STRIKES 18/9/10 till.........

Day 1
So the long anticipated strike hit our hospital today, as it did in throughout the rest of South Africa.
Unions affiliated with Cosatu, South Africa's main union federation, went ahead with the strike after the government failed to rise up to their request of an 8.6% rise, but did place a no unreasonable 7%. Generally the strike took a slow start but this would be made up in the coming hours and days.

It all seemed a bit unreal in many ways, we abandoned our usual grand ward in the morning and people scattered to assess the damage the wards, we had no real preconception of what the following days would be like.
But I had heard strikes by unions in general, are far from civil marching, in preceding years people have been intimidated, verbally abused and physically beaten.

So when I went down to the front gate which is where all the protesters were singing and dancing and blowing Vuvuzela's, I got to see the crowd in full view, police cars were lined up and the security guards were surrounding the gate. Several protestors were carrying snooker poles and bats and someone was just sporting a Robert Mugabe tea towel on his back. I was amused at this general folly which was to later to turn to dismay. I managed to take a few sneaky pictures though people in the frontline, though we kept getting shouted at to not take pictures.
Then I heard that some poor older security guard had been bashed with a cricket bat for turning up o work, by a thuggish HR worker. We were of course outraged and Victor, the manager was infuriated and had that man down a definite sack when the protest was over.
Going to the wards felt very odd, it was extremely peaceful and quiet, there were a few matrons around and some senior sisters and no other nurses. The matrons worked brilliantly, doing all the cleaning, changing all the beds, dishing out medications. I cracked on with my ward round, very aware I had a full ward with very sick people in it. But with the help of my medical student and the dietician (Elvis) to translate, we whizzed by. I rushed off to my antiviral (ARV) clinic, which surprisingly was full and the patients had been let through luckily. But staff levels being low at clinic meant that getting notes and drugs was a bit of a hassle.
The A&E section was almost bare as no patients were coming through, I suppose many people were worried they would be attacked or not receive help so decided the best bet was to stay at home.
All of us united in the doctors office at the end of the day, a little confused by it all but not terribly overwhelmed.

Day 2
The strike heats up, tempers rise and strikers get more confident, luckily for us most atrocities occur in the cities. Horrendous stories of people being beaten, stripped naked, nurses dragged out of theatre. Its awful.
Here in Mseleni, the picket line was hot with dancing and chanting but fewer people it seemed.
Far far fewer nurses turned up to work too, it was only the matrons really, who were already broken from yesterday.
It was unclear if the reason was because they were actively wanting to protest, or fearful of being targeted or if they were just taking advantage of an excuse the not turn up to work. I have to admit the latter did seem to dominate most of our minds. Wrong though it may be to say, nurses working here, more often than not, are not nursing for any interest or care for the job. Infact 'nursing' seems to be far from what a lot of them are interested in. Nursing as a job here, is a career that enables you to make a lot more money than you would normally, consequently enabling you to get a new hairstyle a week.
Wards were being emptied at a rapid rate and people being told to look after their sick at home, with uncertain cleaners, linen and kitchen staff, this was a crisis. Then suddenly, from the local town a load of volunteers turned up and were distributed to help out anywhere they could. They put on aprons and gloves and were sent to all sectors to carry out various jobs.
Us doctors we marvelled, A&E was still quiet, but we did our observations and gave our inpatient's medications, dished out prescriptions in pharmacy, took bloods, treated the sick and did so cohesively.

That night, nurses were sparse, one for two wards. They were sparked with fear and were planning to leave at 4am so as to not risk being followed home if they lest at their usual shift end time. After hours two doctors man the hospital, but this evening we all pitched up to do the drug rounds and general reviewing of sickies, the camaraderie was great and the oncall doctors felt the love.

Day 3
It had been a stormy night and the weather carried onto the day, it was chilly and windy, I donned my trainers and a scarf. The picket line seemed lower in numbers but still loud in volume and conviction, as nursing levels were at their scarcest. Bins hadn't been changed, linen not washed, surgical equipment not autoclaved, the place was coming to a standstill.
I began by discharging the last of my patients, with 'to go home' medication and appointments to return after the strike - Renal failures, cryptococci meningitis, liver failures - if you could breath without oxygen and stand, you went.
Then went round all the other wards mopping up jobs, discharges, medications to be done. Being oncall for labour ward too, I was summoned to theatre to help with a c-section. We had one nurse and the wife of the other doctor who carrying out the section and proceeded relatively smoothly. We functioned and we were cohesive and we genuinely wanted to do the best we could.

Today felt different though, because it felt that this outlandish event was finally real. The disbelief that clinical staff could actually strike and compromise and actually cause death was inconceivable to me . Going to the gate at lunch to take a look, I was very dismayed when I saw several staff members that were that I thought were good workers and my friends, at the front line dancing away and blowing Vuvuzela's. Our viewing got cut short as protesters shooed us away and said we couldn't watch and of course banning us from taking pictures. The security guards got very twitchy and said we must leave. The concept of a public protest that the 'public' couldn't watch is a ridiculous concept and surely defies the point of a protest? Apparently not.

These are truly eventful times, certainly for an outsider like myself, where in the UK such strikes from medical staff would be inconceivable.

How do professionals responsible for life and death of people defer on a mass scale and reject their responsibilities?
Its made me think a lot about my role as a doctor, I grant that many people do not have a choice to often choose a career for its mere satisfaction, but they do a job because it is a job and an income. The healthcare profession though, has to be different because it incorporates the responsibility of sanctioning life and relieving pain. So even if you could on legal grounds be allowed to strike for the sake of a point to be made or changes to occur, how can you on a moral level carry the burden that someone somewhere being unable to receive life saving treatment and died - it could be your mum or sister or daughter?
Nursing in my mind, has as much as a role in duty to care and relieve distress as doctors. But I fear nurses here do not have that inclination, considering almost all of them were on strike. It is a mere job, that doesn't even pay enough. And the nurses who did turn up spent a considerable amount of time moaning about the fact they were here, though face-to-face I thanked them and made them feel as appreciated as possible, always reinforces good behaviour if it occurs;)
Patronising it is and also quite disheartening, that I the foreigner, having no real tie or connection to the patients, didn't question why i was here and why i didn't get a tea break and why I was working the job of a doctor and ten nurses. The fact is, I am a doctor and I have a duty to care and will fulfil it and be able to live with myself. For nurses, it seems it is a favour they bestow upon us to help us, rather than the cause is ultimately in everyone's benefit, to help people, save lives and do what is right.

And the protesters rejoiced in their perceived feat for the day, starting to dissipate at 4 (when work finishes!) and to return for another day or not? We all decided to stay on the grounds this weekend, so if disaster shrikes and a sudden boom of patients enter through the doors we are prepared.......