1. Dr Thandeka Mazibuko works at Durban’s King Edward VIII Hospital.
22 september 09 femina

2. femina september 09 23
honouring women
All ina
day’s
workState doctors have
been in the news
in recent months
because of national
strike action.
We spent the day
with a state doctor
to see what a typical
working day in a
government
hospital is like.
By Jane Cowan
your life
fFinding a 35+ state doctor for
this story wasn’t easy: once
they’ve qualified (in their late
20s) most doctors leave state
hospitals to go into private
practice or work overseas.
Last year an independent
study commissioned by the
South African Medical
Association (Sama) showed
that doctors are underpaid by
up to 200% compared with
other public service
professionals. Yet they are
treating more patients than
ever, with limited resources
and in increasingly difficult
conditions that in June
prompted some to strike.
Dr Thandeka Mazibuko
is unusual because after
qualifying she left to work in
the private sector (earning
R20 000 a month more than she
is currently getting) but chose
to resign and return to the state
sector when the government
issued an appeal for doctors to
return to state hospitals.
‘I’m committed to working
in the state sector – I don’t
want to go overseas, I want to
stay and help people here.’ w

3. 24 september 09 femina
3am Wake up to study for two
hours. I want to specialise in
oncology in the future.
5am Check Sphume’s homework,
which he leaves out for me every
night, make his porridge, do ironing
and housework.
7am Drop Sphume at school in
Pinetown, and battle traffic to
reach King Edward VIII Hospital
by 7.45am. Change quickly into
hospital greens in a toilet with a
door too warped to close.
8am First ward round of the day,
with a consultant (supervising
doctor), a registrar (a doctor
studying to be a specialist), an intern
and a dozen medical students who
we are expected to teach as we
work. This team is responsible for
‘all we want
is a living
wage’
Dr Thandeka Mazibuko, 35, is a
medical officer in the department of
Obstetrics and Gynaecology at
Durban’s King Edward VIII Hospital – a
position she has worked hard and
passionately to achieve. She grew up
in the rural settlement of KwaNyuswa
near Botha’s Hill, the daughter of a
single domestic worker. Maths and
science teaching was poor so she
largely educated herself, and was
accepted into the Nelson R Mandela
School of Medicine at the University of
KwaZulu-Natal. Fighting for loans and
eventually a bursary, Thandeka
graduated seven years later.
She worked as an intern and
community service doctor at Prince
Mshiyeni Hospital until the government
froze posts, then as a medical officer
on the mines in Johannesburg, earning
R20 000 a month more than she does
today and enjoying far better
conditions. Friends thought her crazy
when she was one of a handful of
doctors to heed a call to return to state
hospitals, and took a post in obstetrics
at King Edward VIII. ‘But I felt a
commitment – I’d been given a bursary
here, and I wanted to serve the people
I grew up with, who had prayed for me
to become a doctor.’
It’s commitment that keeps
Thandeka at the hospital today: ‘All
doctors want is a living wage and
decent working conditions. I think the
doctors at King Edward are among the
best in the country.’
She earns R14 000 a month after
tax which she stretches to R20 000 with
four ‘overtime calls’ a month, when she
works from 4pm to 8am, giving her a
six-day week. Thandeka’s normal
working day is officially 8am to 4pm,
‘but no one gets out until the last ward
round is done at around 5.30pm.’ She
struggles to square her earnings and
hours with meeting her student-loan
repayments and the bond on a modest
duplex, and supporting herself and
Sphume, her 14-year-old son.
Thandeka gets up at 3am to study.
Below right Thandeka irons her
son’s school uniform.
‘I STILL CAN’T AFFORD TO FREE
MY MOM FROM HER JOB AS
A DOMESTIC WORKER.’

