ukzn college of health sciences MBChB 6: IPC3 (Integrated Primary Care)
A Decentralised 6 Week Rural Attachment Program
with support from MEPI
foreword
contents
Professor Richard Hift Dean of the School of Clinical Medicine, UKZN
S
ince the advent of democracy in 1994, South Africa has seen a major reform in health care, with a far greater emphasis on health promotion and disease prevention rather than treatment, and a much greater stress on the provision of health care at a level closer to our communities via primary care clinics, community health centres and district hospitals, in contrast to the prevailing emphasis on large urban tertiary hospitals. This primary health care re-engineering poses a major challenge to health services still operating within the old paradigm, and no less a challenge to medical education. Traditionally the education of doctors has also been directed at the curing of disease, and the provision of training in large urban hospitals. The University of KwaZulu-Natal College of Health Sciences has in the last two years fully committed itself to moving decisively to a major commitment to our communities outside Durban and Pietermaritzburg, and to working in close partnership with the provincial Department of Health to shift the greater part of our training to the smaller towns of the province and the rural areas which surround them. As our country moves towards a universal National Health Insurance system built around the provision of health services at primary care level, operating within a district health system, the University of KwaZulu-Natal must ensure that our graduates are fully prepared to take their place as health care providers within such a system. We and our students are extremely fortunate to have the opportunity to participate and contribute at this critical time. Through the MEPI grant awarded by the National Institute of Health (NIH), our sixth year medical students have the opportunity to develop competence in the delivery of health care in a setting which is very real for many South African citizens: district hospitals in rural areas, in some cases far removed from the cities. Practising medicine within these hospitals and communities requires knowledge, skills and
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������UKzn profiles The people behind the programme’s success ������understanding
attitudes beyond those which our students customarily receive in their predominantly urban training. KwaZulu-Natal is a province dominated by a rural landscape. The programme we have introduced this year will stimulate our students to think about the challenges of providing health care across a range of very different settings, both geographic and cultural, and will strengthen their capacity to work successfully as medical practitioners, wherever they may practise. It also brings them closer to the communities we serve and indeed it is essential that our graduates identify fully with all our communities and recognise the challenges each poses for the promotion of health in our country. It has been a source of particular pleasure that the first students returning from their rural attachment have voiced overwhelming support for the rural placement programme. Despite the practical challenges of adjusting to life, study and clinical practice in a rural setting, our students recognise the importance and value of this initiative. “It has been a life changing experience, has taught me how to work in a team and the importance of being humble as a doctor. It taught me things I did not learn at medical school and how to work in an environment where you have limited resources. Most of all, I learnt what it means to be a doctor in the real world.” Comments such as these typify the reports of our students, and confirm the value of our plans to extend our training programme more widely across the province. This publication provides some insight into the experience of our students during the rural placement module and and will be valuable for other students as they prepare for this attachment. As most of our students have stressed, it is a positive attitude and the willingness to be flexible and to embrace new experiences which determines the value of the rural attachment for the student. To our stakeholders, funders and the Department of Health in KwaZulu-Natal, I express our gratitude for making UKZN your preferred partner in Health Education. To our students, take up the baton, run with it and do not look back until you reach the finish line. Success or failure is in your hands.
the mepi programme
An interview with Dr Sandy Pillay
������ Shared experiences from those on the programme
������ A snapshot of the province’s health statistics
6 what the students say... 8 kzn by numbers district hospitals overview 10 12 14 16 18 20 22 24 26 28 30 practical guide to kzn 32 acknowledgements �����bethesda hospital, uMkhanyakude District
������manguzi Hospital, uMkhanyakude District
�����mosvold hospital, uMkhanyakude District �����mseleni hospital, uMkhanyakude District �����eshowe Hospital, uThungulu District
�����st mary’s kwamagwaza Hospital, uThungulu District �����emmaus hospital, uThukela District
�����church of scotland hospital, uMzinyathi District �����murchison Hospital, Ugu District
�����st andrews Hospital, Ugu District
������ For new students
������ A word of thanks to the funders and the team
March
2015
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Ukzn profiles
Professor Rob Slotow
Dr Sandy Pillay
Head, College of Health Sciences
Communicating Principal Investigator, MEPI-UKZN grant
Professor Slotow oversees the activity in the four Schools of Clinical Medicine, Laboratory Medicine and Medical Sciences, Nursing and Public Health, and Health Sciences. An eminent and prolific researcher, Professor Slotow’s work focuses on strategies for the management of ecologically and economically important large mammals such as lion, elephant and rhino as well as processes influencing biodiversity and conservation management. He takes an evidencebased best-practice approach, and focuses much of his research on using hormonal and behavioural proxies for stress in order to understand how to mitigate effects of interventions for effective management and responding
Dr Pillay completed his medical degree at the University of KwaZulu-Natal (UKZN) and entered the field of research immediately, having acquired a Medical Research Council post-internship to spend time in the Department of Pharmacology where he completed research in hypertension and liver disease. He has spent many years in family practice, completing post graduate qualifications in occupational medicine and HIV clinical management. He joined UKZN in 2004 where he led a team that developed South Africa’s only coursework post graduate program in clinical HIV management. He was the director of the Global Fund’s HIV corporate program and coordinated UKZN’s clinical HIV services for many years.
to welfare concerns. Provincially he has made an invaluable contribution towards elephant management planning at the Ezemvelo KZN Wildlife reserves in northern Zululand and the Isimangaliso Wetland Park. Professor Slotow obtained his Bachelor of Science and Honours degrees from Rhodes University and his Master of Science in Zoology from the former University of Natal. He completed his Ph.D. in Biology at the University of California, Santa Barbara. After some post-doctoral work at the University of Tel Aviv in Israel and at UN, he was appointed a Lecturer at UN in 1996, Senior Lecturer in 2000, Associate Professor in 2002 and full Professor at the University of KwaZuluNatal (UKZN) in 2007.
He received the Vice-Chancellor’s Award for Outstanding Research in 2000 and has frequently served on National Research Foundation’s (NRF) Grant Evaluation Panels between 1998 and 2012.
