On the one hand, we have the South African Health Department, headed until recently by a woman who publicly denied the link between HIV and AIDS (perhaps taking her lead from the head of state), at the cost of possibly millions of lives. Admittedly, in taking over power in 1994, the Health Department faced an uphill battle – expanding health services to cater for the whole population on a budget which had previously been used to cater for a mere 15% of the population. The way they have gone about it, however, has been nothing short of disastrous. Primary, secondary and tertiary services are facing similarly ominous challenges; increasing patient loads and increasing burden of disease with the same or dwindling staff numbers and other resources. The hospital I was working at before I left was witnessing a year-on-year increase in patient load of 10-15%, yet the number of doctors in the past 10 years had remained unchanged. In essence, each of us was seeing at least double the number of patients as our predecessors 10 years earlier! From speaking to colleagues at other hospitals, I am certain that my story is in no way unique.

Government’s response to this unsustainable burden has been ludicrous to say the least. They have failed utterly to increase the number of medical professionals on the ground in the public sector, and have dragged their heels on any changes to improve the working conditions of their employees, the most notable of this being the still-unresolved negotiations over doctor’s salary packages (which has not been implemented nearly 18 months after its proposed date of commencement). As a public service doctor — and I am relatively certain this would reflect the opinions of a large amount of public sector workers, be they nurses, educators or members of the police force — one is made to feel unvalued, unnecessary and unappreciated by the people who employ you.

Contrast this with Canada. Upon arriving here, I have been given approximately CAN $ 26 000 to cover relocation expenses and to enable me to establish myself. The town where I am working is throwing us a welcome party which will be attended by the mayor, and is offering us a CAN $ 50 000 interest free loan, to be paid off over 2 years. The various medical associations will cover costs of further training and equipment to my heart’s content. Working rurally, I can earn about 10% more than if I were to work in a major city. The provincial government and clinic managers go out of their way to make sure that their staff are looked after.

Each country has their own set of challenges, and I know that it is futile to compare apples with oranges. South Africa is not currently as resourced as Canada and there is not a lot of capital to “throw” at problems such as these. But one of the great discrepancies I have noticed between the two countries, financial reward aside, it the attitude of those in power towards the people who are vital for society to function cohesively. In Canada, public servants are treated with respect and rightly valued for the role they play in their communities; in South Africa they are treated like outcasts and pariahs.

I plan to return to South Africa in a few years time; the financial rewards and comfortable lifestyle do not tug strongly enough to allow me to ignore the land of my birth – a land that needs the help of all who are able to give it. But thousands of other professionals, medical included, have fled its shores and are not willing to come back. The government needs to realise soon that if you treat people badly they will seek other options, and they have every right to do so. Moaning that these people have no passion for the country considering the country well rid of them is counter-productive, short-sighted and essentially immature. Jacob Zuma and his government will soon need to realise this and implement change if they do not wish to wake up one morning to a country without education, policing or health care. It is good government alone that can respond to such a challenge.

Craig L is a young South African doctor who has recently relocated to rural Canada, but is not yet a maple syrup or RV convert.