Instead of saving lives in hospital, 27-year-old Sherwin Prim, who spent 10 years qualifying as a doctor at the University of the Witwatersrand, is in jobless limbo.
This is Prim’s depressing lot since he finished his internship on April 30 in Cape Town. The Department of Health (DOH) told him there was a delay over the allocation of posts in community service and internship positions, the next stage in his career.
“Fortunately, my mom has taken me in and I still have my car,” he says.
Every day Prim hopes for a post before his life savings run out – a reality unimaginable when he moved down from Johannesburg to take up a bright future as an intern two years ago at the Tygerberg Hospital.
“I can’t practice as a doctor at the moment. It is illegal. It would be against our professional regulations… I can only do so once I have completed my community service,” says Prim.
The rules say doctors need to intern for two years, after graduation, plus complete a year of community service to be allowed to operate within the law. According to the DOH, posts open in two cycles. Once at the beginning of the year, to accommodate those who have qualified in the standard period, and in mid-year for those who qualify later.
Prim hoped in vain for the second cycle, which would have meant a starting date of May 1.
“I have been waiting for the last three months without a salary. It is a serious administrative issue.
Doctors are being misinformed, they are not being allocated to positions.”
It means Prim went from an average internship salary of R380,000 ($28,400) to moving back home to Johannesburg with his mother. These days all he can do is part-time work as a tutor at the university where he graduated.
“I have been doing some casual work through the university, invigilating and facilitating clinical skills with med students in the meantime. But most of this has been once or twice a week. I am not allowed to work more than 23 hours a month. It’s nowhere near my salary as an intern and works out to just R200 ($15) per hour.”
Prim isn’t alone. Other medical staff have found themselves scraping by as waiters in Spur, call center agents and estate agents.
Doctor Naira Langenbach works as a stand-in secretary in Johannesburg.
“The worst part is the unknown. The worst part is that you sit there and ask ‘when are they going to call me?’ I say to myself ‘just breathe, its fine, it’s going to be alright’,” says Langenbach.
“[At the reception desk] I try not to tell people I am a doctor, because I get very indignant, very quickly. I just want to be done with this. As soon as I am given my post I am going to go do my year of community service and then my degree will be worth something. I’ll probably do an MBA or maybe biomedical engineering. I am not going to do this anymore.”
It is worse for Langenbach because she was born in Amsterdam, Netherlands. Despite being educated in South Africa since she was nine years old, she feels she is pushed to the back of the queue.
“What bugs me most about this is my degree is the same. It’s not that I have a dodgy degree. My degree is the same as the people from my year; exactly the same, 100 percent.”
It isn’t the first time she has had to work as a secretary either. When Langenbach graduated from university in 2015, she was forced to scrape for work for five-and-a-half months before her international work permit was issued.
“Last time [I was working for] one of my lecturers, I was helping them out with their accounts. That’s what I ended up doing. It’s not a good use of my skills. Now I’m back [where I started].”
It took a year for Langenbach to get word of a community service post, and when it came she missed it.
“On Saturday, because I am an orthodox Jew, my phone was off. On Monday morning I get a snotty email saying you didn’t pick up the phone and you will have to start work on the first of January 2018,” she says.
Langenbach tracked the caller down but was too late – her post had been given to someone else. The man on the phone promised to resolve the matter. Two days later, on July 11, Langenbach received an email saying she was awarded a post for a hospital in Mpumalanga; she didn’t even apply for it.
“I might have been allocated a spot, but I don’t trust it. There have been a lot of hoax emails going around and I can’t get hold of anybody to confirm it. I have no proof, no contract, no letter, no nothing.”
“I’m broken. I’m so defeated. Even when I tried to call Mpumalanga they hang up the phone after three rings.”
“You reach a point where you accept [the delay] and say okay I’m going to [give up], if I start work I start work. But in the meanwhile I think ‘am going to become a specimen cutter for Lancet?’ The same week that you resign your hopes, the same week, the national department says they are going to open up applications. This hope that you tucked away is suddenly the size of three houses. Then they crush your hope. And you are back to asking ‘am I doing this again?’” says Langenbach.