In 2005 he joined the Durban International Clinical Trials Unit, incorporating the Aids Clinical Trials Group and the International Maternal, Paediatric and Adolescent Aids Clinical Trials group of the National Institutes of Health. He has served as Clinical Trials Unit Coordinator for many years, participating in various research studies and study protocol teams. He was co-author of UKZN’s prestigious Medical Education Partnership Initiative and remains a co-Principal Investigator of this grant. Dr Pillay has led various capacity development and health systems strengthening projects including a successful partnership with the KZN Department of Health resulting in more than 5000 health care workers being
Professor Richard Hift
Dr Mosa Moshabela
Dean of the School of Clinical Medicine
Head, Department of Rural Health
Professor Hift previously served as Professor of Medicine, Head of the Division of Medicine, Head of the Department of General Medicine at the Nelson R Mandela School of Medicine campus at the University of KwaZulu-Natal. He qualified from the University of Cape Town with the MB ChB degree in 1981 and performed his internship at Groote Schuur Hospital. He specialised in Internal Medicine at the University of Cape Town and Groote Schuur Hospital, becoming a Fellow of the College of Physicians of South Africa in 1987. He was awarded the Masters in Medicine (Medicine) degree in 1992 with a dissertation entitled Activated Charcoal in the Treatment of Porphyria, and the
Dr Moshabela joined Rural Health at the University of KwaZulu-Natal in August 2013. Prior to then, Moshabela was the regional health advisor for the Millennium Villages in West and Central Africa, based at the MDG Centre in Mali/ Senegal, and affiliated with the Earth Institute at Columbia University, NYC, USA as a Public Health Specialist. He lead a team of technical experts to support implementation of programmes in nutrition, child health, maternal health, and malaria, HIV/AIDS and tuberculosis sub-sectors, relevant to the Millennium Development Goals (MDGs) for health. Moshabela facilitated integration between health and non-health sectors applicable to the MDGs.
PhD (Medicine) degree in 2000 with a dissertation entitled Variegate porphyria: molecular aspects and their clinical and biochemical consequences. His particular interest is in the early clinical training of junior clinical-year students. He has introduced numerous innovative and progressive educational and assessment strategies at both the Universities of Cape Town and KwaZuluNatal, and has participated frequently in national and international medical education conferences. In his current position he oversees the undergraduate education of over 600 undergraduate students per year and of 74 specialist trainees in Internal Medicine. His current research interests
are focused on the cognitive aspects of learning and assessment in the clinical disciplines, particularly on the application of transfer theory to medical education.
He joined the Earth Institute from the School of Public Health at the University of Witwatersrand, Johannesburg, where he worked for five years as Senior Lecturer and Director of the Rural AIDS and Development Action Research Programme. Moshabela also trained as a clinical specialist in Family Medicine and Primary Health Care, and has more than ten years of on-the-ground and hands-on experience working in rural South Africa focusing on health systems and policy. His interests include health systems strengthening in resource-poor settings, primary health care for HIV/AIDS and TB, maternal and child health care, and the public health dimensions of controlling chronic infectious diseases in resource-
reached with various teaching programs in HIV and TB management. He has been involved in various projects with the World Health Organisation, German Backup Initiative and other partners.
limited settings. He has over the years led several health care programs as well as research projects, translated into a number of scientific publications.
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understanding the mepi programme
Dr Sandy Pillay The Medical Education Partnership Initiative (MEPI) funds foreign institutions in sub-Saharan African countries that receive PEPFAR support and their partners to develop or expand and enhance models of medical education. Thanks to this support, medical students were able to benefit from the experience of health care delivery at community level. Dr Sandy Pillay explains more about the programme…
attitude by communities towards the implementation of undergraduate teaching at rural facilities. The rationale for CBE is that students acquire professional competencies within communities thereby also acquiring a hands-on understanding of the determinants of ill health, the problems faced by communities and skills for solving these. It is expected that this will produce more well-rounded, skilled and empathetic doctors who can provide more relevant health care.
How did the idea of the six week rotation come about?
Is there research demonstrating the benefit of the programme?
Please outline some of the logistics students need to be aware of.
This follows on the new six year curriculum and the reintroduction of the Junior Internship, with all six disciplines rotating through a seven week attachment – with the 7th week taking up exams. This also allows for a smooth re-entry into the program if/ when a student needs to repeat a block.
Most MEPI medical schools have adopted community-based education as a component of their medical curriculum ranging from rotations of 2-10 weeks to 1 school adopting a full year of CBE. In a review of CBE programs within MEPI by the CBE Technical Working Group, it was recommended that structured models need to be developed to adequately evaluate the process, outcomes and impact of CBE programs. However, evaluations have been done in some institutions including the University of Nigeria. These have demonstrated a positive impact of this curriculum on the understanding and development of students.
Students are transported to their rural site by University transport. However, if students prefer to use their own private transport they are allowed to do so (sometimes parents prefer to actually see these sites and often drop off their children at the various sites too). Each site has been set up with adequate accommodation, to the standard of university residences and teaching facilities. The accommodation, although basic, has all the necessities for the students’ stay. Bedding and linen is provided but students often bring their own. Cooking facilities are provided, but students will need to cook their own meals. Most sites have Spar-type stores within close proximity. Most of the medical staff at these sites live on the premises and are always available to aid students with advice.
Communicating Principal Investigator, MEPI-UKZN grant
[CBE] will strengthen the curriculum by adding context to students’ learning experiences...
How does this impact on the curriculum? Community-based education (CBE) refers to that part of a medical student’s teaching which is accomplished within a community setting. This will strengthen the curriculum by adding context to students’ learning experiences and exposing them to common community health and health-related problems. A challenge is to ensure adequate supervision and provide access to the highest quality teaching. To this end, MEPI is using state of the art technology to ensure that the student based in a decentralised setting has access to information and active contact with the medical school.
How does it shape the direction of our health system? Although the impact of communitybased education within MEPI schools has not yet been assessed, it has been shown by the University of Nigeria that there is a positive
Are there any safety issues students need to be concerned about? UKZN is cognisant of the fact that safety is an issue wherever you may be. This may be perceived to be greater in an area that is unknown to the student. The Department of Health provides a competent security service at all its facilities and it will not be necessary for students to enter into unsecured areas. It is important that students abide by the rules of the facilities, respect the instructions from supervisor and staff and not wander around alone. Students’ accommodation is on the hospital premises and there is little need to venture out except for social activities.
What if a student refuses or fails to complete the rotation programme? As this is an exit rotation, these students will not be able to graduate as doctors at the end of 6th year if this rotation is incomplete or they have failed to pass it. It is a compulsory rotation.
What should students be aware of when leaving for their placements? The context for this learning experience is vastly different from the past 5 years in academic institutions
For students to experience and to practise primary care medicine that is responsive to patients, their families and communities within the context of a rural district health system, they must remember that: They will be working outside the central academic teaching hospitals, in peripheral districts of KZN. The facilities, staff and ways of working are very different, and they will need to be flexible, selfmotivated and work in a team. They will be supervised by rural medical practitioners, primary health care nurses and other members of the multi-disciplinary health care team. They will need to be self-directed in their learning. The medical school will not schedule ward rounds, tutorials, seminars, etc, but each hospital will have its own academic and clinical activities in which they will participate. The major element of learning will be through their own self growth and development by managing and reflecting on the patients that they see. The challenge in this block is thus to make every patient encounter a learning experience. Students will need to reflect on their patients and learn from them. This is what it means to be a reflective practitioner.
