It is no secret that South Africa is riddled with violence and crime. In the Western Cape alone, in 2018 there were 62 162 recorded cases of common assault and assault with intent to inflict grievous bodily harm recorded by South African Police Services (Crime stats, 2018). Such assaults are due to various causes and social circumstances. Many of these assaults include stabbings and shootings leaving people with severe injuries requiring medical attention. The people who are involved in some of these assaults may not be innocent victims and may be instigators of the incident or common offenders in such incidents. Therefore following this many of the patients in the health care system may be criminals, gang members or instigators of violence. Western Cape Health MEC Nomafrench Mbombo says that the demand for health care services outweighs the supply and, as a result, more resources are needed to deal with the high crime and murder rates (Somdyala, 2019). With the rising crime statistics, the equality of the quality of health care begins to get compromised.

While working in clinical practice I have come across a few cases where patients have openly told me that they have been in prison, currently in prison, involved in gang related activity or have social circumstances that link them to certain risk and violent related activities. With the increase in violence and crime within South Africa, health care has been strained and more of the above mentioned individuals are being treated in hospitals and clinics by various health care professionals.

This year I was directly exposed to another health professional altering her quality of health care delivery based on a patient’s social circumstances. This particular patient sustained a stab wound resulting from a community assault. The patient was open about his social activities and the reasons behind him getting stabbed, many of which leading towards gang related activities. The health practitioner immediately changed her attitude towards the patient as she obtained this information in the subjective assessment. Her demine changed from a friendly “how can I help you” when she walked in the door to after the subjective assessment, just needing to treat the patient as quickly as possible.  Despite the patient being co-operative, calm and accepting of what he was required to do from a physiotherapy point of view, the clinician’s clinical practice was noticeably altered while interacting with the patient.

I had seen her interact with other patients and her attitude, outlook and presence completely shifted every time she saw the above mentioned patient. Treatment times were shorter and communication was minimal and distant. When asked about her changes in her clinical practice she denied treating the patient any differently to all her other patients. This may have been due to the fact that she did not identify any obvious changes in her practice, she did not want to declare that she may have treated the patient differently or that the interaction with the patient linked to a previous experience that may have had a negative effect on her, thus interfering with the quality of care being given to the current patient.

After experiencing this I felt torn between frustration that the patient was not receiving the best quality health service that the clinician had given the other patients as well as a feeling of  understanding to why the clinician had acted the way she had, possibly due to fear of the patient.

According to the South African constitution (1996), every person has the right to health care services. This then means that every patient should be treated equally when stepping into a health care facility. Each patient should be given the best possible care that the health professional can give without being influenced by any social factors. However this is not always carried through as the health professionals working in the health care system have their own set of beliefs, emotions and opinions about the world and these factors are often what get in the way of impartial health care delivery.

This topic is challenging as without us knowing, our everyday actions within clinical practice or not, are influenced by your own personal belief systems. This is what makes everyone different, why some people act on or in different ways to others when faced with similar circumstances. These actions are being influenced without us even being conscious of why we do or act in ways we do. Therefore in a clinical practice setting, health professionals actions may be influenced by their beliefs or emotions without even being conscious of it. The threat to health delivery is the professionals who consciously treat patients differently due to their social circumstances.

This dilemma will not easily have a resolution. One cannot simply eliminate social information from the treatment of patients. Patients should be treated holistically (Huljev & Pandak, 2016); not knowing social information from a patient will not holistically benefit the patient’s health and may put other community members in danger too.

Every patient should be acknowledged as a human being, irrespective of his background and free of any prejudice (Maji, 2017). However it is not as easy as this in practice. Health professionals have beliefs that may be challenged by the patient that they have to treat. The ethical dilemma that is brought to light is whether  it is possible to leave what you believe in at the “door” of the treatment room and treat the patient as best as you can when what they have done criminally is completely against your belief system? Will your actions be influenced by your belief system without you knowing? These questions are topical when looking at the high level of crime in the Western Cape and the increasing demand for health care resulting from crime related activities. Health care equality will therefore differ from one health professional to another.

References

Crime stats, (2018). Crime stats simplified. Retrieved from https://www.crimestatssa.com

Somdyala, K. (2019). ‘Overburdened’ Western Cape hospitals need more resources to assist with high murder rate – MEC. Retrieved from https://www.news24.com/SouthAfrica/News/overburdened-western-cape-hospitals-need-more-resources-to-assist-with-high-murder-rate-mec-20190730

Western Cape Government, (1996). Bill of Rights (Chapter 2 of the Constitution of the Republic of South Africa). Retrieved from https://www.westerncape.gov.za/legislation/bill-rights-chapter-2-constitution-republic-south-africa#27

Maji, S. (2017). How do doctors deal with the possibility that the person they are saving might actually be a criminal? Retrieved from https://www.quora.com/How-do-doctors-deal-with-the-possibility-that-the-person-they-are-saving-might-actually-be-a-criminal

Huljev, D., Pandak, T. (2016). Holistic and team approach in health care. Signa Vitae 11(2) 66-69. Retrieved from http://www.signavitae.com/2016/06/holistic-and-team-approach-in-health-care/