Guest Column: Dr Johannes Marisa
In politics, the youths are said to be the vanguard of political parties while in medicine I would put it that the junior doctors are the hummingbirds that bring life to central hospitals.
The current medical situation in our country can be described as deplorable, lamentable, regrettable or pathetic and this requires an urgent solution if a catastrophe is to be averted.
It is a fact that patients fret because of poor access to medical care due to unaffordability, doctors are also languishing in abject poverty because a majority of them cannot afford a decent meal at home. Some have resorted to walking from town to Parirenyatwa Hospital because of their tenacity to save patients.
The environment has become so bad that it now requires the government-doctor feud to an end.
While many may think that the issues raised by doctors are nothing, but a frivolity, the grievances need proper consideration if our nation is to move ahead.
For doubters, junior doctors offer some of the most important services in Zimbabwe and there is no alienation between central hospitals and them. They are thus both the stakeholders and stockholders of central hospitals to be frank.
A central hospital like Parirenyatwa has two important points of receiving patients, The casualty and emergency unit, and the outpatients department (OPD). The casualty department is supposed to receive emergency cases or cases that would have been referred from other medical centres while chronic or cold cases are seen in the outpatients department. In both places, it is the junior doctors (who include both junior and senior interns) who have a first touch on the patients. The initial assessment, examination and admission are all carried out by these juniors in consultation with their registrars or consultants. A lot of cases that present in the casualty department are medical and surgical cases that fall under the junior interns.
The phlebotomy and other investigations are done by junior doctors as patients are sent to the wards. Follow-up of results and presentation of patients during ward rounds is the prerogative of the juniors. So without them, life becomes a double tragedy to both patients and remaining staff. This would mean no casualty attention, no OPD attention, no laboratory follow-ups, discharges are impaired resulting in a serious burden on the nursing staff. It will be bizarre to see a specialist doctor in the casualty clerking patients, bleeding them and running up the stairs to follow up on blood results. Without these juniors, hospital function is delegated to a white elephant that has nothing to offer. Critics will tell you that junior doctors are just students or some unscrupulous elements, yet my own experience and knowledge tell me they are of great value and importance if health delivery service is to remain afloat.
It is unfortunate that government and its agents like the Health Services Board (HSB) see junior doctors as cantankerous interns who are always argumentative, unco-operative, yet they have genuine concerns.
In 1996, government fired striking doctors only to reverse the decision within a month after health delivery plummeted to unprecedented levels. In 2007, the then chief executive officer at Harare Central Hospital fired 60 junior interns for going on strike for more than five weeks.
The minister quickly reinstated the fired doctors and the conflict was resolved. Today, I hear that 448 doctors have been fired which is never going to benefit us as a nation, but is actually detrimental to the whole health sector considering the high morbidity and mortality associated with inadequate medical staff.
It is actually incredible to note that some of those in the firing line are actually renowned specialists who have helped everyone since time immemorial. Some served our dear Zimbabwe when they used to be the only ones doing specific operations. It should be noted that conflict resolution includes embracing conflict, talking together, listening, finding solutions, providing guidance and forgiving rivals.
If such steps are observed, it would not take time to solve the health crisis that has ravaged the entire nation. I believe dialogue that has mutual respect is the way forward.
Advertising for doctors’ vacancies will only work as a temporary measure as the fundamentals have not been corrected. We run the risk of cycles of incapacitation repeating themselves.
Government and doctors should immediately find each other with sincerity as heavy-handedness does not help anyone. Together, we will build Zimbabwe!
Johannes Marisa is interim president of the Medical and Dental Private Practitioner’s Association of Zimbabwe. He is also into private practice. He can be accessed on firstname.lastname@example.org