4. your life
a 30-bed labour ward, where women
must be monitored and assisted
through childbirth (though few
of the foetal monitors work). The
beds are always full and women
occasionally have to give birth
on rickety stretchers.
8.30am Break away early
from rounds to start
doing one of three Caesarean
sections left over from night shift
(there are usually more). All show
foetal distress, but must wait their
turn – there’s only me and the
registrar to operate. While I wait for
the anaesthetist, I rush to the
crowded admissions area to check
on a pregnant woman being dropped
off by ambulance. Referrals arrive
all day from clinics and hospitals
surrounding Durban, and there are
numerous walk-ins.
9am Deliver the first of my
C-section babies for the day,
and hurry on to the next. I learned
to operate by watching and assisting,
but wish the training had been
better. Most specialists have left
for the private sector or jobs abroad,
and those remaining have little or
no time to teach.
10am Want to start my next
C-section but the over-
burdened lab is taking two hours
to return blood results that should
take 15 minutes, and anaesthetists
can’t risk taking patients to theatre
if they may be anaemic (which
many are because of HIV, ARVs or
bleeding) or have low platelets.
Respond to a call to attend to
10 walk-ins in admissions.
11am Emergency C-section on
a 14-year-old.
12am Another teen delivers a
stillborn child. ‘It can’t be
dead,’ she cries. ‘I thought this baby
would put food on the table!’ She’s
been counting on getting a state
grant. Another pregnant woman is
brought by the ambulance for
preterm labour, but there’s no spare
ventilator available here or in the
whole province. I have to suppress
this labour until one of our three
becomes available. While still
talking to this patient, Chesterville
clinic calls – a sister is requesting
that we take a patient with
uncontrollable bleeding.
1pm Have an uncontrollable
bleeding case of my own,
prepare and counsel her for a
possible hysterectomy.
2pm Difficult delivery for a
woman who clearly doesn’t
want this child. No time to sit and
ask her about it, just hope she takes
my advice to see a psychologist
later. Another call, this time from
Wentworth Hospital, where a
patient is not responding to blood-
pressure treatment – she too will be
sent to us. Meanwhile two patients
are brought in from Addington
Hospital, one having uncontrollable
fits, the other bleeding badly –
hope my poor-quality gloves don’t
tear as they sometimes do,
exposing us to patients’ blood.
These women must join the
emergency C-section queue.
3pm Call from theatre: ‘The
spinal is in.’ I rush to do another
foetal distress C-section, knowing
there are other unstable patients
who desperately need to be in
theatre. There are two theatres, but
only one is operational because we
have only one anaesthetist instead
of three, which also means labour-
ward patients can’t get the epidurals
many need.
4pm The consultant and others
are here for the last round of the
day. I look as if I haven’t done my
work because there are still many
Caesareans pending, and no blood
results for the patient having fits and
the one who is bleeding. The
consultant starts shouting at me,
asking what we were doing all day.
I’m tired, I’m hungry, my phone is
ringing. It’s my son’s school, asking
me when I am picking him up. No-
one cares, the work must be done.
6pm I’ve seen around 40 patients
today and delivered around
15 babies! Leave at last, shoulders
and feet aching, to fetch Sphume.
He’s waiting on a bench outside
the school, which is closed.
7pm Fix Sphume a dinner frozen
on my one day off each week –
too tired to eat myself. While he
watches TV, I go upstairs to bath.
Hoped to see my fiancé, but he’s
a senior registrar at another state
hospital and regularly pulls 30-hour
shifts. You’ve got to love someone
to date in these conditions! The cost
of lobolo and a wedding are out of
our reach. And I still can’t afford
to free my mom from her job as
a domestic worker.
Before Sphume goes to bed I
have to give him an injection. He
has a rare condition called anterior
pituitary hypoplasia (the front part
of his brain isn’t working) and has
to have a lot of medication.
8pm To bed, alarm set for 3am.
I’ve earned a good night’s sleep.
femina september 09 25
‘I FELT A COMMITMENT – I’D BEEN GIVEN A
BURSARY HERE, AND I WANTED TO SERVE
THE PEOPLE I GREW UP WITH, WHO HAD
PRAYED FOR ME TO BECOME A DOCTOR.’
¢F

5. ‘I can make a
difference’
Dr Rachel Moore, 36
Rachel Moore is a Senior Surgical
Registrar working at a State hospital
in Johannesburg. Married to Dean
Donaldson, she has two sons Joshua
(4) and Gabriel (2). Having completed
her six year primary undergraduate
degree followed by a one year
internship and a year’s community
service in Nelspruit, she’s now
training to be a general surgeon –
usually a five year course (2 years as a
junior registrar; 3 as a senior
registrar).
She started in January 2005 but
chose not to put up with the long 80-
100 hour working week that was
required. While surgery is her passion,
she felt that her job had become her
life: there was no time to see her
husband or her friends. When she told
her professor she was going to resign
she was offered a lifeline, and became
the first doctor countrywide on an
extended registrar programme. This
means she works 40 hours a week
(normally it’s between 80 and 100)
with no expected overtime, and
although she’s regularly on 24 hour
call, her working hours are adjusted
accordingly if she is called out. The
flexibility fits in well with being a
mom but also means that she’ll only
qualify as a general surgeon at the age
of 40! With a monthly take-home
salary of R18 000 (medical aid is
deducted) 11 years after qualifying as
a doctor, money is tight.
‘We’re not saying we’re not
making enough to live on but that
compared to other professionals in the
public sector with similar
qualifications (SA Medical
Association’s independent market
research on magistrates and pilots
nationally and internationally) we’re
earning 50% less. Dean works
fulltime for the church as a pastor so
there’s a lot of financial juggling. If he