‘No doctors in our rural KZN town? Let’s train our own’

When Dr Andrew Ross joined Mosvold Hospital in Ingwavuma, 410km from Durban in KwaZulu-Natal in 1990, there were only five doctors caring for 110,000 people. Without resources to bring health care workers in, he decided to empower the community with medical training so they could eventually work in the hospital themselves. 

It was at the dawn of democracy in SA, 1990, when Ross joined Mosvold Hospital in Ingwavuma, 410km from Durban in KwaZulu-Natal, situated between the borders of Swaziland, Mozambique and the Pongola River. Five doctors were then working in the 250-bed district hospital, which serves 110,000 people.

In 1992 three doctors left Mosvold, leaving Ross with only two. “We’d contacted the provincial administration, who promised us doctors, but when the rubber hit the road no-one came,” says Ross.

A colleague at another hospital told him that as the person on the ground, staffing was essentially his responsibility. He advertised in the South African Medical Journal and the British Medical Journal, but mostly British doctors responded, eager to work in Africa. “South Africans generally didn’t want to come to rural areas.”

For a while, Mosvold had its staffing and funding challenges under control. But as the 1990s ended, it became harder for foreign doctors to work in SA. Ross ideally wanted SA doctors who could speak local languages, but found it difficult to entice them to come to Mosvold.

Watch this video below for more on Umthombo.

Then Ross had an idea based on research in Canada and Australia: “If we could find rural students and train them, they would be more likely to come to work, and stay, in a rural hospital. If this worked, it could solve our staffing problems and we’d have doctors who speak local languages.”

His inquiries faced much scepticism. It’s a bad investment, people said. Rural students often fail at university. The pass rate is poor. Plus, they promise to come and work but don’t. And it’s expensive, they added.

We wondered what we were going to do, but then said: “Let’s give it a crack.”

You need more than doctors to run a hospital

“We contacted all seven high schools in the Ingwavuma area, looking for the best students. Initially we were only looking for doctors but then we thought ‘you need more than doctors to run a hospital’,” Ross says. “You need a pharmacist, a dentist ... we had many doctors pulling out teeth. You must have decent hospital staff and not always just make a plan.”

Ross invited the area’s schools to send their top 10 students to the hospital for an open day. They showed about 100 students how a hospital works and the marks they’d need to enter a university health programme, and shared the idea of a scholarship programme.

The proposal was at first for four scholarships a year, under these conditions:

• the recipient had to be from the area;
• they had to get into a health course at university themselves;
• they had to volunteer at Mosvold Hospital in their area of interest to know what they’re getting into;
• they needed backing by a local selection committee of health care workers and community members; and
• they had to sign a year-for-year contract to work at Mosvold after graduating.

Ingwavuma community invests in scholarship scheme

Then came the hard part — raising money and getting community buy-in. Ross says: “I went to the tribal authorities and I said, ‘we’re starting a scholarship fund, we’re going to staff our hospital with locals who can speak the language but it’s very expensive. Is it possible that everyone in the area contributes R1?’

“It was a way to raise money from local communities and getting people to speak to their children to apply. Many children in rural areas think there are no opportunities. Then I asked the staff to each donate R50.”

“In January 1999, three guys came to me — Frans Nxumalo, Dumsani Gumede and Nkosingiphile Nyawo and said, ‘You said you were running a scholarship scheme. We have places at university, are you in?’ I had R30,000 in the bank. Each student needed about R70,000.”

At the time, Friends of Mosvold had an agreement with Mesab (Medical Education for SA Blacks) to contribute half of the university costs. So essentially, Ross had R60,000. But he needed more for books, accommodation, food and support. “We had to make sure they had the greatest chance of success,” he says.

The students went off to university, and the Friends of Mosvold yet again made a plan.

“We did a combination of things to raise money, writing letters, speaking to everybody we could. I wrote to the Swiss-South African Cooperative Initiative and I said I need R1.5m. And they wrote back and said, ‘Yes, we’ll give you everything you ask for.’ Now we had more money than we needed. We decided to involve three other hospitals in the area. By 2008, we were supporting 55 students.”

Umthombo produces 428 graduates and counting

Dr Gavin MacGregor became the new director in 2009, and in 2010 the Friends of Mosvold Scholarship Scheme changed to the Umthombo Youth Development Foundation. So far, the foundation has had 428 graduates across 18 health science disciplines.

To make Mosvold attractive as a training hospital for young doctors, Ross partnered with the Medical University of SA (Medunsa) and developed a postgraduate training programme in family medicine. “We sent flyers to 2,000 junior doctors. From that we got two people: Hennie Hamilton and Colin Pfaff. Hennie initially started at Bethesda Hospital but moved to Mosvold in 2004 where he is currently the CEO.”

Discovery invests in Umthombo

“The Discovery Fund began supporting Umthombo in 2001 and has to date contributed more than R15m towards their activities,” says Lisa Temkin-Todes, client relationship manager at Discovery.

So far, Discovery’s investment has helped 43 students graduate in 12 different disciplines, as seen in the infographic supplied by MacGregor. With the Discovery Fund’s investment, Umthombo is supporting 30 students at the moment, with future students set to benefit from it as well.

In 2006, the scholarship scheme became the first recipient of the Discovery Foundation Excellence Award to the value of R1m. “The amazing thing about that was it meant I could put a significant amount of money into supporting our students. And it allowed me to employ Ruth Osborne, an organisational development person, to help me with the fundraising and think about the future of Friends of Mosvold,”Ross says.

Umthombo now supports about 250 students every year. “About 98% of graduates fulfil their work-back obligation and 60% stay in rural areas after it’s finished,” Ross says.

The impact? Well-resourced hospitals in rural settings with local employees, offering comprehensive health care services to rural communities. And that’s how you do it in Ingwavuma.

This article was paid for by the Discovery Foundation.