Neo-Apartheid South Africa: “Public Health” Hell

Doctors Strike Defies ANC/SACP/COSATU Government

MAY 4—Starting in the Pretoria area on April 16, doctors in at least 28 public hospitals throughout South Africa have carried out wildcat strikes, “go-slows” and protests against unbearably low pay and horrendous conditions. Pushed to the wall, the doctors, banned by law from striking, faced down the capitalist government of the African National Congress (ANC) and its Tripartite Alliance partners, the South African Communist Party (SACP) and the COSATU trade-union federation. The government mobilized military medical personnel to try to break the strike and threatened hundreds of doctors with dismissal, including those who defied a back-to-work court order.

Strikers have now returned to work and the government has replaced the dismissal notices with final warnings. The doctors are demanding that the government finally begin paying up to 50-percent increases in salaries, as it agreed to do in settling a four-week public sector strike in 2007, and they are also calling for improvements in the hospitals. The doctors fight against all odds to do their jobs in a woefully underfunded system that is hell for patients and staff alike. The basic pay for public sector doctors is around 10,000-19,000 Rand (about $1,200-2,300) per month, with junior doctors and interns making substantially less.

A spokesman for the United Doctors’ Forum, a group formed during the strike, declared: “We will strike again if our needs aren’t met.... Our action may be illegal, but our reasons for doing so are very legitimate” (Mail & Guardian, 1 May). According to today’s Sowetan, the government is offering measly increases of 0.28 to 5 percent. A doctor at George Mukhari Hospital in Ga-Rankuwa township outside Pretoria told our comrades of Spartacist South Africa that while full doctors who were fired could easily find work elsewhere, striking interns, who by many accounts were the backbone of the strike, had no such assurance. With an all-black staff, this teaching hospital was the epicenter of the strike. The SSA stands in full support of the doctors and their demands. No firings! No reprisals!

Running point for the capitalist government were the misleaders of the COSATU-affiliated SA Medical Association (SAMA) and DENOSA nurses union, who denounced the strike from the outset. This betrayal demonstrates in practice the role of the COSATU tops and their SACP overseers in the Tripartite Alliance: to police the working class on behalf of the capitalist rulers. The Alliance partners are reveling in the ANC’s victory—with nearly two-thirds of the vote—in the April 22 parliamentary elections, which clears the way for Jacob Zuma, tirelessly portrayed by the SACP/COSATU tops as the friend of trade unions and the black masses, to become president of South Africa. The bourgeois press is filled with jubilant statements about the “free and fair” elections, while virtually the entire political spectrum talks about a shift to the left. For the workers and the poor there is nothing to celebrate! The day after the election the ANC demonstrated how much of a “friend” this government will be by organizing military doctors to break the strike!

The Tripartite Alliance is a nationalist popular front binding the mainly black working class to its class enemy through the bourgeois-nationalist ANC. Since it first took office in 1994 following the demise of racist apartheid rule, this government has upheld the neo-apartheid capitalist order by breaking strikes and enforcing austerity. Under Nelson Mandela, the same government that decreed free health care for children under six ordered spending cuts that led to hospital wards being closed, medical equipment being denied to staff and clinics being denied drugs. When nurses walked out in 1995 to demand better pay and working conditions, a number of SACP/COSATU bureaucrats branded their action a “counterrevolutionary strike.” Some 6,000 nurses were fired by the Eastern Cape provincial government headed by the late Raymond Mhlaba, who was SACP national chairman at the time. As Safety and Security Minister in 2007, leading SACPer Charles Nqakula set the army and cops against striking COSATU public employees.

Class-conscious workers must defend the doctors as the first line of defense in the fight for free, quality health care for all! As one striker put it, “It’s not just the pay but also the working conditions. There is such a shortage of doctors so we have too many patients to see. Then the hospitals run out of basic antibiotics and Panados [acetaminophen].” While strikers reportedly received verbal sympathy from nurses and cleaning staff, they were stabbed in the back by the union tops and left to strike on their own. There is a history of different sectors of the workforce being pitted against each other, including along “professional” lines. The attacks by the bourgeois government against nurses and doctors alike underscore the need for one union for all medical employees, from doctors to orderlies to cleaners.

Due to atrocious conditions and meager pay, there are more South African doctors working outside the country than in the public sector at home. Every year, doctors and nurses leave the public health system in droves for the private sector, where surgeons, for example, make eight times the salary of government surgeons. There are 4,000 unfilled doctors’ positions in public hospitals, while the nursing shortage is around 40,000. In rural areas the doctor-to-patient ratio is as low as three for every 100,000 people.

