WHY is it that sleep-deprived medical interns and community service doctors are working up to 200 hours overtime a month under the state’s commuted overtime policy?

Trainee doctors don’t get paid for overtime exceeding 80 hours, and their overtime is given "involuntarily under threat of not qualifying to practise medicine in SA," says Nicolette Erasmus, an attorney reading for a PhD in corporate law at the University of the Witwatersrand.

Writing in the South African Medical Journal (Vol 102, No 8, August 2012), Erasmus says sleep deprivation amounts to cruel and degrading treatment and is contrary to international law.

"No other professional group in the country is subjected to such levels of exploitation and discrimination by the state." She says these abuses should be challenged under the constitution; an investigation by the Human Sciences Research Council (HSRC) is overdue.

To support her call for an HSRC investigation, Erasmus says that while the failings of the public health system are well known, what isn’t understood is that hospitals and teaching institutions "teeter on the brink of collapse". Citing unfair labour practices and human rights abuses, Erasmus says trainee doctors are required to work inhuman unpaid overtime under the cloak of training "and a misguided commuted overtime policy".

And, in disregard for statutory limits on working hours, state nurses are selling their off-duty time back to state hospitals with the full knowledge of the state.

Every year about 2,500 medical school graduates start a two-year internship. A further 1,250 go on to serve a further year of compulsory community service in state hospitals before they are permitted to register as doctors. This is, says Erasmus, tantamount to forced labour. All are required to sign a standard two-year contract with a provincial health department and are instructed (or guided) into accepting a specific overtime performance contract. The outcome, claims Erasmus, is that with too few doctors and nurses, the interns are "grossly overworked".

The physical effects of sleep deprivation extend to memory loss, attention deficit, negative mood swings, overconfident risk taking, road accidents, mistakes on duty and in surgery, and needle-stick injuries that can cause HIV infection.

Erasmus contends that this amounts to cruel, inhuman and degrading treatment, supported by psychological coercion. Interns must either work the overtime or face disciplinary action, which can lead to a failure to qualify. "There can scarcely be a more coercive penalty for trainee doctors … provincial administrators and the Health Professions Council know the practice is unconscionable," she writes.

The president of the Junior Doctors Association of South Africa, Kgopotso Pege, tells me qualified doctors are unemployed because there is, apparently, a shortage of funds. The posts are there and allocated, but there’s no money. "How can that be?" she asks, and adds that "it is an outrageous system".

In a statement issued last week, Pege said the Department of Health "is failing doctors in many ways … this crisis is yet another blow to our already limping health system and has dire implications to the working condition of our hospitals. It has not been a month since a junior doctor in Gauteng (was) involved in a motor vehicle accident, primarily due to fatigue after a more than 30-hour long shift."

Meanwhile, Erasmus says a formal request to the HSRC to investigate the situation was turned down. So was an appeal against the original decision. The council said the problem fell under the purview of the Department of Labour or, alternatively, the office of the public protector, which is now thinking about taking on the matter. But it seems the HSRC wanted to avoid a political hot potato. If that is the case, then what is it there for?

It is abundantly clear that Health Minister Aaron Motsoaledi needs to concentrate more on the mounting daily problems in the state’s appallingly managed health system and less on National Health Insurance and shouting about alcohol adverts. In fact, after a trip to a state hospital, a stiff Scotch is probably the best medicine.

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Will Shange be allowed into South Africa?

WHEN Liv Shange (Swedish) arrives at OR Tambo International on July 15 will she be allowed into South Africa? She has incurred the ire of the ruling party and it’s not certain she’ll be permitted to take up residence with her husband, Xolani Shange.

Liv Shange burst onto the South African scene — on television screens and in news articles — after she addressed hundreds of striking miners at Marikana using a megaphone. Shange delivered a hard-line, extreme left-wing message.

Unsurprisingly, there is a longstanding and convoluted problem about her passport and residence status, one that may not be resolved before she is due to board an aircraft in Sweden where she is holidaying.

Shange is a member of the Democratic Socialist Movement (DSM) whose members were previously attached to the Marxist Workers’ Tendency, a movement inside the African National Congress (ANC). Many are also members of the Workers and Socialist Party (WASP, ironically). ANC secretary-general Gwede Mantashe became WASP’s immediate hate pin-up boy when he told businessmen in Sandton last month that people (foreigners) from Sweden and Ireland were the fulcrum of the "anarchy in Marikana".

That really got veteran unionist and former ANC member Weizman Hamilton in a froth. Now general secretary of DSM and, it seems, WASP, he drew up a petition asking readers to protest to Home Affairs Minister Naledi Pandor and the ANC about Shange’s predicament.

He says she’s been in South Africa since 2004, completed her BA in Zulu and economic history at the University of KwaZulu-Natal summa cum laude and regards this country as her home. She is the latest, alleges Hamilton, in a long line of scapegoats the ANC and the Congress of South African Trade Unions "have blamed for the heroic uprising of the mine workers last year".

What does the DSM/WASP want? "Nationalisation of the mines under the democratic control and management of the working class," of course. Heaven help us.