The partnership between Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS) and Dr Harry Surtie Hospital (DHSH) in the Northern Cape will benefit greatly from this year’s Discovery Foundation Awards to several recipients with FMHS ties.
The Discovery Foundation was established in 2006 to invest in medical specialist training and to help retain specialists within the public health sector. Awards to the tune of R24,5 million were awarded this year.
DHSH, situated in Upington, services an area that is bigger than many small countries and is the site of one of the FMHS’ rural clinical schools, where a number of final-year students across the health professions spectrum are trained.
According to Prof Ian Couper, Director of the Ukwanda Centre for Rural Health and professor of Rural Health in the FMHS’ Department of Global Health, the partnership with the Northern Cape Department of Health and DHSH is “a collaboration, involving working together towards the same vision, which is improved health care for people living in the Northern Cape.
“One component is training of final-year students in Upington, based on good evidence that training students in a particular context makes them more likely to work in such an environment when they are qualified. In future we hope to expand this to postgraduate training. However, the Faculty also seeks to support the development of clinical services through specialist outreach,” Couper says.
Rural Institutional Award
Dr Brad Wentzel, a paediatric specialist at DHSH and one of the doctors at the Ukwanda rural clinical school, is the recipient of one of five Discovery Foundation Rural Institutional Awards, which aim to bring more medical expertise to hospitals in under-resourced areas. According to him, vast distances are not the only problem the region faces: it has struggled in the past to recruit and retain the services of specialists, which has hampered the level of care that could be provided to patients.
Wentzel received the award for a project he launched to help health-care workers in far-flung regions of the Northern Cape to access specialists’ advice and support through technology, thereby bringing quality health care to patients as far away as Springbok and Calvinia.
In the Northern Cape, there are fewer than three specialists for every 100 000 people, compared to 33 per 100 000 in the Western Cape. Wentzel believes that technology will amplify service delivery, teaching and learning in public health care.
“We will be able to assist health-care workers with diagnosis and procedures using high-quality video cameras, satellite connections, MTN and Vodacom network coverage - whatever we have available to us. Once this is set up, distance is no longer an obstacle to providing expert care,” he explains.
While there is no substitute for a clinical examination, technology will connect health-care workers and provide much needed access to help and information.
“We hope that the attractiveness of the hospital will increase for staff, recruitment will improve, retention of staff will be enhanced, the quality of care will be improved through the development of a more academic environment, and students will consider returning to work in Upington or other towns in the Northern Cape.
“The Discovery grant will facilitate support of DHSH clinicians by specialists from Tygerberg Hospital and other FMHS departments, assisting the hospital to become a vibrant working environment with a learning culture and evidence-based care.
“Local doctors will be trained and specialists or senior clinicians can do outreach to surrounding hospitals, thus improving care in the entire region.”
Distinguished Visitor Awards
The above ideal will be furthered thanks to the Distinguished Visitor Awards granted by the Discovery Health Foundation to two specialists, Drs Errol Visser and Jonathan Pons. These awards aim to build the capacity of institutions and support institutional partnerships in rural areas by supporting specialists to mentor and help train young doctors in under-resourced hospitals.
According to Couper, one of the FMHS’ goals is to support the development of clinical services through specialist outreach. “We are therefore particularly delighted that two such awards, with the support of Ukwanda as the grant manager, were received in 2021 that will address the needs of our Upington colleagues to support the development of an ophthalmological surgery service and the ongoing improvement of emergency care.”
The award approved for Pons, who provides the only ophthalmological service in the whole of Eswatini, will enable him to visit DHSH regularly to improve overall ophthalmologic care and address the backlog of patients awaiting life-changing surgery, while also providing training and support to local staff.
DHSH makes use of an ophthalmic-trained nurse to assess patients and consult with the Ophthalmologic Department at Robert Mangaliso Sobukwe Hospital in Kimberley, which is 400km from Upington. There is a current backlog of more than 500 patients in desperate need of cataract surgery.
The Discovery Foundation funding will enable Pons to visit DHSH on a two-monthly basis, for three days at a time to consult patients in the eye clinic and provide training and support to the nursing staff; address the backlog of cataract surgeries; and assess and plan surgeries for future visits. This will result in improved care for local and referred patients and enhance the skills of nurses responsible for the eye clinic.
