Stellenbosch University: FMHS’ vision of two decades ago is being fulfilled

The establishment of the Ukwanda Centre for Rural Health by Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS) 20 years ago was a visionary step into the future. It was born out of a desire to meet a diverse range of needs.

Prof Helmuth Reuter, the first Director of the Ukwanda Centre and now Head of the FMHS’s Department of Medicine, recalls: “In 2002, a colleague, Dr Etienne van der Walt, asked me to work with him on a model of a rural health centre. At the end of the year, I was asked to take over the project as Director of Ukwanda.

“I was glad to do that because of my commitment to equity in healthcare. The most important aspects of the model included community-based and interdisciplinary teaching and learning for undergraduate students in rural and underserved areas of the Western Cape.”

The current Director, Prof Ian Couper, elaborates: “The Ukwanda Centre came about because there was a recognition in the Faculty that there was a need in terms of human resources for health in rural areas. Rural areas didn’t have sufficient health professionals to work there.

“Evidence from other countries was that if you train people in rural areas, they are more likely to work there because they are equipped for that. This was really the major motivation behind establishing the Centre.”

Living up to its name, Ukwanda grows and develops

The Ukwanda Centre has certainly lived up to its name – which means “to grow” or “develop” in isiXhosa – over the last 20 years. “There’s been a steady build-up and increase in the extent of exposure of students to rural areas and rural healthcare,” says Couper.

“Prior to the Centre being established, this was fairly ad hoc. Now it’s become systematic that students have the opportunity to get exposure to rural healthcare in every one of the undergraduate health professional programmes.”

The establishment of the Ukwanda Centre’s Rural Clinical School in Worcester in 2011, the first of its kind in South Africa, was the next major step in this process. There is now a significant component of rural training in five of the FMHS’s undergraduate programmes.

In three of the programmes – medicine, occupational therapy, and human nutrition (dietetics) – students can choose to spend their entire final year in a rural site. “This is a first in South Africa, and we have been steadily increasing that cohort in medicine,” says Couper.

The other two programmes are slightly different: all speech therapy students must do a rotation through Ukwanda, while physiotherapy students can elect to do rotations there. But the objective is the same: “It is striving towards giving students exposure to rural healthcare.”

Community-based education

The establishment of the Ukwanda Centre coincided with the FMHS’s drive towards more community-based education. “Subsequently there were decisions at Faculty level to try to move all programmes to be more community-based in their approach,” says Couper. “The rural health component was one part of that.”

The Ukwanda Centre and its Rural Clinical School have achieved notable success in this area: “Students are engaged in various community projects or in quality improvement projects in healthcare facilities.

“There is a lot of community-based activity in allied health programmes, like working in day care centres or on projects for disabled people. Being able to work with local non-government organisations, non-profit organisations, schools and so on in this context is a real bonus.”

Couper points to another important innovation: “One of the things we’re particularly excited about is what we call collaborative care: where students from across the disciplines meet and make plans together about how they can assist patients. They might do a home visit together, they might refer the patient to particular facilities, and so on. In quite a few instances, these are patients who otherwise would not have been properly attended to.”

There is already much evidence of the impact of the Ukwanda Centre and the Rural Clinical School. “We are seeing students who return as graduates to work in rural areas,” says Couper. “The challenge is that there aren’t always posts when they want to go and work in a particular place.

“In some district hospitals, we have graduates who are now the mentors of the students who are coming through the system. We also have people who are working in other rural sites – not ours, but obviously an equally good outcome.”

The Ukwanda Centre has been successful in other ways, too. “The focus for a lot of the time was on training, but part of my appointment when I came in in 2016 was both to get the Centre formalised and to work on some of the other aspects,” says Couper.

“So, we’re steadily increasing our research output. We’re engaged in a number of research activities and the number of publications has steadily increased. We’re trying to do relevant research that is focused on rural health and rural healthcare.”

The Ukwanda Centre is also working towards developing rural postgraduate training. It is launching an 18-month postgraduate diploma in rural medicine – the first of its kind in South Africa. Future plans include working on master’s and doctoral programmes to build up the research base for rural health.

Welfare of rural communities

Couper regards the Western Cape Department of Health, and in particular the Cape Winelands District Department of Health in which Worcester is located, as key partners in the success that has been achieved: “That collaboration is important. Without them, we couldn’t have established the Rural Clinical School.

“It is a symbiotic relationship. We need facilities for training students, and the presence of students in those facilities help in terms of patients being seen. Often students spend more time with patients than qualified professionals are able to. Patients enjoy and appreciate that.”

Couper adds: “What we’d love to see going forward is a recognition that health is much more than related to healthcare. A state of health is not brought about by healthcare; healthcare is needed when there is not a state of health.

“And to promote health for rural communities, we need teachers, engineers, lawyers, agriculturalists, and so on. Our hope is that we can have an even broader range of people working together with us, and us with them, in terms of trying to support the health and development of rural communities.”