FHS Annual Report 2013
PRIMARY HEALTH CARE DIRECTORATE
INTRODUCTION
The vision of the Primary Health Care Directorate is a Health Science Faculty that
promotes equity and quality in health care, guided by the primary health care
approach. The Directorate aims to promote the primary health care approach in
teaching, research, policy, health services and community engagement by the
Faculty of Health Sciences.
Its objectives are to integrate a primary health care approach into the faculty’s
undergraduate and postgraduate curricula by means of extending and developing
the faculty’s clinical teaching platform in rural and primary care sites; deepening
community engagement within the health service and the faculty’s curricula;
enhancing the recruitment and support of students of rural origin in the faculty; and
increasing inter-disciplinary research in health sciences.
The mission of the PHC Directorate is to promote equitable, comprehensive,
compassionate and quality care at all levels of the health system by means of: the
recognition of diversity and culture; evidence-based practice and policy; active
health promotion; community-based education; and strategic partnerships.
HIGHLIGHTS
Medicine and the Arts
A new postgraduate Medicine and the Arts course which commenced in 2014 was
designed by Prof Reid and Dr Susan Levine, Dept of Social Anthropology. The
course contributes to new interdisciplinary research initiatives underway at UCT, and
provides an unparalleled opportunity for students from the Health Sciences and
Humanities to engage with the production of knowledge of and about the body,
from multiple perspectives. The course also provides an intellectual platform for
students to explore new possibilities, already activated on the global stage, about
the ways in which the arts can constructively engage with medical pedagogy and
practice, and to engage in key debates relating to medicine, the arts and medical
anthropology.
Promoting Rural Health
A portion of a faculty 1.2m Atlantic Philanthropies 3-year grant dispersed to the
PHCD was utilized to encourage the recruitment of health sciences students from
rural and underserved areas, support them to develop leadership skills, better
prepare medical students for rural practice, and contribute overall to health equity.
The PHCD worked to raise the profile of rural health amongst the students and
faculty; to expose an increasing number of students to rural situations via the subsidy
provided for 5th year rural electives; to raise awareness amongst rural learners about
health careers and processes to be followed to become health professionals in
future; and to expose students to leadership through workshops and practice whilst
leading their student societies.
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Interdisciplinary Work
James Irlam brought together a workshop on Trans-disciplinary and Inter-disciplinary
(TDID) Research in the faculty, which has the potential for increasing research
output. The statistics from around the world show that the output of those universities
that have deliberately created an enabling environment for interdisciplinary
research, has increased exponentially, as compared to those who continue
ploughing the same furrows within their disciplinary boundaries. Although a lot of the
work done at the PHCD is interdisciplinary, this is not the case for most departments,
and one of our core functions is to initiate and stimulate this kind of thinking within
the faculty.
Curriculum Revision
The faculty-led Curriculum Revision Task Team (CRTT) chaired by Prof Reid met for
their final meeting in October 2013 to review what has been achieved since the
inception of the Task Team in August 2010, evaluate if the major objectives have
been served and to bring clarity to the way forward with respect to salient issues that
remain a work-in-progress and will be taken up by the MBChB Programme
Committee. Initial revisions to the 4th year curriculum would take effect in 2014
including the introduction of primary care Paediatrics, incorporating additional onsite student clinical work, inclusion of alternative off-campus sites, home visits, and
integrating PHC themes and learning outcomes across the curriculum. Revisions to
the 6th year curriculum would continue to be interrogated with the aim of exploring
the implementation of a longitudinal 6th year programme in George or other
community-based off-campus sites on the expanded teaching platform, and
interrogating workable models. Task Teams would continue to examine graduate
attributes in relation to templates that were designed to identify and integrate PHC
principles across the major themes of human rights; inter-professional teamwork;
communications & cultural competence; evidence based practice; life-long
learning; bio-psychosocial approach; ethics; gender & sexuality (LGBT); SHAWCO
Health Proposal; and oral health. The curriculum mapping process which was halfway through, would also be completed. The Culture, Psyche and Illness thread of
the MBChB was reviewed leading to a clarification of outcomes and strategies.
