​"I have a dream… That patients from rural communities have access to all the same health care services we have in the city."

This bold vision, shared by Dr Therese Fish, resonated through a recent gathering of healthcare workers, students, and partners. They came together to celebrate a remarkable achievement: the successful roll-out of a life-changing health initiative in the Central Karoo town of Beaufort West. This initiative provided much-needed cataract surgeries and dental services, eliminating patient waiting lists that had stretched up to three long years.

Spearheaded by Fish, Vice Dean: Clinical Services and Social Impact, and Prof Karin Baatjes, Vice Dean: Learning and Teaching for Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS), the project, aptly named the Central Karoo InReach, brought essential specialist healthcare services to patients in these vast, underserved rural communities.

The Central Karoo InReach was a multipronged initiative that united partners from several universities, the public health sector, non-governmental organisations (NGOs), and private companies who worked together to provide cataract surgery and primary care dental services to patients from the region.

Vast distances and vast needs

"Our undergraduate students do primary care rotation in Beaufort West and the surrounding facilities," Fish explained. "On a recent visit to meet with our training partners there, it became clear to Prof Baatjes and myself that there was a pressing need for additional support. While driving on one of the long roads between the Central Karoo towns, we started to conceptualise a plan to help them achieve their goals of providing access to healthcare for these communities."

Dr Albie van Rooy, Clinical Manager for Beaufort West Hospital, painted a vivid picture of the challenges faced in rural healthcare. "The need in the rural setting, and certainly the Central Karoo, is defined by vast distances, lack of resources, and staffing issues. Reaching our patients and giving them the care they need is often quite a real problem."

Van Rooy described the impact on patients: "We had an incredibly long waiting list of patients in the districts needing cataract surgery. Many of our patients are essentially blind and need assistance just to perform daily activities. Cataract surgery can restore their vision within a few days and give them back their independence and dignity."

Another critical need identified in the region was dental care. With just two dentists serving the entire district, patients faced agonising waits of up to three months just to receive primary dental care.

The power of collaboration

"We recognised an opportunity to leverage our resources and connections to support the health system and alleviate some of the challenges they are currently experiencing," said Baatjes. "At the same time, we're exposing our registrars [medical specialists in training] to non-complicated eye surgery, and our undergraduate medical students to the rural healthcare environment."

The FMHS InReach team joined forces with Africa20Twenty​, an NGO dedicated to providing accessible, quality cataract surgery to patients in underserved areas. "We go into communities and district hospitals to try and alleviate cataract surgery waiting lists," explained Mr Carl Nel from Africa20Twenty. "We have a completely sterile mobile operating theatre where surgeons who have volunteered their time perform cataract surgeries to help reduce waiting lists."

During the week of 16-22 September, this collaborative effort bore fruit. Africa20Twenty worked side-by-side with surgeons and surgeons-in-training from the FMHS' Division of Ophthalmology, and surgeons from George Regional Hospital to perform 94 vision-restoring cataract surgeries, clearing a waiting list that had been years in the making.

"Some of the cataract patients receiving care this week have been on the list for three or four years because we haven't been able to help them," said Van Rooy. "Now we've practically cleared the list. It's phenomenal. The patients are so grateful."

Bringing dental care to the community's doorstep

The dental component of the InReach was equally impactful. Dr Von-Tercia Arendse, Dentist and Dental Supervisor for the Central Karoo District, explained the dire situation: "There is a very long waiting list for dentistry. We are only two dentists, and we cover the entire Central Karoo—that's a very wide region… Just because it's a rural setting doesn't mean the patients don't require the same care as everyone else."

Rising to this challenge, the University of the Western Cape's (UWC) Faculty of Dentistry​ set up a mobile clinic at Bastiaanse Secondary School in Beaufort West. Their team, consisting of four dentists, 15 senior dental students, and five support staff, serviced an impressive 249 patients over just two days. They brought their fully equipped mobile dental unit with three dental chairs and also set up several satellite dental surgeries.

