In South Africa we are currently experiencing a big increase in violence against woman and children, violence associated with robberies, violence associated with unrest and protests as well as gang related violence. In July 2019, President Ramaphosa ordered the South African Defence Force to be deployed within various districts of the Cape Flats. The number of murders taking place over weekends in Cape Town often exceeds 50. Most of these murders are attributed to gang related violence (Davies, 2019).
During my 4th block, I worked in the trauma unit at Tygerberg Hospital. The trauma unit focuses specifically on patients who suffered motor and pedestrian vehicle accidents, stab wounds as well as gunshot wounds. Many of these patients had spinal cord injuries and polytraumas mainly as a result of a gunshot.
During our orientation at the start of our block, our clinician warned us that we will be working with many patients who are part of the number gangs. They might be violent people who have committed serious crimes, while others might be in the trauma ward as a result of being community assaulted because of doing bad things within their communities. However, other patients within the same ward might be innocent victims of crime committed by these same gangsters.
I found it very difficult at first to convince myself that every patient in the ward should be treated without bias. It’s easy to think that these gangsters chose this lifestyle and therefore it’s their own fault for being in hospital. However, after convincing myself that whether this were true or not, that all my patients were still to be treated equally, with the same amount of respect, dignity, commitment and hard work. Once I started to see my patients and got to know them on an individual basis, many of the gunshot wound and stab wound patients confirmed to me that they are gangsters and dealers and that they have committed crimes. However, many patients within the ward told me how they were robbed, hijacked and shot innocently while for instance walking to the shop down the street within their local community.
After a couple of weeks of working in the trauma ward, the moral and ethical considerations of working with these 2 different groups of patients started to get me thinking. Ethics refers to the moral choices that people make, and it includes the study of right and wrong actions of people (Seggie, 2011). I understood that the law provides that all patients must be treated equally, with the same dignity, respect and quality of care. However, for me, the South African law takes the morality of a person and situation away, and only focuses on what the rights of all South Africans are with regards to health care. Section 27 of the constitution states that “Every person has the right “to have access to health care services” and that patients have the “right of access to health care services by not unfairly or unreasonably getting in the way of people accessing existing health care services” (Health and Democracy- Contents, 2002).
However, as time passed, I couldn’t help but think to myself that we as health care workers have so many patients to see in this ward with such limited resources and so little time. Why should Mr X who is a self-acknowledged gangster with the number 28 tattooed on him receive the same amount of time and care as the person who was shot by a gangster or who was involved in a motor vehicle accident? Morally, for me, these victims of crime and those involved in a motor vehicle accident are innocent people who got hurt and ended up in the hospital. I started to ask myself more and more questions about what is morally right. I thought we should be giving all our time, energy and resources to these innocent victims and not at the gangsters who “chose” this life. Surely, I thought, most people will agree with me on that. Lemmergaard & Muhr (2008) argued that under threatening circumstances, like for instance working with a gangster who can look very intimidating, a service worker will not be able to exclude personal moral beliefs from the decision-making process.
However, we are health care professionals and should not be playing God, judging people on their looks, lifestyles and the choices they have made. It is not our job. We have an ethical obligation towards all our patients to treat everyone equally. The HPCSA and the law of South Africa also requires us to treat everyone with respect, dignity and to the best of our abilities.
It is also important for health care workers to remember that when we are treating these patients who are potentially criminals, that we give them the same amount of care as we do for the other patients. If we don’t, these patient’s hospital stay could be extended and prolonged. Furthermore, if their health needs are not properly cared for while they are in hospital, then their demand on the health services afterwards is going to be that much more difficult to handle (The Guardian, 2017). Research found that 95% of prisoners will eventually go back into civil society, thus bringing their health conditions with them. If they don’t receive proper treatment, re-hospitalizing and death rates become very high for this population (Rich et al, 2014).
It is therefore important that we recognize that all patients, no matter their race, religion, gender or criminal activities, we treat equally because it will help our society. I therefore believe we as citizens should rather find ways to prevent gangsterism before it happens, than preventing treatment for those who got hurt as a result of it.
