Joburg Expat: Healthcare in South Africa

December 22, 2011

Healthcare in South Africa

If you’re considering an expat assignment in South Africa, you’ll probably have three main areas of concern: Safety, education, and healthcare. I’ve previously touched on both schools and safety, but a comprehensive post on healthcare is way overdue.

Even though we’ve since sampled several hospitals, just so I can give you a first-hand account in the healthcare department, I don’t think I ever told you of my first emergency room experience. I went ahead and contracted tick bite fever not more than one month into our move. It turns out tick bite fever is very common around here if you do any kind of hiking, especially in the rainy season. That is exactly what we did over Easter weekend 2010, when we went on our first safari at Yellow Wood Game Lodge in the Waterberg (a mountain range about 2 hours to the Northeast of Joburg). Technically it was supposed to be the dry season (“It has NEVER rained here in April!”) but in a twist very typical for our family (we should be called the Murphy’s), all records were broken when WE were there, and it rained and rained and rained, prompting the lodge owner to be worried about leaks in the beautiful thatch roof, which he swore he’d never had to deal with before. So I’m not surprised that ticks were roaming freely. If someone had warned me about it, I might have worn long pants and checked for ticks, but when planning our trip I had dedicated long hours of research into the question of malaria (just FYI, the Waterberg is a Malaria free area), NOT tick bite fever.

Our trip was beautiful, despite rain, but about a week after we came back (incubation 7-10 days) I started feeling very sluggish and feverish (a kind of low-grade fever with chills and a dull backache) and also noticed that one of my lymph nodes was painful and swollen. Priding myself in my knack for self-diagnosis I proceeded straight to Google, and determined that I either had a hernia (I learned that women can and do get them!) or some type of infection, both of which required a doctor’s visit. This, of course, produced more Google sessions and several phone calls, trying to figure out where one might go with such a thing and if it mattered to our insurance. My plan had been to research doctors later, once we were settled, but of course nothing ever goes according to plan. The good thing about being on a global assignment is the fact that our insurance has no network, so there is also no need to research which doctors are in it. You are stuck with an upfront payment, regardless.

I determined that an emergency room visit at Life Fourways, a private hospital nearby, was my best option, as I would be seen right away. I was, and the setting was very professional. I was whisked in to see a doctor after only about five minutes in the waiting room, and she told me that most likely I had tick bite fever, which, if it made me feel any better, she’d already diagnosed in 17 other people that day. At this point I would have been quite happy to go home with some antibiotics, but instead, I was subjected to “some tests, just to make sure.” I suppose South Africa is no I different from other Western countries in that regard. Yes, it is nice “to be sure,” but in light of rising healthcare costs, there will eventually have to be a balance between certainty on one side and cost on the other.

At any rate, I didn’t mind this particular time, as it gave me more insight into the workings of a South African hospital. First, my blood was taken, by a one-woman sort of mobile lab, right where I was sitting, so that was kind of cool. I briefly wondered about needles and safe blood and such, but then just went ahead with it. I’m a sucker in the face of authority, and the doctor had ordered a blood test, so I obeyed. Then I had to go pay separately for the lab costs. When I came back, I waited. After a while, the doctor poked in her head and wondered why I was still sitting there. “Haven’t they taken you to the ultrasound yet?” I assured her that no, they hadn’t, so she reprimanded some idle nurses to take me there ASAP. I had my ultrasound, which confirmed the swollen lymph node due to an infection, then paid again separately in the radiology department – in case you were wondering, it was all very reasonable, on the order of R300-R400 for each of those, which is about $45, not imaginable at a U.S. hospital – and was sent back again to wait. Once again, the doctor poked in her head after quite some more waiting on my part, and was irate that no one had moved me along in the process. It seems like the nurses here, while very friendly, need quite a bit of prodding.

My visit ended with the doctor confirming her initial diagnosis, handing me a few business cards for GPs and Pediatricians of her recommendation, and sending me to the pharmacy, where I bought – quite cheaply – my antibiotics and also some iron tablets, which apparently I also needed. All in all, not a bad experience. I felt much better the next day, and have learned to beware of ticks.

Now for some general healthcare information and tips for prospective expats:

Doctors: South Africans tend to primarily see a general practitioner, adults and kids alike. I was confused at first by the apparent lack of pediatricians. They exist, but mainly in association with hospitals, and you would use them for emergencies or special cases. For checkups and minor problems such as colds, most people tend to see their family physician. I’ve found the doctors at Intercare (very conveniently located at Fourways – find your nearest location here) quite knowledgeable. Intercare centers provide medical and dental services and are also an excellent place to brush up on your immunizations and travel-related issues such as malaria prophylaxis. In comparison to the U.S., doctors here will take much more time for a consultation, and charge you less. We still visit Intercare every once in a while, but have now settled on another practice as our family doctor: Dr. Moray Shirley, Broadacres Shopping Centre, 011 467 1432.

