Academy Quarterly Newsletter
Published on: 29 June 2018
In this newsletter:
1. Advocating for family medicine
2. 21st National Family Practitioners Congress
3. Training of Clinical Trainers Report
4. In memory of Prof Sam Fehrsen: a personal tribute
5. World Organization of Family Doctors
Advocating for family medicine
At last year’s National Family Practitioners Conference one of the workshops looked at future scenarios for family medicine in South Africa (http://dx.doi.org/10.1080/20786190.2016.1272231). The workshop concluded that the Academy should “take a more active role in advocating and communicating for the discipline in South Africa”.
In February the national council met to develop such an advocacy plan. The council identified a number of key stakeholders such as family physicians and other generalists, department of health, private sector medical aids and funders, professional and regulatory bodies, family physicians and universities. For each of these stakeholders, we considered the purpose of engagement, the key messages, best medium and messenger, timing and resources required.
Over the next few months, you should see some of the activity that was planned at this workshop.
On May 19th we celebrated World Family Doctor Day and published an opinion editorial in The Conversation to explain how family physicians are improving health care in South Africa’s communities (https://theconversation.com/family-physicians-are-improving-health-care-in-south-africas-rural-communities-94768)
In the next South African Family Practice Journal, you should find an editorial from Prof Bob Mash on family medicine and advertising for the national conference and membership.
Click HERE for a very brief survey asking you for feedback on what the Academy is doing and how we can serve our membership even better. Please take two minutes to complete this.
We also plan a policy brief for the department of health and a briefing document for the Health Professions Council on accreditation of postgraduate family medicine training.
21st National Family Practitioners Congress
River Club, Cape Town | 24 – 26 August 2018
Have you registered yet for the 21st National Family Practitioners Congress 2018 that will take place 24-26 August 2018 at the River Club in Cape Town? The annual conference is a wonderful opportunity to interact with Family Medicine colleagues from all over South Africa, to get updates on different topics and participate in hands-on workshops.
The theme for this year’s conference is “Family Medicine and the Circle of Life”. There will be a focus on the start of life, or First Thousand Days (from conception to the second birthday) as well as the end of life, with Geriatric and Palliative care topics. There will be Ethics presentations on medical error, as well as the role of palliative care in public health. The workshop topics have been carefully selected to provide practical skills for conditions commonly encountered in primary care. Highlights include an approach to a forgetful patient, Paediatric emergencies, Common sports injuries, Surgical Skills and an Orthopaedic workshop where you can get your hands dirty with Plaster of Paris.
There will be workshops on Family medicine topics such as Patient Centredness as well as Resilience, mindfulness and self-care. A workshop will explore how best to measure the contribution of family physicians. Have you thought of whether involvement of Family medicine could have mitigated the Life Esidimeni mental health tragedy? Come and participate in a workshop exploring this topic.
For family physicians who supervise research, there will be a workshop by internationally recognized professor Michael Samuel. He is a professor in the School of Education, University of KwaZulu-Natal and has developed an excellent tool called “The Research Wheel” which provides a road map for supervisors and students to navigate the research and supervision process. For teachers of Family Medicine, E-portfolios for registrars will be discussed, as well as integrating empathy in health science curricula. The conference is an opportunity for registrars from different universities to meet each other as well as prominent leaders in Family Medicine in South Africa. As a relatively young discipline, it is important that we develop communities of practice to learn from one another. Scientific papers will be presented, with prizes for the best presentation and the best presentation by a registrar.
The conference venue will be the River Club, which has hosted previous National Family Practitioners Congresses. It has been recently renovated and is conveniently located close to the airport. On Friday night there will be a cocktail evening with live classical music provided by a medical student orchestra. The Academy AGM will take place late Saturday afternoon, followed by a free evening to explore Cape Town.
As family practitioners, we are a diverse group including private practice, public sector, academics and those of us who have multiple roles. The programme certainly has something for everyone. This is a conference not to be missed! Please register at http://saafp.org/conferences/index.php/ANFPC/2018
Training of Clinical Trainers Report
4-9 March 2018 WITS University Johannesburg
This Training of Clinical Trainers (TCT) course is an evolution of the Royal College of General Practitioners (RCGP) ‘Introduction to Training the Trainers’ Course. With grant money the RCGP and Stellenbosch University (SU) have adapted the course to be fit for South Africa and presented it the first time in 2014 in Cape Town. The TCT course has been designed to be adaptive and learner centred, to expose clinical supervisors and lead educators to the essential skills and experiences needed to become more competent and confident medical educators.
Family Medicine training moved from traditional training hospitals to decentralized sites in the community where the Family Physician can make a difference. With this move, the focus of training also changed more to clinical training in the workplace. The TCT course is an excellent way to equip the trainers/supervisors of Family Medicine Registrars (but also many other health care workers, including medical students, community service doctors, nursing personnel and allied health workers) to do work place based training and assessment in decentralised sites.
There are two parts to the course namely the training of clinical supervisors and the training of South African course facilitators. This took place under the guidance of Dr Jill Edwards and Dr Steve Mowle, both well renowned and respected GP trainers of the RCGP. Some of the areas addressed in the course are: Knowing yourself and your students, the training environment, different training methods for different situations and students, assessment, feedback as part of learning and support to learners in difficulty. This is a very interactive course where participants need to put new skills in practice under the guidance of the course facilitators.
Jill and Steve spent many hours to assist and empower the new South African course facilitators to ensure high quality training for both the trainers and the participants.
Seventeen clinical supervisors were trained during the week. They represented all nine medical schools in South African and most of them work in decentralized sites in Limpopo, Eastern Cape, Western Cape, KZN, Northern Cape and Mpumalanga.
