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Torchbearer for rural health

Early in the COVID-19 pandemic, Dr Angela Hartwig was the only doctor at Adelaide Provincial Hospital, which offers 60 beds to a catchment area of 13 000 people in the sheep farming town of Adelaide in the rural Eastern Cape. When she started at the hospital in March 2020, she was seven months pregnant with her third child, writes Biénne Huisman for Spotlight.

Pregnancy notwithstanding, she continued treating patients – even after testing positive for the virus in May 2020 and being admitted to a COVID ward herself – up until two weeks before giving birth.

A stressful start

“We moved to Adelaide two weeks before lockdown,” says Hartwig. “It was a very stressful time for our hospital and for me personally. We were swamped with COVID cases. We had a staff outbreak of COVID too, so there was a shortage of nurses – several died from COVID. I think we lost six nurses. It was a devastating time. They were constantly phoning to get people from other shifts to come cover and continuously arranging oxygen for the hospital. There were people driving every second day to fetch oxygen cylinders in Queenstown, so we wouldn’t run out – a six-hour round-trip. So there was a lot going on.”

In February 2020, staff embarked on strikes at Adelaide Hospital, downing tools in support of then-hospital CEO Dr Mandla Makhangala. At the time, Makhangala was being investigated for misconduct.

“There was no protests when I arrived,” says Hartwig. “Dr Makangala was being investigated, but the week before I got there he was seconded to Fort Beaufort Hospital to work under supervision, pending the investigation.”

She spoke to Spotlight from her home in Adelaide, which she shares with her husband, who works in the NGO sector, and their three children aged seven, four, and two years old.

She continued working during her maternity leave in hard lockdown, visiting the hospital on most days, sending voice notes to staff, and attending Zoom meetings often with her newly-born son in her arms.

For the first month of the pandemic, she was the only doctor on duty at the hospital; after that, a second doctor joined, and later in 2020, a third as well.

Making a difference

It took Spotlight more than a year to secure this interview with Hartwig, who has virtually no internet presence. This may attest to her character: an individual too immersed in daily life to court attention online.

A Google search delivers about two items: her winning South African Rural Doctor of the Year in 2020, as awarded by RuDASA (the Rural Doctors Association of Southern Africa); and being named one of the Mail & Guardian’s Top 200 young South Africans in 2020, where she was nominated by RuDASA.

At the time Hartwig said: “Don’t let yourself become frustrated by things out of your control, but work to make a difference in the areas you can control.”

A recurring theme with Hartwig is “making a difference”.

“I’ve been exposed to rural health for many years. Since I was a student I have been interested in it,” she says. “And I’ve watched a lot of other people go through challenges at rural hospitals. There are things you really don’t have control over, and you’ve just got to do the best you can with the resources you have, whatever those might be.

“(W)e are there for the patients, people who would otherwise have nowhere to go. And if we can offer them a decent service, then we accomplished what we set out to do.”

Asked to recall a moment when she knew she was making a difference, Hartwig recounts the time she helped deliver triplets at Adelaide Hospital.

“I was at the hospital when suddenly there was a call to go to maternity for an emergency. There had been a woman pregnant with triplets, already in labour, and we didn’t have time to transfer her to a referral hospital. And so between the midwives and me, we delivered those babies. And later we managed to send them to a referral hospital – Frere Hospital (in East London). They survived, and last month the triplets turned two-years-old. It was great teamwork. This is not very common at all. It was the first time triplets have ever been born at our hospital and it was in the middle of COVID.”

Thrown in the deep end

Homeschooled in Westville, Durban, Hartwig studied medicine at the University of Pretoria, where she first met representatives of RuDASA. She completed her community service at Church of Scotland Hospital in Tugela Ferry in KwaZulu-Natal in 2012, working in the paediatric ward. Even though the world’s largest outbreak of extensively drug-resistant tuberculosis was recorded in the area just five years earlier (in 2007), Hartwig says she mainly treated child patients for HIV and malnutrition.

Subsequently, she also worked as a general practitioner in Greytown, in KwaZulu-Natal, and volunteered as a doctor in Malawi.

Where did her interest in paediatrics start?

“During that year of community service,” she replies. “I actually didn’t think I was very good at paediatrics. It scared me a little. With babies and small children, everything is so different (from)] adult medicine. But I was just thrown in at the deep end, being given a ward to take care of. I learned as I went along. I’m passionate about public health and there’s a lot that can be done in the field to improve child health. If you improve health for a child, you can make a difference to their whole life.”

In the rural reaches around Adelaide, socio-economic ills like substance abuse greatly impact child safety, she adds.

“There are lots of problems with alcohol abuse in our area. So we have lots of parents who are alcoholics. The big problem was the substance abuse treatment unit at Fort England Hospital in Grahamstown – we refer patients to them – closing for the duration of COVID. We had nowhere to refer substance users. Luckily this year it opened up again. At our hospital we treat withdrawal but we can’t do rehabilitation.

“Also, many parents live on farms, and have to send their kids to town to school. Then the kids are all living with some or other caregiver, but often there isn’t a lot of supervision.”

From this year Adelaide Hospital has had a social worker available to children and families once a week.

While the Eastern Cape is widely lamented for its lack of public health services – and unreliable figures pertaining to COVID – Hartwig says the provincial Department of Health supported their hospital during the pandemic

“At that stage, everyone was so thinly stretched. There were problems everywhere,” she says. “It would have been difficult to have received more support than we already did. I mean, we were given contract workers – nurses to boost our nursing staff. And there were some efforts made to track the amount of oxygen being used. And they (the Department of Health) sent people to do repairs to the hospital.

‘Our paediatric ward at that stage was in a prefab building. So they just built a whole new paediatric ward, with three isolation wards and space for about another six kids. We also had oxygen put into a lot of different wards for COVID patients. But yes, there were so many fires that needed to be put out all at once. I don’t how it could have been done any better.”

For food parcels delivered around the community and at the hospital’s own kitchen, she credits non-profit organisation Gift of the Givers.

Go rural

Hartwig closes with a clear message: “I would like to encourage anyone thinking about working in a rural area, to do it. It is such a worthwhile opportunity. For anyone interested in coming to work in Adelaide, we are always looking for people. Anyone can make a difference, it doesn’t matter who you are.”

 

Spotlight article – Women in Health: Dr Angela Hartwig – a torchbearer for rural health (Creative Commons Licence)

 

See more from MedicalBrief archives:

 

Rural Doctor of the Year Craig Parker created COVID lifeline for rural areas

 

Audit explains Eastern Cape’s devastatingly high COVID death toll

 

AG warns urgent intervention needed to prevent provincial health collapse

 

Spotlight: Little or no improvement in dire state of Eastern Cape hospitals

 

 

 

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