• Home
  • News
  • Featured news

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

PrintEmail

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

PrintEmail

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

 

PrintEmail

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

PrintEmail

More Articles ...