In South Africa we have a number of laws and departments which are there to help the poor and third parties yet they seldom seem to work for those who need it most. These are two instances which show clearly that they are not working.
The Road Accident Fund
This Fund was established to assist the Third Parties in a vehicle accident. Eight years ago a young man was knocked over by a car. As he fell, his ankle was seriously broken and he was taken to the local basic, or First Level, hospital where an Orthopaedic Surgeon comes once a week. He waited 3 weeks to have his ankle reset as there were always more urgent cases. Besides this causing the ankle to fuse incorrectly he was taking up a bed which could have been used by another patient. When they did operate they had to re-break the ankle before setting it. He was then unable to work for a further 6 weeks while in plaster and using crutches. In total, he was unable to work for a total of nearly 3 months while the ankle strengthened. All his employment is as a casual for a number of persons and he was not paid by most of them. A lawyer was appointed for him and a claim was made to the Road Accident Fund and settlement is still awaited. He has now been told by his lawyer that he will get a payout quicker (after 8 years??) if he says he is unemployed. Why? Surely he is entitled to compensation for those 3 months at least. What about pain and suffering? It appears that those who can afford a good lawyer get good payments within a couple of years. Where is the justice?
Free Health Care for the poor
We have free health care for those who earn less than a certain amount a month. This includes government pensions as they are very low. It may be free once a person gets to the clinic or hospital but getting there can be very expensive. About two years ago a gentleman aged 69 was diagnosed with Stage 4 throat cancer. As a government pensioner he attends the public hospitals.
There is a process to be followed. First go to a Primary Health Care Clinic where a very junior doctor comes once a week. Initially, you are seen by a nursing sister who will then refer you to the doctor if considered necessary. That can mean up to a week’s wait. The doctor may then refer you to a First Level Care hospital which has specialists in the common disciplines only and they too will come to the hospital weekly, as per above, and they only see admitted patients. If the specialist considers that you need further care he will refer you to the Secondary Level Care hospital and most specialist treatment is given there. Should the medical condition of the patient be complicated or more serious than they can treat, the patient is referred to the highest level of care or Tertiary hospital. These are also the main teaching hospitals. It can be anything from a 1-4 or even 6 months to get an appointment.
The big thing here is that the treatment may be free but the patient has to get to the medical facility. The initial clinic may be close to the patient’s home but not always. To travel anywhere the majority of the poor in South Africa have to travel long distances by minibus taxi which is neither truly safe or inexpensive. An example here is where the gentleman mentioned above went through all the different levels of hospital and to get to each of the latter two, it cost a total of R96 ($8) for both himself and whoever accompanied him as he was too ill to travel alone. It is much more expensive for rural people to get to the major hospitals in the cities. What then usually happens is that the patient is examined and may have blood taken or x-rays done and then told to return in a month for the results.
At most public hospitals the queues are very long and, as there is a cut-off time, usually 4pm for patients to be seen, even if they have an appointment, many are not seen by the doctor. Should a patient not be seen on the day they arrive they are told to return at another date! Who pays?! I am not motivating for everything to be free but there must be a better way for the poor to access medical treatment.
Our President and his cronies all use either the private hospital system, which in South Africa is usually excellent but also expensive, or travel overseas for medical treatment. The politicians blame the private hospitals and other medical facilities for the discrepancies but do little to truly assist the poor. Tell me, where is the justice?
One further thought which is not a legal requirement but still strikes me as unjust are bank fees. Why is it that, for the poor, the charges are significantly higher? In a comparison of 4 South African banks it was shown that with a monthly balance of R2 500 fees range between R23 and R33 for a maximum of 12 transactions in a month whereas with a balance of R10 000 one pays half or even less and gets up to 17 transactions in a month. To make a cash deposit costs another fee and we are told that this is for counting the cash. I thought that was the purpose of a Teller! I know that when one puts money in a bank you are ‘lending’ it to the bank to invest and to give loans as required. But just as a borrower has to pay interest the bank does too but the rate is ridiculous – about 1% where the customer who borrows has to pay prime, currently 10.5%, and even more in most circumstances. Where is the justice?
There is a constant call for people to save but as it costs so much just to put your money or take it out of an account where is the incentive. One suggestion I have is for banks to offer an opportunity for an individual to deposit a very small minimum each month, eg R10 or R20, (based on income) permit one withdrawal of a max of 80% a year on this account and pay a small simple interest but have no charges. Let’s calculate the lowest deposit of R10. This will be R120 + interest in a year and only R96+interest on this amount may be withdrawn after 12 months. This will leave R24 + int. to start the next 12 month period. If a person misses a payment the 12 months can be extended by a month. This may seem a ridiculous example agreed but some folk cannot afford more and at least they are practising saving. Give an incentive rather than a burden.