The clinical training of medical and health sciences students in Upington is well under way, thanks, in part, to the efforts and support of the Ukwanda Centre for Rural Health at Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS). Despite the enormous challenges to the health care sector due to the Covid-19 pandemic, the number of FMHS students doing their clinical training at this Northern Cape site have increased from six in 2018, to 48 in 2020.
Since 2018 the FMHS has expanded its training platform at the Dr Harry Surtie Hospital (DHSH) in Upington, and now accommodates students from four programmes – medicine, occupational therapy, physiotherapy, and speech-language and hearing therapy.
The appointment of Dr Hans Hendriks as a family physician at DHSH has brought additional support for students, and complements the excellent work already being done by a dedicated group of local clinicians, led by Dr George Isaacs (Senior Clinical Manager), Dr Brad Wentzel (Medical Programme Coordinator) and Ms Elmarize du Plessis (Allied Health Programmes Coordinator).
In 2019 four medical students in their final year completed a longitudinal integrated model (LIM) programme in Upington. In the same year 32 students from three programmes (medicine, occupational therapy and physiotherapy) also trained at DHSH. In 2020, 48 students from across the FMHS undertook clinical training there, with students from speech-language and hearing therapy joining their peers.
Training periods at the site have also increased, as in the case of the 12-week integrated maternal and child health rotation.
The expansion at the site is all the more remarkable considering the effect of the worldwide Covid-19 pandemic.
"A global pandemic stretched an already strained health system, and brought with it many challenges for ongoing clinical training. For a new initiative, such as this one, the threat was significant. In light of this, it is remarkable to reflect on what was achieved over the course of last year," says Mr Cameron Reardon, the Upington Expansion Project Coordinator.
There is a strong culture of interprofessional engagement at the site, and this is reflective of the interprofessional culture within the hospital.
"DHSH has a strong interprofessional culture within their rehabilitation departments, which has facilitated high levels of interprofessional engagement amongst students," according to Reardon. "Many of the interprofessional learning opportunities offered to students piggyback off of the current health service offering."
Students get the opportunity to manage patients interprofessionally, and to engage in shared decision-making and collaborative goal-setting with patients.
"I think it is important to note that the training offered at Ukwanda was cross-professional from the very beginning," says Professor Ian Couper, Director for the Ukwanda Centre for Rural Health.
He mentions that it was important that all students whose training were facilitated through Ukwanda engaged as a team across the various disciplines. He feels strongly about input from all participants.
In 2021, an additional interprofessional education opportunity was offered at the site – collaborative care case management discussions. Ukwanda’s collaborative care coordinator, Jana Muller, also posted a series of workshops in order to support local health services staff to develop collaborative care. These sessions are facilitated by Du Plessis and her team of clinicians. Students are presented with an opportunity to present cases they have been involved with, and to problem solve around interprofessional management planning.
"Both the rapid increase in student numbers and the interprofessional nature of the expansion have been encouraging," adds Reardon.
Ukwanda's support for existing healthcare staff and services
The Ukwanda Centre for Rural Health not only assists with the training of students, but also aims to provide support for the existing health services and healthcare workers in a number of ways.
In addition to the previous Discovery Distinguished Visitor Awards for internal medicine and surgery, which support ongoing outreach, news was recently received of two new Discovery Distinguished Visitor Awards being granted to DHSH, for ophthalmology and emergency medicine respectively. Both of these will focus on enhancing the local health services, and providing training for local clinicians.
Since the implementation of this initiative, Ukwanda has been involved in the awarding of four Discovery Foundation Distinguished visitor awards:
These awards allow for specialists in these fields to visit DHSH in Upington, and to provide support to local health services staff by means of capacity building and outreach support.
Student wellness in rural placement
Being situated almost 800km from campus in a rural area brings challenges of its own to students on the academic, social and even psychological fronts. This requires supplementary support strategies to be implemented to promote student wellness.
"The Centre for Student Counselling and Development (CSCD) made online psychotherapeutic services available, which improves access to mental health services for students placed far away," says Reardon.
Lise Marie Goosen has been appointed on a temporary basis as student wellness coordinator in Upington. She supports all students placed at Upington for longer rotations, including the medical, physiotherapy and occupational therapy students. Charlene Atkinson, SUNLOC (Stellenbosch University Logistics for the Clinical Training Platform) coordinator on site, has also been a valuable support to the students as a result of her accessibility and proximity to students.
The Rural Host Initiative also allocates a host family to specific students – a programme started with great success by Gerda Viljoen on SU’s Worcester campus.