Gjo Marincowitz

Perceptions of hospital managers regarding the impact of doctors' community service

Abstract Background: In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. Methods: After ethical approval was obtained from the Research, Ethics and Publications Committee (REPC) of the Medical University of Southern Africa (now University of Limpopo—Medunsa Campus), three focus group interviews were conducted with hospital managers from three purposefully selected hospitals. The interviews were audio-visually taped and supplemented with field notes, transcribed verbatim, with themes identified using the ‘cut and paste’ and ‘colour coding’ methods. Combined themes were categorised and interpreted within the context of the study and the available literature. Results: CS has improved health services delivery, alleviated work pressure, and improved the image of hospital managers. In addition, it has provided a constant supply of manpower, and increased the utilisation of health services by the community. The negative perceptions identified included a lack of experience and skills, poor relationships with the rural health team, lack of support structures for CS doctors, poor continuity of care and budgetary constraints. Conclusions: Hospital managers perceive CS to have had a positive impact on the supply of needed manpower, health service delivery and patient care. As this was a qualitative study, further quantitative and community-oriented studies are required to validate the results.

What helps volunteers to continue with their work

SUMMARY Aim The aim of the study was to understand what volunteers perceived to be the factors helping them to continue working as volunteers, thereby assisting project leaders to improve the recruitment procedures, as well as quality of service, in the future. Methodology A focus group interview was held with the 14 most active volunteers in order to understand their perceptions about their work and their ability to continue their work as volunteers. The recorded interview was transcribed, translated and analysed. Findings The volunteers feel that their work consists of various forms of support to patients. They see themselves as mediators (advocates) for the patients within the health care services. They have difficulties with some patients, who have high expectations of them. They also feel deeply about the difficulties experienced by many patients, particularly poverty. They are strongly motivated by their desire to help their own community. This is reinforced when they are thanked by patients whose health has improved as a result of the assistance they provided. They feel that, as people, they have gained knowledge and confidence. The support from the project coordinators/fieldworkers is very important to them. Conclusions The findings above represent what would be motivational in general: internal motivation, the ability to see the importance of your work, positive feedback, a plan to deal with difficulties and support from senior colleagues. It is therefore important to ensure such support and cooperation at various levels.

Caring, learning, improving quality and doing research: Different faces of the same process

ABSTRACT The aim of this article is to describe the similarities between the consultation process, the quality improvement (QI) process, action-and problem-based learning and participatory action research (PAR). We feel this understanding adds value to our work in enabling personal development as practitioners, fostering teamwork and demystifying the different concepts. Learning to understand the different processes becomes easier, as they have a lot in common. All four of these spiral processes follow a number of steps. They start with building a relationship/team with a patient, students, co-workers or co-researchers. The next step is identifying the problem. The present situation, as well as the required state (setting standards), is identified. An intervention can then be planned, with a follow-up evaluation to see if the situation has improved. The spiral may continue with a follow-up plan. As authors we believe that we can conclude from this that health workers, teachers, managers and researchers can learn from each other and work together more readily if they understand that they share a common action process.

Who are good home-based care volunteers?

Abstract Aim The aim of the study was to describe the characteristics of volunteers who remained active in the home-based care project located in Tzaneen (Limpopo Province) and thereby assist the project leaders to improve the recruitment and quality of the service in the future. Methodology Structured questionnaires were completed with all the available volunteers trained during 1999. The questionnaires were quantitatively analysed manually. Results Ninety-six (96) people attended the introductory phase of the home-based care course during 1999. Seventy-one (71) were volunteers and 25 were people living with HIV. Forty-six (46) of the participants completed the questionnaires (44 volunteers plus two people living with HIV working as volunteers). Twenty-seven (27) volunteers could not be traced, as they were no longer active in the project. The following factors were associated with active volunteers: 1. Married2. Female3. >30 years of age4. Breadwinners themselves or have a husband/spouse who is the breadwinner. Conclusions Presently, most of the active volunteers are married, female, older than 30 and are the breadwinner themselves or have a husband who is the breadwinner.

