Report from Cape Town: Family Medicine in South Africa

David Power, MD, MPH

The following blog post was written by University of Minnesota Family Medicine and Community Health medical student education director David Power, MD, MPH. Power is on a single semester leave at the University of Cape Town School of Public Health and Family Medicine in South Africa. He is teaching medical students and residents, consulting on curriculum, and making connections for University of Minnesota students to study abroad in family medicine. 

Report from Cape Town, South Africa

Written by: David Power, MD, MPH

I am midway through my single semester sabbatical. It has been a full, busy, interesting, disconcerting, warm, but generally fun time so far. Cape Town has been very welcoming. I’ve been given my own small office. They stand on ceremony here more than in the United States; since I am a full professor, they call me “Prof Power.” My host Derek Hellenberg, MBChB, and clerkship director Nazlie Beckett, MBChB, have included me on site visits to the community health clinics where students are placed. In general, students here are given less responsibility in patient care than at our clinics in the United States.

Office at the University of Cape Town

Family Medicine and Public Health Integration

At the University of Cape Town, family medicine is a division in the School of Public Health and Family Medicine, which is quite interesting for me given my appointment as integration leader of public health and health policy in the University of Minnesota Medical School. 

The dean here at Cape Town has asked me to present to the school on the integration of family medicine and public health, which is causing me a little anxiety as I prepare! I’ll also be presenting to educators on the results of the multi-institutional study I was involved in that explored mental health and the impact of burnout on medical students. My intention with both of these presentations is to generate a healthy discussion so that the learning goes both ways.

Family Medicine Residency (or Registrarship)

Left to right: Derek Hellenberg, MBChB,
 Nazlie Beckett, MBChB, and David Power, MD, MPH

Family medicine residency (called a registrarship here) is a relatively new field in this area, first recognized in 2007. There is no residency clinic. Registrars get assigned to hospitals and community clinics on a rotating basis. One of the recruitment challenges is that after six years of medical school, everyone is required to complete two years of internship and one year of community service. Family medicine (and other specialties) are then required an additional four years after that. Hence, the majority of physicians who want to work in primary care do not pursue residency once they have completed their three years of service. 

The internship is designed to enable all physicians to be able to practice independently in a rural hospital—so at the end of it, they should be competent to administer anesthetics, perform cesarean sections, as well as manage acute and chronic diseases. It seems that many of those who do elect to sign up for family medicine residency are either interested in administrative training or in leaving the country, since Canada recognizes training here as equivalent to their own.

The long-term goal in South Africa is that family physicians will be the ones managing the health of entire regions, several with populations of more than a million. They will also manage the budget for that region and distribute funds to specialists and allied health providers—quite the tall order. 

I will be doing site visits to observe registrars in action and provide formative feedback using the Patient Centered Assessment Method (PCAM) tool. I will also encourage registrars to develop individual learning goals.

Cape Town Medical School

The Cape Town medical school is considered one of the premier schools in sub-Saharan Africa. It has taken the lead in promoting multiculturalism and presently 70% of students are female and less than 40% are white—quite the change from 20 years ago. 

Family medicine runs a required course over almost all six years of medical school, teaching students to speak medical Afrikaans and medical isiXhosa (Xhosa). Both of these languages are the primary languages of many Cape Town residents; a desire to provide patient-centered care in the patients' preferred languages is what drives this curriculum.

David Power, MD, MPH, University of Cape Town ID

I hadn’t realized how much of an icon Christiaan Barnard, MD, is in Cape Town. There is a museum here celebrating the first successful heart transplant, which he performed in 1967. Did you know that he started as a general practitioner and received his cardiac surgery training under Walt Lillihei, MD, PhD, during a two-year fellowship at the University of Minnesota?

I’ve enjoyed spending time with Steve Reid, MBChB, MFamMed, PhD. Reid is a family physician and professor at the University of Cape Town. He runs the rural longitudinal clerkship and a multi-disciplinary course in health, the arts, and humanism. I will sit in on Steve’s humanism course when it starts in a few weeks and hope to write with him about the legacy of Christiaan Barnard, MD. Steve and an anthropologist colleague also run a Massive Open Online Course (MOOC) alongside the live course that anyone can join free. Visit https://www.futurelearn.com/courses/medicine-and-the-arts/ to sign up. Last year, more than 5,000 people worldwide participated.