Visser, a consultant emergency medicine specialist and Ukwanda lecturer, received a Distinguished Visitor Award to visit DHSH to enable the restructuring of the emergency department (ED) and to improve care through training and staff development.
DHSH’s emergency centre provides care to Upington, where there are no district hospitals, receiving referrals from four health centres and 20 clinics. It is also the receiving centre for emergency care for the entire western half of the Northern Cape. It has a 12-bed emergency unit and a turnover of up to 2 500 patients per month.
There is no emergency medicine specialist and the hospital has received various adverse reviews from members of the public. Visser, an experienced emergency medicine specialist who has been involved in setting up a number of emergency medicine centres in private and public hospitals, was funded by the FMHS to visit DHSH in 2019 to assess the situation. His report contained a long list of recommendations, one of which was for ongoing support of the process by himself or another emergency physician.
The Discovery Foundation funding will enable such visits to take place and for the necessary changes in the running of the ED to be facilitated, key of which are training of staff and support for restructuring the way it functions. It will enable Visser to visit DHS on a two-monthly basis, for three days at a time to consult patients in the ED alongside existing medical staff, in order to provide bedside training; review case files of patients and discuss these with the medical and nursing staff who managed them; offer accredited seminars for DHS staff, and to provide regular ongoing support through electronic engagement with the local team.
This will improve the emergency medicine services and the functioning of the emergency centre, the mortality rate in the ED will decrease, and the knowledge and skills of doctors and nurses will improve.
DHS will also benefit from the Distinguished Visitor Award received by Prof Kathryn Chu, Director of the FMHS’ Centre for Global Surgery.
In reaction to her award, Chu said “SU seeks to be a leader in clinical excellence and hopefully we are improving patients’ lives by being involved in a partnership such as this one”.
In 2019 Chu visited the Department of Surgery at DHSH to teach FMHS students doing their rural training. That was when she realised that the hospital surgeon, Dr Willem Smith, was essentially working alone. Together they identified gaps in the health-care system, which, if addressed in the right way, could improve surgical services for patients in the enormous district that DHSH serves.
The Discovery Foundation award will help Chu to regularly visit DHSH. She says it is difficult to get specialists to work in rural areas, and patients suffer because treatment is often delayed or simply comes too late due to poor communication, transport costs, lack of family support and long waiting lists.
“My research interest is in improving equitable access to surgical care in Africa by strengthening the surgical system. I hope my contributions will help to improve access and quality of surgical care in the Northern Cape.
“I hope to be able to make sustainable changes in the surgical system, including improving clinical care by updating protocols and referral systems, and strengthening district hospital surgical capacity, which would help many people have better access to care. I hope to strengthen communication of all the surgical platforms at all the hospitals in the health district to reduce barriers to surgical care for patients in the Northern Cape.
“Existing staff can perform many of the necessary procedures. With the help of technology like video conferencing, specialist help can be available, even if only remotely.”
Chu stresses that strengthening the surgical system and identifying and reducing barriers to access to surgical care are key components to universal health coverage.
Academic Fellowship Award
Dr Johann de Wet, a dermatologist and lecturer at the FMHS’ Division of Dermatology, was one of six doctors to receive this award, which aims to promote research-focused training in academic medicine in South Africa by developing clinician scientists.
The award will help fund his game-changing research on the surgical treatment of melanoma in situ – cancer cells in the top layer of the skin – with which he aims to bring a new microscopic surgery for the treatment of skin cancer to more South Africans.
He specialised in dermatology at Tygerberg Academic Hospital and obtained his MMed degree in dermatology cum laude from the SU.
De Wet’s area of special interest and passion lies in Mohs micrographic surgery. This is a procedure where individual layers of cancer tissue are removed and examined under a microscope one by one until all cancer tissue has been removed.
“The wonderful thing about this form of skin cancer surgery is that cure rates close to 100% are achieved with minimal tissue removal,” he says. “It is cost-effective and associated with the best cosmetic outcomes when treating skin cancer.”
