FHS Annual Report 2013
PRIMARY HEALTH CARE DIRECTORATE
INTRODUCTION
The vision of the Primary Health Care Directorate is a Health Science Faculty that promotes equity and quality in health care, guided by the primary health care approach. The Directorate aims to promote the primary health care approach in teaching, research, policy, health services and community engagement by the Faculty of Health Sciences.
Its objectives are to integrate a primary health care approach into the faculty’s undergraduate and postgraduate curricula by means of extending and developing the faculty’s clinical teaching platform in rural and primary care sites; deepening community engagement within the health service and the faculty’s curricula; enhancing the recruitment and support of students of rural origin in the faculty; and increasing inter-disciplinary research in health sciences.
The mission of the PHC Directorate is to promote equitable, comprehensive, compassionate and quality care at all levels of the health system by means of: the recognition of diversity and culture; evidence-based practice and policy; active health promotion; community-based education; and strategic partnerships.
HIGHLIGHTS
Medicine and the Arts
A new postgraduateMedicine and the Arts course which commenced in 2014 was designed by Prof Reid and Dr Susan Levine, Dept of Social Anthropology. The coursecontributes to new interdisciplinary research initiatives underway at UCT, and provides an unparalleled opportunity for students from the Health Sciences and Humanities to engage with the production of knowledge of and about the body, from multiple perspectives. The course also provides an intellectual platform for students to explore new possibilities, already activated on the global stage, about the ways in which the arts can constructively engage with medical pedagogy and practice, and to engage in key debates relating to medicine, the arts and medical anthropology.
Promoting Rural Health
A portion of a faculty 1.2m Atlantic Philanthropies 3-year grant dispersed to the PHCD was utilized to encourage the recruitment ofhealth sciences students from rural and underserved areas, support them to develop leadership skills, better prepare medical students for rural practice, and contribute overall to health equity. The PHCD worked to raise the profile of rural health amongst the students and faculty; to expose an increasing number of students to rural situations via the subsidy provided for 5th year rural electives; to raise awareness amongst rural learners about health careers and processes to be followed to become health professionals in future; and to expose students to leadership through workshops and practice whilst leading their student societies.
Interdisciplinary Work
James Irlam brought together a workshop on Trans-disciplinary and Inter-disciplinary (TDID) Research in the faculty, which has the potential for increasing research output. The statistics from around the world show that the output of those universities that have deliberately created an enabling environment for interdisciplinary research, has increased exponentially, as compared to those who continue ploughing the same furrows within their disciplinary boundaries. Although a lot of the work done at the PHCDis interdisciplinary, this is not the case for most departments, and one of our core functions is to initiate and stimulate this kind of thinking within the faculty.
Curriculum Revision
The faculty-led Curriculum Revision Task Team (CRTT) chaired by Prof Reid met for their final meeting in October 2013 to review what has been achieved since the inception of the Task Team in August 2010, evaluate if the major objectives have been served and to bring clarity to the way forward with respect to salient issues that remain a work-in-progress and will be taken up by the MBChBProgramme Committee. Initial revisions to the 4th year curriculum would take effect in 2014 including the introduction of primary care Paediatrics, incorporating additional on-site student clinical work, inclusion of alternative off-campus sites, home visits, and integrating PHC themes and learning outcomes across the curriculum. Revisions to the 6th year curriculum would continue to be interrogated with the aim of exploring the implementation of a longitudinal 6th year programme in George or other community-based off-campus sites on the expanded teaching platform, and interrogating workable models. Task Teams would continue to examine graduate attributes in relation to templates that were designed to identify and integrate PHC principlesacross the major themes of human rights; inter-professional teamwork; communications & cultural competence; evidence based practice; life-long learning; bio-psychosocial approach; ethics; gender & sexuality (LGBT); SHAWCO Health Proposal; and oral health. The curriculum mapping process which was half-way through, would also be completed. The Culture, Psyche and Illness thread of the MBChB was reviewed leading to a clarification of outcomes and strategies.
