Dr Madeleine Muller - RuDASA and Rural Health in South Africa

Rural Road to Health

Dr Madeleine Muller is a Family Physician and Senior lecturer at Walter Sisulu University and she serves on the RuDASA (Rural Doctors Association of Southern Africa) executive committee.

Episode summary:

00.50 Dr Muller talks about her journey into rural health

04.15 What were the challenges of working with patients with HIV/AIDS in rural areas?

07.40 What impact does mentoring have on providing services in rural areas?

10.30 How did RuDASA start and how did it develop?

15.00 What tools and resources has RuDASA developed? What is the rural onboarding program?

22.00 What kind of training do medical students receive in South Africa?

27.40 How did RuDASA get more involved in advocacy?

32.00 Have there been issues with supporting advocates?

35.30 Has RuDASA had an impact on recruiting and retaining rural clinicians?

37.30 What has Dr Muller enjoyed most about working in rural health?

38.35 What are Dr Muller’s top three tips for people thinking about a rural health career?

Key Messages:

Major HIV treatment program rolled out in South Africa - mentoring and training was needed to help implement this program effectively.

About 7.5mil people in South Africa are on ARVs, with 70% of the population living in rural areas. All of these people need to travel to clinics to collect their medication every month. Patients need to be monitored for side effects and pick up problems early. Logistical challenges in rural areas that do not have easy access.

The more rural the area the more difficult it is to get clinical staff to go there. There are fewer resources and infrastructure. High turnover of young staff coming and going.

RuDASA founded in 1996, created as a support network by doctors passionate about rural health. It can be isolating and lonely and this support was important.

RuDASA holds an annual conference, doctors gather and talk about what they are up to and the challenges they are facing.

Doctors can feel lost and like they do not have the training, backup and support that would be available in a bigger city.

Zoom and internet connectivity helped support the development of training and mentoring that was not possible previously. This has made rural health more attractive.

RuCASA - rural clinical associates

RuNASA - rural nursing

Rural Health Alliance launched through Rural Health Advocacy Project, they have joined all the organizations that are passionate about rural health to create one voice for rural health.

The National Health Insurance Bill has been passed in South Africa recently, it has been controversial. RuDASA and the Rural Health Advocacy Project have been involved in giving input and applying rural proofing.

In South Africa, all young doctors need to spend one year at a rural facility. They are suddenly dealing with a variety of high stakes medical situations with limited resources. RuDASA has developed an onboarding program to help support them in their role.

About 50% of the doctors joining the onboarding program are new young doctors, however 50% are more established rural doctors who are using this to update their knowledge and connect with colleagues.

South Africa has a 2 year internship, this covers different surgical and obstetric skills.

They have been using online tools to link clinicians to specialists. As a group of doctors we know more, on our own we will never know everything.

The difference between rural health being somewhere where you can thrive or where you are barely holding on with your finger nails is having support available. This has been the real benefit of RuDASA, no one needs to feel they are going at it alone.

Public health systems make “complaining” about things that are not working very difficult. They operate as closed systems and it can be difficult to raise concerns without damaging professional relationships.

Rural Health Alliance can give a voice to what they see but it is not one person speaking out leaving them in a vulnerable position. Doctors can get on with their job and the Rural Advocacy Project can write the press statements and give input on public discourse.

Healthcare everywhere struggles with human resources, that gap is much bigger in a rural area then an urban area. If two doctors leave a rural area this could represent 25-50% of all the doctors which has a much bigger impact on the provision of healthcare in rural areas.

Doctors who are passionate about rural health create the conditions to inspire new clinicians to work and stay in rural areas. RuDASA gathers these passionate people together.

To be able to love what you do and thrive in a place you have to feel like it is your calling. Three components - feeling that what you are doing makes a difference, feeling competent at what you do, and feeling appreciated.

RuDASA website

RuDASA Resources

Contact Dr Muller: [e-mail]

Rural Health Compass - Navigating rural health and policy.

Thank you for listening to the Rural Road to Health!