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AFRICA
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Critics questioned the wisdom of training doctors in a
country with a vastly different burden of disease, along with a
completely different approach to healthcare that emphasised
prevention rather than cure. The government’s defence was
that South Africa needed more doctors, and local medical
schools did not have the capacity to immediately expand their
student intake.
The initiative was neither efficient nor cheap, the report
says. Although the cost of living was lower in Cuba, the
students took at least two years longer to qualify than their
locally trained peers. They spent a year learning Spanish
before they could begin their medical training and required
more time to adjust to South African medical schools after
their return. Although the students obtained a Cuban
medical degree, they were required to pass South African
final-year medical exams to graduate and register with the
Health Professions Council of South Africa.
Many students found the adjustment to life in Cuba
daunting, and their return to South Africa as difficult.
‘The South African students were more fluent with the
terminology, the equipment was different, and we were
thinking in Spanish. ‘But the worst part was the lecturers:
they didn’t provide support and (some) would tell us to our
faces, “you are dumb … you will fail”,’ Kegakilwe is quoted
in the report as saying.
His cohort was ill-prepared for the trauma and infectious
diseases affecting South African patients, particularly the
horror of the HIV epidemic. ‘It was before the ARV
(antiretroviral) roll-out and we were seeing patients with full-
blown AIDS and its complications,’ he says. ‘But if you have
the basics right, wherever you go, you can adapt,’ Kegakilwe
says.
The report says now Cuban-trained students appear to be
getting a better reception from medical students who trained
locally than they did in the past. ‘When we came back, they
taught us how to tackle questions and get used to the systems
here. We integrate well, and the students don’t look down on
you. But some lecturers say that we haven’t learnt enough
skills,’ says Cedrick Thete, a Cuban-trained medical student
from Bushbuckridge in Mpumalanga, who is completing
his studies at the University of the Witwatersrand. ‘Yet the
system in Cuba is better: they taught us how to work without
technology, deal with prevention and study a community to
identify risk factors for disease.’
Initially the number of students sent to Cuba each
year was fairly small but, in 2012, Health Minister Aaron
Motsoaledi announced an almost 10-fold increase in the size
of the training programme. At that stage, South Africa’s eight
medical schools were producing a mere 1 200 graduates a year
– a figure that remained flat for more than a decade despite
the growing population and the soaring HIV epidemic. The
plan then was to increase the number of students going to
Cuba to about 500 a year.
In the end, the report says, a far higher figure left for Cuba
and about 720 Cuban-trained students are due to return to
South Africa in July – the biggest cohort to enrol into the
system at once. While they were studying, medical schools
have steadily increased their enrolments and 1 800 doctors
are expected to graduate this year, according to Martin
Veller, chair of the South African Committee of Medical
Deans.
Medical schools and provincial health departments now
have to gear up to integrate an unusually large number of
students at undergraduate level and provide the clinical
training platform they need to get vital hands-on experience.
‘We are wrestling with how to adapt the curriculum,’ says
Lionel Green-Thompson, assistant dean for teaching and
learning in the Faculty of Health Sciences at Wits University,
who recently visited Cuba with deputy health minister Joe
Phaahla to assess the programme. ‘Their skill set is very
similar to South African-trained students, but this needs
to be supplemented with additional competencies to deal
with the different burden of disease in South Africa, which
includes a high level of trauma not seen in Cuba. The
capacity of these students for primary healthcare is greater
and we don’t want to erode that ethos,’ he is quoted in the
report as saying. Wits is expecting to take about 150 students
for their final round of training.
Discussions are under way with the Treasury to ensure
that provinces have the requisite budgets to provide for the
increased number of internship and community service posts
that will be required after the Cuban-trained students and the
enlarged cohort of locally qualified doctors graduate, says
the health department’s chief director for human resources,
Gavin Steel. Internships have historically been conducted
at large hospitals. However, they may in the future also
take place at smaller facilities, while community service for
Cuban-trained doctors is likely to take place in a primary
healthcare setting, Steel says.
Motsoaledi said recently that the Cuban doctor-training
programme was so big it was a headache for both countries,
and the National Health Council had decided it should be
temporarily scaled back but Steel says in the report that it
is likely that there will always be a place for Cuban medical
training but the numbers are likely to diminish significantly
as local training capacity grows.
‘The programme had two targets: increase the number
of medical graduates and provide opportunities for kids
from disadvantaged backgrounds. If you look at it from that
perspective it has been a success,’ he says.
Source:
Medical Brief 2018