Samson Mashaba struggles to retain his sense of humour as he waits to see his doctor. "If you're unlucky, you'll die standing here," says the 69-year-old as he surveys the queue ahead of him at a rural hospital in South Africa's Mpumalanga province.
While South Africa may boast some of the finest hospitals on the continent in cities like Johannesburg and Cape Town, rural health care is dogged by a lack of cash, personnel and facilities to cover the vast areas.
AdvertisementIn Mpumalanga, a northeastern province which covers an area of around 80,000 square kilometers (30,000 square miles) and is home to some 3.5 million people, there are a mere 550 doctors -- a ratio of around 6,000 patients per doctor.
Given only 44 of them are specialists, medics often have no choice but to refer patients hundreds of kilometres away to Gauteng province which contains the cities of Johannesburg and Pretoria.
The referrals have grown so frequent Mpumalanga now owes Gauteng 44 million rand (6.1 million US dollars/4.5 million euros) for treating its patients.
According to Selby Maphophe, chief executive of the Rural Doctors Association of South Africa executive, many of his organisation's members have either headed to the city or gone into private practice after becoming disillusioned about pay and conditions.
"We are facing serious challenges like accommodation, late payment of salaries, and support both in terms of equipment and emotional (support).
"It's frustrating to deal with patients' problems without proper support. We end up playing trial and error with people's lives," added Mphophe, who works in a rural hospital in neighbouring Limpopo province.
Maphophe said he had been forced to turn away patients on a number of occasions because of a lack of equipment.
"One time I had to send back a sugar diabetic patient because we had no facilities to test the blood sugar level on her. It was pretty bad but there was nothing we could do but refer her to the much-equipped hospital".
Mashaba knows all too well how patients can end up being shuffled from pillar to post as he waited to see his podiatrist at Tintswalo hospital.
"I've been turned away three times because there was no doctor to examine me, until I was advised to go to Mankweng", a hospital around 250 kilometers (155 miles) away in Polokwane, he said.
"Coming here you will either be turned back because there is no equipment to check you or there is no specialist."
A fellow elderly patient chimed in that travelling long distances to other health centres was a real hardship.
"Some of us are pensioners struggling and have no money to travel long distances to get medical help," he said on condition of anonymity.
The government is particularly sensitive about criticism of the health service and South African President Thabo Mbeki reacted furiously to a recent expose of conditions at a hospital in East London.
A doctor who did go public about the situation there has been suspended and none of the medics approached at Tintswalo would speak on the record.
A nursing sister however said the squeeze meant colleagues were having to carry out duties beyond their remit.
"We really are operating on a thin staff proportion and this puts pressure on us as it forces us to leave our duties to do what doctors should be doing. It is very bad," she said on condition her name not be used.
"The situation is without doubt putting strain on the limited doctors in the public service," acknowledged Mpho Gabashane, spokeswoman for the province's health department.
"It is not an ideal situation, but one we are working hard to overcome."
The government has even begun recruiting doctors from Cuba, Tunisia and Iran to cover the shortfall and has introduced incentives such as a rural allowance.
"We also have a pool of doctors available every year to do community service in rural areas as a policy and we are planning to include nurses as from next year," said health ministry spokesman Sibani Mngadi.
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