When deciding to enter the medical profession, it is important for students in South Africa to understand the different contexts in which they will be working.
In South Africa's wide-ranging population, some people live wealthy, city-based lifestyles and others live impoverished lives in and around cities and in rural areas. Patients needing medical assistance come from a range of varying contexts.
Exposing students to the various settings from the get go, is the thinking behind a module, entitled Heath in Context, which, for the past five years has been compulsory for first-year medical, physiotherapy and dietetics students.
The module comprises four themes – namely Bio-Psychosocial Perspectives on Health; Enabling Competencies for Scholar Graduate Attributes; Ethics, Law and Human Rights in Health Care; and Health in Context.
The module is chaired by Dr Marianne Unger, who is also a senior lecturer in Physiotherapy - and essentially exposes the students to the health system as a whole. Dr Bart Willems together with Mrs Maryke Geldenhuys run theme four of the module - Health in Context. Geldenhuys, an occupational therapist, has been working in the division of Health Systems and Public Health as undergraduate coordinator for the MB,ChB programme in Public Health. Willems studied medicine and then Public Health and is one of the consultants working in the division of Health Systems and Public Health.
The module was initiated in 2013 through the Stellenbosch University Medical Education Partnership Initiative after leaders in medical education at SU identified the need for students to be exposed early on to the communities in which they will one day work.
“The idea of the module is to get students to understand the social environment where patients live and work and to have a strong grasp of the various factors that affect their lives and which would therefore have an effect on their health," Willems said in an interview.
“In the module, we link the social determinants to the burden of disease and to the main diseases that will be encountered in South Africa. We look at how the health system should ideally be set out to best mitigate the burden of disease."
“It basically introduces the students to the kind of places where they will be working and the type of patients they will be seeing," Geldenhuys added. She said the module exposes students to “the complete South African context".
“Maybe they grew up in a context where they don't understand all the troubles people go through, and all the health problems people are exposed to in their particular environments. This module helps them to grasp these realities," Geldenhuys said.
According to Willems and Geldenhuys, at the end of the module, students visit a community – there are 20 selected communities in the Western Cape, some of which are urban and some rural – where they spend time visiting households, schools, old age homes, crèches and healthcare facilities.
“The idea behind this is to literally put them in the shoes of the patients they will be working with so that they can understand the context of the patients, some of the factors that contribute to their illness and how they navigate the health systems in their communities. At the end of this visit the students have a very good idea of the context of the patients – so they don't just think of their patients as people with diseases but as people with a context," explained Willems.
According to Unger, the module is a favourite amongst the students and they really enjoy getting off campus. The purpose of this early exposure may not always be valued so early in their training, but feedback from the older students suggest this notion changes as they enter the clinical platform as student practitioners.
Photo by Sam Reinders