Rural Doctors in South Africa,

Press Statement: Call for improved cellular network coverage over rural health facilities

Johannesburg, 13 November 2015

The Rural Doctors Association of Southern Africa (RuDASA) would like to call on South African cellular network providers to prioritise the improvement of coverage at rural health facilities.

Although access to mobile telephones have helped those of us living and working in rural areas circumvent many of the challenges posed by the lack of communications and transport infrastructure, health care workers (HCWs) still find themselves in difficult situations when cellular network coverage is weak to non-existent over health facilities. The current situation for many rural HCWs is frustrating at best and at worst, life-threatening for patients. Over the past decade, mobile telephones have replaced the need for doctors to carry bleepers as hospital speed dials are now linked to personal numbers. Many regional emergency services make use of mobile telephone ‘hotlines’, and when an ambulance or hospital is out of network coverage it has huge implications for response times and indirectly impacts on patient survival and morbidity.

HCWs go to great lengths to overcome these obstacles; as a case in point, Dr Adam Asghar, based at Bethesda Hospital, in Northern KwaZulu-Natal, has this to say about his recent experience when providing short-term relief at another hospital:

"The signal at Itshelejuba Hospital is frankly terrible, with very patchy EDGE coverage and absolutely no 3G. The doctors who work there full-time are seriously inhibited in their ability to refer patients to higher-level care because of this - for example the outpatient department has no coverage by major networks, and thus the healthcare workers have to walk outside of the building to make a call, and sometimes wait outside for a response from the referral institution or emergency medical services!

“Liaising with network providers to log coverage queries can definitely bring about change, but this requires time, effort, and a lot of patience. Individual network engineers have, in general, been sympathetic to our plight, but it is clear from the response times (six months from logging a query to a site visit at Bethesda Hospital), that addressing problems in underprivileged rural areas have not been put high on their priority list by their managers.

“It is the same cycle of ‘infrastructural violence’ that continues to disadvantage the disadvantaged. Just as a pot-hole in Umhlanga will be filled in a matter of days, whilst a pot-hole in Ubombo steadily becomes a crater which incapacitates an ambulance, so urban areas have universal high-capacity 4G/LTE cellular coverage, whilst critical rural health facilities lag behind on network technology that is unreliable, and two generations old.”

Many remote rural primary health care clinics and district hospitals have direct access to doctors and specialists at regional hospitals via ‘hotlines’ to mobile telephones. Such access not only reduces waiting times for voice consultations, and allows sharing of salient investigations (e.g. X-rays) via multimedia messaging/mobile internet, but is also life-saving during emergencies. Laboratory results and healthcare resources have also become more accessible through web-based applications that require a mobile internet connection, and when there is a breakdown in facility telecommunication systems, doctors and nurses are using their personal telephones to obtain patient results, and consult guidelines. 

Admittedly, some rural healthcare facilities are based in topographically-challenging areas, but cellular network providers have the technology to surmout this problem. Addressing this inequality in infrastructure will require prioritisation by Radio Planning executives at head offices of cellular network providers. Engineers will then be empowered to timeously build Base Transceiver Stations, and install antennae which will adequately serve rural health facilities and their surrounding communities. In addition, RuDASA strongly encourages Provincial Departments of Health and Public Works to collaborate, and be proactive in finding solutions to long-standing signal issues at some healthcare facilities, which require simple interventions from cellular network providers.

RuDASA recently conducted an online survey and a total of 90 doctors around the country responded. Unfortunately those in areas of poor mobile telephone coverage were unable to complete the survey. The majority of respondents are located in the Eastern Cape (32%), KZN (27%) and Gauteng (22%) and service providers are predominantly MTN (35%) and Vodacom (44%), with a small percentage represented by Cell C and Telkom Mobile. 

When respondents were asked to rate voice coverage in their institution on a scale of one (poor coverage) to ten (excellent coverage), 55% rated it as 3 or less. The most common definitive problems with voice calls from respondents were getting missed call notifications despite the phone not ringing (53%), poor sound quality (39%) and failure to make calls when attempting to do so (39%). Two thirds of respondents reported that signal issues are reportedly worse within buildings, compared to outside. However, it must be noted that one in five reported equally poor signal inside and outside of buildings. 

