Day 324, White Patients

Day 324, A two tier health system isn’t exclusive to the developing world but the wealth gap just makes it more evident. South Africa’s past means that it isn’t only a wealth but also a race gap which prevails. So it is always interesting to see the dynamics when a white person rocks up at a rural district hospital.

There are broadly two types of white patients that may present; the first are out of towners holidaying in the region who happen to need to some medical attention that do not want the two hour drive to private care; the others are those that have fallen on hard times or Previously Advantaged, Now Disadvantaged (PANDAs). The latter will often come and wait in the OPD with all other patients while the former will insist on being seen immediately.

PANDAs will often be patients who aren’t able to afford medical insurance and will end up in a system that 20 years ago they would not have dreamed possible. We aim to treat everyone equally of course, whilst that is a step up for most Zulu patients compared to the past, for this population group it is a downgrade. It can understandably be frustrating to them and they will often get restless in the waiting room. Chronic illnesses are common in this group and occasionally we will even see a HIV positive white patient; it is slightly sad how they often will be at pains to explain how they contracted it through no fault of their own.

The frustrations for us medics tend to be the out of town patients who will demand instantaneous service such as in a resource rich environment. Our limited staffing means that patients are often left waiting for investigations or to be seen by a doctor, especially out of hours. However those used to private care aren’t always as appreciative of this as our regular population. Their agitation is often contagious to the nurses who will be at pains to point out that it is a white patient waiting, as if this can speed up the delivery of care.

One wonders whether the attitudes of both the white patients and Zulu nurses are a throwback to the institutionalised ideas of the Apartheid era. Perhaps it is simply that the reality of having well dressed white patients sitting in the same waiting room where malnourished babies and tuberculous adults are on death’s door is just socially unacceptable.

The problem with treating everyone equally is that not everyone feels they are equal to others. Some people will always see themselves as more privileged while others will continue to feel they are subordinates. With that in mind the only choice is whether to treat everyone with equal contempt, or equal kindness.

http://www.youtube.com/watch?v=THI4U3OsDQY