𝐖𝐡𝐲 𝐧𝐨𝐭 𝐣𝐮𝐬𝐭 𝐡𝐚𝐯𝐞 𝐭𝐡𝐞 𝐬𝐮𝐫𝐠𝐞𝐫𝐲 𝐚𝐭 𝐚 𝐬𝐭𝐚𝐭𝐞 𝐡𝐨𝐬𝐩𝐢𝐭𝐚𝐥?

It's a fair question. I asked it myself when I came home, and everyone in my family has asked it at some point too. You deserve a proper answer rather than a short one.

First, some context about me. I am 44, a South African citizen, and I returned home permanently about a year ago after roughly two decades in Canada. I have no personal income, no overseas assets and no Canadian benefits. I also don't have an established South African SARS/tax history, so proving my current financial position for means testing and government assistance may take some additional work and documentation.

I intend to apply for the SASSA Disability Grant. I haven't yet. The process can take up to three months and involves both medical and financial assessment, and the process also doesn't automatically provide access to surgery.

It is income support, not a treatment pathway.

On the public side, my case would still have to go through the normal referral process, and I would have to be given a patient-fee classification. That classification decides how much of the bill I carry myself, so it matters a great deal.

For anyone who hasn't come across it, it works roughly like this. H0 is free care, but it is meant for people drawing a social grant or registered unemployed through UIF, and you need official proof — an affidavit isn't accepted. I have neither yet. Below that sit H1, H2 and H3, a sliding scale based on annual income, from most subsidised to least. On income alone I would probably fall near the bottom of that scale. But there is one rule that overrides income altogether: if you are a member or a dependant of a medical scheme, you are classified as a full-paying patient, which sits above all of them. My family took out a hospital plan so that I would eventually have some cover. That same plan may be the thing that places me in the most expensive category the state has. I still need the hospital to confirm my actual status, but that is how I read it. And implanted hardware, the screws and rods a fusion requires, is billed separately at cost on top of the theatre fee, whichever category you land in.

Then there is time. Tygerberg's own published spinal referral guideline states that clinic appointments are being booked 12 to 18 months in advance, and that the estimated waiting period before non-emergency surgery currently exceeds a year. That is not a rumour or a complaint. It is their document, and it reflects a unit serving roughly three million people with limited resources.

I want to be very clear about something here. I spent more than twenty years working in public academic hospitals, some in South Africa and the majority in Canada. I have enormous respect for that system and for the role academic hospitals play in training the specialists this country needs. Nothing I am saying is a criticism of Tygerberg, its surgeons or its registrars.

My concern is specific to my own situation. I am facing an elective L4–L5 fusion. It is a significant, irreversible operation. Serious complications are uncommon, but a major neurological complication would change the rest of my life. While the decision is still mine to make electively, I would prefer to choose an experienced spine spinal surgeon, and to know in advance who will actually be operating and what the timeframe will be. Someone else in my position might weigh that differently, and I would understand it. This is simply the decision I am most comfortable making for myself.

There is also imaging. My CT myelogram is nearly two years old, and a surgeon may well require updated imaging before planning anything. That means another consultation, another invasive procedure with contrast, more travel and more cost. I would rather not repeat it unless a specialist says it is necessary, and I may have to repeat it again closer to surgery whichever route I take.

I was recently approved for a private hospital plan, which helps. But there is just over 11-months still on the waiting period before I am eligible for any orthopaedic procedure, and even once that passes, I cannot assume every theatre cost, specialist fee and gap expense will be covered.

So, the honest position is this. Whichever route I end up using, I am likely to face significant costs myself. I don't yet know the amount. With the state route it depends on my classification and what the hospital covers. With insurance it depends on the policy once the waiting period ends. I am pursuing both, and I am continuing with the fundraiser so that there is something in place if there is a shortfall, or if I need treatment before either route can help.

If my condition deteriorates into an emergency, with rapidly worsening weakness, numbness in the saddle area, urinary retention or loss of bowel or bladder control, the equation changes entirely. At that point preventing permanent nerve damage is the only thing that matters, and I would go straight to whatever hospital could treat me fastest. I would not be waiting for preferred circumstances.

And if we don't reach the full target, the money raised is not wasted. It goes to physical rehabilitation, rehabilitation equipment and other recovery costs. Those are substantial in their own right, and they are often the part insurance covers least well.

I am not trying to make this sound more complicated than it is, and I am not approaching private care from a sense of entitlement. I don't believe private automatically means safer. I am trying to make the best decision I can while the choice is still mine, and to make sure that when the time comes, money is not the thing that stops me from having the surgery I need.

To everyone who has donated, shared the page, or simply taken the time to read this far and understand the situation — thank you. I don't take any of it for granted.