Immunizations: If you’re coming from the U.S. and are up-to-date on your immunizations (mainly Hepatitis B, diphtheria, tetanus, measles, mumps, rubella and polio), you won’t need any additional ones for South Africa. But you should visit a local doctor and see what he/she recommends, even if it is not required. When I took Zax, who was 13 at the time, for a HEP-A booster here, the doctor recommended to have everyone get HEP-A shots, even the younger kids, with the argument that this is an excellent immunization to receive, not just in South Africa but worldwide. If you’re planning to travel to other African countries (like Angola, Tanzania, Congo, Kenya) you might require a Yellow Fever immunization. In fact, after having traveled to a Yellow Fever country, South African immigration will require a Yellow Fever certificate from you. Our experience with this has been that no, no one wanted to see the Yellow Fever certificate at all, neither here nor in Tanzania, but I would say you still should get the vaccine before going into a Yellow Fever area.

Diseases: I’ve already told you about my run-in with tick bite fever, which is very common in South Africa, especially during the rainy months. However, it is also easily curable with antibiotics and in that respect much more pleasant than Lyme disease. (Just as an aside, your pets can get it too, so flea/tick treatments are very important). There are several other diseases you should be aware of. Typhoid Fever and Cholera (transmitted via contaminated food/water) are both endemic in Africa, but you won’t have to worry about it in South Africa. If you’re going to spend much time in rural areas, you should be aware of the risk of Rabies, but again, this won’t be an issue as an expat in Johannesburg. HIV/Aids, of course, is a huge problem in South Africa, coupled with the high incidence of Tuberculosis. Sadly, the South African government has only recently started to acknowledge – and battle against – the high rate of AIDS, which puts South Africa much behind even other, less developed, African countries. But I will venture to say that as an expat in South Africa, you are not much at risk, assuming, of course, that you’re sensible. Educating your kids is a must. One concern I did initially have was the quality of South Africa’s blood supply, but I was assured, by everybody I asked, that it is very safe, although I have to admit that I didn’t do any kind of exhaustive research and was quite happy to accept what I was told. You could, I suppose, have your own blood drawn and stored at a hospital of your choice, but I haven’t heard of anyone who’s actually done that.

Malaria: A discussion of diseases in Africa naturally wouldn’t be complete without a mention of Malaria. As I’ve already said elsewhere, there is no Malaria in the Greater Johannesburg Area, or even anywhere in Gauteng Province and most of the rest of the country (specifically, the Malaria free provinces are:  North West, Northern Cape, Western Cape, Eastern Cape, Free State, Gauteng). Kruger Park and parts of Kwa-Zulu Natal (but not Durban) are low-to-intermediate risk areas, and you’ll have to decide if it’s worth taking the prophylaxis (the one recommended by our doctor is called Malanil by Glaxo Smith-Kline, also called Malarone in the U.S. – to be taken daily starting a day before your trip, through your trip, and 7 days after your trip). It is worth noting that the medicine is not 100% effective, and that other preventive methods such as mosquito nets and long sleeves and pants after sunset go quite a long way as well. Most local friends seem not to be overly worried about Malaria. It is just a part of living in Africa. In the end, you must do what you think is right. We have gone both ways, foregoing the malaria prophylaxis in Sodwana Bay, which in winter is a very low risk area, and in Victoria Falls, where we were without kids and just for a weekend, but taking it on trips to Mozambique and Zanzibar. We didn’t find the pills overly invasive, with the exception of Impatience who almost became hysterical from trying to swallow her first pill ever.

Private Hospitals: Life Fourways, Sunninghill, and Olivedale hospitals, as well as Sandton and Morningside Medi-Clinic all have excellent reputations and offer world-class care. They are all part of the Netcare, Life, and Mediclinic groups that together cover most of South Africa in a comprehensive network. As an expat, you will most likely have to pay out of pocket at the completion of your visit (or, like me, several times at one visit!) and then send your receipts to your insurance company to be reimbursed. For any major operations, you might need to check ahead of time to make sure it will be approved. So far, we haven’t had any trouble with anything, maybe owing to the fact that the cost of care here is much more reasonable than at a U.S. hospital.

Public healthcare: Even though as an expat you won’t be affected by it, this article wouldn’t be complete without a discussion of public healthcare in South Africa. From what I’ve glimpsed, it is in dismal shape. There are a number of public hospitals and clinics that, it is my understanding, essentially offer free care. But, as everywhere, you get what you pay for. Many public hospitals are nearly depleted of supplies and medicine, because everything of value is constantly stolen, and patients have to contend with whole-day waits to get a simple prescription filled at a clinic. Our domestic told us that you might have to get up at 4:00 am to even get a spot in line, only to be told by 4:00 pm that you should come back the next day. She had a friend who was once admitted to the hospital with a heart problem, and scared to death for the two weeks she was there, because she was neither looked after nor released. Only some pressure from her employer advanced her case so that she was diagnosed and allowed to return home. She was then put on a monthly treatment plan, which in all probability she could never have afforded at a private hospital, so one could argue that public healthcare saved her, though I don’t know what became of her in the end. The discrepancies are stark, and the majority of people seem to be resigned to the fact that their government is incompetent. Maybe South Africa’s successful hosting of the World Cup will eventually bring the long-awaited change in attitudes. The argument that it simply can’t be done will no longer hold now that everyone has seen that it actually could, where there was enough political will.

I hope I’ve cleared up some healthcare-related questions for you. I don’t think healthcare should be an area of concern when moving to South Africa, unless of course you have some serious or rare condition, in which case the United States is probably still the best (if also most expensive) place on Earth to be treated.