Reasons for and perceptions of patients with minor ailments bypassing local primary health care facilities

Introduction: Despite having access to several clinics and health centres in their local communities, numerous patients opt to go directly to hospitals for non-emergencies and minor ailments. Reasons for this include their perceptions of the quality of primary health care services, the attitudes and perceptions of health workers, opening hours of clinics, community involvement and participation, and drug and equipment availability as well as the quality of infrastructure. Perceptions of size, a lack of specialty care and limited services were most frequently mentioned as reasons why patients bypassed their local primary health care facilities. Aim: This study aimed to identify the reasons given by patients presenting with minor ailments, for bypassing their local primary health care facilities in the Greater Tzaneen municipal area to Letaba Hospital. Methods: A cross-sectional descriptive study was performed at Letaba Hospital over a three-month period, from 23 June 2008 to 15 August 2008, in which non-referred patients presenting with minor ailments were randomised and entered into the study on a voluntary basis. A preset questionnaire was utilised for data-collection purposes. A total of 293 participants were included in the study. The questionnaire aimed to determine the demographic profile of patients who present with minor ailments at hospital, to explore the reasons why these patients bypass their local clinics and to evaluate their knowledge, perceptions and attitudes regarding their local clinics. Results: Most patients indicated that they came to the hospital because they wanted to be seen by a doctor, followed by the request to see a dentist. The study identified that patients expressed both positive and negative opinions concerning their local clinics. Conclusion: Numerous factors influence the service-seeking behaviour of rural patients. Patients bypass their local clinics due to perceptions regarding the quality of health care services at the hospital. Improving the quality aspects of clinics and enhancing the services rendered will not only increase the utilisation of clinic services, but also reduce hospital overcrowding.

Putting participation into practice

SUMMARY Background: The aim of the article is to share the findings of participatory action research performed to develop a mutual participatory doctor-patient relationship model, and to apply this model in a rural cross-cultural primary care setting. Method: Participatory action research was performed with four patient groups. Four patients with incurable illnesses formed groups with their family members and significant others. Seven monthly meetings with each group were audio recorded. The question asked at each meeting was “How can the group work together to achieve the best possible health outcome for the patient?”. The recorded interviews were transcribed and translated from the local vernacular (Tsonga) into English. Themes were identified from the transcripts, field notes and a reflective diary. A list of combined themes was compiled and a model was constructed to depict the themes and their interrelatedness. The model was interpreted and conclusions were drawn. Results: To apply a mutual participatory model in a rural cross-cultural practice, the physician is required to operate from certain basic tenets. The patients have to participate actively to benefit optimally, and basic interviewing techniques are helpful to facilitate mutual participation. Conclusions: It is not easy to implement a mutual participatory model in a disadvantaged, rural practice, but it is possible. We need a paradigm shift in health care, from “helping” patients (which may nurture dependence), towards facilitating the personal growth and development of patients (to nurture self-reliance).

Usefulness of patient studies in learning family medicine at postgraduate level

ABSTRACT Background: The Masters in Family Medicine (M Fam Med) is a postgraduate training programme in family medicine at Medunsa. M Fam Med students have to write patient studies as part of requirements to complete their degree. This research was undertaken to develop a deeper understanding of their perceptions about patient studies. Methods: A descriptive qualitative method was used. A purposeful sample of eight students was selected, with a maximum variation in dimensions of interest. Data were gathered by free attitude interviews, recorded on audiotape. These were transcribed verbatim; themes were identified from the text and were coded into categories. A model was developed to demonstrate the process, and the interrelatedness of and relationships between the themes. Results: The students generally perceive patient studies as a good learning tool. However, they face certain problems while doing patient studies. These problems arise from difficult student-facilitator relations and from the logistics of doing patient studies, such as a lack of orientation and difficulty in obtaining literature. Conclusion: Patient studies are appropriate assignments for the M Fam Med programme at Medunsa. The problems, such as strained facilitator-student relationship and logistic problems, encountered during the writing of patient studies, should be addressed.