It's a long road from medical student to being a doctor.  In rural and remote areas it's not always a given that there'll be enough health care professionals to serve the community. The first thing that struck Dr Therese Fish, Vice Dean: Clinical Services and Social Impact at the Faculty of Medicine and Health Sciences (accompanied by Prof Michael Pather) on an exploratory visit in 2012 to health facilities in De Aar and Upington in the Northern Cape was the distance they had to travel between places. “I remember how far it was to drive and it made me realise the distance people must travel to obtain health services."

Fish recently reflected on 10 years of undergraduate training in the Northern Cape in partnership with the Northern Cape health department, a partnership which provides senior health professional students with training opportunities in health facilities in the Northern Cape; this as part of the distributed training platform.

“In 2013, the first group of medical students in their fourth and fifth years under the guidance of Family Medicine and Primary Care started short clinical rotations in De Aar. This has expanded to include many other undergraduate programmes and the time spent in many of the programmes has increased from short four-week rotations to longer periods of immersion of up to one year. There is evidence that if you immerse students for longer periods, they tend to return to those areas."

Fish says the partnership between the provincial health department and the university proved critical during the Covid-19 pandemic. “Our student interns in their fifth year needed to train in order to graduate and in the latter part of 2020 we implemented the 'IDEAL rotation' (Integrated Distributed Engagement to Advance Learning). Students started a 12-week rotation during Covid, and we able to allocate 280 students to smaller facilities across the Western and Northern Cape. These students were working alongside teams in the Covid environments to assist with service delivery.

“Many of the doctors were sick with Covid or dealing with the situation and our students were helping hands. That was a significantly beneficial experience for them, because they could go into their final year with that experience and are now doctors. If we didn't have the partnerships in the Western and Northern Cape, it might not have been possible to pull that off during Covid."

Fish says during a recent visit to Upington accompanied by the Vice-Dean Teaching and Learning Prof Karin Baatjes, to meet with the provincial and hospital leadership as well as current students based in Upington, they engaged with some of the graduates doing their community service year as well as other alumni who returned to the area as professionals. “The students were asked to reflect on three aspects of their rotations – delights, discoveries, and difficulties. The delights included the hospital atmosphere as extremely welcoming and that they felt valued and part of the team. A predominant theme from many students were that for the first time they felt that they mattered professionally and experienced this in a very positive way. One student commented that she developed a better sense of the health system and how it brings their training into practice.

“Some of the difficulties encountered included loadshedding and the smaller clinical environment. Other students noted that they were now forced to use self-guided study and pace themselves and their progress. As a Faculty, we think this is a great aspect of self-directed learning. Amongst the discoveries, students remarked that they felt a new connection to the community and a much deeper level of understanding which may facilitate a means to preserve empathy in the health care system. These mature insights from our students and our alumni, exemplify why our Northern Cape partnership remains critical for our faculty."

Fish says they are looking to strengthen the monitoring process to establish how often alumni return to rural areas as professionals. “Even if they go back for a short period, they still contribute immensely to health services in that area."

There remains a few challenges such as parents and students being hesitant about placement in the unknown, she says. “There is a perception that the best training happens at bigger hospitals. It's important to let them know it's okay to train in other settings. However, in some remote areas, placing students is a challenge when the rural areas don't have doctors/facilitators/clinicians who can train and oversee the students, as our students need to work under supervision."

One of her goals is to get local communities more involved to make placement easier, for example in the form of accommodation at a lower rate. “The communities as a whole benefit from having these students there – it's extra hands, they tend to listen longer to patients than senior doctors and other health professionals and by living there, they contribute to the local economy. If we can get local communities to say: these are our next generation of doctors and health professionals and we'll house them for free or at a significant discount, it will enhance our efforts to send them there."​

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