The rationale for CBE is that students acquire professional competencies within communities...producing more wellrounded, skilled and empathetic doctors. March
2015
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What the students say... Mohammed Khan
Describe your experience at St Andrews Hospital
Mohammed comes from a traditional background with strong family values. He lives at home with his parents and describes his initial reaction to being sent to live in a rural area for six weeks as ‘a complete shock’. How did you first react to the news that you were going on the six week programme? Mohammed Total shock! I’ve spent most
of my life living in the big cities of KZN and had no idea what to expect from my rural experience. But once I arrived at Emmaus Hospital all my worries were put to bed. I was pleasantly surprised by the living arrangements, the hospital facilities and the welcoming nature of the people of Emmaus.
Phindile My experience was amazing because I learnt so much. I had the knowledge from my studies but now I have the experience and I feel more ready to be an intern than before. In St Andrews I learnt how to manage patients alone, transfer patients and how to treat a patient holistically. There were some challenges but the experience definitely taught me how to be a better person.
Do you have any advice to share with other students? Mohammed Go in with a positive mindset! Take mosquito repellent, as the Emmaus park home is next to a river. Also use bottled water, as most doctors believe the tap water is unsafe for drinking. If you like tea or coffee you should also consider bringing a kettle, although we managed to boil whatever water we needed on the stove or microwave.
Would you go back to work there? Describe your experience from the initial days to the end.
“I was terrified when told I had to live in a rural area for six weeks.”
Mohammed My views of rural medicine changed constantly. The first few weeks were difficult but as I became familiar with the surroundings it became more enjoyable until in the final week, I realised just how much I was going to miss Emmaus.
What are some of the lessons you learnt from the experience?
Mohammed Before I started my rural block I always dreaded getting out of the city for my community service. This experience has taken away that fear factor, and I definitely think Emmaus will be my first choice for comm serv come the end of internship. The main reason for this is the community of Emmaus who made me feel so welcome. I’d like to go back there as a qualified doctor so I can help the people and hopefully make a difference.
Phindile Chonco Phindile was a shy, quiet young woman before going onto the rotational programme. Her experience there not only changed her outlook, but boosted her confidence too…
or no shelter to go back to, so it’s important to be understanding. There were times when I almost lost my love and compassion for people, as some are very rude and don’t appreciate the work we do, but I reminded myself why I chose this career and I remembered my decision to never become like the doctors who only do what they do for the sake of finishing patients in the queue.
What advice would you give to women going on the programme?
What lessons did you learn?
Phindile Be strong, as you might see some
Phindile I learnt how to be confident
gruesome things in the hospital. Learn to be patient and don’t lose your compassion. The work is exhausting, but always remember your purpose of becoming a doctor.
and to stand by my decisions. I learnt about the importance of working as a good team. I also realised that sometimes medical help alone is not enough – showing compassion and empathy and listening to patients is a healing remedy on it own. And of course I learnt that this career needs a lot of dedication!
Did the experience change you? Phindile It’s made me a stronger and more understanding person. Some patients come to the hospital wanting to be admitted because they have nothing to eat
Would you go back to work in a rural area? Phindile As someone from a rural area
I think I would go back and work there, because I know that there is a huge shortage of doctors and a lot of patients who need help. One can make a huge difference in rural areas that is well appreciated by the community as a whole.
Mohammed The NGO’s and the work they
do in the heart of the rural communities really opened my eyes. I learned the valuable lesson that no task is too small to make a difference. Emmaus also taught me how to fend for myself – cooking food and washing clothes were just a couple of skills that I’m glad I had to learn during my time there... better late than never.
As a muslim with a special diet, how did you cope? Mohammed It was difficult at first with not
much freezer space available and the lack of Muslim butcheries nearby. After talking to some of the doctors, we found a couple of Halal food outlets 20 minutes away. This, together with coming home and restocking our supplies midway through the block, allowed us to cope without much hassle.
Siyanda Kubheka Siyanda was among the group of students who studied medicine in Cuba before returning to South Africa to undergo his six week placement at a rural facility. How did your experience at a rural facility differ from Cuba? siyanda The program supplemented the knowledge I acquired in Cuba. I moved from an academic situation into a practical setting where I could experience the daily health challenges that people face in their lives.
Are the health challenges very different from those in Cuba? siyanda In rural areas here we deal mainly
with HIV/AIDS, TB and snake bites which are very common. In Cuba, the main focus is the management of chronic ailments like diabetes and hypertension, so I’ve had wide exposure across all health issues.
Would you change anything about the programme? siyanda I think the program is targeting the
relevant issues by sending medical students to these hospitals. I’ve learnt a lot and it
reminds me of why I wanted to become a doctor. It puts everything into perspective and makes you humble. From a management perspective, ensuring that the place of stay is in good condition and that the hospitals receiving these students are oriented about what to teach and expose the students to would be something to look into.
What advice would you give to other students on the programme? siyanda This is an opportunity to work as a
doctor and to get a real feel of what its like. Students must involve themselves and try to get as much from the experience as possible. You will learn more from working in the rural areas than anything you read in books.
“It’s an opportunity to develop and you should make the most of it.” March 2015
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kwazulu-natal by numbers
Mozambique Swaziland mpumalanga
Geographics
health statistics
free state
Lesotho
durban
KwaZulu-Natal is the second most densely populated province in the country, with just over 10 million people – making up just over 21.4% of the total South African population.
indian ocean
The Province shares borders with Swaziland and Mozambique in the North, Mpumalanga in the North-West, Free State and Lesotho in the West and the Eastern Cape in the South.
eastern cape
The Northern Districts of Umkhanyakude and Zululand attract patients from Mozambique and Swaziland and patients from the Eastern Cape utilise health services in the Southern Districts of Ugu and Sisonke.
Natural features including rivers, wetlands and mountainous terrain, and the scattered distribution of homes in the rural areas pose unique transport and access challenges for equitable distribution of health services.
HIV and TB remain the major challenges facing the population of KwaZulu-Natal - and a significant impact on life expectancy, despite a marginal increase in both male and female life expectancy. A significant component of the burden of disease is attributable to communicable diseases and nutritional, maternal and peri-natal conditions. Diarrhoea and respiratory conditions are also common causes of mortality in young children. Whilst continuing to battle many socio-economic and health challenges, the province has chartered some significant success in health, including:
Child Support Grant continues to be the leading grant type in terms of beneficiaries and by the end of June 2013, the total number of beneficiaries of this grant in KZN stood at 2.7 million which is indicative of poverty levels. The official unemployment rate in KZN stands at
22%
Households in KZN living on less than R800/month
In 2012, Zululand District had the highest unemployment rate at 31 percent followed by Umzinyathi and Amajuba Districts both at 28.5 percent.