Training like this is not possible without the support of many dedicated people and sponsors. A big thanks to SUCCEED who sponsored this event in collaboration with the South African Academy of Family Physicians. The University of the Witwatersrand hosted the event and Joleta from AOSIS provided administrative support. Well done to the two South African facilitators Dr Cyril Nkabinde and Dr Neetha Erumeda for your dedication and huge effort in this training.
In memory of Prof Sam Ferhsen: a personal tribute
My first memory of Sam Fehrsen was as a first-year medical student while on a Christian student outreach to Rietvlei hospital in the (then) Transkei where Sam worked. We spent two weeks at the hospital and Dutch reformed mission. We constructed a wall in a donga just next to the hospital. The idea was to have a dam stocked with fish so that the local community could use it as a source of protein. On the final day we had a ceremony to officially open the dam all geared up in swimming costumes and gear in the middle of winter. Sadly a couple of months later Sam informed us that with the first rain the dam wall was washed away.
Inspired by Sam and the other doctors at the hospital, I decided to become a rural doctor and to specifically work at Rietvlei hospital on qualifying. At the end of my second year I spent another three weeks at Rietvlei being hosted by Sam and his wife Jenneke. One of my lasting memories of that visit was joining Sam on a mobile clinic vehicle, a big lorry equipped with the necessary medications and immunisations. We would stop at different places in the community to run a clinic for the local people. Sam later moved from Rietvlei to nearby Mount Ayliff hospital and in 1975 after 10 years in rural hospitals, moved to Pretoria where he established the first Family Medicine Department at Medunsa in the late 70s.
I kept contact with Sam through the yearly Medical Christian Fellowship (MCF) conferences and in 1983 registered for a post graduate Family Medicine degree at Medunsa with Sam at the helm. Sam ensured that there was an emphasis on the doctor-patient relationship and the principles of Family Medicine, especially continuity of care and seeing the patient’s illness in the context of the whole patient and her context. He introduced us to the seminal works of Family Medicine: Balint’s “The doctor, his patient and the illness”, “The doctor-patient relationship” by Freeling and the foundations of Family Medicine so eloquently described by Ian McWhinney. Rather than lectures by specialists, we had interactive discussions on how to implement the principles of Family Medicine in the diverse contexts where we worked. I well remember early in my postgraduate studies, an “aha” moment when I realised that the patient also comes to us with an agenda. We were required to write up a number of patient studies of patients in our practice. We detailed the patient’s presentation, identified learning needs and used the biopsychosocial approach to come to a clinical, individual and contextual assessment of the patient that guided our management. Sam took exception if we talked about cases, “it is a patient not a case!” Even today I cringe when I hear doctors referring to cases rather than patients. I easily related to the emphasis on the individual doctor-patient relationship, it reconnected me to why I initially decided to do medicine. However, as a young doctor working in underserved rural areas with a doctor-patient ratio of less than one doctor per 10,000 population, I experienced an existential crisis. How on earth could I have an individual doctor-patient relationship if I was responsible for health services to 30,000 people? In typical Sam fashion, he listened to my dilemma, did not give any direct answers but supported me in my journey to apply these principles in my working context. Sam also introduced us to the concept of the doctor serving the population at risk, not just the patients that present to our health service, today known as community oriented primary care. As a postgraduate student, I was initially part of the Transkei group where we met 3 weekends a year. I remember one meeting in Mthahta when Sam suggested we meet at the Mthatha dam, combining work with leisure, meaning windsurfing. I was still a very inexperienced windsurfer, could not handle the wind and Sam had to come and rescue me on the other side of the dam.
Soon after graduating as family physician, Sam invited me to join the Eastern Cape MEDUNSA Family Medicine group. This allowed me to continue to be part of the quest to find a Family Medicine discipline relevant to the South African context. On my own journey from a rural district family physician in South Africa, a general practitioner in remote northern Canada, a rural private general practitioner in the Western and Eastern Cape and then finally a rural family physician academic involved in training undergraduate medical students and postgraduate Family Medicine students, my continued contact with Sam inspired me to apply the principles of Family Medicine in every local context that I worked. I have no hesitation in saying that through my association with Sam, my practice of medicine changed irrevocably to be patient, family and community centred.
Through establishing regional groups of mostly rural Family Medicine postgraduate trainees throughout South Africa, Sam imparted his vision of Family Medicine through the years to many family physicians and so built a cadre of like-minded family physicians. Many today are in senior academic Family Medicine positions involved in training of medical students and family physicians or still working as rural family physicians. We are Sam’s true legacy.
World Organization of Family Doctors
The Academy is the official representative organisation for South Africa in the World Organisation of Family Doctors (WONCA).
In September this year we mark the 40th anniversary of the Declaration of Alma-Ata (http://www.who.int/publications/almaata_declaration_en.pdf), which first articulated a broad and radical vision for primary health care. This declaration made health for all the target and saw primary health care as “the key to attaining this target as part of development in the spirit of social justice”.
Ten years ago the World Health Organization published their World Health Report “Primary health care: Now more than ever” (http://www.who.int/whr/2008/en/) which re-affirmed the central importance of primary health care to national health systems. The report recommended four key reforms.
Later this year governments will meet again in Astana, Kazakhstan, to agree a new declaration and a programme of work. Through WONCA and our own government we have an opportunity to again prioritise primary health care.
In October this year WONCA will also be organising a global conference in Seoul, South Korea (http://www.wonca2018.com/) with the theme “Primary care in the future: professional excellence”. We know that some members of the Academy will attend, participate in this global event and bring us feedback.