Here is a very good video from the Rural Health Initiative of Doctors about the life of doctors working in a rural area in South Africa.



What I am interested in knowing is whether professionals from any field (doctors, nurses, teachers, engineers) are interested in working in rural areas.

What would motivate you to work in a place like this?
What is attractive about working in rural places?
What is not attractive about working here?

I'm really curious and would appreciate it if you could also tell me what has been done, in the countries you live in, to attract more professionals to rural areas and what has been successful and what hasn't worked out well.

If you are someone already working in a rural area, please share your experiences here. Why did you decide to work there? What's wonderful about it as well as what would make living there more enjoyable and attractive.

His feet were sticking out! His pale, cold feet were sticking out! That's all that occupied my mind as we stood behind our cadaver, amidst the solemn atmosphere, on the first day I spent in the anatomy dissecting hall.

The cadaver was completely covered, we were a group of four 2nd year medical students waiting nervously behind our cadaver, to begin our first dissection of a human body. We stood with our heads bowed down, whilst the priest uttered a prayer in front of the dissecting hall. Standing beside him were anatomists, professors and deans who also had their heads bowed down in respect for the many who had donated their bodies for our benefit and to the progress of the Art of Medicine. The hall was filled with eager students, it was my first day in the dissecting hall and it felt like my first day at school. During the prayer and the speeches my eyes kept axiously wandering towards the, pale feet of the huge figure lying in front of us. The only part of the figure that was visible. There's a dead person in there, there's a dead person in front of me....my heart raced with anxiety. The prayer was over and we paid our respects and left the dissecting hall, it was Monday, we would only begin the dissection on the Friday that week. As we walked out, I took one last look at the cadaver's feet, the atmosphere was surreal.

That Friday we ran to our lockers got our textbooks, put on our white coats and raced to the dissecting hall. As we entered the hall, the cold air stilled our excitement, it's smell pungently flavoured with formalin, the chemical that's used to preserve the cadavers. We rushed to our cadaver, put on our gloves, and after the professors had instructed us, we removed the plastic covering from our cadaver. This was it, we were going to open up a dead body. I could sense the excitement in my group as well as the reluctance and anxiety. We removed the coverings and an old, male body, pale, cold and probably 6 feet tall was exposed, with a clothe still covering his face. We all stared at the saffron coloured clothe and we agreed to leave the face covered until we were more comfortable. Our cadaver had been very badly burned from groin downwards. Hinting at how he must have died. Later on, during the year, when we opened up the skull, most of the brain had been turned to mush possibly due to a haemorrhage from falling after getting burnt. We never really found out how he died. But, we always paid our respects, for he gave us the privilege and opportunity as a window into the human anatomy.

It was time for the first cut. As I placed the scalpel on the chest, above the sternum, I closed my eyes and said a quick silent prayer and then pressed the scalpel down. It went through the skin with ease, and I cut downwards, the scalpel was very sharp and cut through the skin and muscle easily. As we tried separating the skin from the chest muscles, first thing I noticed was the subcutaneous fat, globs of yellow, that formed a thick layer under the skin, looking like blobs of margarine. The other groups had cadavers with very little fat so they could proceed to the muscle dissection quickly. We had to spend a great deal of time clearing the fat, slowly so as not to cut away any muscle. It was long and messy too. Sometimes little pieces would spray onto our white-coats as we scraped it off the skin.

All fluids had been drained out of the cadaver already, so there was no blood. The muscles were a pale, greyish-pink colour. As we continued dissecting, our anxieties and fears got washed away by the technical and scientific detail of the body and the engrossing study of the anatomy. We learned mountains from each dissection, more than from a weeks study from books. I felt very privileged.

We became more confident at dissecting as the year progressed and the only time we got a bit nervous was when we saw his face for the first time. It made him seem "alive". But we got over it and learned a great deal. The human anatomy is beautiful. It's a beautiful, perfect machine that had many imperfections.

Today I remain grateful and thankful to the cadaver we learned from. The nameless, fountain of knowledge who helped us "from beyond the grave" to begin our journey to help others .

By your warm, unwavering hands,
You watered the sleeping seeds sown,
Over the vernal, varied lands,
And thus, I had in your hands, grown.
Comforting hands, culling my weeds,
Suavest shelter when storms had blown,
Sapient grace, drying my greeds,
And thus, I had in your hands, grown.
Now a throbbing tree, teeming glee,
Leaf-full, fruitful, flowerful, free,
Under my shade, place your sapient feet,
Through trying seasons, make it your seat.

After reading this amusing article, I realised how free web services like Twitter, blogging and Facebook could change the style and tone of healthcare particularly in a country like South Africa.

The article goes on about how Twitter, a free micro-blogging service, is being used by companies like Starbucks and Amazon.com to monitor their customer's reactions and opinions about their products.