Increase in life expectancy from 54 years to
Reduction of mother to child HIV transmission from 22% in 2008 to
1.6%
60 YEARS
70%
Approximately 54% of the KZN population live in rural areas, and around 10% of the urban population live in underdeveloped informal settlements which have significant health and service delivery implications.
A reduction in reported HIV and AIDS related deaths from
67,429 in 2008/09
in 2013
Socio-economic factors The ten most deprived districts in South Africa fall within three provinces – KwaZulu-Natal, Eastern Cape and Limpopo – with households living on less than R800 per month ranging between 63% and 82%.
A decline in HIV incidence in South Africa from an estimated 2.1% in 2005 to 1.3% in 2008
Almost of the province’s population is below the age of 35 years which has significant implications for planning, resource allocation and service delivery, especially with relation to the current burden of disease (including but not exclusive to HIV/ AIDS, TB and increasing noncommunicable diseases) and the country’s commitment towards achieving the health Millennium Development Goals.
54,337 in 2010/11
An increase in TB treatment success rate from 73% in 2008 to
84% in 2013
857,345
patients on ART in KwaZulu-Natal – the largest ART programme in the world.
The current burden of disease places immense physical, social, emotional and psychological demands on health care providers (both personally and professionally) which in turn have significant implications for service delivery.
March
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overview Winner
bethesda hospital Mozambique Swaziland mpumalanga
Mkuze
free state
of several awards in excellence including the National Batho Pele Award plus proud recipients of the highest order in Nursing
umkhanyakude district
Lesotho
Services The hospital provides an extensive range of services and has substantially reduced its PMTCT levels thanks to an efficient ARV rollout. Despite limited resources, hospital staff work as a winning team to provide health care to the local community, working with NGOs and various community care providers. There is a limited malaria risk due to the elevated position of the hospital. Some of the services on offer include:
durban
indian ocean eastern cape
Visit the Hluhluwe Game Reserve – one of Africa’s oldest game reserves and home to the Big Five!
Location
Background
Considered one of the most established district hospitals in the province, Bethesda Hospital commands a powerful presence with its wide range of health services despite its rural location in the small village of Ubombo overlooking Maputaland. It lies in the heart of the rural community close to the touristic Elephant Coast of KwaZulu-Natal and about 350 km from Durban.
The hospital was established by the Methodist Church in 1937 and like all state hospitals, now falls under the KZN Department of Health. Overlooking the rugged Northern Maputaland planes, the 230 bed facility serves a population of 110,000 with the vast majority living below the poverty line with high levels of perinatal morbidity.
Trauma/emergency – 24hour services Surgery and Orthopaedics Obstetrics & Gynae Paediatrics Dental/Oral Health Services Mental health Eye care & Cataract case finding Rehabilitation services: Physio- and Occupational Therapy Clinical support services Primary Health Care Services Collaboration: District EMRS (Ambulance Services) District Medical Officers Regional and Tertiary Hospitals Social Welfare Community Support Groups NGO’s & CBO’s SAPS Fire Department District Municipality
Rural Doctor of the Year Award 2014 “It’s a wonderful feeling knowing we are making difference. Our commitment at Bethesda is contagious; we are ready to serve because healthcare is a right not a privilege” – Dr Kelly Gate, Rural Doctor of the Year 2014
Leisure Despite its poverty and rural setting, the surrounding area offers spectacular tourism experiences such as sugar cane farms, game lodges and tiger fishing on Lake Jozini. With the breathtaking views, hiking is a popular recreational activity and the neighbouring towns of Mkhuze and Hluhluwe will provide you with some of the finest tourism experiences, such as the iSimangaliso Wetland Park, Sodwana
Bay and the Mkhuze Game Reserve which boasts a sand forest and incredible stretches of savannah. Nearby Kosi Bay is renowned for its beauty, whilst Sodwana is a must if you enjoy scuba diving.
Local Amenities A few stores, including a Spar and a bank are situated in Mkhuze which is 16 km away from the hospital.
In addition, there are eight residential clinics and two mobile clinic teams. The medical staff use a light aircraft or 4x4 vehicle to visit residential clinics weekly and to fly dire emergencies to the relevant centres.
CONTACT DETAILS
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overview
manguzi hospital Mozambique Swaziland mpumalanga
free state
Winner of several awards for service excellence
Maryke Bezuidenhout, senior physiotherapist, has been at the hospital for ten years.
Services Driven by a primary health care approach, the hospital aims to improve the health of the community. For this reason projects such as the training of community health workers, primary health care sister and nurses, a nutritional education unit, AIDS clinic and other community activities are all done at the hospital. In addition, it also provides home-based care through the NGO Tholulwazi Uzivekele which cares and supports those affected by HIV, poverty and a lack of opportunities. Some of the hospital’s many services include:
umkhanyakude district
Lesotho
durban
indian ocean eastern cape
Spar supermarket with an ATM and several other ATMs in the area nearby.
Background
Location
Like most hospitals in South Africa, Manguzi was founded by missionaries with the first nurse, Hanchen Prozesky, visiting the district on horseback and foot to care for people needing health care. The hospital was later registered with 15 beds under the Natal Province with a gradual expansion through the church and generous funders. Today, the hospital has 11 residential clinics and three mobile teams visiting 35 points.
Manguzi Hospital is situated in the North Eastern corner of KwaZulu-Natal, about 20 km from the Indian Ocean and the Mozambique border. It’s a sandy town between Kosi Lake and estuary system which is also a World Heritage Site. Its close proximity to Mozambique means there is no shortage of leisure activities, including snorkelling and other water sports. There is also a well stocked local
Child health including immunisations Dental & Eye care HIV counselling and testing HIV medicine including ART and PMTCT Infectious Diseases Maternity Medical Male Circumcision Occupational Therapy Orthopaedics Pharmaceutical services Psychiatric Physio therapy Speech therapy Social work services Theatres TB Female health including contraception and cervical smears X-ray and Ultrasound
fast fact
Leisure
The 280 bed hospital was among the first in KwaZulu-Natal to establish a dedicated TB ward and has successfully managed to lower its perinatal mortality rate.
The beach around Kosi Bay has long been home to generations of leatherback turtles, which reach 500kg in mass and are the world’s largest marine turtle species. Snorkel or go fishing at Kosi Mouth, or wander through the shallows watching the locals spearing fish in the estuary. Local experts are always available for guided hikes and will point out lots of interesting things that you might otherwise miss. Nearby Ndumo Game Reserve offers spectacular bird watching opportunities.
CONTACT DETAILS Basic but comfortable accommodation for students on the programme.
St Lucia Elephant Coast
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overview Winner
mosvold hospital Mozambique Swaziland mpumalanga
2013
Gold Service Excellence Award in KwaZulu-Natal
free state
umkhanyakude district
Lesotho
durban
indian ocean eastern cape
fast fact uMkhanyakude District is home to the Big Five animals and offers year round tourism experiences with mild winters and hot summers.
