Within the space of less than a year, a doctor has managed to turn a Mpumalanga hospital and its clinics into one of the jewels of the public health care system.

Dr Kobus Hugo, superintendent at Barberton Hospital, will at the end of this year retain two of his six community service doctors and trained most of the clinic sisters, an intervention that has already seen a dramatic reduction in unnecessary referrals from the clinics to the hospital.

“Look, it’€™s simple. You can sit and moan and moan, or you can do something about the situation,” said Hugo, who returned to Barberton after doing his internship at Temba Hospital, a rural hospital in Kabokweni near White River, several years ago.

“My friends and colleagues thought I was crazy taking a post in the public service, but it has been extremely rewarding despite all the hard work,” says Hugo, who doubles as the hospital’€™s soccer coach.

“The Nehawu chairperson is the assistant-coach, so we sort out many problems and hiccups next to the soccer field. By the time we sit down with the union around a table it is to discuss really serious matters,” said Hugo, who is quick to praise his staff for the remarkable turnaround at the Lowveld teaching hospital.

Shortly after his arrival in November last year Hugo identified that the clinic sisters were in desperate need of training, as were some of the interns “who arrive without being able to perform a pendicitis”.

“I realised that it was an impossible situation to send nurses to Pretoria for training. We just can’€™t afford to allow them to be absent from the clinics for long periods.

“With this system, whereby they are trained at the hospitals, it costs us about R150 per person per year and they learn about diseases they will be confronted with in their specific communities such as malaria or bilharzia,” Hugo explained.

He said there had been a huge reduction in referrals to the hospital since the training of the nurses started. Professional, well-presented and well-informed notes, now accompany those cases that are referred.

“You can’€™t separate your primary and secondary health. If your primary health care system (clinics) is battling, secondary health (hospitals) will ultimately struggle as well.”

As little as 15% of clinic nurses had primary health care training and many had been trained under the old system whereby they were never taught to make a diagnosis. “They know how to treat a condition once it has been diagnosed, but they don’€™t know how to make a diagnosis,” Hugo added.

He said less patients were now bypassing the clinics with community service doctors visiting the rural clinics for six months of their service year. This meant that nurses were being trained by these doctors and many patients, in some cases as old as 80 years, being seen by doctors for the first time in their lives.

Only about 15% of chronic cases were currently being treated at Barberton Hospital with the rest being seen at clinic level.

Dr Molly Smit, curative and diagnostic co-ordinator in the province, said they had supplied all the Mpumalanga hospitals with the same guidelines, but that it was up to the individual superintendents to run with it.

“Some of the districts are really getting involved while others are still getting there,” Smit said.

Hugo said one of his biggest challenges was to retain some of the community service doctors. “I can’€™t fight a system whereby young doctors are being offered $150 000 per year to work in Canada. My only tool is to try and stimulate them intellectually. I can’€™t compensate them financially.”

Four of the community service doctors were completing postgraduate diplomas in emergency trauma medicine. The two doctors who had opted to stay next year were travelling to Witbank Hospital one week out of a month to receive further academic training.

One doctor was earmarked to take charge of the paediatrics as well as the obstetrics and gynaecology departments while the other one would run the anaesthesia and surgery departments. Both were also receiving radiology training.

One factor in the community does however disturb Hugo: AIDS. “Look there is no doubt that AIDS has impacted a heck of a lot on us and will continue to do so. Already about 50% of our medical ward cases are AIDS-related.”