why we need radical reform


There is no question that we need a complete reform of the system, so that we are not indefinitely dependent on the goodwill of essential (and scarce) human resources: the nurses who accept this additional patient and run instead to walk, the young doctors who continue to work even if their condition becomes more and more difficult, the hospital coordinator who makes beds appear out of nowhere, the maintenance staff who get into trouble for the kindness of an extra cookie for patients and staff.

Then there are the specialists who fight for new technologies, new drugs, new techniques, GPs who have continued to provide exceptional, world-class care even as their operating costs rise and reimbursement Medicare contributes less, with hospital administrators trying to stretch the crumbs as far as they can, knowing they are compromising patient care and staff well-being.


It’s easy to blame the pandemic for what’s happening now – ambulances swarming and paramedics stretched, resuscitations in hallways and endless waiting lists for surgeries, healthcare workers so tired and exhausted that ‘they would rather leave and be unemployed or seek a career change than stay – a system that is no longer on its knees but completely collapsed.

Of course, the pandemic has had an impact, but governments should have seen it coming, and as crisis conditions worsen, it will only get worse without careful attention.

The connection between moral injury – the cognitive and emotional response that occurs after events that violate a person’s moral or ethical code – and burnout is very clear. To be redeployed against one’s will or to feel compelled to work beyond one’s abilities is a moral offence. Providing inadequate care because there is no capacity or resources to do so satisfactorily is a moral wound.

Given that our healthcare system was already running on generosity and expectations of resilience, it should have come as no surprise that after years of holding things together on hope and a minimum, healthcare workers s wear out and leave.

Providing healthcare is a growing challenge for all governments, but the historical reliance on piecemeal solutions is unsustainable. Comprehensive reform is needed that ensures healthcare workers are valued and able to work within their capacity to provide adequate quality of care. Without radical change, we will see more moral wounds. Quality personnel will continue to be lost to the sector, and there is no health system without caregivers, our most scarce resource.

Dr Neela Janakiramanan is a Plastic and Reconstructive Surgeon


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