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As Sessional GPs we have exciting options to use our time flexibly and explore primary care widely - both in the UK and abroad.
Recently I completed an eight week volunteer attachment in urban Cape Town with non-profit community outreach organisation SHAWCO - a student run volunteer organisation of the University of Cape Town. Its aim - to provide services to the underserved communities in the area.
In the 1970s, as a student, I had worked with SHAWCO, but through my recent contact with them, it had struck me that there was a need and an opportunity for primary care teaching and patient care. As I am nearing the other end of my career I decided that I would volunteer, and in January 2016 I went to work with them.
The organisation has 2000 student volunteers to provide and learn primary healthcare and education (maths, literacy, IT) in townships areas. In addition to the medical students, clinics are staffed by a volunteer doctor and a paid dispensing nurse. The role of the doctor is to have each patient presented and to agree a management plan, prescription or referral. Unsurprisingly, SHAWCO struggles to recruit volunteer doctors and funding is limited, coming only from donations clinic.
Each evening clinic sees 20 patients, Saturday paediatric clinics see about 40 patients and health promotion presentations are given by the pre-clinical students. The clinical students consult with the patients including examination and diagnosis and the preclinical students take a basic medical history and are taught basic examination techniques such as how to take a blood pressure by the clinical students.
Student enthusiasm and energy is huge. They are exposed to primary care early in their curriculum in a practical way which is an inspirational change from the secondary care bias to undergraduate education. A recent academic evaluation of SHAWCO has shown that participation is valued by students in terms of learning and encourages them to consider primary care as a future career option.
Students were mainly confident, a few students were not so good but I found no way of feeding this back to the clinical school. Direct feedback to the students was difficult as I was not part of their regulatory department and with some students there was an attitude that this was meant to be fun, rather than part of their course.
In South Africa there are huge numbers of HIV positive people (20% of SA black population) and social problems and problems of abuse are widespread. There are no easy answers to these issues. Unemployment and migration from the rest of Africa is on a huge scale and poverty is on a scale not seen in the UK.
Despite this, people seen were forbearing and patient and in general, they remain cheerful and positive in the face of huge adversity. They were extraordinarily appreciative of the help we gave. In that aspect it is a refreshing change from the demand culture in UK General Practice and the ever present threat of complaints.
I saw 400 patients. Their problems were varied but their nature was not dissimilar to inner-city UK general practice. Approx 25% of presentation are for skin disease and 15 % for URTI, 15 % acute gastroenteritis, and 15% minor musculoskeletal conditions. There were a few cases of suspected Pulmonary TB, many uncontrolled hypertensive patients having run out of medication, chronic staph skin infections, ascaris in children and urine infections (MSUs were often done by simply passing urine squatting in the sandy soil outside the clinic van). There were many HIV positive patients who have stopped anti-retroviral drugs and who had rampant skin disease (e.g. prurigo nodularis) and infection as a result.
One of the most memorable cases was a woman and mother of 40 years of age who was HIV positive with a low CD4 count. She presented with several skin infections and multiple abscesses, a cough and weight loss. She told us that she wasn’t taking her HIV meds as although they are provided free, she is not able to afford the public transport to get to the clinic. In addition, her abusive partner would not believe he or she could have HIV and got angry if he saw any letter arriving for the clinic. It was so hard to begin to think how best to help.
I have a renewed appreciation of how good our NHS is. That we all have easy access to medical care free at the point of access and that we can access investigations where needed, should be celebrated and nurtured.
SHAWCO is keen that I return to volunteer in clinics again. If any UK GP wishes to volunteer I am happy to be contacted. I plan to write about the organisation and what it gives and offers, so that SHAWCO (UCT) Cape Town can be added to the local medical student elective options menu.
Elizabeth Robinson is a GP locum OOH, A&E and commissioning work
Amazing volunteer experience Elizabeth. I shall recommend this to my medical students.
Mary Anne Burrow.
Very interesting blog. Thank you Elizabeth.
Would Shawco find a GP with a new DSRH qualification helpful? I have been saying for years that I would like to volunteer and I now feel more useful (DSRH = diploma in Sexual and Reproductive Health, it is a primary care qualification)
Best wishes, Elly Stanton
I'm sure they would Elly . The work is mainly basic GP work and teaching but there's quite a lot of six health issues and especially diagnosis of HIV and seeing diseases and how they present in pts with suspect low CD4 counts .
If you are interested email me on [email protected]
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