Zahid Badroodien, a doctor and chairperson of the Junior Doctor Association of South Africa (JUDASA), says four South African community service doctors, 20 international community service doctors, 139 South African interns and 63 international interns remain unlikely to receive any employment this year because of insufficient posts.
Badroodien works at the Site C Youth Centre in Khayelitsha, a township 30 kilometers south east of Cape Town, where he sees the cost of the shortage of doctors.
“This facility sees 200 people a day and we turn people away. We have three or four doctors here depending on the day. We need more people to come into the system.”
“As a community service doctor, who works in a clinic on an ordinary day, I am here from 8AM to 4PM every day. My call [at the hospital in Khayelitsha] then starts at 5PM and finishes at 7AM. I am then back at the clinic at 7AM until 12PM. Then I go home. Then I come back the next day and it starts all over again,” says Badroodien.
This dispute is just one of many complaints by junior doctors about an online system that came in August last year. The system places around 1,200 interns and 400 community service doctors a year.
“There have been many excuses as to what the problems are. Initially we were told there were technical difficulties with the online application system. Subsequent to that we were told the difficulties were with internship posts, specifically that there weren’t enough internship posts for the number of applicants that were applying,” says Prim.
In November, JUDASA cried foul that 307 (of about 1,700) medical students applying for internship had either not been placed or were placed inappropriately. This included neglecting special circumstances because of a computer glitch which overlooked whether a student is married, pregnant or an owner of property.
The issue dates back to November 2015, when doctors got fed up with the manual paper application system that would regularly lose applications, says Badroodien.
“What I gauged at that stage was the [DOH] didn’t really understand the extent to which this impacts doctors’ personal lives, but also the people they needed to serve, the clinics where doctors needed to serve,” he says.
Beneath the surface there is also an internal battle between the DOH and provinces for the control of posts and placements. Provincial departments, that run the hospitals, make the final call. This means the DOH cannot guarantee whether a province accepts the doctor, once the posts are issued.
The process of acceptance can cause months of delay. Letters of employment are issued by the DOH according to vacancies supplied by provinces. The doctors then have to be interviewed by provinces and then issue contracts, which is the guarantee of employment. Then doctors must travel back to Pretoria to submit the contract of employment, along with the DOH’s letter of acceptance, to the Health Professions Council of South Africa (HPCSA).
“There is a lot of bias that comes in. When I was employed as an intern I was approached by a hospital to come and work for them, before I had even applied. That to me is problematic … We all have South African degrees, we all are South Africans, how are you choosing who is better placed for your hospital,” says Badroodien.
The DOH tells a different story. Aaron Motsoaledi, the Minister of Health, refutes claims that the system has been delayed and has denied the freezing of posts.
He claims that doctors are at fault, turning down positions.
“There are those who were placed in January and they declined those placements, saying they’d rather wait for the next cycle because they are not going to a certain hospital which is too rural or whatever. Others give religious reasons while others quote illness,” says Motsoaledi.
In a statement in January, Motsoaledi also addressed the concerns of JUDASA concerning the freezing of posts.
“Since the beginning of the year, we have been inundated with media queries about doctors and pharmacists who could not get employment in the public service because the government allegedly failed to place them into posts, or alternatively failed to create posts.”
“Despite trying very hard, the department is not always in a position to accommodate all the needs.”
South Africa needs every doctor it can get; a rising concern is when hospitals are forced to limit posts due to budget cuts.
In a 2016 announcement Motsoaledi said: “We want to put it on record that there are no medical posts frozen in this country. If there is freezing of posts by government departments, they have nothing to do with medical doctors as posts in the health sector are exempted. The country needs doctors to work in health facilities and therefore there is no way we can put moratorium on medical posts.”
Although the minister has denied there was a lack of posts, the DOH’s director-general, Malebona Precious Matsoso, told a parliamentary standing committee in March the DOH could not afford to hire the doctors they needed.
In Matsoso’s presentation she said the healthcare system had 45,733 vacant posts, and 351,925 filled posts. The vacancy number included frozen posts. The situation is so bad that two state-of-the-art buildings in the Free State cannot be opened because there are no health workers.
At the clinic in Khayelitsha, reality hits home. Badroodien says patients come as early as 4AM to queue and, due to the lack of doctors in other provinces, patients will travel more than 600 kilometers for treatment.
