Johannesburg, 1 April 2008—The uneven spread of HIV-skilled doctors outside of the major urban centres has been highlighted by the experiences of foreign doctors and nurses who have completed a six-week stint of mentoring and volunteer assistance work in the Northern Cape.

The group – two doctors from the UK and two nurses from the USA – form part of a formal mentoring programme. On arrival in South Africa, they were divided into two teams, each consisting of a doctor and a nurse, and allocated to HIV clinics in Prieska, in the northern Karoo, and in Jan Kempdorp, north of Kimberly.

While the Prieska team found itself working at a well-staffed clinic, the team at Jan Kempdorp had to cope with a severe shortage of doctor’s clinic time. The HIV clinic has been allocated only one doctor visiting from Kimberley for one day a week, and staff shortages at the doctor’s home base resulted in his missing two out five visits. The result was that the clinic had only two doctor days in a five-week period.

Both clinics are supported by Right to Care, a non-profit NGO, but, despite extensive efforts, the organisation has been unable to find a doctor fill the post in Jan Kempdorp.

“Finding doctors willing to work in these remote areas is an ongoing challenge,” says Dr Ian Sanne, Managing Director of Right to Care. “Of the doctor's salaries that we are funding at government sites, only a quarter are in small towns.

“We have four doctor’s posts unfilled in the Northern Cape alone, and have not been able to fill these in over a year.

The Ethembeni clinic at Prieska has a fulltime doctor, three sisters, a nursing assistant, three HIV lay counsellors, a TB counsellor, a dietician, a social worker, a pharmacist, and two non-medical support staff. The salaries of some of these are funded by Right to Care, which has signed a memorandum of understanding with the Northern Cape Department of Health to support the government’s antiretroviral treatment programme.

The visiting mentors worked without pay for six weeks. The visits were made possible by the combined efforts of The International Centre for Equal Healthcare Access (ICEHA), a charity registered in the UK and USA, and Right to Care. The charity has a South African office in Stellenbosch, close to Cape Town. Right to Care sponsored the visitors’ travel and accommodation costs.

The intention of the visits was mentorship and the transfer of skills, rather than having the visitors take up the positions of temporary staff members. This was easier to achieve at Prieska, where Dr Chitra Babu, a specialist registrar from Manchester, UK, and Sister Kathy Wolff, a nurse practitioner Philadelphia, USA, spent their service period. The two were able to spend most of their productive time mentoring or conducting training (they devised a series of training modules, which they delivered on a one-to-one basis to clinic staff). These modules were met with enthusiasm by staff members, some of whom used their spare time to attend.

At Jan Kempdorp, also in the Northern Cape, the visitors were hard pressed to balance the need to provide clinical services with the long-term benefit of skills transfer. Serving as volunteers were Dr Mike Snow, a retired physician from Newcastle Upon Tyne, England, and Sister Michelle Evers from Baltimore, Maryland, USA.

Since doctors’ availability was lacking, nursing staff were forced to fill in the gaps. “The nursing staff had to work beyond their scope of practice,” says Snow. “Because of that, much of our mentoring was focused on the sisters, since they pretty much ran the show.”

Personnel shortages were not the only difficulty faced at Jan Kempdorp. The clinic was desperately short of space. Right to Care is in the process of assisting the province with renovating the clinic building. On completion, the project will relief pressure on infection control difficulties and the practicalities of patient flow.

About ICEHA

ICEHA was founded in November 2001 by Dr. Marie Charles, MIA and is an international non-profit organisation with offices in London, New York and Stellenbosch. ICEHA is a registered charity in the UK and has non-profit status in the US.

ICEHA sends healthcare workers experienced in HIV and infectious disease to developing countries to provide clinical mentoring (coaching). ICEHA mentors transfer their clinical expertise in HIV care to local colleagues and help set up operational systems in clinics. Clinical mentors equip local caregivers with the skills needed to take care of their own patients within available local resources. Clinical mentoring is only provided in the context of national treatment guidelines and existing national HIV curriculum. For more information go to www.ichea.org.