Stellenbosch University: Centre for Global Surgery brings health education to rural communities

The Centre for Global Surgery (CGS) at Stellenbosch University (SU) has undertaken a project to improve health education in rural South Africa.

CGS has partnered with the non-governmental organisation, One to One Africa, to improve diabetes management at the community level in the Eastern Cape where the disease is estimated to affect 134 in every 10 000 people.

Since 2014, One to One Africa has sponsored a community health worker programme known as Enable. This project empowers women working within their own communities to provide antenatal and postnatal health checks. These women, called Mentor Mothers, visit up to 200 households in their respective communities. In an effort to expand their reach to other members of the households they serve, the Mentor Mothers underwent training on diabetes mellitus (DM), which was organised by CGS’ postdoctoral fellow, Dr Eyitayo Owolabi.

Owolabi, a nurse midwife by training, has been passionate about improving the management of non-communicable diseases in rural areas. Her PhD, which she completed at the University of Fort Hare, focussed on the clinical management of DM at the primary health-care level through patient reminders. While doing this she learned that the baseline knowledge of persons living with DM was low, and her hypothesis was that if patients have more agency, they can seek care earlier and advocate for their own health.

Owolabi joined CGS in 2020 and began working on research projects related to diabetic foot infection, a surgical complication that can result in limb amputation if not recognised and intervened at an early stage. She conducted a baseline knowledge study that confirmed that understanding about how to recognise and treat diabetic foot infection was low amongst community members, including those with DM.

With the help of funding from the Ukwanda Centre for Rural Health, Owolabi organised training for the mentor mothers on DM, including foot care and examination following evidence-based guidelines. Since then, the Mentor Mothers have incorporated these diabetic management teachings into their home visits. They screen adult clients for signs and symptoms of diabetic foot infection and refer those who need further care to community health centres. In addition, they also teach clients and their family members about DM and diabetic foot infection to improve health-seeking behaviour.

In conclusion, community health workers can play an essential role in DM screening, including identifying and linking individuals with diabetic foot infections to care. CGS plans to measure the impact of the training with the longer-term goal to scale up this intervention and increase timely referrals and access to surgical care, particularly in rural areas where care is most inequitable.