“When a patient from the Eastern Cape comes to our clinic with a broken neck to be seen by a doctor here, you need to say that is unacceptable,” says Badroodien.
“The national health department now finds itself at a tenuous junction: Find the money to open posts for medical interns or risk leaving dozens of graduates essentially unemployable,” says Badroodien.
South Africa’s dwindling economy and recent ratings downgrades could topple the country’s already fragile public health systems, experts have warned. So the next time you are sitting in the hospital and asking where the doctors are, they could be waiting on tables, answering phones or sitting at home.
Understaffed, Undersupplied, Unhappy
A 2015 study by research group Econex shows the extent of the health crisis. South Africa had 60 doctors per 100,000 citizens in 2013, while the world average was 152 doctors per 100,000 citizens.
The South African Medical Journal (SAMJ) in June released a report from 2,225 doctors that revealed the most significant reason doctors gave for leaving the public sector was dissatisfaction with working conditions.
The survey showed 60.73% of public sector doctors said the state of supplies was inadequate. Just over 66% of public sector doctors were concerned about the lack of equipment and infrastructure compared to 20.41% in the private sector. Around 38% of doctors in the public sector said hygiene and management was not of a good standard. In the private sector this was only 5.37%.
The report, conducted by the Colleges of Medicine of South Africa (CMSA) that included South African Medical Association (SAMA) members, found further underlying reasons for doctors leaving: immigration, better opportunities in private practice as well as being unable to apply for posts as they were frozen.
Climate Explained: How Much Of Climate Change Is Natural? How Much Is Man-made?
How much climate change is natural? How much is man made?
As someone who has been working on climate change detection and its causes for over 20 years I was both surprised and not surprised that I was asked to write on this topic by The Conversation. For nearly all climate scientists, the case is proven that humans are the overwhelming cause of the long-term changes in the climate that we are observing. And that this case should be closed.
Despite this, climate denialists continue to receive prominence in some media which can lead people into thinking that man-made climate change is still in question. So it’s worth going back over the science to remind ourselves just how much has already been established.
Successive reports by the Intergovernmental Panel on Climate Change – mandated by the United Nations to assess scientific evidence on climate change – have evaluated the causes of climate change. The most recent special report on global warming of 1.5 degrees confirms that the observed changes in global and regional climate over the last 50 or so years are almost entirely due to human influence on the climate system and not due to natural causes.
What is climate change?
First we should perhaps ask what we mean by climate change. The Intergovernmental Panel on Climate Change defines climate change as:
a change in the state of the climate that can be identified by changes in the mean and/or the variability of its properties and that persists for an extended period, typically decades or longer.
The causes of climate change can be any combination of:
- Internal variability in the climate system, when various components of the climate system – like the atmosphere and ocean – vary on their own to cause fluctuations in climatic conditions, such as temperature or rainfall. These internally-driven changes generally happen over decades or longer; shorter variations such as those related to El Niño fall in the bracket of climate variability, not climate change.
- Natural external causes such as increases or decreases in volcanic activity or solar radiation. For example, every 11 years or so, the Sun’s magnetic field completely flips and this can cause small fluctuations in global temperature, up to about 0.2 degrees. On longer time scales – tens to hundreds of millions of years – geological processes can drive changes in the climate, due to shifting continents and mountain building.
- Human influence through greenhouse gases (gases that trap heat in the atmosphere such as carbon dioxide and methane), other particles released into the air (which absorb or reflect sunlight such as soot and aerosols) and land-use change (which affects how much sunlight is absorbed on land surfaces and also how much carbon dioxide and methane is absorbed and released by vegetation and soils).
What changes have been detected?
The Intergovernmental Panel on Climate Change’s recent report showed that, on average, the global surface air temperature has risen by 1°C since the beginning of significant industrialisation (which roughly started in the 1850s). And it is increasing at ever faster rates, currently 0.2°C per decade, because the concentrations of greenhouse gases in the atmosphere have themselves been increasing ever faster.
The oceans are warming as well. In fact, about 90% of the extra heat trapped in the atmosphere by greenhouse gases is being absorbed by the oceans.