The community
uMkhanyakude is one of the poorest districts in South Africa with the majority of people living in self-made huts of sticks and stones, or basic houses made from cement and stone. Despite the poverty, it remains an area of unspoilt beauty where rural lifestyle and culture is a strong influence in the community. Due to the high number of child-headed homes, illiteracy and unemployment rates remains high with the main sources of income for most people being subsistence farming, migrant labour, and government social grants. Around 85% of people who are employed earn less than R1500 per month.
Location
History
Health challenges
The 246 bed hospital sits majestically on the spectacular Lemombo Mountains, bordering Swaziland. This prime location commands a birds eye view of the coastal plains as far as the coastal dunes to the East and the bowl and mountains of Swaziland to the West. Around 410 km from Durban, the hospital serves a population of around 110,000 including a large number of Swazis and some Mozambicans due to the close proximity to the two countries.
In 1936 the Scandinavian Alliance Mission (now called the Evangelical Alliance Mission – TEAM) set up a basic hut at Ingwavuma which served as a dispensary and two bedded ward. In 1952 the hospital was expanded to its present form and student nurse training began. The name Mosvold came from the family of Esther Mosvold, a Norwegian nurse, who persuaded her wealthy family to fund the cost of the new buildings. In 1978, the KwaZulu government purchased the hospital from the Evangelical Alliance Mission.
The region has suffered malaria epidemics in the past, but is well managed since 2001, due to the DDY house-spraying and anti-malaria medication both in the community and further afield in Mozambique. Although malaria is a health concern, cases amongst hospital residents have been rare even in the middle of the worst epidemics, as the hospital is on high ground. However, students are strongly advise to take precautions and carry repellents and creams against mosquito bites. Interestingly, car crashes are seen as a much greater risk to health amongst hospital staff than malaria.
s left HIV/AIDS ha in many children aned, the area orph high resulting in a dnumber of chil . headed homes
Elephants and more at Tembe Elephant Park
Services
Leisure
The hospital sees around 49,000 outpatients per year and admits 8,000, with an average stay of 7 days. There are six wards in the hospital; Male, Female, Paediatric, Maternity, Isolation and Tuberculosis. The HIV/AIDS department is mainly run by nurses and counsellors. The hospital serves 10 outlying clinics on a 2 weekly basis with a flying doctor service also available when required.
The Ndumo and Tembe Elephant Park reserves, Kosi Bay, Sodwana Bay and Ponta d’Ourro in Mozambique and all within easy reach. The Hluhluwe-Umfolozi Reserve and St Lucia are within two and a half hours drive. There is also a local shopping centre about 500 m from the hospital with a well-stocked Spar supermarket.
CONTACT DETAILS
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overview
mseleni hospital Mozambique Swaziland mpumalanga
free state
Hospital Manager, Dr Victor Fredlund has won several awards for his dedication to rural health.
umkhanyakude district
Local Community Mseleni has one of the highest HIV rates in the world, with almost 33% of the population affected. Consequently, there is a large number of orphans in the area and childheaded households with high levels of poverty. However, those who are employed are able to build their own homes, own a car and are able to meet their basic needs.
Shopping Lesotho
durban
indian ocean eastern cape
Weather Mseleni is situated in a low lying area, with temperatures reaching around 30°c in summer (wet season: November to March ) and 20-25°c in winter (dry season: June to August)
Location
Features
Mseleni Hospital is in a rural part of northern KwaZulu-Natal, a mere 60 km south of the Mozambique border and 370 km north of Durban. An interesting feature about Mseleni Hospital is that it is part of the local community and shares its site with the Mseleni Children’s Home which also runs an AIDS orphan care project called Lulisandla Kumntwana, meaning ‘help the child’.
Originally a missionary hospital which developed from a clinic service, the hospital is a 219-bed facility serving two local municipalities – Umhlabuyalingana and Big Five Local Municipalities – with a population of approximately 90,000.
Facilities 6 wards (labour, female surgical, paediatric, male, female medical and isolation wards). Therapy and Radiography Department with x-ray and ultrasound Pharmacy, laboratory, dentistry and social services. Nine clinics The Outpatients department (OPD) serves as a doctor’s waiting room during the day and also a 24-hour emergency department. Nine community clinics An average of between 5 and 8 doctors are employed at the hospital.
Mbazwana is about 20 km south of the hospital with one petrol station (Engen), two banks (Capitec and Ithala Banks), three supermarkets, including Spar, two clothing shops (Pep and Dunns) and other typical rural shops as well. About 60 km north, there is Manguzi town, with services from Engen garage, Absa, Capitec Bank, Ithala Bank, FNB, KFC, PEP, Boxer supermarket and others.
Leisure activities Mseleni is located in a splendid natural environment under the Isimangaliso Wetland Park with Lake Sibaya 40 minutes walk away and Sodwana Bay around 13 km further afield which boasts an internationally acclaimed scuba diving spot with game reserve, fishing spot, camping sites, accommodation lodges and restaurants.
Common local diseases Mseleni is world famous for what has become known as Mseleni Joint Disease (MJD) - a local arthritis affecting mainly the hips. The community also has a number of diseases associated with living in this area, including Malaria, Bilharzia, Tuberculosis and HIV/AIDS.
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S FAST FACT
cts more se (MJD) affe t yet ea is D t in Jo e is no Mseleni en and its caus t. women than m many studies on the subjec e known, despit mainly with non-steroid Treatment is ammatory s and anti-infl tal hip ug dr ng ni ai to cont many cases, a at medication. In eded. This is usually done s ne ke is t ta d en sthetic an replacem der local anae the hospital un s. ur less than 2 ho
ed fection cauessh in n a is ia rz fr a Bilh which live in by parasiteosugh treatable, Bilharzia water. Althmajor problem. remains a
mains a the area but re aria has in ng si ea cr de m Mal Malaria is e death rate fro r week in Th e. ng le al ch aths pe health ally - from 2 de ntly. This success tic as dr d pe op dr rre ly no deaths cu e of pesticides, 1998 to virtual us d se ea cr in an is attributed to ugs to treat Malaria, use of dr d de en m m reco d coils. an ts ne aria is mosquito the year for Mal es are of e tim st or w The mosquito r to May when to wear shorter be em ov N m fro nd t and people te most prevalen e hot weather. th clothing due to
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overview TB, HIV/AIDS remain the most common health problems addressed by the hospital.
eshowe hospital Mozambique Swaziland mpumalanga
free state
uthungulu district
Clinics served by Eshowe Hospital:
Richards Bay
Lesotho
durban
fast fact The hospital sees approximately 9000 outpatients through their various clinics each month.
