Internationally-trained graduates not practicing medicine. Can SA afford to leave it that way?

Internationally-trained graduates not practicing medicine. Can SA afford to leave it that way?

70% of internationally-trained graduates not practicing medicine

The South African Nursing Council (SANC) is fast-tracking applications by private hospital groups and provincial health departments to re-register retired nurses to prepare for what experts say is an expected wave of Covid-19 cases.

But foreign-trained healthcare workers in South Africa said they were still being sidelined.

All nurses have to be registered with the SANC to practice in the country, but their registrations lapse if they retire or fail to pay annual fees to the body.

Now, it was allowing potential employers with out-of-date registrations to apply on their behalf, streamlining the process to get them back into understaffed wards, said SANC senior communications manager Adri van Eeden.

The body will, however, not be accepting applications from individual nurses looking to re-register during the outbreak. And fast-tracking does not apply to new or foreign-trained nurses.

The country’s national lockdown had helped reduce new cases of the coronavirus, known as SARS-CoV-2, the chairperson of the Ministerial Advisory Committee on Covid-19, Salim Abdool Karim, told the nation in a televised address on 13 April.

But Karim cautioned it was unlikely the country would avoid a sharp increase in cases in the future, saying South Africa was already gearing up for an eventual wave of cases by, for instance, erecting field hospitals and increasing its capacity to conduct burials.

On Saturday, Health Minister Zweli Mkhize said the country would be increasing its medical workforce by bringing in about 180 Cuban doctors.

At a press briefing, he added Cuba had already sent doctors to South Africa as part of a long-standing partnership and the country would be looking to capitalise on the Caribbean nation’s community-based primary healthcare expertise.

Cuba is known for its strong primary healthcare system that helped it achieve one of the world’s highest life expectancies, according to World Bank data, despite spending less per person on health than many other nations.

But, some doctors say South Africa could be doing more to make use of foreign and foreign-trained healthcare workers already within its borders.

Foreign-trained doctors turn up for UK emergency rooms

Within weeks, the UK added more than 11 000 doctors to its workforce during the coronavirus outbreak by granting temporary registration to doctors who had given up their registration in the past three years, its General Medical Council announced in late March.

The regulator was able to do this quickly, it said on its website, because it actively emailed doctors as part of an opt-out programme, meaning clinicians were part of the project unless they declined to participate.

Final-year medical students were also allowed to provisionally register to serve during the outbreak.

Writing for Bhekisisa, South African doctor Koot Kotze, who is studying in the UK, argued South Africa might be able to capitalise on foreign-trained and qualified healthcare workers already in the country. That was, if these workers were able to act as “acute care assistants” during the outbreak alongside registered emergency room doctors, he said.

Health department: No registration, no way

Currently, foreign-trained healthcare workers who are not nurses – South African or not – must apply to have their qualifications recognised by the Health Professions Council of South Africa (HPCSA), national health department and the Education Commission for Foreign Medical Graduates in the US. They must also pass HPCSA board exams, which have been postponed during the lockdown.

Foreign-trained doctors said the process could take up to two years, but the HPCSA refuted these claims, according to TimesLive.

Meanwhile, national health department spokesperson Popo Maja said it would only consider medical professionals who were properly registered with the HPCSA and other statutory bodies.

“We have many South Africans who trained in foreign countries but have repeatedly failed board exams set by the HPCSA,” Maja told Bhekisisa. “The HPCSA is mandated to ensure that doctors are well qualified and do not put patients at risk.”

Bhekisisa asked the HPCSA whether it was considering implementing any of the measures for foreign-trained workers used in the UK, but it had not responded to questions at the time of publication.

Temporary registration for foreign-trained doctors

Some internationally trained South African doctors insisted they have not been given the opportunity to assist in South Africa’s response because they could not register with the HPCSA.

This includes Jehane le Grange, who was trained in China.

“Despite having a matric A-aggregate and two degrees, I could not get into any of the eight medical universities in South Africa back in 2012. So I went and studied at a top Chinese university,” Le Grange told Bhekisisa.

Historically, the HPCSA had had difficulty in registering international medical graduates and the issue was taken up in Parliament as recently as 2018, Le Grange and others wrote in a recent article published in the South African Medical Journal.

Meanwhile, a 2018 national health department policy to better incorporate foreign-trained healthcare workers into the South Africa system has yet to be implemented, they said.

According to the results of a survey Le Grange and his co-authors included in the article, about 70% of 644 internationally-trained South African doctors, were not medically practicing in South Africa and some were unemployed.

The authors surveyed the doctors over a period of two days, and most participants currently in the country said they would be willing to help out during the outbreak.

Although the authors acknowledged using unregistered doctors temporarily during the outbreak was not without risk, they argued ensuring foreign-trained doctors met a predefined set of minimum standards as part of recruitment – as is done in the US – could help mitigate this.

They suggested using such doctors in limited, hospital-based roles much like the UK had chosen to do.

Le Grange said: “These doctors have the training but they don’t have the legal mandate in the form of HPCSA registration, and they can’t currently obtain any registration without taking the board exam so they sit idle during Covid-19.”