A warmer atmosphere and oceans are causing dramatic changes, including steep decreases in Arctic summer sea ice which is profoundly impacting arctic marine ecosystems, increasing sea level rise which is inundating low lying coastal areas such as Pacific island atolls, and an increasing frequency of many climate extremes such as drought and heavy rain, as well as disasters where climate is an important driver, such as wildfire, flooding and landslides.
Multiple lines of evidence, using different methods, show that human influence is the only plausible explanation for the patterns and magnitude of changes that have been detected.
This human influence is largely due to our activities that release greenhouse gases, such as carbon dioxide and methane, as well sunlight absorbing soot. The main sources of these warming gases and particles are fossil fuel burning, cement production, land cover change (especially deforestation) and agriculture.
Most of us will struggle to pick up slow changes in the climate. We feel climate change largely through how it affects weather from day-to-day, season-to-season and year-to-year.
The weather we experience arises from dynamic processes in the atmosphere, and interactions between the atmosphere, the oceans and the land surface. Human influence on the broader climate system acts on these processes so that the weather today is different in many ways from how it would have been.
One way we can more clearly see climate change is by looking at severe weather events. A branch of climate science, called extreme event or weather attribution, looks at memorable weather events and estimates the extent of human influence on the severity of these events. It uses weather models run with and without measured greenhouse gases to estimate how individual weather events would have been different in a world without climate change.
As of early 2019, nearly 70% of weather events that have been assessed in this way were shown to have had their likelihood and/or magnitude increased by human influence on climate. In a world without global warming, these events would have been less severe. Some 10% of the studies showed a reduction in likelihood, while for the remaining 20% global warming has not had a discernible effect. For example, one study showed that human influence on climate had increased the likelihood of the 2015-2018 drought that afflicted Cape Town in South Africa by a factor of three.
Adapting to a changing climate
Weather extremes underlie many of the hazards that damage society and the natural environment we depend upon. As global warming has progressed, so have the frequency and intensity of these hazards, and the damage they cause.
Minimising the impacts of these hazards, and having mechanisms in place to recover quickly from the impacts, is the aim of climate adaptation, as recently reported by the Global Commission on Adaptation.
As the Commission explains, investing in adaptation makes sense from economic, social and ethical perspectives. And as we know that climate change is caused by humans, society cannot use “lack of evidence” on its cause as an excuse for inaction any more.
The Rage And Tears That Tore A Nation
Snapshots of the outrage against foreign nationals and protests against sexual offenders in South Africa in recent weeks, captured by FORBES AFRICA photojournalist Motlabana Monnakgotla.
As the continent’s second-biggest economy, South Africa attracts migrants from the rest of Africa. But mired in its own problems of unemployment and political instability, September saw a serious outbreak of attacks by South Africans on foreign nationals and foreign-owned businesses. And they have been ugly.
The spark that fueled the raging fire was in Pretoria, the country’s capital, when a taxi driver was shot dead by a foreign national who was selling drugs to a youngster in the central business district (CBD).
The altercation caused a riot and the taxi industry brought the CBD to a standstill, blocking intersections. It did not stop there; a week later, about 60 kilometers from the capital in Malvern, a suburb east of the Johannesburg CBD, a hijacked building caught fire, leaving three dead. As emergency services were putting out the fire, the residents took advantage and looted foreign-owned shops and burned car dealerships overnight on Jules Street.
The lootings extended to the CBD and other parts of Johannesburg.
To capture this embarrassing moment in South African history, I visited Katlehong, a township 35 kilometers east of Johannesburg, where the residents blocked roads leading to Sontonga Mall on a mission to loot the mall and the foreign-owned shops therein overnight.
Shop-owners and workers were shocked to wake up to no business.
Mfundo Maljingolo, a worker at Fish And Chips, was among the distressed.
“This thing started last night, people started looting and broke into the mall and did what they wanted to do. I couldn’t go to work today because there’s nothing to do; now, we are not going to get paid. The shop will be losing close to R10,000 ($677) today. It’s messed up,” said Maljingolo.
But South African businesses were affected too.
Among the shops at the mall is Webbers, a clothing and footwear store. Looters could not enter the shop and it was one of the few that escaped the vandalism.
Dineo Nyembe, the store’s manager, said she was in disbelief when she saw people could not enter the mall.
