How P(H)C is your curriculum?

In South Africa and internationally, the alignment of health professions education programme with primary healthcare (PHC) policies is seen to promote the training of fit-for-purpose graduates who can adequately respond to the demands of patient and community needs. This article seeks to describe the development of a tool to assess the degree of PHC in an undergraduate medical curriculum. In defining what is meant by PHC, four dimensions of PHC were identified for the purpose of designing the tool, namely values underpinning PHC, principles of PHC, a generalist focus of the programme, and the level of care that the programme is delivered at.

Medical student learning on a distributed training platform in rural district hospitals.

Background:  Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts.

Aim:  The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation.

Setting:  Final year medical students who had completed their Family Medicine rotation in November 2022.

Mapping Evidence in Teaching Palliative Care in Undergraduate Curriculum of Healthcare Professionals Qualification: A Systematic Scoping Review Protocol.

Background: Clinical Practice Guidelines recommend interprofessional collaboration in palliative care. However, healthcare profession educators lack clear curricular guidance, particularly for undergraduate programs, to adequately train future professionals for effective participation in such teams.

Objective: This systematic scoping review protocol aims to address this gap by: (i) mapping evidence on key characteristics of teaching palliative and end-of-life (EOL) care to undergraduate healthcare and social care students, and (ii) identifying the nature and effectiveness of educational interventions for improving palliative care education in the undergraduate curriculum.

The contribution of family physicians and primary care doctors to community-orientated primary care.

South Africa envisages a community-orientated approach to primary health care (PHC). Family physicians and primary care doctors have important roles to play in leading, implementing, supporting and maintaining community-orientated primary care (COPC). In this article, we define COPC, its key principles and approaches to implementing it in health services.

Revisiting the doctor's role at the primary healthcare clinic.

With the growing evidence regarding the benefit of a primary healthcare (PHC) approach to both individual patients and for a healthier community, a number of policy initiatives in South Africa are aimed at strengthening services at subdistrict level. Historically, the role of the doctor in many PHC clinics in South Africa had been limited to a clinical role. However, in the context of wanting to have a greater impact on social determinants of health, the role of the doctor at the PHC clinic needs to be revisited.

The impact of stress on depression, ill health and coping in family members caring for patients with acquired brain injury.

Background: This study investigated the impact of stress on levels of depression and ill health as an indication of psychological coping. The research sample consisted of 80 family caregivers (who are members of Headway Gauteng, located in Johannesburg, South Africa) of patients with acquired brain injury.

Methods: A mixed method design of data collection was utilised that included self-report procedures (structured questionnaires and interviews) and post-interview content analyses.

History of academic family medicine in South Africa - When did it start?

The literature on the history of family medicine as an academic discipline locates its beginning with the establishment of two faculties linked to the Royal College of General Practice in 1958. However, the history of Community Oriented Primary Care documents, how the Kark's moved from Pholela in KwaZulu-Natal, were involved with the establishment of the Natal Medical School in Durban. As part of this a Department of Social, Preventative and Family Medicine was established in 1956 with Dr Sidney Kark as its first Head of Department.

Family medicine in Tanzania: Seize the moment.

In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC.

Community engagement with HIV drug adherence in rural South Africa: a transdisciplinary approach.

Digital storytelling (DST) is an emerging participatory visual method which combines storytelling traditions with computer and video production technology. In this project, at the heart of the HIV epidemic in KwaZulu-Natal, South Africa, we used DST to create a culturally grounded community engagement intervention. Our aim was to use narratives of people living with HIV on antiretroviral therapy (ART) to stimulate dialogue among the wider community and to encourage reflection on the contextual factors that influence ART adherence in this setting.

Antiretroviral initiation of pregnant women and antenatal care booking practices in eThekwini District, KwaZulu-Natal, South Africa.

Background: The introduction of antiretroviral therapy (ART) in South Africa began as part of the prevention of mother-to-child transmission programme. For significant reduction of vertical transmission, early antenatal care booking and ART initiation are necessary.

Aim: This study aimed to evaluate ART initiation and booking practices of women attending antenatal care in eThekwini district during financial years (FY) 2010/2011 and 2013/2014.

Enabling factors for specialist outreach in western KwaZulu-Natal.

Background: There exists a major disparity in access to specialist care between patients in urban and rural areas. Specialists are a scarce resource and are concentrated in urban areas. Specialist outreach attempts to fill the gap in service provision for patients situated remotely.

The Hidden Curricula of Medical Education: A Scoping Review.

Purpose: To analyze the plural definitions and applications of the term "hidden curriculum" within the medical education literature and to propose a conceptual framework for conducting future research on the topic.

Method: The authors conducted a literature search of nine online databases, seeking articles published on the hidden, informal, or implicit curriculum in medical education prior to March 2017. Two reviewers independently screened articles with set inclusion criteria and performed kappa coefficient tests to evaluate interreviewer reliability.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

Purpose: African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities.

