A world of difference between private and public healthcare in South Africa

In South Africa, the reality of socio-economic inequality is that, often, private healthcare is reserved for those who can afford it while public healthcare sees to the rest. Two Joburg women from different economic backgrounds talk to AAISHA DADI PATEL about their experiences of accessing healthcare.

Ruby Mashaba

Ruby Mashaba, 39, cleaner
I’m a cleaner employed by Wits. I live in Pimville, Soweto. I have two kids – my first is 22, and she’s just completed her BEd at Wits, and my second is 14 and in grade 9. My kids and I live with my uncle and aunt and their kids – there are about 15 of us, and my girls and I have a shack outside on the property.

My daughter was lucky and got a bursary because she was smart. But it was still tough – there were times she had to come to university without any lunch. She told me just last week that she’s pregnant, so she probably won’t be able to get a job now. Her boyfriend is working though. But I’m happy – she respected me. She didn’t drop out, she worked hard, studied, and didn’t disappoint me. She’s the first in our family to graduate.

My current contract has no health benefits at all – that’s why we fought so hard for insourcing, because we would get medical aid. Amongst us cleaners many of us are sick, and the things we get exposed to are not good for our health. With the scourge of HIV a lot of us are affected. I myself am HIV-positive, and was diagnosed about two years ago. I think I have an idea of where I got it from, but I can’t be sure. When I was counselled about it the sister told me not to think about it, and just focus on looking after myself. I try not to think about it, but I know deep down in my heart it was my partner.

I’m working here at Wits for five years – many cleaners die, because of these health issues. In my experience, at main campus alone, we have had to bury a lot of our colleagues – including at least 10 from main campus.

With us, it’s “no work no pay”. I had an HIV-positive colleague who was very sick but had to work or else she wouldn’t have any money – she was lucky enough to have someone to cover for her areas so she could rest. When she did eventually get help, it was too late – she died.

If we get sick, we go to a government clinic. There have been times my kids were sick and I had to miss work for days. The only option is to take your child to get help. We don’t have medical aid. We don’t have money because it’s [the] middle of the month. The only way to get medicine is through the chemist, which is expensive – medication from the clinic is never strong enough in my experience. We have to go to a loan shark because of the stuff we need to buy when they’re in hospital or need care. It’s tough. At the end of the month, your salary is halved.

I can say that I’m lucky because I found out when I got tested at a mobile clinic at Wits. I still have a high CD4 count. I haven’t started ARVs yet, and I’m still healthy. The sister referred me to Helen Joseph and I found out there is a Wits research unit and because I’m a participant on a study there, I get care and a stipend. I’m lucky, but most of the other cleaners don’t have this. It’s not easy for people to disclose as well, so as much as I want to help I can’t always, because I don’t know. At Wits, other cleaners should be made aware of the research unit that Wits has at Helen Joseph. If it was publicised it would help a lot of people, who could be part of studies and then save a lot of money. The study that I’m in gives me R150 for transport when I have to go in every couple of months, and transport doesn’t cost more than R20-R30, so that’s extra money for food. I’m part of a study for TB, but there are a whole lot of other studies that take place as well.

The waiting at the hospitals is terrible. Before you get to the actual doctor you need to see, there are so many processes – testing your urine, your weight, your blood pressure, and there’s always queues for each of these things. The worst is when it’s tea time or lunch time – you just sit and wait. It’s terrible.

Something so many cleaners have to deal with is when there’s an issue with a sick note, even though they’ve cleared and given notice that they won’t be able to work the day before. Something as small as a missing date or signature means the note gets turned away. The company rejects it, and the cleaner doesn’t get paid. And when these small things happen it’s not the clinic’s fault, the staff is overworked.

I would definitely prefer to have private healthcare and one of the reasons we are pushing so hard for insourcing is because we’ll have medical aid. Everything is easier with medical aid. I have heard that the university doesn’t subsidise the medical aid so the costs are high. Someone told me though that I must be prepared for R6000-R7000 of my R10 000 – which is what we are asking for – to go to medical aid. We have been fighting that we can’t live on R2000 a month – if medical aid will take us back there, it’s not worth it.