Visiting Scholars
Prof Stewart Mennin, an expert in curriculum reform from the University of New Mexico, was invited by Prof Reid to run a workshop on “Curriculum Change & Models” at the faculty in September 2013 on the vital subject of curriculum revision, curriculum models and the challenges of curriculum changes pertaining to the MBChB undergraduate early and clinical years. The workshop interrogated the numerous complex issues at play including what rules can be instituted to synergize teachers and learners; how size can be used advantageously; how a teacher delivery model (one speaking to many) can address the fact that size is unlimited and inversely proportional to engagement and meaningful exchange; how basic rules of working together can be better understood and instituted; which curriculum models could work within our context; and how to examine the basic unit of function, which is learning not content.
Prof David Hirsch, Assistant Professor of Medicine at Harvard Medical School and Director and co-founder of the Harvard Medical School-Cambridge Integrated Clerkship, was invited to present to the faculty in August 2013 on “The Case for Curricular Integration: What Harvard’s Longitudinal Integrated Clerkship teaches about educational design”. Prof Hirsch is an expert in the so-called ‘Longitudinal Integrated Clerkship’ model of teaching, in which clinical students undertake their learning in each discipline over a whole year ‘longitudinally’ rather than ‘vertically’ in blocks. The Harvard Medical School Cambridge IntegratedClerkship story has much to say about educational transformation and will be helpful toopen ideas aboutour final year MBChB curriculum revision.
Conference Presentations
Prof Reid, Dr Michaels, Claudia Naidu and James Irlam gave oral & poster presentations at the SAAHE 6th National Conference on “The relationship of health science faculties to their health service partners: implications for clinical teaching in SA”; “Peer review for social accountability of health sciences education: a model from SA”; “The home visit: still a feasible teaching tool for medical students? A pilot study for curriculum revision”; “A system that is constantly trying to shape you in a different way - student’s perspectives on being a good doctor”; “Career and practice intentions of health science students across three SA medical schools”; “A review of the Wits University medical students’ community-based health promotion service learning projects in SA”. James Irlam gave oral & poster presentations on “Advocacy for a health energy policy: the experience of a national roundtable process” at the RuDASA 17th Rural Health Conference and the 9th PHASA Conference; “Micronutrient supplementation in children with HIV infection: a Systematic Review for the HIV/AIDS Cochrane Review Group” at the African Cochrane Indaba; and “A cost-effective strategy for primary prevention of acute rheumatic fever and rheumatic heart disease in SA children with pharyngitis” at the UCT SCAH Research Day. Prof Reid gave oral presentations on “Why we do what we do: the philosophy of rural health” at the RuDASA Conference and “Medicine and humanities in conversation” at the WiSER Body Knowledge Medical Humanities in Africa Conference.
DEPARTMENTAL PROFILE
The PHC Directorate staffprofile in 2013 included 24 staff members: 1 professor & Director of the unit; 2 senior lecturers; 3 lecturers; 3 honorary lecturers;1 junior research officer; 1 health teaching platform manager; 4 site facilitators; 2 NGO facilitators; 1 facility manager; 4 site coordinators; and 2 admin staff.
The Directorate has strived to build a diverse, high quality staff profile as well as an academic staff profile which promotes equal opportunity, encourages development and adds value to the teaching experience of a diverse student population.
Honorary Lecturers
Dr Ben Gaunt, the Clinical Manager of Zithulele Hospital - a remote district hospital in the Eastern Cape - and Dr Karl le Roux, the Principal Medical Officer have together been powerful role-models for students with respect to delivering primary care services, leadership and teaching, and their understanding of the PHC approach. They have addressed staff and students on rural health and presented the 4th year MBChB rural health block seminars, highlighting the challenges and rewards of working at the rural coalface, thereby promoting the agenda of PHC in the faculty.
Dr Rob Baum is an experienced academic in the field of dance and movement therapy and has brought in a trans-disciplinary approach to medical teaching. She has contributed to the Directorate publications output in the areas of dance movement therapy, transgenerational trauma and health, and the transformation of the body through art praxis.