Visiting Scholars
Prof Stewart Mennin, an expert in curriculum reform from the University of New
Mexico, was invited by Prof Reid to run a workshop on “Curriculum Change &
Models” at the faculty in September 2013 on the vital subject of curriculum revision,
curriculum models and the challenges of curriculum changes pertaining to the
MBChB undergraduate early and clinical years. The workshop interrogated the
numerous complex issues at play including what rules can be instituted to synergize
teachers and learners; how size can be used advantageously; how a teacher
delivery model (one speaking to many) can address the fact that size is unlimited
and inversely proportional to engagement and meaningful exchange; how basic
rules of working together can be better understood and instituted; which curriculum
models could work within our context; and how to examine the basic unit of
function, which is learning not content.
Prof David Hirsch, Assistant Professor of Medicine at Harvard Medical School and
Director and co-founder of the Harvard Medical School-Cambridge Integrated
Clerkship, was invited to present to the faculty in August 2013 on “The Case for
Curricular Integration: What Harvard’s Longitudinal Integrated Clerkship teaches
about educational design”. Prof Hirsch is an expert in the so-called ‘Longitudinal
Integrated Clerkship’ model of teaching, in which clinical students undertake their
learning in each discipline over a whole year ‘longitudinally’ rather than ‘vertically’
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in blocks. The Harvard Medical School Cambridge Integrated Clerkship story has
much to say about educational transformation and will be helpful to open ideas
about our final year MBChB curriculum revision.
Conference Presentations
Prof Reid, Dr Michaels, Claudia Naidu and James Irlam gave oral & poster
presentations at the SAAHE 6th National Conference on “The relationship of health
science faculties to their health service partners: implications for clinical teaching in
SA”; “Peer review for social accountability of health sciences education: a model
from SA”; “The home visit: still a feasible teaching tool for medical students? A pilot
study for curriculum revision”; “A system that is constantly trying to shape you in a
different way - student’s perspectives on being a good doctor”; “Career and
practice intentions of health science students across three SA medical schools”; “A
review of the Wits University medical students’ community-based health promotion
service learning projects in SA”. James Irlam gave oral & poster presentations on
“Advocacy for a health energy policy: the experience of a national roundtable
process” at the RuDASA 17th Rural Health Conference and the 9th PHASA
Conference; “Micronutrient supplementation in children with HIV infection: a
Systematic Review for the HIV/AIDS Cochrane Review Group” at the African
Cochrane Indaba; and “A cost-effective strategy for primary prevention of acute
rheumatic fever and rheumatic heart disease in SA children with pharyngitis” at the
UCT SCAH Research Day. Prof Reid gave oral presentations on “Why we do what we
do: the philosophy of rural health” at the RuDASA Conference and “Medicine and
humanities in conversation” at the WiSER Body Knowledge Medical Humanities in
Africa Conference.
DEPARTMENTAL PROFILE
The PHC Directorate staff profile in 2013 included 24 staff members: 1 professor &
Director of the unit; 2 senior lecturers; 3 lecturers; 3 honorary lecturers;1 junior
research officer; 1 health teaching platform manager; 4 site facilitators; 2 NGO
facilitators; 1 facility manager; 4 site coordinators; and 2 admin staff.
The Directorate has strived to build a diverse, high quality staff profile as well as an
academic staff profile which promotes equal opportunity, encourages
development and adds value to the teaching experience of a diverse student
population.
Honorary Lecturers
Dr Ben Gaunt, the Clinical Manager of Zithulele Hospital - a remote district hospital in
the Eastern Cape - and Dr Karl le Roux, the Principal Medical Officer have together
been powerful role-models for students with respect to delivering primary care
services, leadership and teaching, and their understanding of the PHC approach.
They have addressed staff and students on rural health and presented the 4th year
MBChB rural health block seminars, highlighting the challenges and rewards of
working at the rural coalface, thereby promoting the agenda of PHC in the faculty.
Dr Rob Baum is an experienced academic in the field of dance and movement
therapy and has brought in a trans-disciplinary approach to medical teaching. She
has contributed to the Directorate publications output in the areas of dance
movement therapy, transgenerational trauma and health, and the transformation of
the body through art praxis.
