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As Obama healthcare debate rages, a glimpse into S. Africa's care gap

After rushing an ill friend to a public hospital in Johannesburg, the sight of skeletal men staring in vain to get the attention of overworked nurses raised a number of questions for me.

By Scott BaldaufStaff writer / August 17, 2009



JOHANNESBURG, SOUTH AFRICA – From the moment I heard my friend’s voice, I knew he was not well.

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He wanted me to take him to a doctor. I shut down my computer, canceled all my appointments, and rushed to his house.

For the next 12 hours, the two of us got a closeup look into the wide gap between South Africa’s first-class private health care system, and the overwhelmed and underfunded public hospitals that serve the vast majority of South Africans. And at a time when Americans are debating how to make their own world-class health care system more available to the uninsured middle class and poor, the sight of skeletal men here in South Africa staring in vain to get the attention of overworked nurses raised a number of questions in a visceral way.

How can societies across the globe ensure that not only the rich and comfortable are able to remain healthy? And having decided to do so, how can they pay for it? There are no easy answers – and comparing South Africa's rather dismal healthcare system with that of the US is to compare apples with oranges – but a majority in both countries share the view that healthcare can improve. The debate centers around how that's best done.

But back to my friend.

First a private hospital – then a public one

He met me at the door, a shadow of the man I had met three years ago while researching an article on Zimbabwe’s fast-disintegrating military. A former commander in the military wing of South Africa’s ruling African National Congress, and also a man who had worked for a time in the Zimbabwean government, Commander is a good man to know. His curiosity about my stints in Afghanistan and Iraq, and my curiosity about life under two very different liberation movements kept us talking. A difficult trip into Zimbabwe during elections, and a narrow escape from arrest bonded us.

Now, Commander was in trouble. I rushed him to the emergency room of a posh private hospital in my northern suburb of Johannesburg. But while this hospital offered the best care that money could buy, my friend had no money. Private treatment would cost 20,000 rand (nearly $3,000), he was informed. My friend, who has a good job but no health insurance, asked to be transferred to a public hospital.

South Africa's healthcare system

Troubled as it is, South Africa’s healthcare system is the envy of the continent. Funded by taxpayers, and modeled after Britain’s or Canada’s free-health-care-on-demand, South African hospitals have done a relatively remarkable job of delivering healthcare to those who cannot afford private hospitals, or private health insurance.

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