GOVERNANCE
Prof Reid was an invited reviewer for the VLIR-UOS Team Uganda 2013 project proposals and a manuscript reviewer in the Journal of Child and Adolescent Mental Health on “Improving mental health and well-being for young men in the building and construction industry”. He co-convened the Gordon Institute for Performing and Creative Arts (GIBCA) Medical Humanities Public Lecture Series; was a musical participant in the faculty Unplugged Series music and literary concerts; a member of the SA organizing committee on “PH and Climate Change & Health” for the Worldwide Universities Network (WUN) Global Challenge Health 2014 Conference; the academic lead & coordinator of the WUN Resilience in Young People/Adolescents Working Group; the African Palliative Care Association and HPCA Conference workshop chair on “Creative and artistic encounters in palliative care: developing a community of practice in Africa”; DiraSengwe Conferences board-member and Bravery Award presenter at the 6th SA AIDS Conference; plenary speaker on the “National Health Insurance Pilots” at the PHASA Conference; and roundtable discussion leader on “How to capture the patient perspective and an independent view of health service quality” at the Provincial Quality Improvement and Patient Centered Care Research Day.
Aside from numerous ongoing UCT and external committee memberships Prof Reid was a member of the following new committees in 2013: DoH Specialized & Emergency Services Access to the Service Platform Working Group; DoH HRH Strategy Rural HRH Task Team; UCT Health Economics Unit Integrated School Health Programme Task Team; Joint UCT/Stellenbosch University Expansion of the MBChBProgramme Committee; Nelson Mandela Metropolitan University Expert Reference Group for the establishment of a new medical school in Port Elizabeth; DoHNational District Clinical Specialist Teams Steering Committee; Academy of Science of South Africa (ASSAF) Standing Committee on Health.
James Irlam chaired the FHS Professional Standards Committee; was a PHCD representative on the FHS Assessment Committee and FHS Research Committee;
Dr Lauraine Vivian was an invited expert reviewer on the Anthropology & Development Studies Panel for the NRF Postdoctoral Programme. Sarah Crawford-Browne was an expert participant in the Centre for Study of Violence and Reconciliation’s research in Developing an African Torture Rehabilitation Model, and facilitated a session for first year academic support.
TEACHING
Undergraduate
Prof Steve Reid lectured on the 1st year MBChB Becoming a Health Professional course giving an overview of primary health care (PHC); the key principles of the PHC approach; the different levels of the PHC system; and PHC & comprehensive care. He lectured on the 2nd year MBChB Becoming a Doctor Part 1A course providing an orientation for becoming a doctor; an introduction to health promotion (HP) and approaches; the principles of health communication and development of mass media; an introduction to behaviour change theories to address cultural beliefs and practices; HP ethics; health rights; and the principles of PHC.
Prof Reid, Dr Lauraine Vivian, Johannah Keikelame/Dr Des Michaels, James Irlam and Sarah Crawford-Browne lectured on the 2nd year BSc(Sp&Aud) Becoming a Communication Therapist, the BSc (OccTher) Occupational Therapy 2 and the BSc(Phys) Applied Physiotherapy 1: Disability in Primary Health Care courses on the integration of the PHC approach into the Allied Health Science (AHS) curriculum; an introduction to HP; behavior change theories and approaches; and the planning of a HP project.
Prof Reid, Dr Vivian and Sarah Crawford-Browne lectured on the 2nd year MBChB Integrated Health Systems course on alternative medicine perspectives; ethical issues; belief systems; bio-psychosocial and cultural issues; and relevant PHC principles. Prof Reid and Dr Vivian lectured on the 4th year MBChB Medicine course on teaching PHC at the patient’s bedside at GF Jooste Hospital and integrating the PHC approach into clinical rotations in medicine.
