As Obama healthcare debate rages, a glimpse into S. Africa's care gap

JOHANNESBURG, SOUTH AFRICA – From the moment I heard my friend’s voice, I knew he was not well.

He wanted me to take him to a doctor. I shut down my computer, canceled all my appointments, and rushed to his house.

For the next 12 hours, the two of us got a closeup look into the wide gap between South Africa’s first-class private health care system, and the overwhelmed and underfunded public hospitals that serve the vast majority of South Africans. And at a time when Americans are debating how to make their own world-class health care system more available to the uninsured middle class and poor, the sight of skeletal men here in South Africa staring in vain to get the attention of overworked nurses raised a number of questions in a visceral way.

How can societies across the globe ensure that not only the rich and comfortable are able to remain healthy? And having decided to do so, how can they pay for it? There are no easy answers – and comparing South Africa's rather dismal healthcare system with that of the US is to compare apples with oranges – but a majority in both countries share the view that healthcare can improve. The debate centers around how that's best done.

But back to my friend.

First a private hospital – then a public one

He met me at the door, a shadow of the man I had met three years ago while researching an article on Zimbabwe’s fast-disintegrating military. A former commander in the military wing of South Africa’s ruling African National Congress, and also a man who had worked for a time in the Zimbabwean government, Commander is a good man to know. His curiosity about my stints in Afghanistan and Iraq, and my curiosity about life under two very different liberation movements kept us talking. A difficult trip into Zimbabwe during elections, and a narrow escape from arrest bonded us.

Now, Commander was in trouble. I rushed him to the emergency room of a posh private hospital in my northern suburb of Johannesburg. But while this hospital offered the best care that money could buy, my friend had no money. Private treatment would cost 20,000 rand (nearly $3,000), he was informed. My friend, who has a good job but no health insurance, asked to be transferred to a public hospital.

South Africa's healthcare system

Troubled as it is, South Africa’s healthcare system is the envy of the continent. Funded by taxpayers, and modeled after Britain’s or Canada’s free-health-care-on-demand, South African hospitals have done a relatively remarkable job of delivering healthcare to those who cannot afford private hospitals, or private health insurance.

Any patient, in theory, who comes in the door will receive medical treatment for free. But unlike Britain or Canada, where the ratio of well-trained doctors to patients is generally adequate to meet the demand of patients – and the much-hyped long waiting lists are mostly a fiction – South African hospitals receive inadequate funding to meet the demand. Doctors and nurses scurry around from patient to patient.

Tough to get a bed

Getting a bed in a public hospital was a challenge. It took three hours for the public Gauteng Province ambulance service to pick my friend up. It took another three hours in the emergency ward for a doctor to work his way through a crowded room of patients to finally see my friend and have him admitted for treatment. The public hospital – Tembisa – serves the poorest of the poor, and, like America’s own public hospitals, it is this overwhelmed emergency room that is the poor man’s only access to healthcare.

Doctors and nurses here in South Africa are clearly not easily shocked – a result of the overwhelming demands on them. Some of the doctors, many of them fresh out of medical school on their first residency, and a few of the nurses, are kind and idealistic – the sort of people who will build a new post-racial South Africa. But others march through the wards like drill sergeants, shouting at patients as if they are idiots. Posters on the walls talk about patient rights, but their message of respect is mostly ignored in practice.

As the sole white person in the room, aside from a few doctors, I managed to bring a little quicker attention to Commander than perhaps would have occurred otherwise. The young, conscientious Dr. Mpahlele quickly recognized my friend needed attention. Even so, the process took about three hours from the time of arrival.

A shocking difference

To see the well-functioning private hospital and this subpar public hospital on the same day was a shock to me, and a disappointment for my idealistic friend, a man who had fought for years for a majority-ruled South Africa. One could understand such abysmal care under a racist apartheid government. But what excuse did my friend’s own African National Congress - the party of antiapartheid icon Nelson Mandela – have for such miserly care 15 years after liberation?

Over the next few days, I stayed in touch with my friend by cellphone. The food was “despicable” in his words, so I brought him a grocery bag full of juice, fruit, yogurt, and grilled chicken. On one day, a public holiday called “Women’s Day,” the nurses simply forgot to give medicine to the patients. But after five days, my friend was discharged, well on the road to recovery.

Back at home, I read about the all-consuming and vociferous debate in America over the Obama administration’s plans for health insurance. Hopefully, both countries will find a way to improve access – public, private, or a hybrid of the two – for more of the people who need it most.