References:
Davis, R (2019, July 12). Army deployed as gang violence escalates to unprecedented levels and residents cry out for help. Retrieved from: https://www.dailymaverick.co.za/article/2019-07-12-army-deployed-as-gang-violence-escalates-to-unprecedented-levels-and-residents-cry-out-for-help/
The Guardian. (2016, November 2). Prisoners ‘should get same healthcare as general population’. Retrieved from: https://www.theguardian.com/society/2016/nov/02/prisoners-should-get-same-healthcare-as-general-population
Health and Democracy- Contents. (2002). Retrieved from:https://section27.org.za/wp-content/uploads/2010/04/Chapter2.pdf
Lemmergaard, J., & Muhr, S. (2009). Treating threats: the ethical dilemmas of treating threatening patients. The Service Industries Journal, 29(1), 35–45. https://doi.org/10.1080/02642060802116370
Rich, J., Chandler, R., Williams, B., Dumont, D., Wang, E., Taxman, F., & Allen, S. (2014). How health care reform can transform the health of criminal justice-involved individuals. 462 – 467. Retrieved from http://www.escholarship.org/uc/item/2gc4g0n0
Seggie, J. (2011). Bioethics, Human Rights and Health Law. Principles and Practice, Ames Dhai and David McQuoid-Mason : book review. 4(1), 43–43. Retrieved from http://reference.sabinet.co.za/webx/access/electronic_journals/m_sajbl/m_sajbl_v4_n1_a12.pdf
4 thoughts on “Who’s more deserving of our precious time”
Hi Jaco
Thank you for sharing your piece and your experience. I think the current escalating crime situation in South Africa is definitely something to take note of. It causes more casualties and hospitalizations, thus directly affecting us as health professionals. I could relate to your situation as I myself have treated patients part of the number gangs during some of my clinical practice rotations and these questions that you mention often do come up in these situations. I think it is an important ethical topic you addressed.
Content: Your content was well within the scope of the ethics module. You gave a brief background of the current state in South Africa relating to crime and gangsterism, which described the situation and it was a good foundation on which your clinical experience paragraph could build. You explained the situation well. I think there are a few things that you could possibly address to strengthen and improve the content even more. In paragraph 4, the first sentence you say “After convincing myself that all patients were to be treated equally, with the same amount of respect, dignity, commitment and hard work”. Perhaps you could elaborate and explain exactly how you convinced yourself and why? Where you not going to treat them equally initially? Why was it necessary for you to convince yourself to treat them equally? I think explaining this could give the reader more insight as to what you were experiencing and the moral dilemma you faced. You also mention that if we do not treat these gangsters we would be keeping them hospitalized and using up crucial bed space, but perhaps you could look into other consequences that would/could occur if you did not treat them equally, such as violations of South African law and disregard of patients’ rights. I did not fully understand your last sentence, perhaps you can reword this to make it easier to read.
Argument: You have a good foundation for your argument, but I think it is leaning a bit more towards one side. You are strongly arguing as to why they should not be treated equally (the crimes they commit etc.), but your argument as to why we should treat them equally is bit lacking (there is one sentence about playing God). In your final paragraph you are strengthening the fact that they should only be treated for the reason that they are taking up more beds in the hospitals. Is this the only reason you believe they should be treated with dignity and respect and to the best of our ability? And why do you believe this? I think it would greatly benefit your piece if you could maybe find more substantial reasons as to why they should be treated equally to overall strengthen your argument.
References: At the moment you do not have any in-text references or a reference list. In your piece you make various statements that should be back up with literature. I think good references will benefit your piece greatly.
Spelling and grammar: There were a few grammatical errors. Just double check to ensure that you are using all the correct and same tenses when writing. I used the hypothesis to make annotations, to highlight a few grammatical and spelling errors for you.
I think you are on a good track and with a few additions and adjustments, your piece can possibly improve even more. I hope you find my comments helpful and please let me know if anything was unclear.
