The Disability Grant

You will not get through the day without having a patient consult for a DG. It stands for Disability Grant and is a state issued benefit, which rather tragically is the main source of income in this area.
The DG being a finite resource, it is meant to be to candidates who fulfil a specific criteria. Essentially, you have to have quite a serious degree of disability and functionally incapacity (practically dependent on others for activities of daily living) which isn't reversible in order to qualify. Once the benefit is obtained, you have it for life more or less.
The gatekeepers to this grant are us, the doctors. I find this position find highly contentious. Often you have never met the patient before, you rely on information from the records to tell what the problems are and there is the constant factor of poverty that they highlight to you. The aim should be to objective and try and get a functionality assessment and if you are struggling with this, there are Occupational therapists who do these extremely well. Many DGs have been given out to patients who wouldn't technically qualify because of the constant overlying factor of poverty. But spot checks are performed and the rest of the multidisciplinary team frown on spurious handing out of DGs.

Unemployment and opportunities being scarce here, there is little else for people to live on, so a visit to the doctor for a DG is an attempt at survival I suppose. In the past with the advent of HIV, DGs were being distributed out in mass, particularly if you were stage 3/4 disease or had low CD4 counts. Prior to accessible antiretroviral medication, HIV was certainly a terminal illness. Now that antiretrovirals are available and free there has been a shift in the handing out of DGs, so it is based on functional capacity as I have mentioned previously. Unfortunately, we see many patients requesting the DG because of their positive status rather than debilitation.

This scenario highlights resource allocation and obligations we as doctors have in a impoverished region with very limited capital. The balance of trying to look after our patients and their welfare and not bankrupting the state, has and is an unremittingly difficult position. In parallel as a doctor in the UK I have had similar scenario with sick notes and repeated sick notes. But knowing that there was limit and that eventually social services would take the role of determining those who qualify for sick leave benefit by means of their own specific occupational doctors.