"After 18 months of waiting, documents getting lost, over 50 unanswered emails and even more unanswered calls, I really don't see any other way to put pressure on these people. That's why I want to go public," says Dutch physiotherapist Liesbeth Raymakers.
She is one of many foreign health professionals who have been having protracted battles to register with the Health Professions Council of South Africa (HPCSA) to work in the country.
According to Retha Grobbelaar from Africa Health Placements, a nonprofit organisation that recruits local and foreign-qualified healthcare workers to work in rural and underserved areas, South Africa "does not currently have enough doctors to deliver quality health services under universal coverage".
Foreign doctors, she says, are one way of addressing the problem and will be "essential" for the success of the National Health Insurance scheme being piloted at 11 sites.
Klara Buntzen*, a German doctor, says South Africa is a popular destination for foreign doctors because "you actually become a better doctor. You get much wider experience than you would in Europe and also this a beautiful country". Buntzen submitted her application to the council more than six months ago and has also experienced problems similar to Raymakers.
She is speaking to Bhekisisa on condition of anonymity, afraid that if her real name appears in the media her application will be "deliberately delayed even further".
Grobbelaar says that foreign doctors often also want to work in South Africa for "humanitarian reasons" and want to improve medical care in underserved areas.
Fewer doctors but longer process than other countries
The World Health Organisation statistics show that, as of 2011, South Africa had less than one doctor per thousand people whereas Germany had close to four.
"The registration period in South Africa is longer and more bureaucratic than countries such as Australia and Canada," Grobbelaar says, "countries we are competing with for these resources."
According to Jason Day from the United Kingdom's General Medical Council – the body responsible for registering doctors there – depending on whether all the documents submitted are correct, it takes approxi-mately six months for a foreign doctor to register to work in the UK. Raymakers has been waiting four times as long – almost two years – for her South African registration to conclude, and the process is still not complete.
Buntzen, who is engaged to marry a South African man, says she knows of at least one other doctor who applied to work in South Africa, became frustrated along the way and gave up. He is now practising in Germany.
"If you don't have a really good reason to move here, like a long-term partner, you actually give up halfway because it takes so long and becomes so complicated," she says. "I don't know of one foreign doctor who has not experienced problems registering with the HPCSA."
Raymakers's struggle with the council began at the very start of the process, when she was sent the application forms. After filling them out and sending them back, she was told that she had filled out the wrong form – the council had given her an outdated version.
"After that, I sent all the required documentation by registered mail in early 2012, costing me €400 [which includes postage and legal certification fees]. It was never picked up and was returned to Holland three months later. I had to pay and send it again," she says. "I think I have been particularly unlucky, but it doesn't excuse the council from not even acknowledging emails sent or calls made."
Buntzen says she doesn't "bother phoning them anymore because they never pick up their phones. I just send emails and emails and emails. I have to send at least five to get one response – if I'm lucky."
HPCSA's costly mistake
After it was found that a Congolese "neurosurgeon", who had worked at three Gauteng public health facilities from 2007 to 2011, did not pass the required exam or possess the required qualifications to practise as a neurosurgeon, the council decided to re-evaluate its verification process.
Since 2012, the council has outsourced the verification of foreign doctors' qualifications to an American company, the Education Commission for Foreign Medical Graduates, which is one of the reasons that the registration process has become longer, according to Saul Kornik of Africa Health Placements.
"By all accounts, this doctor seemed to have slipped through the system because of processes that existed but were not followed, not because of insufficiencies in the processes themselves," he says.
But Buntzen says this is "no excuse" as they "always lose something".
Raymakers agrees. "Everyone at the HPCSA always seems to be either in a meeting or in a workshop when you call them or pay them a visit, which I did three times. That has nothing to do with verifying our qualifications," she says. "There are small changes that could be made to make a big improvement: one case manager should be appointed to handle each professional, a clear time frame should be communicated to us and the HPCSA should consider launching an online application option."
The government decided not to recruit doctors from developing countries, which could "deprive our neighbours of their scarce resources in order to meet our needs", according to a 1995 press statement.
According to Grobbelaar, there are however many doctors from developed countries, where there is an abundance of professionals, who want to work in South Africa and should not be discouraged. "Foreign-qualified doctors hold out a lifeline for many rural hospitals and we cannot afford to lose them because our registration process takes too long."
The HPCSA did not respond to repeated requests for comment, despite committing to doing so since last week.
* Not her real name
The 'total nightmare experience' appears to be widespread
After "battling" with the Health Professions Council of South Africa to get registered to work in the country since early 2012, Dutch physiotherapist Liesbeth Raymakers drew up an online survey and posted it to Africa Health Placements' Facebook page, as well as her own, to ask about the experiences other foreign doctors have had while registering to work in South Africa. Twenty-three professionals responded but wished to remain anonymous.
Here are some of their comments:
• Specialist doctor, the Netherlands: "I dealt with seven different people for the same registration. These people do not hand over to each other so you have to explain your situation over and over again. My emails got replied to on average after two weeks, if at all."
• Physiotherapist, Zimbabwe: "Delays with processes."
• Doctor, United Kingdom: "I didn't have any major problems with initial registration but getting independent practice [which allows a practitioner to work in the private sector] was a major nightmare. I was told I needed to sit the exams, which I did. When I had the exams, I was then told I needed permanent residency, so had to wait for that. When I had that, I sent all paperwork to Naledi Mfafudi [from the HPCSA]. She took many months to respond to countless emails and phone calls. Whenever I did manage to get a response she would ask for something that I had already sent her. A total nightmare process."
• Dental surgeon, France: "The secretary in charge of the foreign practitioners is absolutely useless. She never answers her emails, or puts the documents she asked for in your application!"
• Doctor, the Netherlands: "[The] HPCSA was the biggest problem. I had to postpone my flight twice. At the beginning of 2011, when my application was filed, the process changed: I had to have HPCSA permission first before flying to South Africa. Before that period, you could get a work permit, fly to South Africa and start working, and the HPCSA permission would be finalised within six months after arriving. This frustrated my entire application. I was without a job for three months."
• Specialist doctor, Norway: "I found the whole process very demanding. It is sad because South Africa really needs doctors, but they are not well treated at the different workplaces."
• Doctor, Germany: "Communication is a general problem. Phone calls remain unanswered, so do emails usually. The tone the employees at HPCSA address the healthcare professional with is highly rude and unprofessional. No one seems interested in helping you at all and important documents that have been sent get 'lost', which I think happens deliberately."