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GOVERNANCE
Prof Reid was an invited reviewer for the VLIR-UOS Team Uganda 2013 project
proposals and a manuscript reviewer in the Journal of Child and Adolescent Mental
Health on “Improving mental health and well-being for young men in the building
and construction industry”. He co-convened the Gordon Institute for Performing and
Creative Arts (GIBCA) Medical Humanities Public Lecture Series; was a musical
participant in the faculty Unplugged Series music and literary concerts; a member of
the SA organizing committee on “PH and Climate Change & Health” for the
Worldwide Universities Network (WUN) Global Challenge Health 2014 Conference;
the academic lead & coordinator of the WUN Resilience in Young
People/Adolescents Working Group; the African Palliative Care Association and
HPCA Conference workshop chair on “Creative and artistic encounters in palliative
care: developing a community of practice in Africa”; Dira Sengwe Conferences
board-member and Bravery Award presenter at the 6th SA AIDS Conference;
plenary speaker on the “National Health Insurance Pilots” at the PHASA Conference;
and roundtable discussion leader on “How to capture the patient perspective and
an independent view of health service quality” at the Provincial Quality
Improvement and Patient Centered Care Research Day.
Aside from numerous ongoing UCT and external committee memberships Prof Reid
was a member of the following new committees in 2013: DoH Specialized &
Emergency Services Access to the Service Platform Working Group; DoH HRH
Strategy Rural HRH Task Team; UCT Health Economics Unit Integrated School Health
Programme Task Team; Joint UCT/Stellenbosch University Expansion of the MBChB
Programme Committee; Nelson Mandela Metropolitan University Expert Reference
Group for the establishment of a new medical school in Port Elizabeth; DoH National
District Clinical Specialist Teams Steering Committee; Academy of Science of South
Africa (ASSAF) Standing Committee on Health.
James Irlam chaired the FHS Professional Standards Committee; was a PHCD
representative on the FHS Assessment Committee and FHS Research Committee;
Dr Lauraine Vivian was an invited expert reviewer on the Anthropology &
Development Studies Panel for the NRF Postdoctoral Programme. Sarah CrawfordBrowne was an expert participant in the Centre for Study of Violence and
Reconciliation’s research in Developing an African Torture Rehabilitation Model, and
facilitated a session for first year academic support.
TEACHING
Undergraduate
Prof Steve Reid lectured on the 1st year MBChB Becoming a Health Professional
course giving an overview of primary health care (PHC); the key principles of the
PHC approach; the different levels of the PHC system; and PHC & comprehensive
care. He lectured on the 2nd year MBChB Becoming a Doctor Part 1A course
providing an orientation for becoming a doctor; an introduction to health promotion
(HP) and approaches; the principles of health communication and development of
mass media; an introduction to behaviour change theories to address cultural
beliefs and practices; HP ethics; health rights; and the principles of PHC.
Prof Reid, Dr Lauraine Vivian, Johannah Keikelame/Dr Des Michaels, James Irlam
and Sarah Crawford-Browne lectured on the 2nd year BSc(Sp&Aud) Becoming a
Communication Therapist, the BSc (OccTher) Occupational Therapy 2 and the
BSc(Phys) Applied Physiotherapy 1: Disability in Primary Health Care courses on the
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integration of the PHC approach into the Allied Health Science (AHS) curriculum; an
introduction to HP; behavior change theories and approaches; and the planning of
a HP project.
Prof Reid, Dr Vivian and Sarah Crawford-Browne lectured on the 2nd year MBChB
Integrated Health Systems course on alternative medicine perspectives; ethical
issues; belief systems; bio-psychosocial and cultural issues; and relevant PHC
principles. Prof Reid and Dr Vivian lectured on the 4th year MBChB Medicine course
on teaching PHC at the patient’s bedside at GF Jooste Hospital and integrating the
PHC approach into clinical rotations in medicine.
Prof Reid, Johannah Keikelame/Dr Michaels, James Irlam, Dr Ben Gaunt and Dr Karl
le Roux lectured on the 4th year MBChB PHC/HP course covering a range of topics
including HP ethics and health rights; community participation and partnerships;
behaviour change theories and HP approaches; Ottawa Charter actions; planning
cycle process and health communication for behavior change; rural health; poverty
and inequality; access to services; nutrition; maternal and child health challenges
facing rural doctors; equity in health; health for all; principled health care; the PHC
lead theme; patient rights; the role of doctors; advocacy; communities; right to
health; putting PHC principles into practice; the PHC approach; district health
systems; the Alma Ata Declaration; and millenium development goals.
