Maverick Citizen


A junior doctor’s battle to keep death at bay for state patients

A junior doctor’s battle to keep death at bay for state patients
Young doctors’ mental health is especially at risk when they first start working at a hospital. (Photo: iStock)

One in four South African medical students shows signs of depression, and most doctors are at risk of burning out. Read about one state doctor’s road to hell and back again.

I spent half a decade working to get into medical school, then another six years training to become a doctor, but it took just four months in my dream job before I was completely flattened by it.

I’m now a junior doctor at a major state hospital in Johannesburg. I pushed hard to get a post at this facility because I knew I would get unmatched training.

This hospital’s legacy of chaos is well known, and I realised the stress of working there would likely be worse than what people had warned me about.

But nothing could have prepared me for what lay ahead of me — and I wasn’t ready.

I expected that I’d work long hours, that I’d have to deal with losing patients, that there would be unkind seniors and absent colleagues. But I did not anticipate that I’d have to face all of it at once, all the time.

I was walking up to 20,000 steps (about 16km) on a normal day and no matter what I did, the system failed the patients before they even arrived in my ward. I spent the hour’s drive to and from work crying and eating, because there was no time for either on the job.

Read more on Daily Maverick: Open Letter: A wake-up call for Health Department heads – Children are dying because of horrendous state of our public hospitals

One day I arrived at the hospital to find a patient’s bed drenched in blood; she had a rare blood condition and had bled all night. The nurses didn’t notice because the night shift was understaffed.

On another occasion, I remember having had to resuscitate a patient for 15 minutes by myself because the nursing staff refused to help. By the time my colleagues arrived, the patient was dead.

But each day I would return, hoping to keep death at bay for my patients for as long as I could.

In May 2021, I cracked. I woke up every day, still tired, and dreading work. Life was a cycle of work, sleep and sobbing.

I didn’t see it coming, even though I’d been working for two months with only two days off.

I was physically exhausted, and emotionally too. The job robs you of moments you can’t get back: religious holidays, important family moments, weddings, funerals.

Every time I tried to figure out how I got to this place, I would retrace my steps only to find that it was all me. I made decisions and commitments that led me to this. For what? Dread, a deep hatred for my job and anger at the path I had chosen.

I felt unbearably alone, even though I knew I wasn’t the only one. For every horrifying story I can tell, other doctors I’ve worked with can give 10 more.

I’ve spoken to colleagues all around the country and time after time health workers — from juniors to those who’ve been at it for years — all relay how they are brought to a standstill by the mental toll of this job.

The world’s doctors are detached and dissatisfied 

Looking back, I realise that I was close to burnout last year.

The World Health Organization says people get to this point because of “chronic workplace stress that has not been successfully managed” and lists feeling exhausted, detached from your job and getting less and less satisfaction from it as tell-tale signs that someone’s job has pushed them to their breaking point.

It’s something many doctors experience, and although there aren’t consistent figures (because methods to measure burnout rates among health workers aren’t standardised), research shows that the signs of burnout are seen in more than 80% of physicians

It’s not surprising. 

Studies, both from South Africa and elsewhere in the world, reveal that medical students experience a high mental health burden, with as many as one in four students showing symptoms of depression, especially when they start working in a hospital.

And amid the Covid-19 pandemic, hospital health workers had to deal with even more stress because of relentless workloads, many patients dying and uncertainty. Young doctors, who already experience high stress levels, were particularly vulnerable to burnout, a study from the United Kingdom found.  

Crawling back to health  

I’m grateful that I had people around me when I reached breaking point: trusted colleagues I could turn to; family who tried very hard to understand even when they didn’t; a therapist willing to see me after hours. 

I managed to crawl out. But not everyone does.

And this can have devastating consequences — not only for doctors’ own mental wellbeing, but also for patient care and the broader health system. 

Research shows that doctors who are burnt out, or close to it, make more mistakes. They also struggle to make decisions, lose compassion for their patients and may ultimately leave the system, which a public health sector that’s already buckling under the load can ill afford.

But there are things that can help health workers to become more resilient, which may carry us through stormy times — perhaps not unscathed, but at least intact. And building these skills as students already may help young doctors to cope better when they start working.

Support programmes such as talking to a counsellor or practising mindfulness are some tools that can help, and a small study among medical students from the Western Cape showed that participating in a structured online programme significantly improved students’ mental wellbeing and stress management.

Visit Daily Maverick’s home page for more news, analysis and investigations

Setting up a system where students can talk to peers can also be part of the solution. A study among medical students at a university in the United States revealed that both the person offering support and the one seeking support benefit from talking about their work-related stress.

