Busisiwe is 9 years old. She lives in rural Acornhoek in Mpumalanga, and she attends her local school. Unfortunately, she struggles to see what her teacher writes on the blackboard and her writing, spelling and reading skills are suffering. By the time she’s 12 years old, she will be a few years behind her peers. By the time she’s 17, it will be a challenge to pass matric.
Busisiwe’s situation is far from unique. If she lived in an urban area her eyesight would be tested during routine eye exams at her school. She would already have glasses and her school career would be taking a completely different direction. Unfortunately, there are many healthcare challenges that rural areas face, from local healthcare capacity to the distances that parents must travel to access healthcare. The result is that proactive healthcare is often not an option.
For Busisiwe, this means not receiving the glasses she needs. For some of her classmates, it means not receiving TB medication or having a treatable illness diagnosed. Busisiwe and her friends face another challenge as well. For many of them, one meal per day is normal, and they are growing up and trying to concentrate at school without sufficient nutrition, even though many of their parents work long hours and some even hold more than one job.
“Across South Africa there are dedicated school nurses, hospitals and community health workers who focus on outreach programmes that go into rural communities to provide proactive healthcare,” says Dr Inez Allin, Clinics Coordinator at Tshemba Foundation. “These programmes screen for TB, HIV and Covid, and perform routine healthcare checks. The challenge is capacity – South Africa’s rural areas are vast and populous and seeing everyone regularly is difficult.”
The COVID-19 pandemic has diverted already-scarce resources as well, with the necessity for screenings and vaccinations overburdening already stretched school outreach programmes.
To support the existing infrastructure as much as possible, the Tshemba Foundation, a medical volunteer programme that attracts healthcare professionals from around the world to share their knowledge, skills and experience, is now focusing on an outreach programme over and above the volunteers who routinely spend time at Tintswalo Hospital, the district hospital in Acornhoek.
Rural communities have broad healthcare needs
“When the Tshemba Foundation was launched, our focus was bringing general doctors and specialists to Tintswalo to support diagnostics and surgeries in the hospital. Over the years, this has grown into a far more holistic and long-term vision for the region,” says Godfrey Phillips, co-founder and director at the Tshemba Foundation and the founder of the Foundation’s outreach programme.
“We no longer want to only support the medical side of healthcare. Our goal has grown to have a more holistic, long-term impact on the community by laying the foundations for happier, healthier and better educated children. This first step is currently in progress. Tshemba and our volunteers are going into local communities, visiting schools and working with local support structures to deliver proactive health screenings. Long-term however, our goal is to establish permaculture programmes that feed more children at schools, giving these communities the foundations to nutritionally feed themselves.
“We also want to bring learning development specialists and psychologists into these areas to help teachers identify and support children with learning and behavioural difficulties. Right now, many classrooms hold up to 100 students. The burden teachers are under is extreme and children are slipping through the cracks. The beauty, however, is that there are so many volunteers who can add value if we can connect them and build long-term programmes and training initiatives. We can change these communities from the ground up and provide thousands of children with a better future.”
Building communities from the inside out
“Outreach programmes are an important element in primary healthcare,” explains Dr Allin. “Rural communities face many barriers to accessing healthcare. Children cannot take themselves to clinics and most caregivers struggle to take the time off work to travel long distances to their local clinic or hospital. Transport can also be prohibitively expensive, and this is even if someone wants to go to a clinic or hospital. Many residents will only go to a healthcare facility once they are extremely ill – often too ill to receive care. This has led to distrust of hospitals, which creates even more barriers.”
The result is that treatable illnesses go undiagnosed without outreach programmes that go into communities, taking healthcare to the people instead of waiting for the people to come to the healthcare.
“Every volunteer adds immeasurable value,” says Phillips. “For example, a generalist doctor who spends two days at Tintswalo hospital will also spend two days in the outreach programme and they will not only diagnose patients, but can help educate the community and motivate healthcare workers who benefit from fresh, motivated faces as well.
“Things that are taken for granted in urban areas, such as having dental work done or being able to see an ophthalmologist, gynecologist or a host of generalists, can change a life in a rural setting. We’ve seen older family members have their sight restored through routine cataract surgery that is anything but routine in these areas, children who are healthier after simple dental work – and whose pain is removed – and young women receiving their first gynecological exams.”
It’s a deeply rewarding experience, for Phillips and Dr Allin, but most especially for the volunteers who frequently return to Tshemba after their first volunteering experience.
“The graciousness and gratitude of communities who deeply appreciate the support, assistance and care that our volunteers show them is both humbling and a real joy,” says Phillips. “We often forget that the healthcare profession is a calling in the day-to-day ‘busyness’ of working. Spending time in areas that are so deeply in need of these interventions reminds us of what that purpose is and how fulfilling it can be.”