When asked what she likes most about her work, she offered: “being involved with GHLI long enough to see many of the graduates of our programs move into ever-greater positions of responsibility and impact. I am inspired by each new group of men and women who enroll in our management training programs. I know the GHLI model of engagement works.”
Itumeleng Ntatamala, M.D., Community Service Medical Officer
Working in a lower income country’s public health sector is usually fraught with challenges, but this work can be equally fulfilling when a smile is shared…or a life is saved. It was in my first year as a medical intern at Mokopane Regional Hospital in rural South Africa that I found myself faced with either giving into an inefficient system or helping to transform it. Being selected to partake in the Advanced Health Management Programme (AHMP) and Yale University’s GHLI, was life changing as it jump-started an exciting journey of profound self-discovery and professional development.
The AHMP approach to health management is the concept of action research, which requires identifying challenges and then conducting research and continuous self-inquiry to solve those challenges. It was this approach that forced me to reflect on why I was concerned about health systems and how my own values tied into this work — a far cry from my previous notion of leadership that oft times neglected the self and only focused on “getting the job done.” I undertook a collaborative hospital renovation project that saw our hospital’s pediatric ward — which was originally designed for adult patients — morph into a conducive healing environment for children with the support of colleagues, local business and interested community members. Colorful murals and paintings adorned previously dull walls, a kitchen was built to teach parents about healthy ways to prepare children’s food and a secure playground was erected to the children’s delight. The Limpopo Province recognized the transformation of the ward with the Limpopo Province Premiers’ Service Excellence Silver Award for “Innovation in the Public Service.”
As I reflect on this past year, I started out as a frustrated young health professional in a small town and am now a confident professional with the skills and capacity to lead an award winning team to help improve hospital efficiency and patient care. I am grateful for this work and the group of people with which I get to work. Each day I have the opportunity to redefine my concept of health leadership.
|Testing a community well during household
visits with a community care giver (CCG)
My final weeks in South Africa were spent on site visits documenting the piloting of the National Health Insurance initiative. This work allowed me to see the many different facets of the South African health care system and two things in particular that stood out to me: First, while talking with the pharmacy staff at the anti-retroviral clinic in the district hospital, I learned they filled an average of 500 prescriptions a day. While you cannot visit, work or live in South Africa without being constantly reminded of the HIV and AIDS crisis, it took standing inside the pharmacy looking at the large queue of people waiting for prescriptions to fully comprehend the volume of people affected.
Second, I realized the extensive role of the community care givers (CCGs). Previously called community health workers, it took only a few household visits to see why these invaluable community members were considered care givers. While these women do cover all aspects of community health, they also serve as quasi social workers, advocates, and administrators. With the CCG, donned in her winter coat and me, woefully underdressed for the chilly weather, we went from house to house where she knew all of the details of the families under her prevue. It was very impressive.
Overall, when reflecting about my time in South Africa, I think the most notable aspect of my experience was the constant excitement I felt being involved in public health work. A year ago, I was enthusiastic but also nervous embarking on the MPH program as I was leaving my successful career to essentially start over. Having been out of school of a number of years, I encountered some academic challenges I had not anticipated. Sometimes I wondered if I had made the right decision. However, my time in South Africa reinforced that I had made the right decision and I cannot wait to start a career in global health.
|With Fikile Ndlovu — a member of the
delegation — at a township school.
2012 GHLI Fellow
On July 16, I had the privilege of participating in South Africa’s National Day of Service in commemoration of Nelson Mandela’s 94th birthday. I joined an event with the Premier’s office at a township school outside of Durban. The day included various projects such as painting, planting trees, setting up a library and cleaning the school grounds. The event was joined by the Premier who reminded the students that they were the first generation born out of apartheid. It must be truly heartening for people to know that that there is a new generation that never had to endure that horror.
While this was only a daylong event, countless hours went into preparing for this project. The night before we did not leave the school grounds until midnight and many of the same people returned at 6 a.m. It was amazing to see so many people work so hard not only for their appreciation of Mandela but also, their own engagement in improving their country. And, the school and the community will continue to improve their facility and educational outcomes.
After being here six weeks, I am continually impressed with the passion and dedication people have for their community. For me, this is most noticeable in the provincial and district government offices.
Most importantly, the National Community Service day is also a humbling reminder of the dedication, innovation and passion it takes to build a nation. South Africa’s democracy is only 18 years old and its constitution, while a strong foundation, is still a working document. This is a nation still in its infancy. They have been forced to tackle enormous challenges that other democratic institutions have been struggling with for centuries.
