generally saying was that for whites its around 72, 62 for colored and 52 for blacks. INSANE. There was ten years added to the life expectancy because of HIV treatments becoming readily available to the public. This means that for black males life expectancy was just RECENTLY around 40 years old. It’s hard to fully wrap your head around a life like that.

What is so terrible about what the doctors at Victoria Hospital see is that the patients present late with advance diseases and they are mostly non-communicable diseases. They rarely have the chance to see a doctor because there is such little preventative care. The government puts such little effort into public health and preventative medicine. By the time one makes it to the doctor, they are so so sick that there is little the doctors can do to help them. Dr. Nasief usually will see a patient in heart failure, which is so upsetting because in most cases it can be prevented with diet and life-style changes. 25-30% of the patients they see have TB or HIV. In hospitals in Durbin, 82-90% of their patients are HIV positive. This is so common that if they find a patient who comes up negative on a test, they have to redo the entire test and triple check it because of how rare it is to see that.

At Victoria Hospital they have all of the basic staff, but in a limited capacity. Dr. Nasief said that African medicine, though, is all focused on the bedside where as US medicine is moving away from it. They want to develop a system like Canada and the UK, but it seems that there is a long way to go. In Africa, they focus on meaningful engagement, supposedly, with the patient (This was not the experience of what I saw though walking through the hospital).

After speaking with Dr. Nasief, Dr. Clint Cupido came to speak to us. He runs the ONLY palliative care program in all of Africa that I was discussing in my previous post. It’s called abundant care. I could feel his passion just by sitting there listening to him speak. He saw that there was a huge need for this in South African hospitals so he decided to make it his life goal to give everyone the care they deserve as they exit this earth. He had seen too many patients take harsh dying breaths and wanted to be the face of change. He said it’s sexy to have cancer (uhh no??): you can wear pink, run, ride bikes, it’s been so promoted and socialized by the media. But dying, death, old people: that’s not sexy. The elderly don’t add anything to society, he says. He’s true in his observation about where attention is placed for sure, but still there is nothing “sexy,” per say, about sickness. He is spot on with his view of the elderly though.

When attempting to get the palliative care program started, which focuses on holistic physical, emotional, spiritual and mental care for the patient and family, he received immense push back from the South African government on his desire. They wouldn’t give him the proper funds and communicated to him that palliative care does not belong in hospitals. After hearing such a bold statement, he then conducted an in depth study to prove that, yes of course, it does belong in hospitals. He was able to show the government, through numerous positive patient outcomes, how needed and effective palliative care was in a hospital setting. He only saw positives from it and now has presented this study all over the world. It was interesting because he said just this past weekend he had presented the study in Cape Town after being in other major cities like London, New York, Vancouver and San Francisco.

When I physically walked into the hospital it was unlike anything I had ever been exposed to in my entire life. Each department is split up on different levels just like the hospitals in the US, but patients were lined in beds like animals alongside each other with minimal space and air to breathe. There was no privacy, not comfort, no feeling of safety. It was not sanitized, understaffed and totally under resourced. Each floor is separated by gender because of a previous rape problem in the hospital. I felt a chill run through my entire body upon hearing this.

We walked into one of the female wards and as we entered we saw see a woman crying. She was probably in her mid 40s. As we continued, literally just walking through the room, we saw a white sheet over a bed near by her. It turned out she had just lost her mother. It felt cruel that her mother was laying there, objectified so publicly, for the entire room and us as onlookers to see

After going through that ward we made our way to Abundant Life. The palliative care unit was just one small room with a doctor and a bed. They do make a lot of their visits to the home, but it was not what I would have imagined for the only palliative care unit it Africa to be like. Cupido spoke in such a passionate way and this just kind of seemed half created. It was not set up in to be a positive environment and seemed very underwhelming to me, but hey at least it was there.

The psychiatric ward I think was the hardest one for me to see. The patients were again filed tight together in rows of bed, but the psych ward was inside a cage like setting with two security guards standing outside. It looked like a prison. There were women in there with long looks on their faces pleading to be removed. They had the craziest of the crazys with people with surface psychiatric problems they were working through.

I tried my best to hold back tears as we continued on through the tour. I felt so uncomfortable, scared and out of place. I was walking through the halls and feeling eyes and eyes upon me. I didn’t felt like I belonged. I felt like a white burden in an African, judgmental world. I hated how they brought us to walk through this place like it was a tourist attraction. I know a lot of this was my own perception. The staff and doctors were nothing but nice and friendly Cape Townians, but I felt so on edge.

The entire experience was really emotional for me, so incredible humbling and another reinforcer of how lucky I am to have been given the opportunities and upbringing that I have. I decided that it probably is not the place I want to volunteer my time, just because I want to have an experience that is positive and makes me feel good as I am making others feel good. This wasn’t the proper setting to foster that, but I am in search of a meaningful volunteer project that makes me feel like I am giving something greater than myself to the Cape Town community. All in all it was an experience I won’t forget for a long time. Crazy that this is supposed to be the epitome of health here… publically.