South Africa is a remarkable country, not just for the mere obvious attributes, like the superb weather, unparalleled history, Game Parks, Beaches, extraordinary medicine and disease etc.
What I have found quite remarkable is the huge disparity in healthcare within the country.
South Africa is far from a typical African country. Having ownership of a city like Cape Town which feels like an idyllic Mediterranean town, to the other end of the spectrum being KwaZuluNatal - unruly, unpredictable and impoverished but undeniably beautiful in its own right.
Medicine seems to follow a similar path of immense disparity. In KZN we have rural hospitals, with limited money and resources and doctors, in Durban, four hours drive away we have the state of the art tertiary hospital with a mountain of specialities.
Its clearly a socio-economical issue why the standard of health has no uniformity, but the government try to tackle this by ensuring bush hospitals have a supply of doctors, by making it obligatory in their second year to do a community service - comserve. And it is not just doctors, but other health care professionals, like physiotherapists, occupational therapists and dieticians, much to the benefit of everyone really. As it is an obligatory part of the career of most government workers are aware of the healthcare structure, or so you would think.
I have found on a number of occasions being very confounded by the lack of insight to bush hospital structure, by our referral hospital colleagues. At Mseleni, there is a constant problem with urgent blood samples, running out of cartridges for blood gas machines, finding appropriate equipment when needed, US probe breaking, valves for BIPAP going missing and on and on......
So when the accepting doctor at the referral hospital asks you to do all the above then ring back, my frank refusal and clear portrayal and the resources we have to work with in the time frame the patient has sometimes gets the patient sent across and sometimes not.
So referrirng patients is a challenge but when successful, satisfying.
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