“We got here this morning and the ceiling was wrecked but there was no sign that the shop was entered, everything was just as we left it. Now, we are packing stock back to the warehouse, because we don’t know if they are coming back tonight,” lamented Nyembe, unsure if they would make their daily target or if they would be trading again.
Across the now-wrecked mall are small businesses that were not as fortunate as Webbers, and it was not only the shop-owners that were affected.
Emmanuel Nhlane’s home was robbed even as attackers were looting the shop outside.
“They broke into my house, I was threatened with a petrol bomb and I had to stand outside to give them a chance; they took my fridge, bed, cash and my VHS,” said Nhlane.
Nhlane had rented out his yard to foreign nationals to operate a shop. He does not comprehend why his belongings were taken because he doesn’t own a shop. Now, it means that the unemployed Nhlane will not be getting his monthly rental fee of R3,700 ($250).
Far away, the coastal KwaZulu-Natal province of South Africa, was also affected as trucks burned and a driver was killed because of his nationality. This was part of a logistics and transport industry national strike.
Back in Johannesburg, I visited the car dealerships that were a part of the burning spree on Jules Street.
The streets were still ashy and the air still smoky, two days after the unfortunate turn of events.
Muhamed Haffejee, one of the distraught businessmen there, said: “Currently, we are still not trading.”
Cape Town, in the Western Cape province of South Africa, which hosted the World Economic Forum (WEF) on Africa from September 4 to 6, was also witness to protests by women and girls from all walks of life outside the Cape Town International Convention Centre, demanding that the leadership take action to end the spate of gender-based violence (GBV) in the country.
There were protests also outside Parliament. What set off the nationwide outcry was the shocking rape and murder of Uyinene Mrwetyana, a 19-year-old film and media student at the University of Cape Town, inside a post office by a 42-year-old employee at the post office.
There was anger against the ghastly crimes and wave of GBV in the country that continues unabated. According to Stats SA, there has been a drastic increase of women-based violence in South Africa; sexual offences are up by 4.6%, from 50,108 in 2018 to 52,420 in 2019.
A week later, on a Friday, Sandton, Africa’s richest square mile and one of the biggest economic hubs, was shut down by hundreds of angry women and members of advocacy groups from across Johannesburg. They congregated by the Johannesburg Stock Exchange (JSE), the cynosure of business, singing and chanting, to demand “a 2% levy on profits of all listed entities to help fund the fight against GBV and femicide”.
Among the protesters was Cebi Ngqinanbi, holding a placard that read: “I’m not your punching bag.”
“We came here to disrupt Sandton as the heart of Johannesburg’s economic hub. We want to make everyone aware that women and children are being killed every day in South Africa and they [Sandton] continue with business as usual, sitting in their offices with air-conditioners and the stock exchange whilst people on the ground making them rich are dying. That is why we are here, to speak to those that have economic power,” said Ngqinanbi.
She added that if women can be given economic power, they will be able to fend for themselves and won’t fall prey to abusive men, since most women stay in abusive relationships because men are more financially stable.
Amid the chanting and singing of struggle songs, Nobuhle Ajiti addressed the crowd and shared her own haunting experience as a migrant in South Africa and survivor of GBV. She spoke in isiZulu, a South African language.
“I survived a gang rape; I was thrown out of a moving car and stabbed several times. I survived it, but am I going to survive xenophobia that is looming around in South Africa? Will I able to share my xenophobia story like I can share my GBV story?” questioned Ajiti.
She said as migrants, they did not wake up in the morning and decide to come to South Africa, but because of the hardships faced in their home countries, they were forced to come to what they perceived as the city of opportunities. And as a foreign national, she had to deal with both xenophobia and GBV.
“We experience institutionalized xenophobia in hospitals; we are forced to pay huge amounts for consultation. I am raped and I need medical attention and I am told I need to pay R5,000 ($250).
“As a mere migrant, where am I going to get R5,000? I get abused at home and the police officer would ask me where I’m from because of my accent, I sound Zimbabwean. What does my nationality have to do with my husband beating me at home or with the man that just raped me?” she asked.
Addressing the resolute women outside was the JSE CEO Nicky Newton-King who received the memorandum demanding business take their plight seriously, from a civil society group representing over 70 civil society organizations and individuals.
