DON'T MISS : Talking Africa Podcast – Mozambique's insurgency: After Palma, what comes next?

South Africa: Hundreds of foreign-trained doctors shut out as Covid rages

By Ray Mwareya, Nyasha Bhobo
Posted on Wednesday, 28 July 2021 15:46

Medical workers prepare to test people for Covid-19 at a testing clinic in Khayelitsha, Cape Town, South Africa on April 2, 2020. (AP Photo/Nardus Engelbrecht, File)

In the grips of a third Covid-19 wave, along with soaring rates of the delta variant, South Africa needs all hands on deck. But many of those trained hands are blocked from working as doctors in the health sector due to a quota system that was meant to undo the wrongs of the past. Only now it's creating a new wrong.

“Here’s the experience of our doctors: if they don’t have [a] 50,000 rand ($3500) bribe, they fail the South Africa medical board exam,” says D. Govender, the lawyer leading a class court action for hundreds of South African medical graduates who obtained qualifications abroad, but cannot work when they return home.

Pranav Singh, 27, a South African-born citizen of Indian ancestry, is distressed by the impediment to practice medicine in his country of birth after graduating in 2018.

“I was always a straight-A student. Sadly, I was forced to leave South Africa to study medicine in Mauritius. Upon return, when I approached the Health Professional Council of South Africa (HPCSA) to register, I was told to [sit for] the South Africa medical board exam,” says Singh, who cites the country’s racial-quota system as the reason that forced him to study medicine abroad, at the Anna Medical College.

As someone born after 1994, the year of Nelson Mandela [and] apartheid-free South Africa, I am still mistreated and prejudiced because of the colour of my skin (Indian-South African).

Singh and 300 other South African medical graduates who trained abroad say they were prepared for the board exam until the council abruptly changed the rules.

“A month before the exam, we were informed by HPSCA that we will no longer be [sitting for] the South African board exam, but [rather] an American-based exam. It made no sense to us as to why we were expected to write [this] exam to go practice medicine in a South African hospital,” says Singh.

Christopher Tsatsawane, head of corporate affairs at HPCSA, however tells The Africa Report that the council has exclusive authority to determine what type of medical board exam is offered. “The exam, although set by institutions based in the US is not an American exam, [it is] used in many parts of the world.”

Exiled by racial quotas

The long-standing issue of race drives many South African students – of mainly white and Indian ethnicity – to seek undergraduate medical degrees abroad.

“In South Africa, we have the quota system to undo the effects of apartheid. In medical school, you would get 50% black students, 20% of u students, 10% of Indian students, and 10% white [students]. As an Indian student [my application] had been declined by multiple (local) universities,”says 27-year-old Geremie Nayager, who was born in Durban, South Africa, but trained as a doctor in China.

Nayager, who dreams of being a family physician, is furious because he says the HPCSA has also grounded him since 2019.

I applied for minimum wage jobs; they see a medical degree and say, ‘what are you doing here?’

South Africa’s university racial quota system is retrogressive and passionate medical students can’t be held back by race, says Noel Desfontaines, secretary-general of Health and Other Services Personnel Trade Union of South Africa (HOSPERSA). “Considering the shortage of doctors in public sector hospitals, the quota system does not make sense,” says Desfontaines.

So, in 2019, after graduating from medical school in China, Geremie traveled to South Africa’s capital Pretoria, to hand in his medical qualification transcripts and certifications. What happened next pained him.

“I was told explicitly that my university was not recognised in terms of their curricula. That was puzzling to me because one of the requirements was to call the HPSCA before leaving for study (abroad), and ask them, ‘which university should you choose?’ We were told, ‘so long as the university is WHO and ECFMG approved, we will accept you (on return)’,” he says.

Kafkaesque certification

After deliberations with the HPCSA, in June 2020, hundreds of foreign-trained medical graduates like Nayager and Singh got notices that their foreign university curricula had been accepted. They were excited to finish the exam and hopefully register as doctors.

But they say goalposts were once again shifted. “The HPCSA (then) introduced something called the new pathway for foreign graduates, which now entails people (like us) coming home with foreign degrees [who] have to [sit for] the board (theory) exam, [then] apply to a local university at your cost. Upon completion [in] 12 months, [one is expected to] return to the HPCSA, apply to [sit for] the medical practical exam, then apply to get a clinical internship before getting a proper paying job,” says Nayager.