Eshowe Gateway Clinic King Dinizulu Clinic Siphilile Clinic Nkwalini Clinic Ekuphumuleni Clinic Ndlangubo Clinic
What makes Eshowe Hospital special?
indian ocean eastern cape
contrast studies and ultrasound examinations. In addition, it also has a dedicated Primary Health Care team serving 53 fixed Mobile points in the area.
Location
Features and Services
There’s a modernistic feel about Eshowe Hospital that belies the fact that it is actually 58 years old. Situated on a site overlooking the Dlinza Forest – often described as a birdwatcher’s paradise – the hospital was built in 1957. The town of Eshowe itself is steeped in Zulu history and the area is noted for more human, natural and agricultural diversity than you will find anywhere else in Southern Africa.
Eshowe Hospital is a 460 bed hospital has been adequately serving a largely rural population of about 300 000 for over five decades. Amongst its services offered are:
Crisis care for adult and child abuse Dental services Dietetics General medicine Obstetrics and Gynaecology Occupational Health Optometry Mental Health Care Physiotherapy and Primary Health Care services.
The hospital has a staff of over 500 staff, including twenty doctors, (Eshowe Hospital is accredited for training interns), four pharmacists and 290 nurses. Facilities include an emergency room, an endoscopy room, four fully-equipped operating theatres, a small physiotherapy department and a radiology department capable of doing a variety of investigations including
For the enthusiastic health professional, the facility offers the opportunity to gain a wide variety of clinical experience in a friendly atmosphere, working with a committed team. An added bonus comes from living in a town with a pleasant climate, good educational and recreational facilities, plenty of sites of historical significance and easy access to some of KwaZulu-Natal’s prime beauty spots such as the Drakensberg Mountains, various Indian Ocean resorts and the famous Hluhluwe-Umfolosi Game Reserve.
Local stores sell basic everyday items On the hospital’s successes
“Our Medical Male Circumcision has had a great impact on the community. We’ve already had two MMC camps this year and at each more than 100 young men and boys were circumcised.”
Leisure Eshowe boasts some restaurants, fast food outlets and a small shopping mall, all within walking distance from the hospital.
Point of interest Eshowe Hospital has gained much expertise in the management of Cholera following an epidemic in the area. The hospital also provides a base for a primary health care team comprising two mobile clinic teams, a school health team and a tuberculosis control team which provides community outreach health care.
m the A word froM atron hospital’s : Mthembu must not
ork, students “Apart from w aces to h. There are pl expect too muc pends de l ings, but it al see and do th kind of e th d an person on the kind of parent, I’d t to have. As a ‘fun’ they wan verns for ta ainst going to warn them ag howe is Es at th el if they fe instance. But al n ways r them, they ca too ‘sleepy’ fo ngeni, pa s Bay and Em go to Richard’ far.” which are not
The Aerial Boardwalk in Dhlinza Forest offers great birdwatching opportunities.
CONTACT DETAILS
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overview
st mary’s kwamagwaza hospital Mozambique Swaziland mpumalanga
free state
uthungulu district
Richards Bay
Lesotho
durban
S FAST FACT
indian ocean eastern cape
Features
The hospital is often used for Medical Male Circumcisions during school holidays.
The hospital has 141 beds and 5 fixed clinics KwaYanguye, Ndundulu, Melmoth, Nogajuka, and Thubalethu Health Post. The catchment population is approximately 60,000.
Services Location The large pot-holes on the road leading to St Mary’s KwaMagwaza Hospital make it one of the worst roads in the country. But once you get there, the lush, tranquil scenery and sprawling sugarcane plantations quickly make up for the inconvenience. It’s much like the road medical students have to travel before they can graduate: uphill, painstaking and rocky, but ultimately reaching the summit is spiritually rewarding.
Acute and chronic care, child and women’s Health, clinical psychology, communicable disease management, counselling, dental health care, HIV and Aids, X-Ray & Ultrasonography, among others. Like other health care facilities throughout the province, the hospital is faced by the quadruple burden of disease - HIV, Aids and TB; trauma and accidents; non-communicable diseases and acts of violence.
the Opathe Umfolozi and home to euw hl lu H e Close to th District is Mthonjaneni ht game reserve, ople. Apart from some lig pe – e 0 0 ur ,0 lt cu 38 t ri abou nds on ag pe de n w to e . and cattle industry, th r cane, timber primarily suga
t 75% mploys abocuados and e re u lt u c ri g o A force. Av l of the labosurare produced for loca it u fr s citru arkets. and foreign m
tons of sugar about 300,000 r year, as well es uc od pr ea ar The ber pe 000 tons of tim cane and 470, wers for export. flo as delicate cut
CONTACT DETAILS
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overview
emmaus hospital Mozambique Swaziland mpumalanga
number of different doctors joined the institution, Dr Humphrey being one of them. In 1980 the Zamimpilo Community Centre was established by the hospital to deal with the high incidence of kwashiorkor (severe form of malnutrition due to lack of protein) in the community caused by poor socio economic conditions. Using the Centre as a base, the community was given nutritional, hygiene and gardening education.
free state
Ladismith uthukela district Lesotho
Services
durban
indian ocean eastern cape
fast fact In 1963, artist Hedwig Escher sketched a good samaritan drawing on the hospital walls which continues to serve as the hospital’s emblem today.
Location
Background
The hospital is situated in Majestic Mountainous Bergville area under KwaZuluNatal’s towering Drakensberg Mountains. Despite the rural area characterised by high levels of poverty, the region continues to draw tourists because of its location and stunning landscape. There are a number of hotels, B&B’s and resorts dotted around the area, with the hospital being a stone’s throw away from Bergville and Winterton, which is covered in a blanket of snow each winter.
It began with a passion to heal the sick and a couple’s quest to find a place of healing for those who needed to be cared for. Reverend Bernhard Schiele and his wife Dr Magdalene Schiele, missionaries from Germany, founded Emmaus hospital in 1947 after identifying a need following home visits to care for the sick in the community. In 1970 the National Government took over the Hospital and in the same year a
Emmaus Hospital is a 156 bed facility providing District health care services to a population of just over 150,000. The hospital has 375 staff members including clinical staff and also serves as a referral facility to five Primary Health Care clinics. There are three mobile clinics operated by the hospital which conducts health care screening and services to 54 points around the region. Some of the services offered by the hospital include:
Trauma Dental Surgical Maternity Medical Laboratory Services Tuberculosis X-ray PHC service PMTCT service Crisis centre Paediatrics Eye clinic Pharmacy Dietetics Physiotherapy Occupational therapy
ow? did you kn umphrey – In 1970, Dr H us tor at Emma a young doc vented Hospital – in wn as the valve kno y Valve, the Humphre part of the which forms d machine use anaesthetic orld today. around the w
The Drakensberg Mountains form the border between KZN and the Kingdom of Lesotho.