James Irlam lectured on the 2nd year MBChB Integrated Health Systems Part 1A
course on RCT evidence for TB; the 3rd year MBChB Integrated Health Systems Part 2
course on evidence for causality ; and the 4th year MBChB Public Health (PH) course
on an introduction to the PHC approach, equity and health, and evidence-based
practice. He is the convener of the 5th year MBChB PHC Electives..
Dr Vivian and Sarah Crawford-Browne lectured on the 2nd year MBChB Integrated
Health Systems course on culture, psyche and illness; bio-psychosocial and cultural
issues; and relevant PHC principles. Dr Vivian lectured on the 5th Year MBChB
Paediatrics course on integrating the PHC approach into clinical rotations in
paediatrics. Johannah Keikelame was the the 4th year MBChB Health Promotion
course convener, with Dr Des Michaels taking over the role when she went on
sabbatical to complete her PhD.
Special Study Modules (SSMs):
Prof Reid convened an Arts and Healthcare SSM together with Dr Patrice Rapar from
the University of New Mexico (UNM) exploring the links and integration of the
creative/expressive arts and health care in the South African (SA) context including
music, visual arts, dance and movement, creative writing and drama. 7 UCT
medical students were joined by 7 senior students from UNM who were participants
in a College of Fine Arts initiative designed to promote and support courses based in
community-engaged learning, affiliated with the UNM clinical Arts-in-Medicine
programme.
Prof Reid also convened a Stories of Illness SSM together with Dr Dawn Garisch where
students explored through a literature search and observation how practitioners of
medicine and of the arts use language to describe illness, investigated the strengths
and weaknesses of both approaches, and researched the benefits and limitations of
narrative medicine and other story-based approaches to promoting healing and
well-being.
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Prof Reid and Dr Michaels convened a 3rd SSM on the Follow-up of Patients after
Discharge from GSH Hospital. Sarah Crawford-Browne supported Prof Reid and
Dr Rapar’s SSM students, and Dr Michaels 4th year students in developing digital
stories and convened an SSM on Developing Media for Research Participants.
Johannah Keikelame convened an SSM on Using Observations to Understand
Factors Impacting on Care of Patients with Epilepsy in which one of her students,
Sbongiseni Mashinini, presented a poster at the FHS Undergraduate Research day
winning a prize of R1000. James Irlam supervised a SSM study at Woodstock CHC on
non-adherence to diabetes and hypertension medication.
Postgraduate
Prof Steve Reid lectured on the Masters in Public Health MPH course on PH & society
as well as on the Masters in Family Medicine MMed course on community oriented
primary care. James Irlam convened and lectured on the Masters in Public Health
MPH course on evidence based health care. He also lectured on evidence based
practice on the Masters in Occupational Therapy MSc (OT) course; and on the
Diploma in Family Medicine course for family physicians. Dr Lauraine Vivian lectured
on the Masters in Genetic Counselling MSc(Med) course and the Masters in Family
Medicine Health & Culture course. Dr Michaels lectured on the Mphil in Maternal
and Child Health course on research ethics. Sarah Crawford-Browne lectured on the
Masters in Social Justice, Law and Poverty course and the Masters ICTs in Education
course. Johannah Keikelame & Dr Vivian lectured on the Vision 2020 Diploma in
Community Eye Health course. Johannah Keikelame lectured on health promotion
on the Allied Health Sciences OT Masters course and the Ophthalmic Nursing and
Nephrology Nursing in Primary Care Settings Diploma courses.
TRAINING
MMed Research Methods for Registrars Workshops were conducted in June and
November 2013 with the purpose of strengthening research capacity of Registrars
within all departments. The two-day Saturday workshops included: Research
hypotheses; selection and sampling; quality control of measurement; systematic
reviews; ethical issues; case-control, cross-sectional and cohort studies; collecting
and organizing data; data management; hypothesis testing; and library literature
reviews.