The South African healthcare system is crippled and in serious need of intervention. In some instances, poor financial systems devolve into outright corruption.

If this Kafkaesque process is followed, the board exam will take up three years. In total, 10 years [of study] must be completed to practice medicine in South Africa, says Singh.

But Tsatsawane, the HPCSA spokesperson, says the so-called ‘pathway’ is very important because it was introduced to assist South African citizens who hold qualifications not prescribed for registration, and who were not registered as medical practitioners in the countries where they studied.

“Such applicants would be denied registration (on return home). The pathway is intended to give an alternative to being denied registration,” Tsatsawane tells The Africa Report.

Class action

Feeling hard done by, hundreds of medical graduates like Nayager and Singh have cast aside the fear of being victimised. Represented by Govender and the South African Internationally Trained Health Professionals Association, they have launched a class-action lawsuit against the HPCSA to defeat the ‘pathway’.

“I have taken that leap forward: you know, someone needs to stand up against the HPSCA,” Nayager says.  “People are scared of being victimised due to past fears of [the] government and the HPSCA who are corrupt. I’ll speak on behalf of all internationally trained doctors.”

These hardships, upon returning home, boil down to racism, they say. “As someone born after 1994, the year of Nelson Mandela [and] apartheid-free South Africa, I am still mistreated and prejudiced because of the colour of my skin (Indian-South African). I often think to myself – had I been a different race would I have been in this situation?” Nayager asks.

R50,000 bribes

Serious allegations of corruption have surfaced as the main reason why hundreds of medical graduates like Singh and Nayager have seen their careers frozen. The HPSCA is accused of demanding bribes from graduates in this predicament. “A lot of (would-be) doctors, who studied abroad like me, were taken advantage of during their board examinations,” says Singh.

“They were given phone calls…bribes of R50,000 [and] you will end up passing. The HPSCA administrative staff are doing this, for their financial gain. If you fail to pay the bribe you fail. A bribe [and] it’s a guaranteed pass. This comes with a lot of consequences.” This has been going on for the past 10 years, he adds.

Our health system has a gross shortage of health care personnel including doctors. The situation is dire now

When asked about corruption allegations, Popo Maja, the spokesperson for South African health minister said “this is beyond (our) scope” and directed The Africa Report to the HPCSA which admitted that corruption exists within its ranks.

“The HPCSA is not immune to fraud and corruption. It is true that allegations were made against certain employees. Those whose charges were confirmed were dismissed by the HPCSA, and criminal charges have been [brought] against them,” says Tsatsawane.

Dire situation

South Africa is in the grips of a devastating wave of the Covid-19 Delta variant that killed nearly 400 healthcare workers by December 2020. However, the country’s foreign-trained South African doctors are at home or restocking supermarket shelves.

It’s strange to watch senior doctors pass away or juggle a huge load of patients without any assistance, when some 400 graduates are blocked from assisting them, says Singh. “I was unemployed, [with] no source of income, [and] had to partially volunteer my time, at my own expense, at a local hospital,” he says.

The South African healthcare system is crippled and in serious need of intervention. In some instances, poor financial systems devolve into outright corruption. “As a trade union, we are very concerned especially given the fact that our health system has a gross shortage of health care personnel including doctors. The situation is dire now,” says Desfontaines.

“I applied for minimum wage jobs; they see a medical degree and say, ‘what are you doing here?’ It’s illegal for me to help (as a doctor),” says Nayager who considers himself one of the ‘lucky ones’, since he gets his livelihood working as a minimum-wage clinical administrator at a local hospital. That’s how far he’s allowed to go.

Understand Africa's tomorrow... today

We believe that Africa is poorly represented, and badly under-estimated. Beyond the vast opportunity manifest in African markets, we highlight people who make a difference; leaders turning the tide, youth driving change, and an indefatigable business community. That is what we believe will change the continent, and that is what we report on. With hard-hitting investigations, innovative analysis and deep dives into countries and sectors, The Africa Report delivers the insight you need.

View subscription options