And how protestors used it as a rallying tool in a country called Moldova

But, what really enthralled me and left my mind swelling with prolific innovative, ideas, was the Kickbee.

It's a machine developed by Corey Menscher, a graduate Student of New York University. It consisted of an elastic band with vibration sensors, worn by his pregant wife. And everytime the baby kicked, the machine sent a message to Twitter saying, for example :

“I kicked Mommy at 13:34 PM on Sun Mar 9!”

That little kicker had already started blogging from the placid abode of Mommy's uterus! Talk about being tech-ready!

Imagine the possibilities of such ideas in the healthcare industry. A doctor could use a machine that measured a patient's BP or glucose levels. Or perhaps monitor how compliant a patient is to their medication.

A doctor could even keep track of his patient's daily activities like where or how often they exercise, what kind of meals they have, their general health and emotional status. The list can be as long as your creative imagination wants it to be.

The doctor could take it a step further. Here's an example:

You are a doctor working at a Rural hospital in South Africa. You have queues of patients to attend to and it's really difficult to give enough of your time and attention to each and every patient. Some might have BP problems and some diabetes. Others are perhaps on TB and HIV treatment. Some are having emotional and psychological problems. Some difficulty coping with their illness.

This is perhaps an everyday clinical picture in a South African hospital. And being a country where doctors face huge workloads and staff shortage, it is not feasible to give proper attention and much required insight and hence build a very good doctor-patient relationship so pertinent to quality healthcare.

So what you decide to do is go to the relevant communities from where your patients usually come, and educate them on services like Twitter and Facebook. Ofcourse they might not be computer literate let alone have access to one, however there is a growing number of people with cellphones and perhaps there's a way around with this.

Or the hospital or government could provide community cafes etc... and educational workshops for this purpose. I really haven't thought about it but I am sure there is definitely a way around to make this service accessible to such communities. Even the media such as radio, TV and newspapers can be powerful educators.

Then you could start a forum or a blog, or even a Facebook group or network, where your patients can leave their thoughts, feelings, updates etc... as well as follow them on Twitter and also enable them to follow you and thus building a consistent and healthy relationship with them. The forums and networks could even be run using the local languages, making it even more comfortable and easier for patients to express themeselves.

You could even give advice to rural mothers about chilhood diets etc.. and put up regular medical advice which patients could interact and learn with.

If your patients are using devices like BP monitors or blood glucose monitors “married” to Twitter, you could just visit their profiles and extrapolate a pretty could history and insight into their health status.

Twitter and Facebook are free services and so are blogging services like Wordpress and Blogger.
These services can catalyse our healthcare system and even improve the doctor-patient relationship. This will speed up a doctor's consultations and even give the doctor an opportunity to get feedback on his methods and approaches. It could even open up huge doors to community reasearch etc where researchers could use it to accelarate there analyses etc.

There are several hurdles to implementing such ideas in a country like South Africa due to issues like computer literacy, costs etc...But I obstinately believe it can easily be overcome.

Any ideas on its implementation? Any loopholes? Any suggestions on how the problems can be overcome or perhaps you have ideas of even better reaching power? I will be thrilled to hear them!
:-)

Life is a jaunty journey to the oblivion,
A blind mapper's origami ornamenting scenes,
That shadow the scenes to come
On a road misted with malingering memories.
No driver can drive with eyes on the horizon,
Nor with eyes behind, but only
At the piece of road, just ahead.
With you there are travellers on warm chairs,
Broken chairs, new chairs, wise chairs,
And those that pass by, waving, floating,
Sitting, dreaming or pleading a lift...
Segments of sentimental seas embrace the road,
Clouds cast patchy rains of epiphany,
The sun and moon smile and cry mockingly...
And yet you travel forwards and never backwards,
To a destination mapped by your origami...
Until you realize....everything starts
And ends-

Where you began.

Like a rusk in hot tea -
is hate in compassion.
Like sunshine through soft clouds -
is peace amidst violence.

An old man's hands are warmed in a boys palms,
As he teaches him the winters of his wars
With sickness, wrinkling and other men.
He fed the boy a rusk without hot tea
Under the clouds with weeping sunshine.
And cried: "our land is our land and not the other man's"

But what the man said, the boy forgot,
And the man and the other man
Were buried in same sand.
As the boy and the other man's boys,
Drank hot tea without their rusks,
Under the sun. Under a clear sky.

Sometimes the surreal and the real rarely row apart.
Ascending and descending, into and out of reality I dart.
But if there was anything that could clamp me to permanence,
Nothing can be better than your beauty, your excellence.
The first step thrives me with thoughts of new roads to traverse.
The second, cowers my fears, crowning courage with your converse.
The third, trembles my worries to nothingness
as I behold the everlasting –
It gives me glory in breathing, a beginning, a benediction –
Beyond your beauty, beyond your embroidery –
Is my Love for your Being.