The list of demands include that at all JSE-listed companies contribute to a fund to resource the National Strategy Plan on GBV and femicide, to be launched in November; transport for employees who work night shifts or work after hours; establish workplace mechanisms to provide support to GBV survivors as part of employee wellness, and prevention programs that help make workplaces safe spaces for all women.
Newton-King assured the protestors she would address their demands in seven days. But a lot can happen in seven days. Will there be more crimes in the meantime? How many more will be raped and killed in South Africa by then?
Quality Higher Education Means More Than Learning How To Work
When people talk about quality education, they’re often referring to the kind of education that gives students the knowledge and skills they need for the job market. But there’s a view that quality education has wider benefits: it develops individuals in ways that help develop society more broadly.
In Zimbabwe, for example, the higher education policy emphasises student employability and the alleviation of labour shortages. But, as my research found, this isn’t happening in practice.
University education needs to do more than produce a graduate who can get a job. It should also give graduates a sense of right and wrong. And it should instil graduates with an appreciation for other people’s development.
Tertiary education should also give students opportunities, choices and a voice when it comes to work safety, job satisfaction, security, growth and dignity. Higher education is a space where they can learn to be critical. It must prepare them for participating in the economy and broader society.
This isn’t happening in Zimbabwe. Graduate unemployment is high and employers and policy makers are blaming this largely on the mismatch between graduate skills and market requirements.
Investigating Zimbabwe’s universities
My research sought to examine how a human development lens could add to what was valued as higher education, and the kind of graduate outcomes produced in Zimbabwe. I investigated 10 of the universities in Zimbabwe (there were 15 at the time of the research). Four were private and six public.
I reviewed policy documents, interviewed representatives of institutions and held discussions with students. Members of Zimbabwe’s higher education quality assurance body and university teaching staff were also included.
I found that in practice, higher education in Zimbabwe was influenced by the country’s socio-political and economic climate. Decisions and appointments of key university administrators in public universities and the minister of higher education were largely political.
In addition, resources were limited and staff turnover was high. Universities just couldn’t finance themselves through tuition fees.
Different players in the higher education system – employers, the government, academics, students and their families – have different ideas about what “quality” means in higher education. The Zimbabwe Council for Higher Education understands quality as meeting set standards and benchmarks that emphasise the graduates’ knowledge and skills.
To some extent, academics and university administrators see quality as teaching and learning that gives students a mixture of skills and values such as social responsibility.
But lecturers must comply with the largely top-down approach to quality. They tend to do whatever will enhance students’ prospects of getting employment in a particular market.
The educators and students I interviewed acknowledged that developing the ability to work and to think critically were both central to higher education. But they admitted that these goals were hard to attain. This was because of the country’s constrained socio-political and economic environment. Academics and students felt that they couldn’t express themselves freely and critical thinking was suppressed.
Stuck on a road to nowhere
The study illustrates how an over-emphasis on creating human capital – skilled and knowledgeable graduates – limits higher education’s potential to foster broader human and social development.
University education should do more, especially in developing countries such as Zimbabwe that face not just economic, but also socio-political challenges. Before building more universities and enrolling more students, authorities and citizens should consider what quality education means in relation to the kind of society they want.
It’s possible to take a broader view of development, quality and the role of higher education. This broader approach – one that appreciates social justice – can equip graduates to address the country’s problems.
The road ahead
Universities can’t change a society on their own. But their teaching and learning practices can make an important difference.
Because quality teaching and learning means different things to different people, people need to talk about it democratically. Institutional and national policies must be informed by broad consultations to identify the knowledge, skills and values they want graduates to have.
University teaching and learning should emphasise freedom of expression and participation so that students can think and act critically beyond university.
Also, academics don’t automatically know how to teach just because they have a PhD. Universities should therefore ensure that academics learn how to teach and communicate their knowledge. Curriculum design, student assessment and feedback, as well as training of lecturers should all support this goal of human development.
When universities see quality in terms of human development, their role becomes more than production of workers in an economy. It gives them a mandate to nurture ethically responsible graduates. These more rounded graduates are better equipped to imagine an alternative future in pursuit of a better society, economically, politically and socially.
–Patience Mukwambo: Researcher, University of the Free State
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