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HMR 1st Qtr 2013: The Cuban solution: is it producing?

HMR Africa

Discussing the Cuban medical training initiative, launched by the government to address the shortages in the doctor numbers in the country in 1996, Dr Dan Ncayiyana (Director, Benguela Health) elaborated on the programme’s major problems, most notably the Cuban-trained doctors’ underperformance in the South African healthcare system. He based his observations on a study he conducted in 2007. “It needs to be emphasised, though,” Dr Ncayiyana said, “that the Cuban-trained students underperform in South Africa, not because they are stupid or know less than their South African counterparts. It’s just that they have a different kind of knowledge than South African-trained students.

Dr Dan Ncayiyana
"The Cuban medical system aims for preventative primary care which enables the country to achieve outstanding health indicators that are the envy of the entire world,” said Ncayiyana. The South African health system, conversely, aims largely for individual curative care within the public employment sector, and the two systems require doctors with different competencies, a different orientation and different mindsets.

This creates considerable problems in the South African health sector for the newly-qualified doctors, who had to learn a new language, endure Spartan living environs, change their diets completely – in short, change their lives radically (some argue ‘traumatically’) in order to obtain the qualification. “Cuban-trained doctors typically cannot deliver a baby, haven’t seen an HIV/AIDS patient, have not been exposed to trauma care, have not seen a snake bite, as there are no snakes in Cuba, and have not seen a dying patient,” related Dr Ncayiyana. “Consequently, (in the South African healthcare system) they have great difficulty coping with, and are stressed by the expectations of registrars and others in the busy and pressurised clinical settings.”

At the end of five years in Cuba, the students return for a final year of clinical orientation, but, according to Dr Ncayiyana, the majority of the students are unable to pass the South African final year examination, and it generally takes two years for the Cuban returnees to reach a level of clinical competence on par with that of their South African counterparts.

To remedy these obstacles, Ncayiyana suggested returning the students home sooner. “We shouldn’t wait until the fifth year, but bring them back after the fourth year to a medical school in the country.” This is done at UCT already, where the returnees are entered at a South African fifth-year level, and then receive ‘finishing’ training during a truncated sixth year.

He went on: “The second thing I think we should do is training them off the metropolitan campuses. We have seen that students who are trained in the regional and major community hospitals actually do very well in learning clinical skills and so on.” This should eliminate most competition with traditionally-trained students, and Ncayiyana expressed the hope that it would encourage the students to stay at these hospitals to establish their careers.

To conclude, he stressed that the Cuban programme is a necessary stop-gap to address South Africa’s doctor shortage, but that the solution is to increase the training capacity here. Also: “We need to be open to doctors who want to come and work in this country.”

Posted on Monday, May 27 @ 11:47:27 SAST by E-Doc
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HMR Africa


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