Similar programmes have popped up at many medical schools in several countries over the past two years, perhaps driven by the increasing mental health burden brought on by the Covid-19 pandemic — to such an extent that young doctors have called for peer support to be incorporated into medical students’ training

Recovery without hope

I don’t cry every day on my way to and from work any more; I guess that’s a type of recovery. 

What I feel now is closer to hopelessness. 

I don’t know what I can do to improve things for my patients because I cannot imagine the public health system changing. 

At the very least, though, my experience has taught me that having compassion for myself will help me to keep treating my patients with care. 

I’ve also learnt to look at my colleagues who lack empathy with kindness and my harsh seniors with some care, because I don’t know where they are along the chain of brokenness. Everyone has a story and everyone carries around the burden of seeing how their job has whittled away their joy.

Changing the state health system’s crises is complicated. It’s something outside the scope of the doctors who show up for work every day. But perhaps the first step is acknowledging that doctors aren’t heroes; they’re humans trying to do a superhero’s job. DM/MC

This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.


Comments - Please in order to comment.

  • Malcolm McManus says:

    I feel for you. If dogs where allowed to be treated at certain government hospitals, I would still, by far, prefer to treat mine at the local vet. I have assisted people who can’t afford private hospitals and have first hand experience with two of them, both on a number of occasions. Hygiene, sense of urgency and compassion are far superior at the vet. Also getting a patient admitted to a government hospital, besides the queues, is an administrative nightmare. Trying to help the less fortunate by taking them to a government hospital and going through the whole process with them, is very time consuming and traumatic in itself. Often, so are the outcomes.

  • Dee Knoesen Knoesen says:

    I salute you for continuing your care of people who have no other recourse to health care. What you see and experience on a daily basis must be horrific. Please continue taking care of yourself because where will we be without you and your colleagues? Thank you.

  • Dennis Bailey says:

    The state hasn’t just become the enemy of the people it’s become the breaker of people too and energised, intelligent, loyal, even patriotic officials of the state. That SA insists on breaking it’s own rules in order to break its citizen is illustrative not just of a corruptive failed state but of the sickening dictatorship we’ve become – where only those in power prosper; the powerless get little sleep and eat sandwiches in their cars. A better life for all. In your dreams.

  • Wilhelm van Rooyen says:

    I was tearful after reading this – for your sake, but also because I have been through the same experience with a child who have recently walked this road too. I vividly remember the sparkling eyes that set off on the road to become a doctor to help fellow humans, and how those eyes became dull through the experience in the public health system. I heard about people left dying because support staff took lunch with no regard for the patient. I heard about broken equipment that was never fixed and how she had to improvise to try and save a life. There were instances where she had to take patients home in her own car, because the person couldn’t walk and the ambulance was broken. I heard about how she had to support family members in their grief, without training or even knowing how to deal with her own. After the two years she came out of the state system suffering from depression, total burnout, and seeing no joy in life. The experience drained not only her, but also the supporting family, even though they didn’t understand the full scope of what the person was going through. Thankfully, she is now on the road to recovery.

    The state system is broken, and no-one cares. The terrible part is that the government does this to it’s own people.

  • A Z says:

    Welcome to the fallout from 2 years of a concerted campaign to ignore, discredit and demonize the cheap, generic multi-drug treatment option which saved thousands of South Africans from severe disease; and which could have kept hundreds of thousands from even needing hospitalization. This poor medic has paid the price for health journalism platforms, newspapers, health regulators and financially invested research academics and institutions choosing funding for their organizations and research over the health and lives of our people and frontline doctors. That’s the real sickness our health system needs to reckon with.

Please peer review 3 community comments before your comment can be posted


This article is free to read.

Sign up for free or sign in to continue reading.

Unlike our competitors, we don’t force you to pay to read the news but we do need your email address to make your experience better.

Nearly there! Create a password to finish signing up with us:

Please enter your password or get a sign in link if you’ve forgotten

Open Sesame! Thanks for signing up.

[%% img-description %%]

The Spy Bill: An autocratic roadmap to State Capture 2.0

Join Heidi Swart in conversation with Anton Harber and Marianne Merten as they discuss a concerning push to pass a controversial “Spy Bill” into law by May 2024. Tues 5 Dec at 12pm, live, online and free of charge.

A South African Hero: You

There’s a 99.8% chance that this isn’t for you. Only 0.2% of our readers have responded to this call for action.

Those 0.2% of our readers are our hidden heroes, who are fuelling our work and impacting the lives of every South African in doing so. They’re the people who contribute to keep Daily Maverick free for all, including you.

The equation is quite simple: the more members we have, the more reporting and investigations we can do, and the greater the impact on the country.

Be part of that 0.2%. Be a Maverick. Be a Maverick Insider.

Support Daily Maverick→
Payment options