Rural healthcare is crying out for a good plan and a real budget

Madwaleni is one of those rural hospitals that has managed to attract and retain health professionals. Currently the hospital has 10 doctors with pharmacy, radiology, nutrition and rehabilitation health professionals as well," said the 2009 report of the integrated support team appointed by Barbara Hogan, then the minister of health, to investigate the severe overexpenditure of provincial health departments. Madwaleni hospital emerged as a shining example of good rural healthcare. By 2012, however, Madwaleni, deep in the Transkei, was "running" on a skeleton staff of only one doctor and one health professional. Nurses, under enormous pressure, were left to run the maternity ward without doctors'' support – this in a district with the highest maternal mortality rate in the country. Pregnant women needing Caesarians had to go elsewhere. The causes of the Eastern Cape health crisis are well known: the provincial health department's chronic inability to manage its resources and the historical underfunding of rural health has brought the provincial health system to its knees. In 2012, misguided attempts to deal with the department''s snowballing debt led to a moratorium on the filling of vacant posts. This has meant that, despite a number of applicants for positions at the hospital, these remain unfilled.

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Open letter in support of Positive Practice Environments

The Rural Doctors Association of Southern Africa (RuDASA) and the Rural Health Advocacy Project (RHAP) commend DENOSA and SAMA for initiating the Positive Practice Environment Campaign.

Rural health care workers are often faced with minimal resources to provide a health care service to communities in the poorest districts of the country, which are faced with high burdens of disease. RHAP receives regular reports from RuDASA members and other health care workers regarding the dismal working conditions and the right to quality health care denied to the communities they serve.We know for a fact that areas with the greatest need receive the least resources. This is not only in terms of health care workers, but also in terms of financial support. In a North West hospital in deeply rural Ganyesa, it took more than three years for a generator to be replaced and in the meantime an infant died an entirely avoidable death during childbirth. In that same hospital, as elsewhere in North West, doctors in severely understaffed facilities are expected to be on standby for overtime every second weekend, yet do not get compensated. A recipe for a high turn-over. In the Eastern Cape, Komga Clinic went from 6 to 3 nurses and entirely halted its mobile outreach clinic service. The issue has been addressed repeatedly with the National and Provincial Department of Health yet no response nor has relief been forthcoming. Rehab professionals have gone without correct payment for months, and have not been able to procure any equipment since 2009.

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Introducing RuReSA

RuReSA (Rural Rehabilitation of South Africa) is a newly formed interest group for rehabilitiation professionals who have an interest in Rehabilitation in rural places. Members have the chance to input on policy, give and receive personal and professional support, work with universities to promote rural-friendly curricula and encourage students to go rural. "We believe that rural work can be inspiring and fun, and with a little support we can achieve great things". RuReSA provides support to rehabilitation therapists in rural are as through our resource website, an online discussion forum, and advocating for change through input on policy and service strategies as well as working with the National Department of Health, professional bodies and universities.

To join, or for more information about RuReSA, visit their website.

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Interview with RuDASA chairperson, Desmond Kegakilwe

Dr Desmond Kegakilwe was the RuDASA chairperson for 2012-2016. 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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