Dr WP van Zyl from UWC's Faculty of Dentistry shared the focus of their efforts: "There has been a big emphasis on primary oral health care, which includes extractions, removing pain and infection that may be preventing patients from eating properly." He added: "It's been very rewarding for the students to be able to take the clinical platform and apply it in a rural setting, and to relieve the demand that's on the local clinic and in the communities."

Dr Khabiso Ramphoma, Community Dentistry Specialist for UWC's Faculty of Dentistry, praised the students for their enthusiasm and care. "The dental students were very excited to join the InReach because it's a great learning experience and good for their confidence. They want to help, and they want to learn," she said.

"It was exciting working with the medical students and to see how fascinated they were with dentistry," Ramphoma continued. "It was heartening to see the students work together and watch our students teach the medical students about dentistry, and the connection between oral and systemic health."

Three third-year medical students from Nelson Mandela University in the Eastern Cape also joined the SU and UWC students on their various serving and training activities in Beaufort West, further enriching the collaborative spirit of the initiative.

Serve as you learn

An overarching theme of the InReach was collaboration and training. In addition to the ophthalmology surgeons-in-training taking part in the cataract surgeries, third and fifth-year medical students from the FMHS trained and volunteered on the periphery of the activities, whether in supporting roles with the cataract surgeries, or health screening and consulting dental patients waiting for treatment.

"This has a dual function," Baatjes explained. "Firstly, for the students to see what the rural region looks like and experience rural health care. The second is the clinical experience they gain serving the communities in this way." Undergrad students also assisted an emergency medicine specialist on ward rounds where they learned about patient care in an emergency room environment.

Baatjes continued: "Clinicians at the Central Karoo facilities also requested training to develop their own professional skills, and therefore we arranged two workshops. The first was a point-of-care ultrasound workshop and the second was the Clinician as Trainer workshop, which strengthened their teaching and training abilities for the students they teach."

A vision for the future

All role players agreed that the Central Karoo InReach was a resounding success, which, if all goes to plan, will become a regular occurrence, bringing hope and health to underserved communities where SU trains students.

"For our students, it was a great opportunity to engage with patients from a rural setting and meet students from UWC and NMU, and hopefully share experiences and learn from each other," said Fish. "It helped the public health care sector by cutting down their waiting lists, and NGO partners fulfil their mandate.

"But the most important outcome was for the patients of the Central Karoo. By now, there are hopefully 94 people who will be able to see properly again. Who, for many years, may not have been able to do even basic things, like reading the newspaper, doing their banking, or reading WhatsApp messages. Of all the good things to come out of the InReach, I think the biggest benefit is for the patients."

Acknowledgements

We extend our sincere gratitude to the following partners for their invaluable contributions:

• Western Cape Government Department of Health and Wellness: Provided essential facilities, consumables, and patient transport.
• Africa20Twenty: Supplied mobile theatre and medical personnel to conduct cataract surgeries and offer general support.
• Al-Imdaad Foundation: Generously provided consumables for cataract surgery, patient support, and care packages.
• Zeiss: Kindly loaned surgery scopes for the project.
• Respiratory Care Africa: Provided a Mindray machine on loan for the point-of-care ultrasound training.
• Zebra Medical: Loaned a Butterfly ultrasound for training purposes.
• Pathcare: Contributed lanyards, pens, booklets, lip balm, tourniquets, and other necessary supplies.

We are deeply grateful for the support and dedication of these organisations. Their contributions were instrumental in the success of our project.

Caption:

Photo 1: Dr Therese Fish, FMHS Vice Dean: Clinical Services and Social Impact. 

Photo 2: Patients from all over the Central Karoo received cataract surgery at Beaufort West District Hospital.

Photo 3: Surgeons from the district, Africa20Twenty and Stellenbosch University worked side-by-side and successfully completed 94 cataract surgeries during the week of the InReach.

Photo 4: Senior dental students from UWC working under supervision from the satellite dental surgeries they set up at Bastiaanse Secondary School in Beaufort West.

Photo 5: An SU medical student doing medical screening on a patient waiting for dental care. 

Photo 6: SU medical students accompanying emergency medicine specialist, Prof Sa'ad Lahri on a ward round through Beaufort West District Hospital's emergency ward.

​Photos: Wilma Stassen