The following statements are additional feedback from respondents:

“I have had to get another phone for work because sometimes the hospital cannot reach me on [provider name]”

“When we have signal it is good, however it frequently drops for hours and you are unable to make any calls or use any data during this time”

“Data frequently is unavailable in parts of the hospital”

“Sometimes we have good reception but when it's bad we don’t have any ability to get onto the Internet or Whatsapp messages. When this happens it makes work very difficult”

“Extensive communication with colleagues in other hospitals [is used] via WhatsApp. Very poor data signal strength.”

“Getting Whatsapp images is a nightmare. Can't do anything that requires data”

All survey data collected, including respondents contact information and location is available on request for the purpose of investigating and upgrading existing services. 

We make this appeal on humanitarian grounds and in the interest of patients' health and lives. Will network providers rise to the challenge or "drop the call" on rural patients? 

For more information contact:

Dr Indira Govender (KZN), This email address is being protected from spambots. You need JavaScript enabled to view it., 0734759114

Dr Adam Asghar (KZN), This email address is being protected from spambots. You need JavaScript enabled to view it., 0781220300

Dr Desmond Kegakilwe (North West Province), This email address is being protected from spambots. You need JavaScript enabled to view it., 082 960 7571

Dr Garrick Barber (Eastern Cape), This email address is being protected from spambots. You need JavaScript enabled to view it., 076 849 0642 

The Rural Doctors Association of Southern Africa (RuDASA) strives inspire others towards rural healthcare in South Africa. Our aim is to support and empower those committed to making health care available to all South Africans.

ENDS

Press Statement: RuDASA supports #FeesMustFall

Johannesburg, 23 October 2015

Press Statement: RuDASA supports #FeesMustFall 

Rural Doctors Association of Southern Africa (RuDASA) stands in solidarity with the non-violent, united student movement currently known as #FeesMustFall. The groundswell of activism demonstrated by students exposes an obvious structural elitism. This struggle is about human dignity and equal access for everyone, and it affects us all. 

We know that health science students from rural areas are beacons for their communities and more likely to return to serve and lead these communities. However rural students are underrepresented at tertiary institutions and denied access precisely because of poverty and the vicious cycle this creates in preventing access to financial aid. All this amidst numerous other access challenges such as inadequacy of rural schooling, lack of support and mentoring and an absence of role models. This movement is representative of a class struggle that recognises one of the roots of social exclusion: lack of access to higher education. Therefore we choose to add our voices to this movement, for rural students and graduates who persevere despite loans, debt and financial constraints hanging over their heads, and rural communities battling in the face of the human resources for health crisis. 

As former president Nelson Mandela once said, "Education is the most powerful weapon which you can use to change the world." In post-apartheid South Africa, being rural should not be a barrier to education, upliftment and breaking the cycle of poverty. 

For more information contact: 

Dr. Indira Govender, 0734759114 This email address is being protected from spambots. You need JavaScript enabled to view it.

Dr. Desmond Kegakilwe, 0829607571, This email address is being protected from spambots. You need JavaScript enabled to view it.

The Rural Doctors Association of Southern Africa (RuDASA) strives to inspire others towards rural healthcare in South Africa. Our aim is to support and empower those committed to making health care available to all South Africans.

ENDS

Press Statement: Support for healthcare workers working in precarious situations is needed not vilification

Johannesburg, 23 July 2015

The Rural Doctors Association of Southern Africa (RuDASA) would like to express our serious concern in relation to the suspension from duty of two doctors from Evander Hospital in Mpumalanga for performing an emergency perimortem caesarian section in the hospital’s labour ward. RuDASA firstly extends heartfelt condolences to the family of the mother and baby who died. We hope, however, that a small measure of comfort can be gained from a proper understanding of the facts surrounding the healthcare that was provided, and the reasons for which the caesarian section was performed in such unusual circumstances.    

While not privy to the full and specific details surrounding this incident, RuDASA acknowledges the necessity of a perimortem caesarian section in the event of maternal cardiac arrest as a legitimate emergency procedure that facilitates effective cardiopulmonary resuscitation (CPR). In addition, accepted best practice necessitates this intervention to be performed within 4 minutes of cardiac arrest in order to reduce the chances of intrauterine asphyxia (lack of oxygen) to the foetus. 

RuDASA understands that the Evander hospital staff, a rural site in the Gert Sibande District, were forced to intervene as a matter of urgency as they witnessed their patient’s condition deteriorate while waiting for a helicopter to arrive. The promised clinical and criminal investigations will reveal whether the staff were correct in their assessment of the steps required. 