Prof Reid, Johannah Keikelame/Dr Michaels, James Irlam, Dr Ben Gaunt and Dr Karl le Roux lectured on the 4th year MBChB PHC/HP course covering a range of topics including HP ethics and health rights; community participation and partnerships; behaviour change theories and HP approaches; Ottawa Charter actions; planning cycle process and health communication for behavior change; rural health; poverty and inequality; access to services; nutrition; maternal and child health challenges facing rural doctors; equity in health; health for all; principled health care; the PHC lead theme; patient rights; the role of doctors; advocacy; communities; right to health; putting PHC principles into practice; the PHC approach; district health systems; the Alma Ata Declaration; and millenium development goals.
James Irlam lectured on the 2nd year MBChB Integrated Health Systems Part 1A course on RCT evidence for TB; the 3rd year MBChB Integrated Health Systems Part 2 course on evidence for causality ; and the 4th year MBChB Public Health (PH) course on an introduction to the PHC approach, equity and health, and evidence-based practice. He is the convener of the 5th year MBChB PHC Electives..
Dr Vivian and Sarah Crawford-Browne lectured on the 2nd year MBChB Integrated Health Systems course on culture, psyche and illness; bio-psychosocial and cultural issues; and relevant PHC principles. Dr Vivian lectured on the 5th Year MBChBPaediatrics course on integrating the PHC approach into clinical rotations in paediatrics. Johannah Keikelame was the the 4th year MBChB Health Promotion course convener, with Dr Des Michaels taking over the role when she went on sabbatical to complete her PhD.
Special Study Modules (SSMs):
Prof Reid convened an Arts and Healthcare SSM together with Dr Patrice Rapar from the University ofNew Mexico (UNM) exploring the links and integration of the creative/expressive arts and health care in the South African (SA) context including music, visual arts, dance and movement, creative writing and drama. 7 UCT medical students were joined by 7 senior students from UNM who were participants in a College of Fine Arts initiative designed to promote and support courses based in community-engaged learning, affiliated with the UNM clinical Arts-in-Medicine programme.
Prof Reid also convened a Stories of Illness SSM together with Dr Dawn Garisch where students explored through a literature search and observation how practitioners of medicine and of the arts use language to describe illness, investigated the strengths and weaknesses of both approaches, and researched the benefits and limitations of narrative medicine and other story-based approaches to promoting healing and well-being.
Prof Reid and Dr Michaels convened a 3rd SSM on the Follow-up of Patients after Discharge from GSH Hospital.Sarah Crawford-Browne supported Prof Reid and
Dr Rapar’s SSM students, andDr Michaels4th year studentsin developingdigital stories and convened an SSM on Developing Media for Research Participants.
Johannah Keikelame convened an SSM on Using Observations to Understand Factors Impacting on Care of Patients with Epilepsy in which one of her students, SbongiseniMashinini, presented a poster at the FHS Undergraduate Research day winning a prize of R1000. James Irlam supervised a SSM study at Woodstock CHC on non-adherence to diabetes and hypertensionmedication.
Postgraduate
Prof Steve Reid lectured on the Masters in Public Health MPH course on PH & society as well as on the Masters in Family Medicine MMed course on community oriented primary care. James Irlam convened and lectured on the Masters in Public Health MPH course on evidence based health care. He also lectured on evidence based practice on the Masters in Occupational Therapy MSc (OT) course; and on the Diploma in Family Medicine course for family physicians. Dr Lauraine Vivian lectured on the Masters in Genetic Counselling MSc(Med) course and the Masters in Family Medicine Health & Culture course. Dr Michaels lectured on the Mphil in Maternal and Child Health course on research ethics. Sarah Crawford-Browne lectured on the Masters in Social Justice, Law and Poverty course and the Masters ICTs in Education course. Johannah Keikelame & Dr Vivian lectured on the Vision 2020 Diploma in Community Eye Health course. Johannah Keikelame lectured on health promotion on the Allied Health Sciences OT Masters course and the Ophthalmic Nursing and Nephrology Nursing in Primary Care Settings Diploma courses.