International guidelines on skin cancer treatment recommend Mohs micrographic surgery as a first-line treatment and gold standard for locally aggressive tumours, for tumours in places where it’s necessary to spare tissue, such as the face, and for patients at highest risk for the cancer spreading.
“My research goals are to improve the treatment of skin cancers with this medically advanced surgical technique and to help to firmly establish this treatment in South Africa,” De Wet explains.
Dr Sihle Nhlabathi, a psychiatrist sub-specialising in geriatric psychiatry at Stikland Hospital and a FMHS lecturer, was one of seven doctors to receive this award. She is researching effective ways of getting correct and helpful information to caregivers of the elderly. The award will help her to measure the impact that digital information can make in this field.
The Sub-Specialist Awards aim to improve medical skills by boosting sub-specialist training and academic medicine in South Africa.
Nhlabathi recalls how she tried to avoid her grandmother while growing up because of her aggressiveness and irritability. “It is only now that I am studying geriatric psychiatry that I realise that my grandmother’s behaviour was the result of serious mental problems experienced by many elderly people,” she explains.
This problem is not going away, because many elderly patients are now living longer and conditions associated with ageing, such as dementia, are becoming more common.
"There is a huge amount of social pressure in our society to care for elderly relatives at home, but this comes with its own challenges for both caregivers and patients,” she says. “The vast majority of caregivers have very little real information on how to deal with the elderly in their care, especially if they are exhibiting signs of dementia.”
Nhlabathi is deeply concerned about the wellbeing of caregivers. Supporting the carer, she says, ultimately benefits the person they are caring for. “Many caregivers suffer from a combination of caregiver burden and depression.”
A website, which will be developed as part of her sub-specialisation, will provide medical and legal information, links to specific service providers and information on referral pathways to get assistance for caregivers. There will also be podcasts providing information about dementia and medicine.
The end goal is to create a service that can be offered to elderly patients and to their caregivers. Digital communication will help people to access this service even in remote rural areas.
Dr Sibusiso Nhlapo, another Sub-Specialist Award recipient, hopes to make a difference in the lives of rural women with high-risk pregnancies complicated by medical conditions and foetal anomalies. He obtained a MMed degree in obstetrics and gynaecology at SU.
Pregnancy risk factors could include being under 17 or over 35, having HIV, high blood pressure or diabetes, or heart, lung and kidney problems.
Nhlapo’s concern is the difficulties that women with high-risk pregnancies experience in accessing specialist services in the urban centres several hours away. “It is heart-breaking when a high-risk pregnancy has a poor outcome because of a lack of access to maternal foetal medical services. These services save lives,” he says.
Nhlapo was elated to receive the Discovery grant, as it will help him establish a maternal foetal medicine service in Mpumalanga.
“This will also provide mentoring and educational opportunities for the doctors providing maternal health care and benefit medical students who may be sent for practical training in the province from the nearby medical schools.”
One of the FMHS’ MMed students, Dr Kartik Naidoo, received a Rural Individual Award. His research goal is “to understand unplanned pregnancies in Mossel Bay by researching the experiences of nurses and clients in family planning at local clinics”.
Prof Hoffie Conradie, former Director of Ukwanda, received a Distinguished Visitor Award “to host workshops for health-care workers in rural Eastern Cape focusing on self-awareness, reflection and developing tools to prevent burn-out”.
A home-grown response to health challenges
The Discovery Foundation was established in 2006 to invest in medical specialist training and to help retain specialists within the public health sector.
Since its establishment the Foundation has invested over R261 million in grants to support 473 medical specialists and institutions. This year’s awards include R16,6 million for 28 individual recipients towards their fellowships and R11,1 million for 14 institutions to boost academic, specialist and rural medicine in areas of critical need.
According to the Chairperson, Dr Vincent Maphai, the Foundation believes that South Africa’s doctors are in a unique position to solve some of the most perplexing health and clinical challenges the country faces. “By giving our healthcare professionals the opportunity to learn and grow, we can facilitate a home-grown response to some of the world’s most challenging health problems.”
Additional source: www.discovery.co.za