Without having undertaken such investigations, however, hospital management and the Department of Health were quick to publically vilify the doctors involved and to suspend them without giving them an opportunity to argue against their suspension. Doctors with advanced skills in obstetrics and the management of obstetric emergencies are a scarce resource in rural areas and the suspension of the doctors involved has left an unnecessary gap in essential services at Evander Hospital and the community it serves. 

RuDASA is well aware of challenges faced by rural health facilities, including long distances between PHC facilities and referral centers. Rural doctors and their patients are often caught in precarious situations while waiting for emergency services that need to traverse poorly lit dirt roads or triage responses to more than one facility that are long distances apart. Frozen health care worker posts, budget cuts and medicine shortages further affect the care health care workers can provide for their patients. It is therefore critical that the full circumstances on an adverse event are fully understood before passing blame. 

We call on the Department to apologise publicly and to reconsider the suspension of the doctors involved, while obtaining a full understanding and measured assessment of the facts of this case. We call upon patients, communities and authorities to work together with health care workers to protect, promote and advance access to quality healthcare services in a healthcare system under strain. 

For more information contact: 

Dr Karl le Roux, 0728589751, email: This email address is being protected from spambots. You need JavaScript enabled to view it. 

Dr Desmond Kegakilwe, 0829607571, This email address is being protected from spambots. You need JavaScript enabled to view it. 

The Rural Doctors Association of Southern Africa (RuDASA) strives inspire others towards rural healthcare in South Africa. Our aim is to support and empower those committed to making health care available to all South Africans.

ENDS

 

RURAL DOCTOR OF THE YEAR

We celebrate unsung heroes who makes a difference in a rural context. The Rural Doctors Association of Southern Africa (RuDASA) inaugurated an annual award for the Rural Doctor of the Year in 2002.

The award is presented to a rural doctor, working at the coal face, who is judged by the RuDASA Committee to have made a significant contribution towards rural health in the previous year. It is intended to be awarded to a practicing rural doctor rather than to someone who has made achievements in the academic arena. It is also awarded for a specific contribution within the previous year rather than for long service. The nature of the contribution is not defined given the great variety of work and activities of rural doctors.

The award was named after Dr Pierre Jaques, a founder member of RuDASA and a doyen of rural practice in South Africa. He spent most of his working life at Elim Hospital in rural Limpopo province and has been a tireless advocate for rural health and the role of the rural doctor in South Africa.

The first recipient of the award, in 2002, was Dr Thys von Mollendorf, previously medical superintendent of Rob Ferreira Hospital in Nelspruit, Mpumalanga. Subsequent recipients of the award have been as follows:

2003: Dr Victor Fredlund, from Mseleni Hospital in northern KwaZulu-Natal

2004: Dr Hermann Reuter, from MSF in Lusikisiki in the Eastern Cape

2005: Dr Nigel Hoffman from Rietvlei Hospital in the Eastern Cape

2006: Dr Vanga Siwisa from Taung, North West Province

2007: Dr Gert Marincowitz from Tzaneen, Limpopo Province

2008: Dr Munyadziwa Kwinda, from Donald Fraser Hospital, Limpopo Province

2009: Dr JJ Ogole from Piet Retief Hospital, Mpumalanga

2010: Dr M Kekana from Hlabisa Hospital, KwaZulu-Natal

2011: Dr KR Adigun from Bethal Hospital, Mpumalanga

2012: Dr Kelly Gate from Bethesda Hospital, KwaZulu-Natal

2013: Dr Ben and Taryn Gaunt from Zithulele Hospital, Eastern Cape

2014: Dr Jenny Nash from Amahlathi District, Eastern Cape

 

2015: Dr Ndiviwe Mphothulo from Taung District in North West Province

 

2016: Dr Nomolindo Makubalo from Nelson Mandela Bay District  Eastern Cape

 

CALL FOR NOMINATIONS

 

The RuDASA Committee calls for nominations for the Pierre Jaques Award between April - July each year. Any interested person may nominate a rural doctor working in Southern Africa for consideration of the  Rural Doctor of the Year.  Nominations should be submitted to: This email address is being protected from spambots. You need JavaScript enabled to view it.

Nominations should be accompanied by details of the nominee, including his/her place of work and contact details, as well as a clear motivation as to why the nominee should be considered for the award. Nominators should also provide all their contact details in case more information is required. Please note that current members of the RuDASA committee are not eligible for nomination.