Junior doctors and interns describe working 80-hour weeks, with 10-to-14-day work cycles, in massively overcrowded hospitals where many of the sick have to return home without treatment after waiting long hours. Doctors at the Red Cross Children’s Hospital in Cape Town have taken to wearing black to protest the fact that sick children wait up to 12 hours to see a doctor. While much of the bourgeois media denounced the strike, even as it feigned sympathy for the doctors’ plight, a Johannesburg Star (30 April) editorial stated: “Government doctors believed they had a point in striking that went beyond the demand for a pay rise, and we cannot disagree.”

In an attempt to whip up public anger against the strike, government spokesmen accused the doctors of “endangering lives.” This from a government that under former president Thabo Mbeki denied that HIV causes AIDS and held back the provision of antiretroviral medication (ARVs) to the sick, causing the needless deaths of an estimated 300,000-plus people. The AIDS pandemic has hit South African women particularly hard, with the largest cohort of AIDS sufferers being women in their 20s. The government’s criminal policies on AIDS also helped spur the spread of tuberculosis, including its drug-resistant strains, throughout the population.

The government eventually discarded its AIDS denialism and began rolling out ARVs, which has saved untold numbers of lives while also allowing the implementation of programs to prevent the transmission of HIV to newborns from their mothers. But the lack of government funding and the abject condition of public health infrastructure leave most with no access to such drugs. Only 34 percent of those requiring ARVs in 2007 actually received them. Last November the Free State province announced a “moratorium” on giving ARVs to new patients because it had run out of money, leading to some 30 deaths per day over several months. This decrepit system is overseen by the strikebreaking health minister Barbara Hogan, who is held up as a hero by the ANC-loyal Treatment Action Campaign and others who opposed Mbeki’s AIDS denialism. We demand free ARVs for all who need them, now!

A stark measure of the enduring racial divide under neo-apartheid capitalism is the contrast between the relatively efficient, state-of-the-art private health facilities available to the people who can afford them, mainly whites, and the minimal, crumbling, dangerous public facilities that most of the black and Coloured (mixed-race) population relies on. According to a Human Rights Commission report, the private health care sector spends R43 billion servicing seven million people while the public sector spends R33.2 billion on 38 million people. Meanwhile, the government reinforces superstitious beliefs by legitimizing “traditional healers” and helping to subsidize tribal kings and chiefs. The inaccessibility of decent health care for poor people leaves them with nowhere to turn but to dangerous quack “remedies,” including for AIDS. As part of the struggle for genuine social equality, we call for nationalizing the private hospitals and clinics and for massive investment in health care in the townships and rural areas.

How cheap black life is still held in the “new” South Africa can be seen in the Eastern Cape, where hospitals with overflowing morgues have been handing stillborn babies over to their mothers in cardboard boxes, telling them that there is a new rule that they need to bury the remains themselves (Johannesburg Times, 19 April). Last month newspapers reported the story of Ntombizodwa Mali, a Western Cape woman who was turned away by three clinics when she sought treatment for her critically ill one-year-old grandson. He died as she carried him on her back, having walked for hours to reach the clinics. Local ANC politicians took advantage of the tragedy to campaign for votes at the baby’s funeral (!), promising they would “investigate” why the clinics turned her away. Mali later said in disgust, “The only time we see politicians is during election time; they promise us all sorts of things, after that we never see them again.”

At the root of the masses’ miserable living conditions—mass unemployment, homelessness, poverty, cop violence, hellish “health care”—is a capitalist economic system that continues to be based on superexploited, mainly black labor and white privilege. The SACP and COSATU misleaders politically chain the workers and poor to this murderous system through their ties to the bourgeois ANC, which they falsely portray as the embodiment of national liberation.

Spartacist South Africa fights to break the proletariat and oppressed masses from the Tripartite Alliance and to forge a Leninist-Trotskyist party to lead the struggle for socialist revolution—for a black-centered workers government. This is the only way to open the road to genuine social and national emancipation. As we wrote in “South African Elections: No Choice for Workers, Poor” (WV No. 933, 27 March): “The neo-apartheid capitalist state must be smashed and replaced with a workers state that expropriates the banks, mines and factories and creates a planned economy where production is for social use, not private profit.” Under the rule of the working class—extending throughout southern Africa and into the advanced capitalist countries of North America, Europe and Japan—the world’s scientific and industrial resources will be used to build a decent life for all and the scourges of poverty, hunger and criminal medical neglect will be seen as the relics of a barbaric past.