Getting a win for patients

I’m fortunate because I see the absolute best of health care, but I unfortunately also see the worst and the scarring trauma it leaves.

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This week I had the honour of watching a medial patellofemoral ligament reconstructive surgery (don’t worry, that is the only fancy word in the entire blog), in theatre with one of SA’s top orthopaedic surgeons. It was nothing like I expected. Upon the patient’s arrival the anaesthetist asked her what song he could play her while he put her to sleep. He was clearly brilliant, but also gentle and funny, and the fact that he was eye-candy on steroids certainly helped. When the surgeon arrived, I thought there would be a frenzy and anxiety, but the whole scene was like a beautifully choreographed ballet. The lack of ego in the room was palpable. Everyone had respect for one another, everyone knew exactly what to do and how to do it. I was astounded by the technology and whilst watching the surgeon work, I understood what it must have been like to see Auguste Rodin chisel the Danaid sculpture to perfection. It was pure dignified beauty and I was in awe of the human race and what we can achieve, not to mention the miracle of our bodies and how they work.

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What I cannot understand is: how do we get this part of medical intervention so right? This is the difficult part, the almost impossible bit! After this it gets simpler, so why is it then that the wheels fall off? If this profession can push cameras around bodies, and harvest ligaments, transplant hearts and concoct a sperm and an egg into an embryo in a dish to create a life, how can we forget the basics: to empty catheters, bring pain meds on time, serve a decent meal, remember to turn a patient every hour… something does not add up.

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Every day, without fail, I speak to patients who’ve had the most atrocious experiences in both hospitals and sub-acute facilities (I am talking private here not government). Because of stories like this, Dr Noach, CEO of Discovery Health has started to engage with us. I am delighted in the responses we are getting from this giant in the industry. Dr Ronald Whelan, Chief Commercial Officer, has shown incredible support to us and I understand completely that by law medical schemes are not permitted to pay monies to non-registered healthcare providers. As he says, without this requirement, there would be significant risk of many unscrupulous and unqualified operators coming into the system, posting significant risk to patients.

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But there are risks now too, as the system is terribly flawed. I think medical schemes, patients and health care workers all agree that the narrative in South Africa has to change around the medical space. This is how it works in SA. When Eskom failed, we simply got our generators and our solar installed. When COJ stopped maintaining pipes and completely lost the ability to count, we sank boreholes and put up Jojo tanks. When the UIF’s TERS was willing to let our staff starve, us employers begged, borrowed and stole to keep our staff protected and fed. The time has come for us to make our own alternatives in the healthcare industry too, as the department of health has proven, and spectacularly so, how incompetent and corrupt they are.

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I get the feeling that SA is trying to over-regulate an industry in a country that cannot be governed ethically and using systems which have crippled Americans with individual medical debt of $88 billion in 2021, or systems used in the NHS in the UK which is hardly keeping it together. Why not do it differently? This is how we roll as SAfers isn’t it?

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This blog is all ready too long, and I apologise that we are in injury time (do you see my pun here?).

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I suppose I am relaying conversations that I seem to be having every day because fundamentally, we believe in providing excellent care to patients (we prefer to call them guests) without ever losing sight of their humanity, dignity or personhood, and the bottom line is that being an institution simply does not make this possible.

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I get asked, also daily, why we have chosen to not register with the BHF (which is the institution with the magic wand which gives you a number so that medical aids will pay for their patients to stay with you). When we first opened, we tried to get a BHF number for some time. We spent many months and time on a feasibility study. It made sense to get one. The only person who ever willingly came back to us, was in fact the shadow minister of health of the DA, Dr Jack Bloom. With some guidance from him as well as ************, CEO of ********** Medical aid, we attempted the laborious task of dealing with the Department of Health (DOH). We jumped through all the hoops, and I do not want to bore you with this, but suffice it to say, that when the director of operations of the DOH, suggested I demolish my existing building and then only apply, I realised that I would sooner end up in an institution myself than succeed in becoming a BHF member.

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In a nutshell, it was clear after interacting with both the DOH and BHF for months, that it was just about impossible to get a license to operate as a sub-acute.

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As Dr Whelan says, we need the regulators to protect the patients, but who is protecting the staff? These health care workers are over-burdened by administrative tasks, are under-staffed, badly treated and underpaid. How do you expect to love a patient, if nobody even remembers your name?

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Somewhere we need to find a way to ensure that profit, patients and staff can all be a priority. The way the BHF and the DOH approaches this makes it impossible. One cannot allow a corrupt and highly inefficient Department of Health to overregulate institutions. The results are traumatic and sadly, often fatal.

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Interestingly enough while on this journey of trying to acquire a BHF number, I realised without a shadow of a doubt that what we do here, and what patients really need, would not be possible under the conditions set by the powers that be. The more I engaged with health care practitioners, the more I was met with absolute joy and they encouraged me to stay away from both institutions as much as possible and were delighted at what we offered and how we could care for their patients.

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We are half the price of hospice and other sub-acutes and step-down facilities, our patients have privacy, dignity, fantastic food, a view of the pool and garden, therapists that they choose, flexible visiting hours, great wifi and a team of carers that are validated, well paid and loved by management.

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I know my concept works. I know it is profitable. I know that people recover faster and better when they are properly cared for in an environment conducive to real care and that the medical aids would save fortunes while their members would be treated well and cared for. Everyone would win if we could find a way to work together (especially the angels that still manage to offer good care in health care institutions despite all the obstacles and who are committed and brave and work tirelessly. They mostly manage to care in a system, almost purposefully designed to prevent good care and are true heroes in my book).

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I am ecstatic that conversations are now taking place and that we are investigating other avenues to find a solution for us all.

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