Good luck for the final piece
Janine
Hi Jaco. Thank you for sharing this piece with us. I think working in the health sector expose us to various situations i.e. working with patients who are part of gangs. I can relate to this as I had a similar experience. I realized that as human being we will always have judge situations and people – which is not our job as you said. I think this is a very nice topic and especially with the violence going on in SA at the moment.
Content: The content covered in your piece relates well to the topics covered within the ethics module. I would’ve liked you to give a bit more on the statistics with regards to health professionals encountering such ethical dilemmas on a daily. You could also include literature on how health professionals deal with such dilemmas and how we can ensure that every patient gets the same quality and amount of care and resources. i suggested that you maybe start your piece with some statistics around these crimes to strengthen your argument later in your piece.
Argument: this is a very nice topic that is open for a serious discussion. As aspirant health professionals working within the Western Cape this became a crude reality. We do have to treat each and every patient equally. I would’ve liked to see that you’ve looked into both sides ( why we should treat them and why we should not) and then maybe pick your side and explain with evidence why you are siding with that specific sides.
references: Currently no references (in-text ) as well as reference list present. I think that your piece would benefit a great deal from references as you are making claims that need to be backed with evidence.
Spelling and grammar: Few grammatical errors picked up in your piece. I made a couple of suggestions using hypothesis to help with improving the flow of the text and to make sentences easier to read.
I hope you’ll find this feedback useful. All the best with your final piece.
Thank you for sharing your thoughts.
Hello Jaco. Thank you for sharing your piece.
I think what you are addressing in your writing is a very important topic and I’m sure there are very few health professionals who havent experienced this.
Your introduction was written well. Good statistics and opening up with the current problem in the state.
Content :
Your content is related well to the topics discussed in ethics. Perhaps you could look into more references related to the topic example non malifecence etc. I think it’s a good idea to explain gang related violence as it is such a trending terror in our communities, perhaps you could add more statistics or references to emphasize the seriousness thereof.
As mentioned before, perhaps you could explain just how you felt, was it anger, sadness etc. And how exactly you dealt with it. This will strengthen your argument and can also possibly be used by others experiencing the same thing.
Argument:
I think. You put up a good argument however, I feel there’s room. For more, Perhaps state more reasons why they should be treated equally example the constitution states that it should happen that way, they’re also human something like that, and then more reasons as to why you felt they shouldn’t. When arguing a bit more for both sides it eliminates bias and strengthens your argument
References
At the moment your piece lacks in text referencing. Perhaps you could add them and then also adding more statistics or articles on how these situations have escalated or how others have handled them will also open more room for references.
Spelling and grammar
The spelling errors were not many and were highlighted, however perhaps you could go over sentence construction and make sure all sentences are in the correct tense and easy to read.
Overall, this was a good read, I could relate to it very well and it wasn’t complicated. It linked well to the topics discussed and was well explained.
All the best with the final.
Kayelene
Hi Jaco
Thank you for your piece. I am commenting on your post because one of the student who’s work I am supposed to comment on is not doing ethics this year. I think most of the students in class can relate to this as most of us have treated gang members as the Western Cape are filled with gang members. These members are often in hospital due to the high gang violence rate. We often judge these patients and think that they do not deserve the treatment you would provide to a law abiding citizen.
Content: Your content reflects the work covered in class. Statistics on how many gang members are admitted to hospital can be added and literature on how medical practitioners feel about these type of patients regarding treatment. You also add literature regarding medical practitioners ethic obligation to treat these patients as they would treat any other patient.
Argument: I think you should make a good argument as to why these gang members should treatment and why not in two different paragraphs and then maybe pick one side in your final paragraph. I think it would benefit your piece if you highlight what you believe more and express what you did in this situation more.
References: Currently no references present. I think it would strengthen your piece greatly if you backup your claims with literature.
Spelling and Grammar: A few mistakes were picked up and highlighted.
I hope my feedback helps and all the best on writing your final piece.
Robert Bantham