The focus of World Health Day this year is ‘universal health coverage’ and I can’t help but be touched by what is such a pertinent theme in South Africa today. As a medical student in this country, it goes far beyond just a title; it resonates deeply in the challenges I face daily in the public health sector. I am reminded time and time again, of how inadequate access to health care, or access to inadequate health care, has a direct bearing on the lives of the patients I see—patients whose lives are lost because of it.
One such story has touched my life and will continue to shape me into the doctor I want to one day become. This is a story of a three-month-old girl, Nobuhle, who died because of the circumstances she was born into. Nobuhle had been diagnosed with biliary atresia— a rare, life-threatening condition which causes your liver to fail. She required a life-saving surgery, which is only performed at the big academic hospitals, 3 hours from where she lived. This surgery has to be done as soon as possible—at 3 months old, it was already getting late for Nobuhle. In the developed world, Nobuhle’s condition would have been diagnosed in the first few weeks of life, not after 3 months, as it was in her case. After weeks of waiting for this life-saving surgery—each day bringing her closer to the brink— she received her operation. But, it was too late. Within 24 hours, Nobuhle was gone. Her life was taken at the hands of a system that is failing the very people it is meant to serve.
I had seen Nobuhle the day she came in to the hospital, and I had seen her every day after that. I had seen the despair in her mother’s eyes every day longer the surgery was delayed. And I had seen the joy in her heart when her girl was finally taken to theatre. And then she was gone. She was the first patient I had lost, and it hit hard. It made me angry. Frustrated. Helpless. She could have been helped. She could have been diagnosed earlier, and referred earlier, and received surgery earlier. She could have made it to her first birthday, and grown into a young girl, a woman, a mother herself. But instead, she was buried an unfortunate, unworthy victim of an inadequate health system. Yet, in the bed next to her, a young girl did make it. She survived against all odds. And thousands more children with this rare condition will survive into adulthood– but that all depends on something as simple as where you are born. We will not have achieved universal healthcare until who you are, and where you are born doesn’t determine the standard of care you will receive.
In South Africa, our health system is falling apart at the top because of the unsteady foundation at the bottom. To make sure that Nobuhle’s tragedy is never repeated again, we need to start from the bottom. The bottom being the primary health care system and the clinics. The bottom being the diseases that are killing South Africa’s children at a much higher rate than it should be. These diseases are easily preventable and easily treatable, once they are easily identified. The under-5 mortality rate in South Africa is around 40 deaths per 1000 live births, that’s about 100 babies dying every day. In the time it took for me to write this piece, 20 babies died. And this is not okay. We need to address issues such as those that faced Nobuhle and countless others that are worthy of a better health system. A health system that can provide care to the country’s most vulnerable.
Universal health coverage is only achievable once we understand the immense challenges we are facing in the health sector, and address those challenges at the most basic level.
