Entitlement

The current economic environment and pricey private medical care has lead to many previously advantaged people now having to rely on state medical facilities. A state-employed doctor's worst nightmare patient nowadays is no longer the drunk, verbally abusive guy dumped at casualties by a police pick-up van with a couple of stab wounds in the chest and as many scars from previous drunken brawls who vomits stale papsak wine on you. Recent times have created a much more feared patient: the PANDA ( Previously Advantaged Now Disadvantaged ). This is the white lady with the manicured nails and beehive who can no longer afford her private GP's fees so has to submit to state provided medical care. She always arrives at hospital with an entourage: the highly-strung husband who feels like a utter failure for having to bring his pretty wife to a state facility where she is forced to sit in the same queues as her garden boy and domestic worker. Instead ofverbalising his feelings to his wife, he has become moody, added 20 kg to his midrif and has been banned from attending family get togethers following a certain incident concerning his brother-in-law, CEO of a successful company, and a black eye. Also in tow is the bored teen who would rather be slouched in front of his play station but couldn't be left home alone after his mother discovered a little packet containing an unidentified white powder in his sock drawer. And of course, the concerned granny, because the patient needs some form of support and the husband and son clearly don't fit the bill.

So here's the scenario: casualties is busy, as per usual. There are long queues of patients to be seen. The folders are stacked high. As per protocol patients are classified as red, orange or green. Red meaning they are seriously ill and often in mortal peril. Obviously those are seen first. Green patients have non life-threatening complaints and stable vital signs. You are rushing about trying to sort out your patients as best and as fast as you can when a very agitated PANDA husband comes up to you, "Excuse me, girly,  when will my wife be seen?" 
"I am Dr Guinevere, Mr Panda. Have you opened a folder yet?"
"We arrived before the man you've just been examining, and my wife is tired, and I have to be at work in the morning. We can't wait any longer."
You look to where the man is gesturing and quickly spot the only white patients in the waiting room. Sure, the wife looks tired, the son morose, the gran is apparently admonishing the young girl with babe in arms beside her for her teen pregnancy.
"I'm sorry you're having to wait, Sir. I had to see the gentleman who arrived after you, first because he is very seriously injured was about to die. You might have seen the paramedics bring him in on a spinal board with head blocks, noticed the endotrachial tube in his throat and the nurse giving him oxygen via a face mask. Perhaps you also saw that his leg had been severed just above the knee, was oozing blood in a steadily weakening stream as his blood pressure was falling and his heart quickly weakening, on the brink of asystole. I had to help him as a matter of emergency, you do understand, Sir."  Mr Panda goes to sit down and is placated for a full 5 minutes. Or is it perhaps queasiness with the mildest green tinge you spy round his mouth? Wife and gran give hubby a look that says so clearly they both think he's an absolute loser for not being able to afford the luxuries of the Mediclinic waiting room. Not 10 minutes later, Mrs Panda stands before you.  Mascara slightly smeared  and lips too pale but still poised on high heels, she holds on to granny's arthritic hand for support. The sullen teen has obviously been told to get up and help his mother but he drags behind, dying from embarassment behind his greasy fringe. Just as your eye catches Mrs Panda's, she starts moaning bitterly and grabs hold of  her abdomen, bending over double. 
"Dear Mrs Panda, won't you sit down before you hurt yourself. I'll ask the nurse to give you something for the pain." 
"I don't want an injection, I want the doctor to see me." She drops the charade and hands you her cellphone. "Here, speak to Mrs de Klerk, she's the dominee's wife you know, and her son-in-law is an orthopaedic surgeon in Australia. She'll be able to tell you how serious my condition is and that I am to be seen right away. And do remember that I can't have penicillin or voltaren because of my delicate constitution."
"I am sorry for the delay Mrs Panda, kindly sit down and await your turn. Everyone in this casualty is ill and will be attended to." You hand her telephone back to her and indicate the full waiting room. There is a dehydrated baby with sunken eyes you know you'll have to attend to quickly. An old man is coughing up blood. He has either TB or a lung tumour. A mom is comforting her toddler who has a rash that looks suspiciously like measles. Next to her is a man covered in bloody crusts from a wound to his scalp.

 I wouldn't very much like to wait hours on end in this waiting room full of unpleasant smells and infectious diseases. Some of us have experienced air conditioned waiting rooms with old editions of Fair Lady and Weg to page through. Others have never had this luxury. No matter how uncomfortable a state hospital's  casualty set-up is, all the South African hospitals I've worked at have provided care of a very high and academic standard to their communities. With the advent of the NHI ( National Health Insurance ), patients from the extremes of social backgrounds will be thrown together more often. It will make for a very interesting study in social adaptation and human tolerance. Whether South Africa is ready for such a dramatic amalgamation of the classes I find doubtful. 

Mrs Panda, glances over her shoulder, in a soft voice, discreetly, she says to  you, "Ag, kom nou, Sussie, jy's mos een van ons. Sit nou die Tannie se leer bo-op die hoop dat ons volgende gesien kan word."