 

The award will be made during the Annual Rural Health Conference.

 

 

 

 

Rural doctors are a prescription for good health

by Sulaiman Philip

23 October 2014, Media Club South Africa 

It's a 140km round trip to the furthest of the five clinics in rural Eastern Cape's Amahlathi Municipality for Dr Jennifer Nash. This year's Rural Doctor of the Year uses the time to think, to relax, to chill. She sounds chipper as she talks: "It's my alone time. I have 20 minutes of radio reception, and then it's me and the beautiful scenery."

The roads that Nash travels may be an hour from East London but it may as well be another world. She is not tempted by the bright lights of that big city; instead, she is driven to help the impoverished population. "There are doctors who will tell you that you lose your skills working in a backwater or that the rural areas are where bad doctors go to practice. They could not be more wrong. My skills are sharper because I see so many different kinds of patients."

To illustrate her point, she tells of a missing drug order: a pharmacy order was placed; when it failed to arrive she called to track it. "They had no record of the order so we had to send it through again. But the hospital's fax machine wasn't working so I had to track down a fax in the middle of nowhere to place the order."

There are infrastructure challenges, she explains. There may be no water at the clinic, or bandages, but the dedicated people with whom she works make things happen. "My point is, challenges have made me a better doctor. Not expecting to have a working X-ray machine or gloves mean I have find ways to [make] do."

Her beat may not be in the deepest hinterlands of rural Eastern Cape, but she is one doctor keeping hope alive for thousands of patients. She draws inspiration, Nash says, from the indomitable spirit of her patients and the sense of community of her practice. "When I am out in the market I meet my pregnant mothers, their grannies and their sisters. I get to see the context in which I practice medicine. That is not something you get if you work in a city."

Click Here to Read the full article

SA needs Rural Doctors - Opinion Piece

Although working conditions are tough in rural areas, doctors need to go where they are most needed, says a medical student.

Although working conditions are tough in rural areas, doctors need to go where they are most needed - writes medical student. (AFP)

I am a medical student; one of a mere 1 200 that will graduate each year in a country besieged by challenges in delivering health care to a primarily disadvantaged population.

It is not hard to imagine that medical students (and the doctors into whom we are moulded to become) have an inherent social conscience. As students, we want to help and heal people. All of us have worked incredibly hard to access one of the most sought-after study programmes in the country, and continue to work hard to graduate after six intense years of non-stop exams, clinical rotations, skills-building sessions, and hours spent in teaching hospitals around the country.

There is, however, a significant disconnect between student idealism and professional reality, which has been made apparent by the application to the Constitutional Court that junior doctor Miguel Desroches brought against the minister of health and the Health Professions Council of South Africa in February. Desroches objected to being placed in a rural area for his compulsory community service year, which follows two years of internship at a select group of state hospitals or clinics, and is required for doctors to be able to practice medicine in South Africa. The court challenge revolved around him being placed in an area he did not choose to be in, the hospital’s lack of resources, and unreasonably lengthy and exhausting hours.

SA doctors don’t work in rural areas Despite the court dismissing Desroches’s case on February 19, this incident underscores a painful reality: South African trained doctors do not end up working for the people of South Africa. According to a 2009 survey conducted by the Health Systems Trust and Africa Health Placements, of the doctors that graduate annually a tiny fraction – 35 out of 1 200, or just 3% – end up working in rural areas. Yet, just under half of the country’s population resides in rural areas. Each statistic rubs further salt into the wound: According to a 2011 health department document, the three provinces with the highest number of rural inhabitants have the lowest number of medical practitioners, and rural provinces have an average of only 13 general practitioners and two specialists per 100 000 people. The same document noted that in 2010 more than three quarters of all medical posts in Limpopo were unfilled.

The districts with the highest HIV prevalence, such as the Sisonke district in KwaZulu-Natal and the Gert Sibande district in Mpumalanga, are all more than 50% rural. As someone preparing to enter the system, these statistics weigh heavily on my mind. More importantly, so do the people that they represent. Desroches may be able to cite plenty of reasons why he is entitled to avoid the often gruelling working conditions in rural areas. But how far does entitlement extend in a profession where lives and livelihoods are at stake? Dr Mzamo Jakavula, a senior medical officer who served at St Barnabas Hospital in Libode in rural Eastern Cape for his community service year, offers up another perspective. Rural areas provide opportunities He believes that rural work shouldn’t be simply endured, or if possible avoided, but rather viewed as an opportunity to refine your craft and gain an understanding of the real face of South African patients. His words are passionate and inspiring: “Community service is an invaluable tool by which the government forces us medical practitioners to develop a conscience and to serve the poor and neglected. How many young doctors would have otherwise run away immediately after internship? Young doctors have very negative perceptions about rural medicine; the government has to intervene.”

