'Death and dying in the Eastern Cape'

By Zimbini Ogle

Death and dying is something we are certain of. However, we cling to a hope that our death will be delayed when we come into contact with healthcare professionals. This hope is soon shattered by the SECTION 27 report titled “Death and dying in the Eastern Cape: An investigation into the collapse of a health system”. The report details problems with the state of facilities, availability of medication and supplies, patient transport, emergency medical services and equipment.

The report highlights pain and sadness and suffering experienced by the patients and loved ones at a “hopeful” place, really a place of “life and not death” where patients can no longer run to their family/friend/traditional healer for help, but only to a health facility. Hope is what brings these patients to a health facility. The healthcare professionals are expected to inspire and or strengthen hope in the patients. And this hope is embedded in the patient-doctor relationship. During training at university healthcare professionals in training are taught of the doctor-patient relationship before they set foot in healthcare facilities. Fields of specialisation such as mental health emphasise the patient-doctor relationship. The patient-doctor relationship is central to the healthcare practice and remains keystone to the delivery of high-quality healthcare. The SECTION 27 report shows an unfavourable attitude by healthcare professionals towards the most vulnerable; the patients. The Eastern Cape is the poorest province, which means that many of the poor people are more vulnerable to ill-health and these are the individuals who use the public health service and unfortunately experience the attitude of healthcare professionals portrayed in the report.

Healthcare professionals such as medical doctors have the Hippocratic Oath to which all medical doctors swear upon admission into the practice of medicine. Does the Hippocratic Oath mean anything? Perhaps not to all the medical doctors? Or is it something that is just said because they have to? Does it mean anything? Does it make one think that they are entrusted with someone’s well-being and not only the particular individual’s wellbeing but the individual’s family and system? The nurses have taken a pledge of service. Does the pledge of service mean anything to them? Do these make one think of the power they hold over individuals’ lives? Does it make one think of their attitude towards patients?

What is the role of the training institutions and healthcare facilities in assisting staff to maintain the highest standard of care? A highest standard of care is not just measured by the availability of resources or whether the patients received the care but how the care is perceived by the patient and the healthcare professional’s attitude towards the patient.

Again, beyond the availability or lack of resources in healthcare facilities is the keystone, patient-doctor relationship, which seems to be “disappearing”.

There are those who still understand that doctor–patient relationship is critical for vulnerable patients. How are these particular healthcare professionals able to maintain the “sacred” doctor-patient relationship despite the challenging environments they work under? For those who this sacred keystone to healthcare practice is disappearing … why is it disappearing?

Clearly, the hope is not being practised. There seems to be a shift in values. This hope is about how we think of our ourselves and patients, it is human-ness, it is in being and doing “umntu ngumntu ngabantu”, it is the actions we take in the present when the patient is in need of care in order to provide healing to the patient and or even the family, be it biological, psychological or social interventions/treatments, hope is providing healthcare to patients despite challenging work environments and treating patients appropriately and putting their care as first priority. It is keeping a goal in mind, it is working to improve healthcare, it is pushing for healthcare for patients, it is engaging with colleagues for resources, it is admitting failures and fixing them and it working with others and mentoring each other in order to achieve a high standard of care for patients.

The death and dying report by SECTION 27 highlights the dying of hope in the province. With the death of hope in healthcare professionals the patients suffer a physical death, which could have been prevented.

Zimbini Ogle has a master’s degree in clinical psychology.

For more information on clinical applications of hope read: “Reasonable Hope: Construct, Clinical Applications and Supports” by Kaethe Weingarten (2010).