In terms of mental health – we have a lot of guys that have mental health issues. You can see that they are unwell. I think if we were able to have access to counselling and psychologists, it would really help us. A service such as debt counselling, for example, could be really helpful for us. Some workers are driven to quit work because they couldn’t handle the pressure. You see, we earn very little, so we end up taking multiple loans from multiple loan sharks to buy what we need and to pay back other loan sharks. The only solution some cleaners have is to just leave, and hide, and stay at home because they don’t know how they’ll be able to pay. Loan sharks are known for being violent.

We have deaf people working here as well, and I feel bad that we have these very important meetings but they don’t know what’s going on. We try to communicate with them, but it isn’t easy.

Standardising health care will never work. The government promised free education and free healthcare, and look where we are now. Before these empty promises were made, there was good service – people didn’t drag their feet, and people didn’t die in queues. It really won’t make much of a difference, we’ll experience the same thing we’re experiencing now – and we know about corruption.

Phindile Maphanaga

Phindile Maphanaga, 22, law student
I’m a final year law student this year. I’ve lived in the north of Johannesburg for most of my life, and I’ve been living in Sandton for the past three years. I’m a student and I don’t have any form of income except for my allowance, so you could say that my parents support me.

I sometimes deal with healthcare issues mostly coming from my stressful lifestyle – I’m sick at the moment – but I have pretty good care and always recover. I’ve been admitted to hospital once before for fatigue and exhaustion, and I went to Netcare Waterfall overnight to recover. I have medical aid, but since I turned 21 it only covers certain things. I do have hospital cover though.

When I get sick, I usually like to opt for herbal solutions and healthy alternatives before anything else. But I will usually also just go to a GP and get help there, such as a script for an antibiotic. For the most part though, I’m in a safe and clean environment so my health is never compromised.

When I was admitted to hospital, it wasn’t the smoothest process but it wasn’t that difficult either. There is a lot of admin work and a waiting list, but waiting is much shorter than a public hospital. It was late at night when I went. I had to wait in the casualty section and I waited for an hour and a half before I got assistance, but I received very good care once I was in. Family members drove me there, and were able to be by my side the whole time.

My family and I have dealt with quite a few issues related to travel, and especially travel in the rest of Africa. I’ve had experiences coming back from countries like Angola – where my sister contracted malaria – and Tanzania/Kenya, where we also picked up something when we were at the Serengeti. Even though I’m feeling sick and so terrible, at least I know I’ll get the healthcare I need and recover. I can’t imagine what the people who remain in those countries have to go through because they have to stay there. Without your health, you are nothing.

If I had to, I would use public health facilities – the degree of the standards and quality varies across all hospitals, so even though some public hospitals are really in bad shape, some of them are quite decent. I think public health needs to be made a priority over private health because that’s what the majority is using and the state needs to improve that. There shouldn’t be a great degree of difference in terms of quality and service.

I think an aspect that really gets neglected, especially in poorer black communities, is mental and emotional health. I really think there should be a lot more focus on counselling and interventions in the black community. There’s a misconception that these are only “white people” concerns, which leads to a lot of stigmatisation. Things like bipolar disease, black people consider so taboo – “you’re bewitched”, they’ll say. We need campaigns and more focus so that people can become aware of these things.

People need to learn about things like depression and anxiety – these are serious conditions, stemming from serious issues, and they need to be dealt with – it’s not a case of people being rude for the sake of it. They are ill, and need care, and I’m sure that many people from poorer black communities who suffer from it are not even aware of it. But when they’re stuck in a cycle where they can never take a break, because it will mean they won’t be able to make ends meet, how do you deal with that? It’s a difficult one.

*Name has been changed.

The Daily Vox, in partnership with Oxfam SA, will be highlighting the challenges of socieo-economic inequality in a special project this month.

Featured image via Flickr