Jakavula admits that his community service year was difficult and frustrating, fraught with substandard accommodation, salary and human-resource issues, and a lack of resources with which to serve patients. However, his resolve and commitment is evident and admirable. “Despite … [the issues] there isn’t a single day that I did not look forward to going to work. You know why? The patient. The typical rural patient is so appreciative of your efforts. “They made me enjoy my work so much. I learnt a lot from working there. I learnt how to be humble. I learnt to love older people and how to communicate with them. I wouldn’t substitute that experience for anything for it is exactly what is lacking in my colleagues today. It is the rural experience which gives doctors the humanity our patients yearn for in us.” Make rural positions attractive Current and future doctors like myself have inherited a health system fragmented by historical inequalities, interspersed with ongoing financial, administrative and logistical challenges that make patient care that much more difficult. It is a field where the rewards and the pitfalls are equally enormous, and the insecurity of operating in a rural area can be so intimidating that we may feel compelled, like Desroches, to fight to stay in our comfort zone.

But patients in rural areas need us to be their voice and advocate for equitable health care for all South Africans. Government and civil society efforts need to focus on making rural health an attractive career option for aspirant doctors, and resources must be diverted into equipping and restoring rural facilities. Over and above, I believe that we need a change in mindset. Students and young doctors need mentorship from doctors like Jakavula, need to hear from the dedicated health professionals who endure the difficulties of rural medicine because it shapes them into practitioners who are versatile, skilled, compassionate and courageous.

We need to be reminded why we do what we do and who we do it for. We need to be constantly reminded of a fundamental truth: community service should not be regarded an inconvenient period in a medical career. A medical career should be cultivated as a continuous act of community service.

Michelle Robinson is a fourth year medical student at the University of the Witwatersrand.

Source: http://mg.co.za/article/2014-04-08-comment-sa-needs-rural-doctors/

South Africa: Rural Health Workers Honoured

Published on allAfrica by Wilma Stassen

Creativity and an understanding of where your patients come from are key to being a successful rural doctor, says Dr Jenny Nash, who this week was named Rural Doctor of the Year.

Nash, who oversees primary healthcare clinics in Greater Kei in the Eastern Cape, was chosen by her peers in the Rural Doctors Association of Southern Africa (RuDASA) at their annual conference in Worcester this week.

"You have to be able to network with the doctors in the bigger centres and explain about a patient - so you can use WhatsApp, e-mail, send pictures, and sometimes you can save the patients having to travel themselves," says Nash.

Nash adds that it is essential to understand where patients come from "so that you can understand what is influencing patients, why they might not be not taking treatment and some of their beliefs that influence their health".

"I get my inspiration from my faith, and my belief in wanting to help people and more than just giving out pills for every ill. In the rural areas you have amazing people, and in working with the different clinics it is important to draw in the people and all share a common vision. Sometimes it means doing many things that are not in your job description, but in serving the team to work together to achieve a goal," Nash tells Health-e News.

For Jabulile Ndlovu, named Rural Occupational Therapist of the Year, " you have to be multi-skilled", adding that she has to sometimes be a physiotherapist and social worker.

"You have to be sensitive to the needs of the patient and the effort that they've made to present themselves in a health facility, and try not to turn them away," says Ndlovu, from Manguzi Hospital in northern KwaZulu-Natal.

"You have to wreck you brain to come up with a solution. So the achievement of this award is like a handkerchief, wiping all the sweat of the years of frustration."

Meanwhile, Western Cape's rural doctor of the year, Dr Hans Hendriks from the Ceres District Hospital, says "often you are the final frontier for most patients".

"When you're on call, it's only you. You have to sort out the problem, so you need a wide range of skills. What we see in the rural setting is very diverse and you cover the full range of medicine and you have to be able to handle any situation that come your way," says Hendiks.

"When you are a rural doctor you live in the community and you start thinking community. You see where the problems are come up with ideas of how to solve it."