Palesa Dwaba* sat down on a chair in the shabby room holding her black handbag tightly on her lap. “Good morning doctor,” she greeted.
It was early January 2013 and Dwaba was in a small private dental practice in Orlando, Soweto, for an interview for the position of dental assistant.
“Good morning Palesa,” said the owner of the practice, Dr Mashaba*, as he paged through her CV. “You seem like a smart lady; you’ve got the job.”
Dwaba smiled uneasily and shifted in her chair. Maybe this time it will be different, she thought.
“Thank you doctor. What will my duties be?”
“You’ll be assisting me mostly. But there are certain favours I might ask you to do but only when it’s quiet,” he answered.
Dwaba glanced at the peeling blue paint on the walls and nodded politely.
Mashaba continued: “I might ask you to just sweep the floor in the morning because I get in late and you will be sitting and doing nothing.”
Dwaba nodded her head again.
“I will start you out on R1?300 a month and we can increase it with time,” he said.
Her heart sank. The last dentist she had worked for had also asked her to clean in addition to her regular assisting duties. He, too, had paid her a low wage, one on which she could hardly survive, despite her one-year diploma and registration with the Health Professions Council of South Africa (HPCSA).
But I need a job, she thought despondently.
“You start on Monday,” Mashaba said.
He smiled, lifted himself off the dental chair he was perched on, and led her out of the practice.
Dwaba took a last look at the disorganised files and walked out into the streets of Orlando with a heavy heart.
ExploitationDwaba is one of many dental assistants being taken advantage of in the private sector. Even with a formal qualification in dental assisting she acquired from the then Technikon Pretoria in 2002, she could not find a job that paid a decent salary to support her three children.
In her previous job, assisting another Johannesburg-based dentist, she was unable to take leave even when she was sick, was asked to do menial chores such as cleaning the dentist’s car and was shouted at by her employer when she raised issues about her working conditions. Her salary was R1?200.
“He said to me: ‘Don’t forget, there are a lot of people looking for a job’,” she said.
It is for this reason that the Dental Assistant Association of South Africa approached health minister Aaron Motsoaledi in 2009 to request that dental assistants be given a professional status, as previously promised, to protect them and patients, according to one executive member of the association who asked not to be named.
In 2005, then health minister Manto Tshabalala-Msimang introduced regulations requiring all dental assistants to register with the HPCSA, said the South African Dental Association (Sada) chief operations officer, Maretha Smit.
This requirement, however, was not enforced until the Dental Assistant Association reignited the process some years later.
Accredited qualificationThese regulations required all dental assistants to provide proof of a formal and accredited one-year qualification.
Vidyah Amrit, chairperson of the board of Dental Therapy and Oral Hygiene at the HPCSA, said that for the past seven years there had been a “grandfather clause” in place to allow dental assistants with more than five years’ experience to register without a formal qualification.
This grace period came to a close at the end of 2012.
There were four institutions with accredited dental assisting courses, Amrit said: the Central University of Technology in Bloemfontein, Durban University of Technology, Tshwane University of Technology and the Cape Peninsula University of Technology.
“All but the Cape Peninsula University also offer a distance learning programme for this one-year course.”
After fighting against the regulations for about 10 years, Sada’s application was dismissed with costs by a high court in March this year.
“This is not the end, however,” said Smit.
On August 29 Sada’s leave of appeal the March judgment was granted at the Gauteng division of the High Court in Pretoria.
Occupation, not profession - SadaSada has argued against the forced registration of assistants because it makes them “overqualified for the job”.
“The assistant sits at the side of the dentist and hands him his instruments, sterilises the instruments and may perhaps perform other administrative functions in a small practice – that’s the job.
“They don’t do procedures on the patient. It’s an occupation, not a profession.”
As with other medical professions, dental assistants are now also required to earn continued professional development (CPD) points throughout the year to keep their registration valid.
Smit argued that this places an unnecessary financial burden on dentists who have to do without assistants while they attend CPD events.
“Who is going to pay for their absence from the practice when they go for CPD courses? The dentist must pay but who ultimately foots the bill? It’s the patient. It will continue to make private dentistry unaffordable to most people,” said Smit.
But Amrit said it was not only important for dental assistants to be protected by recognising them as professionals, it was also vital for patient safety because dental assistants were responsible for infection control.
“We may argue that the dental assistants aren’t working directly on a patient but they are responsible for the key clinical environment in which the patient is treated. With the rise in infectious diseases, for example HIV and tuberculosis, it is vital this category of health worker is properly trained in infection control,” Amrit said.
ResponsibilityBut some dentists argue that they themselves are responsible for their practices.
Kobus Van Rooyen*, a dentist working in eMalahleni, said: “At the end of the day it’s my practice so the buck stops with me. I’m the employer and the most qualified person so I should be responsible for anything that goes wrong.”
Sada is also concerned that there are not enough registered assistants. “You need one and a half dental assistants per dentist,” said Smit.
“There are about 4?000 dentists working in the country in both sectors so we need about 6?000 assistants.”
There are only 3?060 registered assistants, according to the HPCSA.
It is a criminal offence to employ unregistered people, according to Amrit.
Van Rooyen said: “I’ve advertised for the position but there are no qualified people applying. This means I’m breaking the law by employing an unregistered person, but what else am I supposed to do?”
Thabo Twala, a dentist who works in Mahikeng, does not ask his assistants to clean the practice and pays them between R6?000 and R8?000, but he is aware that other dentists “don’t treat dental assistants as they should, presumably to cut costs”.
“Some dentists are asking their assistants to clean without paying them well, but it’s definitely not all of us.”
Although the HPCSA has released statements saying all dental assistants need to be registered by March 2016 or risk legal action, Sada argued that the issue was unresolved because their appeal had been accepted.
“Despite the fact that we appealed [against] it, the HPCSA sent out a statement about the fact that registration was required and that it is a criminal offence to employ unregistered assistants. And that is actually disingenuous because the case in on hold,” said Smit.
Peace in the public sector For Dwaba, registration as a professional is the only way to protect against the “exploitation” she and her colleagues experience.
“I think the only reason Sada is opposing this is so that dentists in private practice can continue to employ lay people and pay them next to nothing,” she said.
“I was lucky enough to get a dental assisting job in a government clinic this year and it has changed my life.”
Dwaba receives a salary of R13?000 and performance bonuses – a far cry from the R1?300 she was earning in Orlando.
“Yoh, it was just terrible,” she remembered. “I only got peace when I came here to the public sector. I said: ‘Oh thank you God’. I’m relaxed and so happy – I’m so happy.”
* Not their real names
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
Medical aids have dentists over a barrel
Humanoid teaches dentists to feel patients' pain
The case of the dirty dentist
Finding gender-affirming care can be tough but there are some tips and resources to help.
Climate change and air pollution could be conspiring against the continent, and fuelling new levels of death and disease.
A new kidney disease is striking down labourers in what could be one of the first epidemics caused by global warming.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.