The relevance and role of homestays in medical education: a scoping study.

Background: The community-based medical education curriculum is growing in popularity as a strategy to bring universal health coverage to underserved communities by providing medical students with hands-on training in primary health care. Accommodation and immersion of medical students within the community will become increasingly important to the success of community-based curricula. In the context of tourism, homestays, where local families host guests, have shown to provide an immersive accommodation experience.

The value of internal medicine outreach in rural KwaZulu-Natal, South Africa.

Background: Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)'s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal Province (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care.

Doctors as street-level bureaucrats in a rural hospital in South Africa.

Introduction: In the perspectives of implementation of policy, the top-down and bottom-up perspectives of policy-making dominate the discourse. However, service delivery and therefore the experience of the policy by the citizen ultimately depend on the civil servant at the front line to implement the policy. Lipsky named this street-level bureaucracy, which has been used to understand professionals working in the public sector throughout the world.

Description of an internal medicine outreach consultant appointment in Western KwaZulu-Natal, South Africa, 2007 to mid-2014.

Background: . This study is a description of an Internal Medicine outreach appointment in western KwaZulu-Natal (KZN) from 2007 to mid-2014, facilitated by the transport services of the Red Cross Air Mercy Service (AMS) and funded by the KZN-Department of Health (KZN-DOH). The hospital visits represented 'multifaceted' as opposed to 'simple' outreach.

Bortezomib-containing regimens are effective in multiple myeloma--results of a non-interventional phase IV study.

Background/aims: The incorporation of bortezomib into the chemotherapeutic regimens for non-transplant patients with multiple myeloma resulted in improved outcomes in controlled studies. This prospective, non-interventional study assessed the effectiveness and safety of bortezomib-containing regimens in daily practice.

Methods: Patients with untreated or relapsed multiple myeloma not eligible for high-dose chemotherapy followed by autologous stem cell transplantation and who were scheduled for bortezomib mono- or combination therapy or melphalan-prednisone (MP) alone were included in this study.

The social and clinical characteristics of patients on antiretroviral therapy who are 'lost to follow-up' in KwaZulu-Natal, South Africa: a prospective study.

A significant proportion of those initiating antiretroviral treatment (ART) for HIV infection are lost to follow-up. Causes (including HIV symptoms, quality of life, depression, herbal treatment and alcohol use) for discontinuing ART follow-up in predominantly rural resource-limited settings are not well understood. This is a prospective study of the treatment-naïve patients recruited from three (one urban, one-semi-urban and one rural) public hospitals in Uthukela health district in KwaZulu-Natal from October 2007 to February 2008.

Randomized, multicenter, controlled trial comparing the efficacy and safety of darbepoetin alpha administered every 3 weeks with or without intravenous iron in patients with chemotherapy-induced anemia.

Purpose: The concomitant use of intravenous (IV) iron as a supplement to erythropoiesis-stimulating agents in patients with chemotherapy-induced anemia is controversial. This study was designed to evaluate the efficacy and safety of darbepoetin alpha given with IV iron versus with local standard practice (oral iron or no iron).

Patients And Methods: In this multicenter, randomized, open-label, phase III study, 396 patients with nonmyeloid malignancies and hemoglobin (Hb) less than 11 g/dL received darbepoetin alpha 500 microg with (n = 200) or without (n = 196) IV iron once every 3 weeks (Q3W) for 16 weeks.

Social support and health behaviour in women living with HIV in KwaZulu-Natal.

The article explores the relationship between social support and health behaviour of rural and urban women who are living with HIV in South Africa. Our study was a descriptive survey of a group of pregnant and non-pregnant women living with HIV. The sample size was 262 women, 165 from urban area and 97 from rural area.

Limitations to practising holistically in the public sector in a rural sub-district in South Africa.

Introduction: The healthcare system in South Africa is based on the district health system through a primary healthcare approach. Although many vision and mission statements in the public healthcare sector in South Africa state that the service aspires to be holistic, it is at times unclear what exactly is meant by such an aspiration. The term 'holism' was coined in the 1920s and describes the phenomenon of the whole being greater than the sum of the parts.

Complete haematological and cytogenetic response to interferon alpha-2a of a myeloproliferative disorder with eosinophilia associated with a unique t(4;7) aberration.

A female patient with eosinophilia and cardiac symptoms was found to have a unique chromosomal aberration [t(4;7)(q11;p13)] of bone-marrow precursors. The disorder was classified as a chronic myeloproliferative syndrome with eosinophilia. Due to a significant increase in the white blood cell and eosinophil count during initial treatment with prednisone and hydroxyurea, Interferon alpha-2a was administered at a dose of 3-5 x 10(6) I.