Interview with RuDASA chairperson, Desmond Kegakilwe

Dr Desmond Kegakilwe is the current RuDASA chairperson. Born in Tlakgameng Village in the far west of the North West province, Desmond matriculated from Mafikeng with dreams of being a law enforcement officer, or an engineer. His life changed when he was granted a scholarship to study medicine in Cuba, which became one of the most exciting and challenging moments of his life! He drew on inspiration from the elders in the village, especially his grandfather, and graduated with a medical degree in 2004. Desmond currently works for the Wits Reproductive Health and HIV Institute (WRHI) as a Clinical Quality Improvement Mentor for the Mafikeng Sub district, mentoring professional nurses, mostly on HIV/AIDS and TB clinical issues, in 29 clinics. He works in the hospital one day a week to keep his clinical skills sharpened. In 2012 he was given the honour of being nominated one of the Mail and Guardian’s “200 Young South Africans”. Find out a bit more about Desmond below.

What was it like studying medicine in Cuba?

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How golden policies lead to mud delivery – and how silver should become the new gold

Karl le Roux presented at the 2012 RuDASA/Phasa conference. The following article is one he wrote based on his presentation, which can be found originally on the PHASA website (www.phasa.org.za)

"My job today is to describe to you what it is like being at the rural coalface. Though I have loved working in a rural hospital for the past six years, it has also been one of the toughest periods in my life. Working in rural medicine is a bit like sitting on a rollercoaster: a combination of enormous challenge and reward, feeling exhausted and exasperated and then inspired and invigorated, seeing dignity and strength in patients, but also sadness and unnecessary suffering and death. One always feels stretched and one often feels as if one is hanging on by one’s fingertips.  The rural idyll is something that might be experienced on weekends off, but the reality of the working week is that on the whole one is extremely busy and constantly rationing care and doing the best one can with the resources available. It therefore might come as no surprise to the reader that at the coalface “policies” are more often seen as a hindrance than a help to the delivery of health care.  Policies or programmes are often imposed from above, with no consultation and with little understanding of realities on the ground.  There is usually poor data collection and feedback, lots of time-consuming and unnecessary paperwork and a focus on irrelevant aspects of care with the neglect of critical aspects. I need to make clear that good, realistic and helpful policies are greatly appreciated by most clinicians working at primary care level, as they improve care and the health of our patients (for example the new antiretroviral treatment guidelines). But there are also many examples of policies and programmes that aim for an unrealistic gold standard (with its unnecessary and unhelpful complexity) and which, as a result, undermine the provision of good healthcare to as large a population as possible.

The first example of this is the new Road to Health Booklet. Although an extremely well-intentioned document, it is completely unrealistic to expect a busy primary care nurse to use this tool properly. 

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Doctor of the Year 2019 Andrew Miller


I first met Andrew when he was an intern, exploring rural hospitals for a place to make a difference. Emboldened by his OT wife, Katie, and the friendship of two other couples of similar mettle, his search was not for a well-functioning place, but a hospital and community which really needed a doctor. The trio of friends settled on Madwaleni Hospital, our neighbour. At the time, there was only one doctor, a Dutch TB specialist, bravely holding her own, but barely managing. Madwaleni was at its lowest ebb for a long time. Today things are vastly different. A vibrant team of doctors, including a Family Physician, registrars and allied health professionals, provide excellent quality care. How did this happen?

Of course, many people have played a part in the renaissance, but Andrew’s role has been critical. I’d like to highlight four things I think deem him worthy of the Rural Doctor of the Year award.

First, his longevity. The award is not recognition of long service, but the ability to endure the tough, lean, pioneering years is a critical success factor that requires courage and resilience. It’s a marker that he’s in it for something other than his own salary or gratification. He truly wants to improve health care in the community he serves.

Second, his ability to connect with people. His team will tell you of his grace under pressure and ability to hear and understand where people – both his patients and his colleagues – are coming from. This is an essential skill in the small hospital environment and Andrew embodies it.

Third, his ability to ask for help. Rural care isn’t a second-rate version of urban care. I always tell new doctors that an ability to work hard and to know when to ask for help, is essential to safe medical practice. This is especially true for the generalist. Andrew is not afraid to say when he doesn’t know something, will readily discuss cases and has been able to reach out and ask for management or departmental-politics advice when needed. He is humble and approachable.

Fourth, his selflessness. Perhaps this is the 2018/19 story that really caught my attention. When the previous clinical manager resigned, Andrew was the obvious replacement. But by this stage, he was in a Family Medicine Registrar post and half-way through his time. It’s a complicated story as anyone familiar with HR processes will appreciate, but the short version is that in order to act formally (the current status) or be appointed as clinical manager (the logical next step), he’d need to vacate the registrar post. His prayerful consideration of this came down to doing what was best for the Hospital, not himself. (The good news is that the University was flexible enough to accommodate the shift – to everyone’s advantage.) Being willing to give up specialising, not because he wasn’t enjoying it, felt overwhelmed, or had changed his mind, but simply because it was the best thing for the hospital, illustrates the kind of person Andrew is.

He couldn’t do what he does without the team he works with, or his wonderful, supportive wife. But I’m confident to say that Madwaleni’s past six and a half years would not have been the same without him and neither would its future.

Andrew is exactly the kind of doctor I believe the Pierre Jacques award is intended to recognise and I believe he’d be a worthy recipient in 2019.



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Student Rural Health Clubs


We are proud of the students developing health clubs to bring together students interested in rural health! 

If your university or College has a health club and would like to be part of RuDASA please Sign UP!

Student Health Clubs we know about are: Rural Support Network at UCT, Walter Sisulu University Rural Advocates for Health, Tuks Rural Health Society, WITs Rural Health Club. Click on their logo's to go to their social media pages. Find out more about Young Advocates for Rural Development YARD


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