Reflections of an intern psychologist burning out in a public hospital

By Jordan du Toit

There was a strike at Bara yesterday. Someone from Soweto came to watch and said, “Ask anybody here in Soweto and they will tell you they don’t want to go to Bara because they might come back in a coffin”.

I couldn’t go to the protest. I was literally too busy to go and protest about how busy I am.

Most days I eat standing up. Some days I forget to even go to the bathroom. In Psychology, the World Health Organization (WHO) specifies that the ideal ratio is one psychologist for every ten patients. In 2014, the Minister for Health, Dr Aaron Motsoaledi, stated South Africa has 0.7 psychologists for every 10 000 citizens.

I cannot begin to explain how broken our health-care system is and Chris Hani Baragwanath Academic Hospital is just one example of this. However, I see such dedication in our staff despite the way we have to work. I see nurses kindly monitoring patients who spit and scratch at them while they are halfway through their “normal” 36 hour shift. I see doctors still taking patient questions after being 36 hours on call. I see community members volunteering for no other reason than to make this hospital, the largest in the southern hemisphere, work more compassionately.

But.
But.

I see the woman I am asked to treat screaming because the ambulance said they were not qualified to drive her to Bara from Orange Farm and while she waited for another, her baby died inside her.

I see the patients with HIV and a mental illness supporting whole 5+ member families on their SASSA grant of R1780 (as of our new minister’s budget) because their boss fired them for being HIV+ or taking the time off work to attend the clinic. They are often told ‘if you can walk, you can work!’ Our doctors recommend that they dress like they’re homeless because otherwise they won’t be seen as sick enough by SASSA to get the badly-needed grant.

I see myself seeing 7 patients in four hours who have all attempted suicide. Not one was employed. Not one had tertiary education. Not one had been supported through adequate schooling. I could barely remember their faces or names – only their desperation. I couldn’t even cry. I was too tired.

I see more and more patients with crippling symptoms due to unexpressed trauma and emotional distress, manifest in paralysis, blindness, epilepsy, and other conditions. It’s called a conversion disorder and the rate is skyrocketing.

I see patients in their late 20s with kidney failure from alcoholism or substance abuse.

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This is what the understaffed departments must hold, while barely holding themselves together. We are paid late, or not at all. We hand write our notes on carbon paper because no technology exists in the hospital for electronic records. We use WhatsApp groups for emergencies because the phone lines are down so often. We are shouted at by patients for the water being off or for the poor quality of the food. We have nightmares every night because of what we see.

This is a system running on fumes. In my field alone the burnout rate is rumoured to be 5 years from starting to work in the public health sector to completely burning out and leaving, either primary healthcare, or even the profession altogether.

We cannot fix this country if we cannot educate or treat our population. We cannot treat our people if we are barely staying afloat ourselves. Adding a National Health Insurance (NHI) plan will make things worse if no new posts are created or if the system is not overhauled.

I can’t express how dire the situation is. We are being broken down and our patients are dying. It’s as simple as that.

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Jordan is currently an intern clinical psychologist at Chris Hani Baragwanath Academic Hospital. She is pursuing her passion to one day work as a clinical psychologist supporting accessible and fair mental health care in South Africa. She is passionate about critical studies, particularly in gender and sexualities research, and has focused her Honours and now Masters theses in these areas. Her MA research focused on queer experiences in single-sex South African boys’ schools. She is also a Mandela Rhodes Scholar and enjoys engaging in critical leadership development in her personal and work environments. She enjoys writing and is currently working in her spare time on a web series centred around mental illness.