The Junior Doctors’ Association of South Africa (JUDASA) is calling for critical discussions between role-players in the health sector to reconsider the structure of the on-call system for junior doctors.
This call was elevated by the recent death of a junior doctor, Ilne Markwat from Durbanville, who died in a car crash after reportedly falling asleep behind the wheel after a long shift on Friday June 3.
Dr Markwat was on her way home when her car crashed into a barrier before rolling and colliding with two vehicles on the N1 near Klapmuts.
Judasa Western Cape chairman and national executive committee member, Dr Zahid Badroodien of Tygerberg Hospital, said junior doctors were expected to work 40 hours a week and then, in addition to that, between 60 to 80 hours of overtime a month, which equates to over 300 hours of work a month.
“As it stands, it is common to see junior doctors work continuously beyond 30 hours from 8am to roughly 4pm the next day. This results in an increase in medical errors, which can lead to poor patient management. We are currently challenged by the perception of administrative and senior medical staff that long slogs through the night are a right of passage and as such will make us better doctors.”
He added: “This is unacceptable and is dangerous towards ourselves as well as our patients. Furthermore, we are bullied into disregarding our rights, as we are held to ransom by the threat of not being approved for completion of the specific rotations that we work in.”
Mark van der Heever, spokesman for the provincial Department of Health, said they strove to strictly adhere to the Guidelines for Internship Training as published by the Health Professions Council of South Africa.
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“All health institutions in the province have monitoring processes which ensure interns do not work hours over and above the stipulated timeframe. Interns should not exceed 30 hours of continuous work and therefore should be released on or before completion of a 30-hour period.”
He added: “Hospitals also have intern curators and intern domain co-ordinators, with intern representatives. Interns are, by and large, responsible for their own roster allocation and therefore are able to take cognisance of their own leave allocations.”
Dr Badroodien was adamant that doctors, particularly those at district hospitals, were working beyond the 30-hour cut-off. He said Judasa was calling for a cap on continuous working hours at 24 hours and a strict rule that doctors should leave the working environment once these hours were reached.
“We call on the Minister of Health, a doctor himself, to heed the calls of his colleagues and assist in addressing the unfair working conditions we are being subjected to. As a result of serious human resource shortages, it is impossible to end the commuted overtime system.
“We believe serious consideration must be applied to the possibility of 12-hour shifts within rotations and adequate rest facilities on site to be made available for all health staff who have far exceeded the legal limit of continuous hours of work.”
Mr Van der Heever said the HPCSA Sub-Committee had confirmed in June 2006 that interns were required to work overtime duties. It was indicated that due to exhaustion and the resulting possible risk to patients, interns should not be required to be on duty for more than 60 hours a week.
“It furthermore states that interns require being off-duty one full weekend per month, continuous service should not exceed 30 hours, on-call after hours duty should not be more than 1:3 and interns should not exceed 80 hours of commuted overtime a month.”
Mr Van der Heever said the department had again responded in 2013 to a South African Medical Journal article citing internships. Arising from that, the department investigated the working conditions and working hours of interns.
“The outcome of the investigation was that the department fully complied with the HPCSA guidelines.”
HPCSA spokesperson, Fezile Sifunda, said the current guidelines on working hours were not written in stone.
“It is imperative that the contractual relationship between intern/doctor and employer is consistent with the Basic Conditions of Employment Act and conditions of service which are applicable in the public sector. Concerns of excessive working hours should be directed to the national Department of Health. The HPCSA provides guidelines only and does not stipulate working hours.”
Dr Badroodien, however, said the association was clear on its position that junior doctors must enforce their contractual obligation to cease work after 30 hours of continuous labour.
“We have embarked on various campaigns as well as direct interaction with members at their facilities to inform them of their rights and responsibilities as young doctors.”
Dr Badroodien said Dr Markwat’s death was a loss for the South African health system.
“I have worked personally with Dr Markwat when she was still a student at Stellenbosch University. She had a wonderful, caring nature for both colleagues and patients. She had a giving heart and warm smile.”
The department said it mourned the young doctor’s death.
“Her passing is a great loss of a young life full of potential. Our thoughts and prayers are with her family, friends and co-workers during this time of bereavement. The sad news of her passing is now being used by various bodies to propel their view around the working hours of medical interns. We now wish for the family of our deceased colleague to be granted privacy to mourn the passing of their beloved,” said Mr Van der Heever.
Various people and groups took to Facebook to express their shock and sadness over Dr Markwat’s death.
Safe Working Hours for Junior Doctors wrote : “We are shocked by the news that our classmate, colleague and friend, Ilne Markwat, passed away in a car accident on her way home after a call yesterday. She was a talented medical intern who always had time for a smile and treated her patients with kindness. We are thinking about her family and friends. South Africa lost a wonderful doctor.”
Facebook user Diketso Dixie Mathebula wrote: The news of your passing was so unexpected and so surreal. I sat next to you just this morning Ilne. You’re in a better place now, but it still hurts knowing you won’t be in the consulting room right next to me. You were so easy to talk too. I won’t be running up to labour ward after hours to give you my charger and have a giggle anymore. We’ll never get to share a bag of biltong ever again. And that road trip we spoke about? I’ve only known you for five months, but we’ve made a lifetime of memories, so I’ll hold on to those.”
Mr Van der Heever said the department strove to ensure the safety of its staff.
“Further strengthening the monitoring processes, supervisors and heads of health institutions ensure that the logbooks are completed correctly as per the HPCSA Handbook Guidelines with each hospital monitoring the working hours and conditions of interns, as per the policy parameters.
“Health institutions have confirmed that interns did not work hours over and above the stipulated timeframe provided for by the HPCSA guidelines.”
The Cape Times reported on Monday June 20 that the family of a survivor of the car crash had threatened to take action against the Department of Health.