Op-Ed: Minister Motsoaledi, we need more medical doctors

Dr Aaron Motsoaledi is probably one of the most respected people that our country has produced. He is that rare breed, a politician who is trusted, honest, and willing to give up his own Christmas holidays and go to a hospital and help out when medical personnel are running short. I happily gave him the highest possible “Moral Authority Rating” in my book SA Politics Unspun when it was published last year. (Daily Maverick named Minister Motsoaledi a Person of the Year runner-up in 2012, together with Section 27 - Ed)

The reason was simple: he came into office, and immediately set about giving ARVs to the millions who needed them. Then he tried as hard as he could to improve government hospitals, while at the same time starting the implementation of the National Health Insurance system, which had been mandated by the ANC.

As a result, he is someone who is hard to criticise. To be fair, he became Health Minister at exactly the right political time. All he had to do was sound sane, and he would be hailed as a hero compared to the AIDS madness that had come before.

However, that doesn’t mean he’s perfect.

On Tuesday Motsoaledi came on the Midday Report, and was asked if he was still opposed to private educational institutions training medical doctors. “Yes,” he replied, “extraordinarily so.” His rationale is this: if there are private medical schools, then only the children of rich families will be able to become doctors. Even if there is a complimentary system, where the private institutions help or work with the public institutions, eventually the good lecturers will leave the public sector and go to the private sector. He also claims the real problem here is not that the private sector is not involved, it’s that South Africa last built a new medical school twenty-nine years ago. That’s a long time. Pre-internet, in fact.

But Motsoaledi is wrong. On the facts, on the ideology, and on the outcomes.

Firstly, the point of training doctors is not actually, as weird as this may sound, to produce doctors. In the same way that building power stations is not about building power stations, training doctors is not about training doctors. It is about producing healthcare. If you like, you could work out how many treatment hours, or patients treated, you produce with each doctor. It’s not that we want more doctors, it’s that we want more patients to be treated.

And so what if the doctor was the third generation of his family to go to St. Johns, didn’t leave Houghton until he was eighteen and was a keen snowboarder?

Just state the bleedingly obvious, and quickly, I don’t think that anyone who urgently needs medical treatment gives a flying fig who actually treats them, rich or poor, black or white. You just want to be treated well, and quickly. You just want to get better. (Hell, if you are about to die, you would probably accept healthcare from Wouter Basson, if it would give you your life back.)

But this is just the starting point of where Motsoaledi is wrong. The fact is, if there were a private health school, he would be able to force those doctors to work for him. Not forever, of course. But as things stand at the moment, people who graduate as doctors are only allowed to practice once they’ve done their community service. And they do that in the rural hospitals that really need them. Here the minister is simply cutting his nose to spite his face; he’s deliberately preventing someone training doctors for him to use, at no cost to himself or government.

He is also ensuring that anyone who has an interest in pursuing a career in teaching doctors will know that they will have only one employer. Him. That is unlikely to be very attractive to people who want to create a stimulating career in medical teaching. No parent is going to recommend someone go into a career that can have only one employer who can sometimes behave arbitrarily.

It gets worse. Currently, there are thousands of clever eighteen-year-olds coming out of schools with too many distinctions for this mathematically-challenged hack to even count. And yet they are turned away from medical schools, not really because they are too pale or male, but because there is just not enough space for them. So those who are indeed the third generation to go to St. Johns will go somewhere else. I hear there are some even going to China. Why not? If you can afford it, and you really want to become a doctor, off you go. But those clever youngsters are never going to come back. They’ll go wherever their skills are in demand, and wherever those medical skills are accredited.

We will basically lose our best and brightest permanently. And gain nothing in return.

Just to illustrate how utterly schizophrenic this situation is: Motsoaledi’s stance is in direct contradiction to what happens in the education sector. There the education company Curro has started its own teacher-training college. We all know that there are not enough teachers, and so the education department has welcomed any move to create more of them.

Why is the healthcare sector different?

But it is also in direct contradiction to the rest of our health policy. There is at the moment private healthcare. This private healthcare reduces the demand on our government healthcare sector. In the same way that private schools reduce the strain on our government schools. So if Motsoaledi had his way, would he also ban private hospitals? While Cosatu and NUMSA might be pretty pleased with that, most MPs are unlikely to be so.

Even the man who generally occupies the centre of gravity in our politics, Gwede Mantashe, has used a private hospital on occasion. And he, let’s not forget, was once the Chairman of the South African Communist Party.

So then, what could be the real reason for this stance? It is certainly not logical. The DA’s Shadow Health Minister Wilmot James, while stressing his respect for Motsoaledi, says that when it comes to the private sector, “his intellectual doors seem to shut”. Certainly that suggestion does seem to have some merit. What else could it possibly be?

Motsoaledi will continue to be a highly respected figure in our society. Rightly so. But surely on this, he is misguided, and should think again. We need more doctors. More doctors will make our people healthier.

What else matters? DM

Photo: U.S. Secretary of State Hillary Clinton (not in the photo) talks with South Africa's Health Minister Aaron Motsoaledi after attending a PEPFAR (U.S. President's Emergency Plan for AIDS Relief) Transition Signing, at Delft South Clinic in Delft South, a suburb of Cape Town, August 8, 2012. REUTERS/Jacquelyn Martin/Pool