"Our Clinics are Over-Researched. I'm ready to lock the doors!"

I've not written much about my work with the two Universities in service learning. Curriculum development, course evaluations and faculty workshops are not always the most exciting thing to read about. I guess I was waiting for some inspiring gems of wisdom to share. There have been some great moments, some real goose-bumpy, light-bulb illuminating, insight-rich moments. But now that there is only six weeks to go on our year here, I better start sharing a few. Let me start with yesterday, Friday.

4th Year Pharmacy Students and Day Hospitals
I went with two colleagues from the UWC School of Pharmacy to meet a community partner and continue the planning of a new 3rd year service learning program for the School of Pharmacy. I've done a lot of work with their 4th year program, helping it more clearly address issues of social responsibility and social justice, and providing a richer framework for reflection and learning. In their 4th year program, the students spend 6 weeks in pharmacies in both tertiary teaching hospitals and local "day hospitals." The "tertiary hospitals" include Groote Schuur Hospital, which is famous for being the place where Dr. Christian Barnard did the first heart transplant, and are generally modern and well-equipped. On the other hand, the "day hospitals" are the government hospitals that serve the majority of the population. Only 20% of the S.A. population have health care, and they use private hospitals. The other 80% get virtually free health care at these public facilities, and the "day hospitals," are the first point of access for many people. They have a reputation for being overcrowded and underserved, which is pretty true (fact: the Mitchell's Plain day hospital serves a catchment area of about 1 million people. It is the only hospital in that area!). These hospitals also have a reputation for having poorly trained doctors and nurses, which is VERY UN-TRUE! However, patients often wait for hours before seeing a doctor, and then additional hours in order to get their medicines from the pharmacy. You can imagine how crowded these hospitals and pharmacies are in the context of AIDS and TB, both of which are endemic in many of these communities. You now hae thousands of people coming in regularly for their anti-retral virals, and their TB medicines, which makes for even more stress on the pharmacies! Not a pretty picture.

New 3rd Year Service Learning Program
Working in the pharmacies in these "day hospitals," the pharmacy students get great insight into the pharmacy/drug side of health care, and the realities of the difficulties of the public health program in South Africa. BUT, given the workload, they get very little time to actually talk with patients, or to get to know the communities that their patients come from, and their social context. So for example, you give someone medicines which need to be refrigerated, and they have no electricity where they live. Or, if they have electricity, they don't have a fridge. What do you do? Or, you give someone a medicine that has to be taken 3 times/day with food, but in fact, the person only eats one meal per day. What do you do?

So, the 3rd year service learning program is designed to give the students more exposure to the patients and their communities by doing service in city health clinics which provide primary health care services to women and children. So, we went to meet with Mary (not her real name), who is the district manager for 10 clinics in the area surrounding UWC. Mary is amazing, and has been actively involved with service learning at UWC for 10 years. Ironically though, even though she has been at many meetings, she has yet to really get into a true service learning partnership with the university. Don't get me wrong, there are plenty of students who come to Mary's clinics to "serve," including many nursing students. But as Mary says, they just come with their sheets, with a number of boxes that need to be checked off: x number of babies to be weighed; y number of pre-natal consults to be observed; z number of vaccinations to witness. From Mary's perspective, this is far from service-learning. This is checking-off boxes.

Service Learning is Really about Finding Common Agendas
What truly made this conversation different was the starting point. Our initial question to Mary and her staff was, "What kinds of issues do your patients experience with regards to compliance to their medications?" Well, that question set of a flood of stories and examples and situtions which people experience every day with regards to medication. And from there, we asked, "so, how can the 3rd year pharmacy students get exposure to these struggles and issues?" Together, we then developed an idea which is both at the heart of what Merle is struggling with at her clinics with regard to medications, and which provides the pharmacy students with the real-world exposure to communities and primary health care, which they have been missing. It was wonderful to see both the 2 academics from the UWC school of pharmacy, and the two health care administrators becoming so animated and excited, as the project began to come alive, and its scope and significance became more and more evident.

By the time the meeting ended, there was a wonderful sense that the beginning of a truly meaningful and reciprocal program had been created. Then, unprompted, Mary started to talk about her frustration with all the requests for research that she receives. As her clinics are right in the middle of neighborhoods hard hit by TB, by HIV, and by the "methamphetamine" scurge, they are prime targets for research. And yet, Mary's sense was that none of this research really had any impact on her capacity to delivery health care to the population. She recognized that there were undoubtedly some important insights that had been generated by the research, and that perhaps they did lead to some new laboratory-based innovation. But, none of this helped her deliver health care. Her issues continue to go un-met. It was then that she said, "I should just shut the door and say, 'No More.' Our clinics are so over-researched. We need some real research.

Hopefully, some "real research" will be one of the fruits that grow from the seeds of collaboration that were planted the other day.

Blog ya later.

Seth./.