Learning to read from the same script

Nurse Elise Visser has spent her working life feeling as if she is wading through treacle.

Patients at her clinic in Worcester would have to see a number of doctors to be diagnosed, their treatment changing every time a different doctor handled them.

Today, Visser's life has been transformed and patients are getting better care. It's all thanks to a team from the University of Cape Town Lung Institute, whose simple but revolutionary primary healthcare methods are now being rolled out abroad.

The Practical Approach to Care Kit, or Pack, developed by UCT's Knowledge Translation Unit, maps out how to diagnose, manage and treat various common symptoms and chronic conditions.

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"At first I thought Pack was just a new thing that would create more work, but once I received training it opened my eyes," said Visser.

During training, doctors and nurses work as a team on real-life case scenarios so that everyone ends up speaking the same language.

"Traditionally, health services have trained workers separately with the expectation that they will return to their facilities and magically knit all the processes together, when in fact people were talking past each other," said the head of the Knowledge Translation Unit team, Professor Lara Fairall.

"Our training is aimed at fostering relationships so that healthcare workers can troubleshoot problems with one another," she said.

Pack has treatment plans for conditions such as HIV/Aids, TB, diabetes and hypertension, mental health, women's health and palliative care.

It also helps clinicians manage patients with more than one condition.

"It covers the more general things you see in the clinic, which helps a lot, and can deliver a better service because you have a standardised treatment for everything," said Visser.

"You know that everybody is doing the same thing and that patients are getting consistent treatment."

Continually updated with the latest evidence-based medicine and aligned with World Health Organisation guidelines, Pack empowers nurses to make diagnoses and provide treatment without consulting a doctor.

It also indicates which medications they can prescribe and when a doctor needs to be called.

Sister Claudia Gordon from Ceres Hospital said: "Before Pack, you had to diagnose out of your head and then go to a specific guideline based on the diagnosis you made yourself.

"Pack gives you so much confidence because you know you are within the prescribed guidelines of the Western Cape health department, so you are covered."

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The Pack programme is designed to be localised, making it perfect for adaptation to different communities with specific needs, and is being piloted in Nigeria and Brazil.

Brazilian GP Ronaldo Zonta said: "Pack is a game-changer for our nurses. They used to spend their time doing very bureaucratic work and not seeing any patients, but now they are doing more clinical procedures, which is good for the population.

"We've improved the quality of care for our patients."

Joseph Ana, a clinical evidence researcher in Nigeria, hopes to see Pack rolled out across all 36 states.

"We are currently in three states but we already have indications from other states that they want Pack."

Said Fairall: "In most parts of the world primary care depends on health workers who are not doctors. In South Africa, nurses provide the backbone for our almost 3,600 primary care clinics and have been instrumental in improving access to care, like scaling up antiretroviral treatment, which has saved many thousands of lives.

"They work tirelessly and often without much recognition. It is an honour to partner with them to provide a quality service to patients and communities."