Start main page content

Get doctors out into communities

- By Kemantha Govender

The focus in producing new medical graduates should be as much on creating socially conscious doctors, as it is on increasing the numbers of medical professionals.

This was a common consensus at the annual Centre for Rural Health seminar held on 8 September 2015 at the Alder Museum, Wits Medical School.

Dr Henry Campos, rector of the Federal University of Ceará, in Fortaleza, Brazil, shared his experiences about health care challenges in his country and the measures that are being enforced to address them.

Brazil's challenge 

Campos said there is an imbalance in the way doctors are distributed throughout Brazil. In more than 1900 municipalities, there is only one medical doctor for every 3000 inhabitants in primary care settings.

There is also severe shortage of medical doctors in 700 other municipalities, where the majority of them do not have a doctor living in the municipality.

To address this critical shortage, it became compulsory for all medical students in Brazil to do their training in the health system since. “Thirty percent of the internship has to be done in primary care and emergency settings of the public health system,” said Campos.

During the two-year internship, the students are supervised by the faculty of their medical school and by preceptors recruited in the health system.

The internship is done in the region where the medical school is located, as students who come from rural areas to urban areas to study often do not return home.

Campos is an advisor to the Brazilian Ministries of Health and Education, and is currently coordinating the Commission for Expansion of Medical Schools.

He has played a major role in the expansion of medical training in Brazil over the last five years, including leading the development of 29 new rural medical schools. 

Shortage in SA

South Africa’s challenges are similar to those of Brazil. Director of the Centre for Rural Health, Professor Ian Couper said South Africa needs to scale up its training of medical doctors.

“We currently have about 0.8 per 1000 population, compared to the minimum of 1.4 per 1,000 recommended by World Health Organisation. Brazil has 1.9 per 1000, but has a target of 2.7 per 1000, with ambitious plans to reach that,” said Couper. 

“A major component of the plan is to scale up training by starting new medical schools. We can learn a great deal from these ambitious efforts, and other health professional development initiatives in Brazil in which Professor Campos has played a leading role.”

Professor Vic Exner, Dean of the Faculty of Health Sciences at the Nelson Mandela Metropolitan University (NMMU) in Port Elizabeth said his institution wants to start getting students involved in communities in their first year.

“There must be a shift in health science training to global, rather than individual, focus. Students need to learn how to operate in teams and should not see themselves as one more important than the other. They need to prioritise the health concerns of the community,” said Exner.

Bottom-up approach

Exner said traditional teaching in classrooms must be replaced with facilitating blended learning in groups.

His bottom-up approach seeks to look at what can be done internally and trying to eliminate endeavors such as building new buildings. He believes there should be an assessment of available resources and infrastructure.

Exner said his university is looking to establish a new School of Medicine to give effect to national imperatives, such as the National Health Insurance.

But the vision is also to deliver a broad spectrum of scarce skill health professionals Eastern Cape.

This school aims at also address regional needs in the National Health Sciences Training Platform.

The faculty has already commenced with a four-year emergency medical care practitioner degree and is gearing to have a three-year clinical associate’s degree approved by the Health Professions Council of South Africa in 2017.

The NNMU is working towards offering the Bachelor of Medicine and Bachelor of Surgery degrees by 2020 and Masters in Medicine by 2025.

To bring about some of these changes, Exner said there should be transformation within the academic staff and a workplace-based learning on a common clinical training platform.

Exner said NMMU is exploring opportunities for collaborations – they want to partner with Walter Sisululu University to address health problems in the Eastern Cape and with the University of Cape Town who are expanding into George, an area in which NMMU has a campus.