Life in Cape Town

Lion's Head - Cape Town, South Africa

I can't say I'm missing the Minnesota winter! We're staying in a beautiful area. Our views each morning are of the harbor with Robben Island on one side and Lion’s Head—part of the dominating Table Mountain—on the other. 

Our kids have settled into the American International School of Cape Town quite well. The only minor headache is twice a week having to endure traffic jams as I drive 30 kilometers (18.6 miles) each way to pick them up from their sporting activities, which prevents them from taking the bus home. Minneapolis-St. Paul traffic has nothing on the gridlock that occurs here daily in the mornings and from about 3:00 pm to 7:00 pm.

I’ve maintained my University of Minnesota Medical School role from a distance, so I have regular Skype calls around 5:00 pm here, which is 9:00 am for you. Well, I better sign off now. I hope to share more learnings when I return. 

David Power, MD, MPH, with wife and children

Beginning Your Story in Family Medicine at the U of M

U of M, Class of 2018

The following message is from University of Minnesota Family Medicine and Community Health department head Macaran Baird, MD, MS, to our incoming class of residents, the class of 2018. 

This July will be the start of my fourteenth year leading this department. It's been an incredible journey.

Every day I have the privilege of working alongside talented, dedicated colleagues, such as yourselves, who truly believe that the specialty of family medicine can transform our nation's healthcare system.
 

And, each year, I am encouraged by the residents that join our ranks. I'm encouraged by your passion, by your dedication, by your talent. 



It's no secret that family medicine is NOT for the faint of heart. You're entering residency at a time when the landscape of healthcare is not only challenging but ever changing—sometimes for the good, sometimes for the bad. You chose this field not because it would be easy, but because you care—you care about people, you care about relationships, you care about transformation. 


Some of you may already know this, but we were among the first family medicine departments and residencies in the nation. We believed then, as we believe now, that caring for the whole person, across the lifespan, is preventive medicine at its best.

Each of our eight residency programs—Duluth, Mankato, Methodist, North Memorial, St. Cloud, St. John's, St. Joseph's, University of Minnesota Medical Center—shares in the commitment to full spectrum family medicine training. Each program will prepare you to provide comprehensive, personalized care for the whole person in ANY setting: urban, rural, global. But each program is also distinguished by its community, unique feel, and curricular strengths. 


You are part of your residency program, but you are also part of a greater whole. You are part of this department, part of this University. You’re part of our mission to transform and renew family medicine through education, research, and patient care.  



This is an exciting time to be joining our ranks. Why? Because, we're energized, we're excited. We want to see reform in payment models. We want to see reform in healthcare delivery. We want to knock down barriers to care. We have a vision for family medicine—a vision for change, for transformation. We want to make individuals healthier, families healthier, communities healthier. This fall, we'll be sharing more about that vision, and we couldn't be happier to have you on our team. 


Our desire, though, is that you’re an advocate for family medicine beyond the walls of your clinic, this department, this institution. Family medicine is in the fight of its life. I would encourage you to get involved in professional organizations, both on the local and national level; be part of a national movement for change. Get connected to organizations like Primary Care Progress, Family Medicine for America’s Health, MAFP, AAFP, and STFM.

Stand up for your patients. Stand up for patients who have no one standing up for them. Stand up for your training. Stand up for your future practice. Stand up for our specialty. In doing so, remember you’re a professional and a representative of this department, this University. You’re accountable for your behavior, your words, your actions.

Residency is the start of a new chapter in your lives. These next three years will be challenging, rewarding, and fun. As a University of Minnesota alum, I can tell you that your time here will be a great way to begin your story in family medicine.

I look forward to watching your stories unfold and am so glad that you became part of our story as well.

U of M Family Medicine and Community Health
department head Macaran Baird, MD, MS