From the burden of disease to the diseaseof burden

The burden of care that healthcare workers in South Africa shoulder as a result of the failings in service delivery in the public healthcare sector is having devastating effects on the healthcare workers themselves.Moral distress is increasingly being recognised as the primary occupational hazard for clinicians working in South Africa.But recognising the problem is not enough; we need to talk openly about it.Moral suffering needs to be discussed in medical curricula, professional development environments, and in our hospitals and clinics.We need to change the culture of 'suffering in silence' to one of 'supporting in community'.In 2009, Mayosi et al. 1 described South Africa as being "in the midst of a profound health transition that is characterised by a quadruple burden of communicable, non-communicable, perinatal and maternal, and injuryrelated disorders".The so-called 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, have been recognised to have "had substantial effects on health and well-being" 2 .In this Commentary, we draw attention, not to the patients who are burdened with these diseases, but to the (public) healthcare workers who attend to them.We argue that the burden they shoulder as a result of the failings in service delivery in the healthcare sector is similarly a disease, one which is reaching epidemic proportions and having devastating effects on healthcare workers and on the healthcare system in which they work.