The South African Medical Association Trade Union (Samatu) has written to Health Minister Joe Phaahla, bemoaning his department's continued discrimination against Cuban-trained South African doctors. 

In a letter dated 5 December 2021, the union, through administrative officer Simon Madini, said it noticed a tendency by the department to implement discriminatory practices in preference of certain South Africans.

"To be precise, this refers to a practice where Cuban-trained South Africans are placed at the tail end of the placement list and treated like outcasts in their own country," the email read.

The union's complaint comes after it emerged last week that the national Department of Health did not have funding for 644 community service and 384 interns at government health facilities for 2022. 

For the most, the lack of funding is expected to affect 600 Cuban-trained South African doctors, compared to 64 South African-trained junior doctors.

In total, the department need R824 million to place all 1 028 junior doctors and it has since approached National Treasury for a once-off bailout. 

Samatu described the ongoing doctor placement crisis as self-made. 

"It is indeed cause for concern that the department continues to outplay its incompetence time and time again, every time when it is supposed to place doctors in various hospitals. We need to bring it to your attention that the placement of doctors in internship and community service is a statutory obligation.

"The same incompetent practice that continues to defy logic was displayed in July 2021 when the department again failed to meet its own deadlines until it was threatened [with] legal action. Non-placement of the doctors, especially for community service, would mean that as of the 1st of January 2022, they are practically unemployed, and this happens while we observe an increase in Covid-19 infections, with citizens losing their lives daily," the email read.

National health department spokesperson Conrad Fortune did not respond to questions from News24 about the perceived discrimination against Cuban-trained doctors. 

Madini also highlighted that the union had been made aware of a planned graduation ceremony to celebrate the achievements of Cuban-trained doctors while the health department had still not placed them.

The email read, "This is nothing but an insult to the working class."

Samatu also rubbished the excuse the department officials made to a doctors' association last week that Treasury failed to allocate budget for the payment of the doctors. 

"While that might be correct, when it comes as a yearly problem, it then points to a chronic maladministration of the programme.

"Ordinary citizens, including doctors should not be dragged and exposed to endless infighting of state organs but rather be provided with a service fit enough to allow them to practise medicine and help rescue the health system which is likely to collapse. Samatu pleads with your office to take a decisive action and intervene with a view to avert the imminent calamity. The failure of your office to take drastic steps will, most unfortunately, throw the health sector into a deep monumental crisis.

The union said, "In this day and age, particularly during this pandemic, it cannot be correct that doctors are treated with disdain. It would be unfortunate if members would have to take to the streets to get your undivided attention."

A doctorate published in 2020 by Buhle Maud Donda, found that South African medical students returning from five years of training in Cuba were "seen as foreign and incompetent" and taught "with humiliation" at the University of KwaZulu-Natal (UKZN) Medical School.

Donda, said that hundreds of would-be doctors who were being trained each year as part of the Nelson Mandela-Fidel Castro Medical Collaboration (NMFCMC) programme were being undervalued.

According to a study titled "Cuban medical training for South African students: A mixed methods study", the programme was initiated in 1996, and was expanded in 2011. This expansion amounted to around 800 students per year training in Cuba with a total number of around 4 000 training in Cuba by 2017.

In 2018 around 700 Cuban-trained doctors returned to South Africa where medical schools have provided one to three years of extended medical school training when they returned.