Surviving The System

Left: Jacob’s Ladder, St James, Cape Town. Right: Surfer’s Corner, Muizenberg, Cape Town

The pictures chosen represent a health care system that is constructed for those who are “strong”, those who are patient, and those who can endure an endless cycle of disappointment of a system that is rundown and dysfunctional.

The picture on the left shows a staircase that is steep and seemingly never ending, thus only those who are “strong” enough can make it to the top and reach a satisfactory outcome from our health care system. The word “strong” is not meant literally but rather metaphorically to symbolize those in a position to withstand the exhausting nature of our health care system. The cycle of consulting a doctor, being diagnosed and admitted to a hospital, receiving treatment to then finally be discharged is only tolerable to patients who can afford the time to do so. Inevitably the old and the poor are severely impacted because most cannot afford medical insurance. The older population group who are weak and do not have time on their side, cannot bear the lengthy time in the health care system. The poor suffer the most as they cannot afford to be hospitalized for a prolonged period time because of the cost, the need for beds, and the unpaid time taken out of work.

The picture on the right depicts a train track, this is a representation of a deteriorating transport system. The train tracks and the carriages themselves are neglected, thus falling apart, much like our health care system. The expectation of a good service is hindered as the railway system is not reliable as many trains are delayed or cancelled on a daily basis. Patients in the health care system face the same outcome. Services are not being delivered to the people who need it most and this is detrimental to ones health. Overloading, damage and quality of the transport system are the major problems that exist today and this is not different to our health care system. Passengers on the trains are ultimately the victims as they face robbery, train delays, injury or death while travelling by train. The same can be said about patients in the health care system, they face similar problems like overcrowding, delays in the system or death by contracting diseases from the hospital or waiting much too long to get help. There is much reliance, a considerable demand for adequate health care and a lack of service to meet the needs of the people.

In other words, a patient can stay on the “journey” of surviving the health care system for a long time, making very little progress and encountering old or new infections on the way. Our train lines and the trains themselves have not been improved upon for many years and the same can be said about the heath care system in South Africa. In fact it can be said that this transportation system is deteriorating despite many South African’s still requiring the transport. Likewise, the South African health care system is also impaired.

The top 3 dissatisfaction with the metro rail in the Western Cape
(Weiner, 2019)

The state of our nation’s health care system can be further exemplified by Mayosi and Benatar who express that many of the state hospitals are in a state of crisis, with much of the public health care infrastructure run down and dysfunctional as a result of underfunding, mismanagement, and neglect (2014). Much like our transport system, our health care system is experiencing the same fate. In our hospitals the patients lie in damaged to almost broken beds, there is a lack of medical resources and equipment, and under-staffing. Furthermore, to strengthen the statement that only the “strong” can endure the strenuous journey through our health care system one third of nurses are not confident that patients can care for themselves after discharge and half of our nurses are not confident that management will resolve patients problems (Coetzee et al., 2013). To resolve the issues within our health care system, improvements need to be made in multiple areas such are education, poverty, quality of care and the patient to health professional ratio.


Coetzee, S., Klopper, H., Ellis, S. and Aiken, L. (2013). A tale of two systems—Nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey. International Journal of Nursing Studies, 50(2), pp.162-173.

Mayosi, B. and Benatar, S. (2014). Health and Health Care in South Africa — 20 Years after Mandela. New England Journal of Medicine, 371(14), pp.1344-1353.

Weiner, J. (2019). Metrorail. Retrieved from

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One thought on “Surviving The System

  1. Hi Courtney. Thanks for the opportunity to give you some feedback on your writing. I liked the attempt to look at the health system through the lens of the transport system, although I think that the metaphor breaks down a bit. I wonder if it’s because your post is not specific enough and tries to do too much without giving any real suggestions for what can be done. Maybe if you tried to narrow the focus of the post to one particular aspect, you may find that it’s easier to link the two different ideas.

    Some of the claims you make are vague and it’s not really clear what point you’re trying to make. For example, when you say that the “system is falling apart” you don’t give any specific example of what you mean. What parts of the health system are failing and what evidence can you provide that it is? Another example is when you say that the “old and poor are severely impacted”…what is the nature of this impact? And why is it the old and poor who are most affected?

    I’m not 100% convinced of your train metaphor for being on a repetitive cycle. To me, a train is on a linear journey from point A to B…where is the repetition? You say that a patient may not be making any progress, which I can see, but how is that like a train, which is always progressing somewhere? I can see how the transport system hasn’t been improved, much like the health system, but this is a comparison and not a metaphor. I also wonder if you’re really looking at the health system from the point of view of a patient, or if it’s from your own perspective.

    Finally, I thought that you could’ve made better use of the references you cite, as you only include each in-text citation once, which means that your claims aren’t really supported with evidence.

    Again, I enjoyed reading the post and like the idea of using one system to look at the other. I hope that my comments are useful and wish you all the best for your final submission.

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