Equipping our future doctors with the tools to advocate for themselves and their patients should start long before they begin making ward rounds. (AFP)

Curing a sick system: Doctors and nurses must speak out for patients and themselves

Samantha Khan-Gillmore
Medicine shouldn’t be the only thing on the books at our medical schools. Here are some tips for healthcare workers to handle abuse.

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The diseases of racism and sexism have been allowed to fester far too long in our healthcare system. Workers must take a stand when their rights – and those of their patients – are violated. It’s time medical schools started speaking up about speaking out.

Recently, Yumna Moosa took to social media to bring attention to her struggle as a young doctor at a public hospital. In a video that went viral, Yumna recounts how as a junior doctor, she was subjected to racist slurs and racial profiling. She was also allegedly sexually harassed.

Yumna’s superiors told her not to complain about the harassment because it “would be better for her career if she remains quiet”.

Instead, she bravely chose to expose a hidden, exploitative organisational culture that feeds off the young, the vulnerable and the inexperienced. It’s a culture in which centuries of patriarchy within the medical profession have been allowed to smoulder in pockets where it continues to be wielded by a minority of abusive senior doctors.

In the wake of the video, her alma mater, the University of Cape Town, has voiced its support for her.

“Racism and sexism have been embedded in the health services environment for too long. This is abhorrent and unacceptable,” said Faculty of Health Sciences interim dean Gregory Hussey in a statement.

“We in the health professions must ensure that we are not part of a system that protects abusers.”

The Health Professionals Council of South Africa, which is responsible for registering doctors, is currently reviewing complaints made by Yumna against the physicians who allegedly harassed her.

But there are so many more Yumnas in South Africa.

The Rural Health Advocacy Project (RHAP) travels the country speaking to healthcare workers and especially medical students as part of its Voice Project. The project works to increase health care workers’ ability to report and act on failures in our health system, whether that’s a lack of staff or, like in Yumna’s case, victimisation.

Every time I enter a lecture room to speak to final year medical students about the project, I brace myself for the stories I hear repeated from Johannesburg to Durban.

Clinical rotations are an important exercise in the lives of medical students, particularly for final year students. After the fifth year of medical school, two years are spent as an intern in the public health system before becoming a qualified doctor.

During this transition from student to doctor, students experience a range of negative experiences at the hands of senior staff, most of which they believe are beyond their control.

“How can I say anything if I need him to pass me at the end of the year?” one student laments.

Another says: “I have a bursary to study medicine so I need to complete my final year to finish my studies and repay my debt.”

Discrimination comes in all forms. No matter the extent or mode of it, the results are debilitating, humiliating, and unfair. At the start of their careers, these healthcare professionals have a lot to lose. They face tough choices about whether to stay quiet and support the status quo, or to speak up and risk victimisation.

Part of RHAP’s Voice Project is about empowering and capacitating healthcare workers to speak out each time human rights – theirs or those of their patients – are violated. This is a healthcare worker’s right and duty.

Healthcare workers have an obligation to speak out against practices that are prejudicial to the public interest, and this duty is not limited to their patients but includes themselves.

The health system is rife with many challenges like understaffing, mismanagement and a lack of resources. These problems are exacerbated by the struggles of all the Yumnas in our clinics and hospitals who, like her, are often victimised when they report abuses.

As part of the Voice Project, we teach healthcare workers to report abuses safely. Doing so means knowing the resources available to you – inside and outside of the public health system. These include legal advisors, regulatory bodies and even the media or the police.

There's no one-size-fits-all approach to this, but here are some tips for those looking to speak out:

1) Start early and gather all the facts.

2) Remember, there’s strength in numbers. Organise. Get help if you need it.

3) Report it to your facility first before escalating the issue at the district, provincial or national level.

4) Leave a paper trail. Document all efforts made to improve the situation and all complaints, and always follow up in writing.

5) Use the law. As a whistleblower, the Protected Disclosures Act can ensure you are covered legally.

But equipping our future doctors with the tools to advocate for themselves and their patients should start long before they begin making ward rounds.

Advocacy should be a critical component of university curriculum. Graduates need to have the requisite skills and expertise outside of the clinical environment to defend, protect and advance a rights-based culture in the workplace. They must be able to question, for instance, the recycled patterns of social relations that constitute men as dominant and women as subordinate.

Too often, students are graduating with the full complement of clinical skills but not enough expertise or exposure to a sound social justice system. The inclusion of advocacy in the curriculum would go a long way in preparing and empowering students to be ardent health advocates – for their patients as well as for themselves.

Every generation has a new gender layer to wade through, and unless notions of sex, gender, class and race are holistically addressed, these four layers will continue to intersect, pervade and be a dominant struggle for women and society at large. The field of medicine is not immune from this.

Yumna is a brilliant example of what can happen when students, interns and community service doctors realise that they have a voice.

In the words of author and human rights activist Arundhati Roy: “There really is no such thing as the ‘voiceless’. There are only the deliberately silenced, or the preferably unheard.”

Samantha Khan-Gilmore is the programme manager for human resources for health at the Rural Health Advocacy Project.

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