Cuba and vineyards

Wednesday 12th September

Today, I met the a group of South African medical students who have spent the last 7 years studying medicine in Cuba. They were there as part of a South African government funded scheme aimed to get more doctors equipped and prepared to work in rural, under served areas of South Africa. They have just come back, and now dealing with the culture shock and prospect of starting final year medicine here. I joined them on their orientation to get back into South African medical school life and today was their trip to a rural hospital.

It one the best med school trips I’ve ever been on. It involved a trip to vineyard on the way to the rural hospital, and on the way back! (Included tour of the cellars in photo). The ladies who run the rural health health department, Ukwanda, thought it would be a good way to get them keen on working in a rural setting when they qualify.

After 3 hours packed into the med school minibus we arrived at Ceres valley. It’s an incredible setting, the hospital encircled by jagged mountains. We met Hans one of four doctors there. The challenges of rural medicine are significant: they serve 94000 patients over an area of 80km, by 200km, an HIV prevalence of 15.2% with 30 beds, 4 docs, and a team of nurses. The UK has about 600 patients per doc. As a doctor in a rural hospital you have to be a generalist, Hans will do everything, trauma, performing Caesarean sections (from anaesthesia to delivery), paediatrics, HIV treatment, geriatrics, neonates... part of a exhausting routine of over 80 patients in a morning.

I was fascinated to meet the students who had been studying in Cuba. Cuba is put on a bit of a pedestal in Global Health, boosting one of the highest life expectancies in the world, despite being one of the most economically poor in the world. The Cuban students were explaining how infectious disease “hardly ever occur in Cuba - it’s all prevented”, “there you are basically treating healthy patients”. There seems lots South Africa can learn from Cuba, but they felt that some of the key elements of the success are intractable from communism. In particular they thought you couldn’t get doctors to work where ever they were told, so every one has a doctor living near by, without communism.

There was an animated debate about how you can enforce or motivate more doctors to work rurally, and equally importantly not leave the country entirely. And they know what its about - they all bonded to work for 5 years in their home community once they have done two years as a junior doctor. Cuba seems to have left many of them with strong views about being motivated by treating patients, not money, but at the same time a few have aspirations to work in Canada. Whatever happens they have an impressive grasp of public health and are an interesting lot. The dean here joked that the next health minster will come out of this group!