Reports of misbehaviour by South Africans studying medicine in Cuba have focused attention on the programme to alleviate rural doctor shortages. Chris Barron of The Sunday Times spoke to a founding member of the Rural Doctors Association, the University of Cape Town’s Professor Steve Reid.
Is the programme working?
If you’re talking about the existing programme that has been in operation for the last 15 years or so, that is working fairly well.
Has it alleviated the shortage of doctors in rural areas?
No, because it is in too small numbers. There’ve only been about 70 doctors coming back each year.
How good are they?
They’re not fully trained. They have a four-year degree in Cuba, and that has to be supplemented by 18 months to two years in a South African medical school. Then they have to do a South African internship and a year of community service.
Do our medical schools have the capacity to accommodate them?
They’ve had the capacity for the last 15 years to accommodate between six and 10 returning students per year. The current cohort who will return next year number 800. So that is quite overwhelming.
How did we jump from 70 a year to 800?
That was the minister’s decision. He wanted to increase the output of medical doctors in the country, and the existing medical schools could only increase their numbers by a small percentage. And so five years ago he announced this scheme in collaboration with the Cuban government to expand the programme by a factor of 10.
What’s going to happen to them if our medical schools previously only had the capacity to accommodate up to 10 a year?
There are lots of plans afoot to try and accommodate them. Kwa-Zulu-Natal have said that they would accommodate up to 250.
If they can accommodate extra numbers now, couldn’t they have done so from the start?
They could have, but that was a political decision that was made over their heads.
You’re saying the programme wasn’t strictly necessary but was embarked on for political reasons?
They couldn’t accommodate them en masse from first year. This scheme means they get their first four years in Cuba and about two years in South Africa. In retrospect I think we could have, or should have, made more effort to accommodate larger numbers here in South Africa.
Instead of sending them to Cuba?
Given the same budget that has been used for transporting students to and accommodating them in Cuba, I think we could have done a much better job here. But that’s water under the bridge. The Cuban training programme is turning out to be a very expensive one.
How much is it costing per annum?
I don’t know the figures.
Is the idea that when the doctors are ready they’re sent to the rural communities from which they come?
That’s the idea, yes.
The argument being that they’ll feel a sense of commitment and stay?
Is this what has happened?
There’s been no research on that. I’d dearly like to know the answer.
So we don’t know if they stay in these rural districts for any length of time?
That’s an important thing to know, surely, given that we’re paying all this money to alleviate shortages in these rural districts?
Absolutely. It’s a highly political question you’re asking.
Is there any anecdotal evidence?
Well, whenever I go to rural hospitals I ask whether there are Cuban-trained doctors at that hospital, and I do visit a lot of rural hospitals. And, anecdotally, I don’t see them in great numbers. But that’s not objective.
But it’s all we’ve got to go on?
Your sense of incredulity is what I share. So much has been invested in this, surely they [the government] would be interested in the outcome.
How do you explain it?
That it was a highly political process. That’s the only way I can understand it. That there was more to the deal with Cuba than we know about.
That it wasn’t about alleviating the doctor shortage in rural areas?
Well, I think it was. That was the ostensible reason. And a justifiable one.
But we don’t know if it has alleviated the shortage or not?
How does their training compare with that of South African students?
It’s more theoretical and less practical.
Are they trained to handle TB cases?
In theory rather than practice. Translating that into practice is the challenge of the reintegration process. That’s what the 18 months to two years is geared around.
Once they get this experience, how good are they?
They vary. It’s difficult to answer that without any objective evidence.
So, again, we’re spending a hefty sum on the programme but don’t know the results?
That’s right.The Sunday Times article