After much searching and staying at seven different places in my first two weeks in South Africa, I found a little cottage to rent on the same land as the owners – who have kindly helped me out with rides to work or the store, site seeing and inviting me to their beach house.
I am living in the city of Pietermaritzburg in the KwaZulu-Natal (KZN) province and working with the KZN Department of Health and the Office of the Premier (similar to a governor). Pietermaritzburg is about an hour west of Durban and the province borders Lesotho, Mozambique and Swaziland. The area boasts of a number of historic events from the train station where Gandhi was inspired to start his passive resistance movement to the capture site of Nelson Mandela.
The Premier’s office coordinates all activities, projects and programs related to HIV/AIDS while the Department of Health focuses on treating the disease and the medical side of it. Given my interest in health promotion and community health workers, it is the perfect location for me — when I hear about something that is really interesting, like the work with the integrated wellness centers at truck stops, I have the opportunity to work on these projects as well. And, thanks to some interns here from the University of Natal I am also learning what streets I shouldn’t use as short cuts on my walk home to where to find the best pizza.
South Africa is currently piloting a National Health Insurance plan that is based on re-engineering the primary health care system to focus on community health care and preventative medicine. Three provinces in KZN are piloting the program. My role is to document the process in the Umgungundlovu district through interviewing key stakeholders and accompanying clinicians and health care workers in the field. This project ties in to the delegation’s work in improving maternal and child health indicators as well management leadership training.
Coming home to be met by Hurricane Irene and the frantic pace of senior year only solidified my feelings of missing South Africa. Though I left South Africa at a time when my work was just starting picking up speed, I’m very proud of what I was able to help the delegation accomplish. We’re working with two private organizations, BroadReach Health Care and Foundation for Professional Development, to provide training, mentorship, and resources to facility-level health care managers and leaders. Programs will start in the next month in two districts in KwaZulu-Natal and several areas of Gauteng. Since these programs address an area of critical need for South Africa, everyone involved is extremely hopeful that they will have a large impact on maternal and child deaths and on the strength and efficiency of the health system overall.
I’m incredibly grateful to the countless South Africans who made my time in their country the most productive and intellectually stimulating experience of my life. At every meeting, whether it was at district, provincial, or national health offices, with private health care organizations, or at the University of Pretoria, people were welcoming and friendly, yet extremely professional and dedicated. Many people with whom I worked (including the six delegates) had enormous work-loads and severe staff shortages – particularly by U.S. standards – yet they jumped at an opportunity to contribute to the GHLI delegation’s project, seeing in it a way to improve their country’s health system. It was such a privilege for me to work with so many dedicated people throughout the health sector, and I feel very fortunate that GHLI made the opportunity available to me. Even before the plane took off from Johannesburg, I was already brainstorming ways to go back.
Ryan Park, GHLI Student Fellow
|Informal settlement in KwaZulu-Natal|
|The Voortrekker Monument in Pretoria|
One of the greatest opportunities I have had this summer has been meeting so many people across the health sector – from nurses at rural clinics to senior managers of regional hospitals (including the largest acute hospital in the world!), and from health policy makers and managers at district, provincial and national health departments to the founders of private institutions that provide technical assistance in health care delivery throughout South Africa.
Meeting all these people and learning their unique perspectives has shown me why policies and programs that seem so straightforward on paper are astonishingly difficult to implement in reality. In the countless steps beginning with policy design and ending with implementation at the point of care, dozens of different opinions, interests, and concerns – from clinic workers to private sector consultants – constantly fight to be heard. If the voice of a single critical stakeholder is not accounted for, the entire process may fall apart. One main challenge to executing a health program like ours is navigating the delicate politics – luckily for me, navigating politics usually means talking to many fascinating people and taking road trips to the heart of Zululand in KwaZulu-Natal.
As an unrelated side note, the 18th of July was Nelson Mandela’s 93rd birthday. Though it’s not a public holiday, it’s a huge national event. People were asked to volunteer 67 minutes (for his 67 years of public service) towards community service, with an official website listing pre-organized activities like painting schools, gardening, serving meals to kids, and donating blood. Can you imagine that happening in the U.S.?
It’s hard to believe my summer in South Africa is coming to an end. I’ve been here six amazing weeks, and with only two left to go, I’m already starting to respond to some meeting requests with “I’m so sorry, but I’ll be back in the States by then.” I’m usually then asked when I’m coming back, and I give the somewhat awkward “I’m not sure… maybe next year?” Sometimes they press further, and I must add, “I have to finish school!”