Vital foreign-qualified doctors face xenophobia.

Foreign doctors, the backbone of South African rural health care delivery, are being 'thrown in the deep end' with little support, supplementary training or supervision, resulting in serious miscommunication and sometimes even xenophobia from health care colleagues who treat them as professionally inferior. This emerged during a discussion at the 15th annual conference of the Rural Doctors Association of Southern Africa (RuDASA), entitled 'Foreign qualified doctors; an essential and globally mobile resource – perspectives from healthcare workers and stakeholders in rural settings'. Held in the picturesque and historic mountain village of Rhodes in the Eastern Cape from 8 to 10 September, the conference attracted public sector doctors from across South Africa and neighbouring countries to focus on the theme 'Making primary health care better'. Tunisian Dr Hichem Ben-Azouz, stationed at Tintswalo District Hospital (Acornhoek) in Mpumalanga, said medicine was practised very differently in his (much smaller) home country, being highly specialised with 'a very easy' referral system – and doctors were trained accordingly, resulting in one of the best health indicators on the African continent. Back home, primary health care was 'totally covered, both in preventive and curative medicine' , but he and many of his compatriots encountered major problems locally. A colleague told him that his medical manager (not well informed by the Department of Health about the foreign doctor workforce programme), believed that a doctor who could not do a C-section or give anaesthesia was 'totally useless'. 'I disagree, ' says Ben-Azouz. Unlike Iranian doctors, who were not exposed to obstetrics and gynaecology in their country, Tunisians were trained in that specialty, but not allowed to do a C-section – identical to any other medical practitioner coming from France or many other European countries. 'In our health system only a specialist is allowed to have those skills'. He believes the responsible officials should have taken that into consideration at the outset with the country-to-country agreements and trained the Tunisians accordingly, placing them where their skills were the most appropriate. 'I had to sacrifice my family time and regularly travel 400 km to Nelspruit every weekend to learn how to do a C-section and anaesthesia. We were confronted here by very unfamiliar HIV, trauma and violence. In my curriculum HIV consisted of one paragraph, ' Ben-Azouz said. He has up-skilled himself so well that he is now an honorary lecturer in HIV at Wits University and heads his hospital's …