CONTACT DETAILS
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overview
church of scotland hospital Mozambique Swaziland
Services
mpumalanga
The hospital works closely with 15 outlying outpatient clinics, and clinical services provided by Philanjalo which serves as a step down facility for the hospital. Together, they delivery health care to the more than 180,000 community of Msinga. COSH inpatient services include TB wards, mother and child health, surgical and psychiatric wards. Outpatient services consist of a modern HIV/antiretroviral (ARV) clinic and a TB DOTS program. There are around 8 - 12 doctors based at the hospital, all of whom are generalists and many, superb clinicians, teachers and extraordinary role models. The doctors who staff the hospital, along with hospital and clinic nurses also serve as the primary health care for the people of the area.
free state
umzinyathi district
Tugela Ferry
Lesotho
durban
indian ocean
Location and background
eastern cape
fast fact The hospital is world famous for discovering the first XDR-TB outbreak in 2005
Set in an impoverished part of KwaZulu-Natal, the 350 bed COSH is located in a dramatic aloe-clad valley and is used as a training ground for many medical students. The hospital was initially a clinic in the 1870s when the Church of Scotland sent Dr Gordon, a missionary, to Umsinga area. Unfortunately he drowned at sea before reaching South Africa and a Dr James Dalzell was sent as his replacement.
Dr. Dalzell purchased a piece of land where he established a clinic and a school to uplift the local community, although sadly he passed on before the clinic could be developed. The project was then taken over by Dr Gale who was forced to move the clinic closer to the Tugela River due to a shortage of water in its former site – and so the Church of Scotland Hospital was born.
The community
POINT OF INTEREST
The COSH ARV clinic was the first site to provide antiretroviral therapy in KZN’s public sector. Scholars from the Yale/Stanford Global Health Program, representing institutions throughout the United States also work throughout the hospital and its clinics.
Msinga is a poverty stricken area with few economic resources and little economic activity. Social services and private households generate 29% of the income for the area with the vast majority of residents relying mainly on social grants as their main source of income. A few stores are located in the areas around the hospital along with informal trade including tuck shops and street traders. However, despite the dire poverty, the area has historic sites, beautiful scenery and interesting topography in some parts. Rorke’s Drift, situated 46 km southeast of Dundee,is the site of the famous battles of the Anglo-Zulu War. Today the centre is well known for its Zulu handicrafts.
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ABOVE Rorke’s Drift,
famous for the many battles fought there during the Anglo-Zulu war.
LEFT Zulu crafts are prized
worldwide.
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overview Winner
murchison hospital Mozambique Swaziland mpumalanga
of several awards including Silver and Gold Premiers’ Good Governance award and recognised for its Baby Friendly Status
free state
Lesotho
ugu district indian ocean
Port Shepstone
fast fact Then hospital was among the first in the province to establish a MDRTB centre
Casualty Department / Trauma General Medical General Surgical Heliport/Helipad Maternity Medical Laboratory Services Theatres Occupational Therapy Stomatherapy Tuberculosis X-ray
KZN’s South Coast boasts some of the world’s most beautiful beaches.
Winning the Batho Pele Award
durban
eastern cape
Services offered
Location
Background
Murchison Hospital is on the beautiful south coast of KwaZulu-Natal and although situated within a rural district, the hospital is just 13 km from the bustling town of Port Shepstone which boasts a number of shopping malls. The hospital is situated on the Main Harding and Kokstad Road on the South Coast and approximately 120 km from Durban.
In the early days of 1928, Dr Barton used to ride out on horse-back to treat his patients in their mud huts. However, many came to see him in his own mud hut, and this was the start of what became known as “KwaBathini” – The Place of Barton. After being granted land by the chief at the time, Dr Barton went on to establish a six bed facility on the site which later grew to become Murchison Hospital.
Features The hospital is a 300 bed facility and provides district care to a population of approximately 226,008. It also serves as a referral hospital for six satellite clinics in the area, namely Imbunde Clinic, Thonjeni Clinic, Bhobhoyi Clinic, Izingolweni Clinic, Mthimude Clinic and Thembalesizwe Clinic.
Murchison Hospital prides itself as a hospital of putting people first - the cornerstone of the principles of Batho Pele. Through engagement and open communication with the local community and patients, the hospital has managed to establish a three-way system of communication between staff, management and visitors to the hospital. Amongst its key community achievements include: Strong TB programme - rated amongst the best in the country. Effective HIV-Aids support centre which helps to co-ordinate treatment and dissemination of information vital to the well-being of its patients and the community at large. Hospital Occupational Therapy and Nutritional Programmes take services to the community through home visits. Partnerships with local schools, NGO’s, churches and other organisations assist in raising awareness of health and social issues in the community, thereby maintaining strong community links.
Leisure Murchison lies in the heart of KwaZuluNatal’s beautiful south coast. Stunning scenery, sandy beaches and the famous wild coast are all within proximity of a few kilometres.
2002 the In November assessed by the hospital was ealth Service Council for H of Southern Accreditation ASA) and won Africa (COHSn of being the the distinctio pital to achieve first KZN hos on its first accreditation attempt. tion The accreditahospital as e l benchmarks th d internationa ve ie ch a g n vi a h uality care. standards in q
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overview
st andrews hospital Mozambique Swaziland mpumalanga
First hospital to win the MEC’s Annual Excellence Award 2014 for meeting National Core Standards in health!
free state
Lesotho
durban
Harding
ugu district
indian ocean
eastern cape
fast fact The facility also took top spot in 2013 as one of three cleanest hospitals in the province!
Location
Background
St Andrews is a district hospital with 268 beds, based in Harding on KwaZulu-Natal’s south coast, 197km from Durban and close to the Eastern Cape. The hospital is easy to get to as it is on the main N2 South route between Port Shepstone and Kokstad.
The town of Harding was established in 1877 as a military outpost and named after Sir Walter Harding – the first Chief Justice of Natal. The Roman Catholic Church purchased a plot of poor grassland, between 1915 – 1920, in Harding for 40 Sterling Pounds and used the area to build St Andrews Mission School. With an increasing population in the area, a hospital was needed and so a house owned by a Mr Nimack near the school was converted into a 12 bed hospital which later grew into a training school for nurses and eventually in 1970 the original hospital was demolished and replaced with what it is today. Among its many achievements, St Andrews Hospital has also achieved Baby Friendly Status and COHSASA accreditation for meeting international standards in health care.
Features
The rare Blue Swallow nests in the Ingeli Forest.
Harding is considered an important link between the Eastern Cape and KwaZuluNatal for travellers. The main source of income for the area is derived from the municipality’s extensive wattle, gum, pine and poplar plantations, and associated industries, including saw mills and furnituremaking factories. The hospital itself serves a predominantly rural population. About 21% of those who access the hospital are cross-border patients, mainly from the Eastern Cape. The majority of patients are from the Harding suburbs (Ghost town, Zelia, Mazakhele, and Greenfields), and rural areas KwaMbotho, KwaJali, KwaMachi, KwaNyuswa, Umzimkhulu, Bhizana and Weza. Many of uMuziwabantu’s rural residents depend on natural water sources and dams, with a consequent risk of various diseases related to seepage, pollution and water-borne diseases.
Services offered
Ante Natal Clinic PMTCT Programme Medical and surgical services Paediatrics Operating theatre Dental Clinic Ophthalmic Services Laboratory X-Ray Pharmacy Physiotherapy Speech and Audiology Mental Health Clinic Occupational therapy Dietetics
Additional Programmes
HIV/AIDS TB Crisis/Trauma Care Occupational Health & Safety Employee Assistance Programme Best Birth Initiative Programme Baby Friendly & Kangaroo Mother Care
Leisure Umuziwabantu Municipality offers a wide range of natural habitats, veld types and bio-resource groups which are of interest to eco-tourists. The blue swallow, an extremely rare bird, breeds near the Ingeli Forest. Other places of interest to tourists are two game reserves, KwaFodo and KwaMachi. In addition, the South Coast boasts pristine beaches and many soughtafter tourist attractions, which transform the area into a vibrant tourist hub during peak seasons.
The Ingeli Forest and surrounding areas provide great oppotunities for hiking and bird watching.
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practical guide to kzn
DON’T FORGET! Spending six weeks in a far flung rural area may never have crossed your mind as part of your career as a medical student, but it’s a unique opportunity which creates a lifelong impression and impacts on your role as a health professional. The following guide will assist in getting you started on your journey…
Carry plenty of mosquito and insect repellant!
The Climate
Clothing
KwaZulu-Natal, and Zululand in particular, enjoys a warm sub-tropical climate for most of the year. During summer (Nov – Feb) temperatures are hot and humid from 24–30 degrees celsius, dropping to around 20 degrees during winter. Northern highaltitude areas such as the Drakensberg region can be bitterly cold in winter, with snow in some regions. However, winters are short and warm, humid weather is the norm for most of the year.
Comfortable, light cotton clothing is advised, plus a hat, sunglasses, swimming costume, sunscreen, binoculars, camera and a pair of comfortable walking shoes.
For information on specific weather conditions before venturing out, you may want to contact any of the following:
Roads The N2 is the national road through Zululand linking Mpumalanga with the KwaZulu-Natal Coast. The regional roads connecting most of the towns in Zululand are tarred and well maintained, but other minor routes are mainly dust or gravel roads with many potholes. If you plan on using your own vehicle whilst there, ensure you have adequate insurance to cover you for off-road driving and always carry a spare tyre!
Remember charges at toll gates
differ depending on the size of vehicle and stretch of road. Some toll gates charge R5 whilst other can exceed R31. For up to date traffic advice, contact: KZN Traffic Department................... 0800
339 911
National Roads Agency............................. 033
392 8100
Automobile Association.................... 031
265 0427
Breakdown Services.................................. 082
16 111
The working environment in health facilities is comfortable yet professional. You can wear semi-formal clothing and there is no requirement to wear a tie. However, avoid shorts and revealing clothing at work as this can be considered inappropriate and/or disrespectful.
Useful Tips Carry plenty of insect repellents, coils, mosquito nets (where needed), sunburn creams and ointments to counter bites and burns.
Swimming and paddling in rivers, lagoons and lakes is not safe unless the area is free of bilharzia, hippos and crocodiles. Sea bathing is best undertaken on demarcated beaches or pools deemed safe for use.
Note that the Hluhluwe Imfolozi Game Reserve only accepts cash at the entrance gates. Please call KZN Wildlife for updates on entrance fees
033 845 1000.
Carry plenty of bottled water (or top up by purchasing more when needed). Although considered amongst the safest drinking water in the world, there are times when the water is deemed unsafe due to imbalances in the chemical content of the water, so it may be best to avoid consuming tap water altogether.
Understanding Zulu culture When invited into a hut… The host will always walk into the hut before his guest to ward off a snake or something else inside the hut which could harm the guest.
On beliefs… Ancestral spirits play a huge part in Zulu culture – treat it with respect, even if you don’t agree. It is believed that ancestral spirits ‘like to be remembered’, and offerings will be made to show that they have not been forgotten. It is usual for the head of the family to sit beside his cattle byre and pour a little beer on the ground ‘for his fathers’ before he starts to drink. A woman may take a small piece of bread and place it under the eaves of the hut for an old matriarch of the family. They also believe that if the ancestors are forgotten, they may show their displeasure by bestowing some misfortune on the family.
On sangomas… Sangomas play a huge role in African culture and the Zulu tradition is no different, especially in rural areas where they are the first port of call for any problem or illness. Strive to: Accept the value of traditional healers
in treating minor ailments and providing psychological support. Understand the remedies that your local traditional healers offer, and the possible drug interactions with commonly prescribed medication.
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acknowledgements
With special thanks to the following people for their dedication and time to making the programme a success and to those whose invaluable feedback contributed to the success of this publication:
the UKZN Medical Education Partnership Initiative (MEPI) project – Enhancing Training, Research and Education (ENTREE) Program
MEPI Program officer USG: Dr Myat Htoo Razak MEPI Project Manager UKZN: Dr Nisha Nadesan-Reddy MEPI Communicating PI: Dr Sandy Pillay Co-PIs: Professor Umesh Lalloo, Prof Raziya Bobat, Prof Doug Wassenaar, Prof Jack Moodley, Prof Scott Hammer (Columbia university), Prof Phil LaRussa (Columbia University). Head, Department of Rural Health, UKZN: Dr Mosa Moshabela Medical Officer, Discipline of Rural Health, UKZN: Dr Neeri Moodley
A heartfelt thank you to all the staff at health facilities for their co-operation and the students who participated in the rotational programme. Dr Nisha Nadesan-Reddy, MBChB, FCPHM, M Med (Public Health Medicine) Public Health Medicine Specialist, MEPI Project Manager Room 302, DDMRI Building, Nelson Mandela School of Medicine University of KwaZulu-Natal, Congella, Durban 4000
This publication was made possible by grant number: 5R24TW008863 from the President’s Emergency Plan for AIDS Relief (PEPFAR), and the National Institutes of Health, U. S. Department of Health and Human Services. Its contents are solely the responsibility of the UKZN MEPI program and do not necessarily represent the official views of the government.
Tel: 031 260 4668 • Email: nadesanreddy@ukzn.ac.za
Telephone: 031 562 9803
Email: editor@ezempilohealthmatters.co.za March 2015
ukzn mepi contact details Room 302, DDMRI Building Nelson Mandela School of Medicine University of KwaZulu-Natal Congella, Durban 4000 Tel: 031 260 4668 • E-mail: nadesanreddy@ukzn.ac.za