RESEARCH
The PHCD produced 11 peer reviewed journals, 1 book chapter and 10 articles &
letters to the editor in non-accredited journals on a broad range of primary health
care foci, namely, a) Interventions for squamous cell carcinoma of the conjunctiva
in HIV-infected individuals (James Irlam) b) Understanding of Family Medicine in
Africa: a qualitative study of leaders’ views (Prof Reid) c) Lost opportunities to
improve health literacy: Observations in a chronic illness clinic providing care for
patients with epilepsy in Cape Town South Africa (Johannah Keikelame) d)
Communities’ views, attitudes and recommendations on community-based
education of undergraduate Health Sciences students in South Africa: A qualitative
study (Prof Reid) e) Primary prevention of acute rheumatic fever and rheumatic
heart disease with penicillin in South African children with pharyngitis: A costeffectiveness analysis (James Irlam) f) A lay carer's story about epilepsy in an urban
South African context: They call it an illness of falling or an illness of fitting because a
person shakes and eventually falls (Johannah Keikelame) g) Qualitative exploration
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of the career aspirations of rural origin health science students in South Africa (Prof
Reid) h) Micronutrient supplementation for children with HIV infection (James Irlam)
i) Internship training adequately prepares South African medical graduates for
community service – with exceptions (Prof Reid) j) A cost-effective strategy for
primary prevention of acute rheumatic fever and rheumatic heart disease in
children with pharyngitis (James Irlam)
k) Career and practice intentions of Health Science students across three South
African Medical Schools (Claudia Naidu & James Irlam) l) The transformation of
medical education in South Africa (Prof Reid) m) Human resources for Family
Medicine in Africa: a qualitative study of leaders’ views (Prof Reid) n) The
Contribution of Family Medicine to Improving Health Systems: A guidebook from the
World Organization of Family Doctors, Chapter 7: “The African family physician:
Development of family medicine in Africa in the twenty-first Century, 247-265 (Prof
Reid) o) The Peoples’ Health Movement: An opportunity to put climate change and
occupational health onto a social justice agenda for health (James Irlam) p)
Advocacy for a healthy energy policy – The experience of a national consultative
process (James Irlam) q) Opinion piece: “Time to push for a healthier national
energy policy” (James Irlam) r) The Chronicles of Chapota 1927-1943, Queen’s
College Record, The Historical Record: 27-30 (Dr Vivian) s) Letter to the Editor:
“Cleaner = Healthier” (James Irlam) t) Challenging medical knowledge at the
source – attempting critical teaching in the health sciences (Sarah CrawfordBrowne) u) Letter to the Editor: “Creatures of hope” (James Irlam) v) Peer Review for
Social Accountability of Health Sciences Education: A model from South Africa (Dr
Michaels, Claudia Naidu & Prof Reid). External authors not noted above.
Prof Reid was engaged with a number of ongoing research projects spanning the
themes of Human Resources for Health, Medical Education, Primary Health Care,
Family Medicine in Africa, and Creativity in Health. Ongoing projects include: Career
aspirations of rural origin students; exit surveys of compulsory community service by
doctors and dentists; evaluating the performance of initiatives to recruit and retain
health workers in a rural district; social accountability outcomes of medical
education; impact of undergraduate students on service delivery in the district
health service; admission processes at SA medical schools; rural-based medical
education - principles of practice; global consensus on social accountability;
responding to health needs of the population - striking a balance between
generalists and specialists; the implementation of community-oriented primary care;
continuity of care at the primary level of care in the SA public service; PGWC
community cased services (CBS) support project: intermediate care policy for the
WC DoH; access to the service platform (PGWC); patient-centered experiences
(PGWC); an evaluation of the utilization of the Discovery Health ID; resilience in
young people/adolescents (Worldwide Universities Network); pathways to care of
the critical ill child: epistemological crossroads on the ‘pathways to care’; evaluation
of CBS in the Eden and Metro districts of the Western Cape: formative assessment for
the development of a revised provincial framework for CBS; stakeholder views on
family medicine in Africa; creatively caring project at South Coast Hospice;
enhancing creative process in hospice and palliative care in South Africa: Arts in
Medicine; and the potential of systematic patient narratives to improve the
pathway to hospital care.
James Irlam completed a cost-effectiveness study with a research group in the Dept
of Medicine that showed that a simple clinical decision rule (CDR) to diagnose
pharyngitis in children in primary care followed by a single dose of intramuscular
penicillin is the most cost-effective strategy for primary prevention of rheumatic heart
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disease (RHD) in South Africa. He initiated an inter-disciplinary study in the faculty
that is examining the development of agency in undergraduate students. He
provided technical assistance with a review on therapeutic hypothermia for
neonates. He was an associate staff member of the SA Cochrane Centre that
promotes the science and dissemination of systematic reviews.
Johannah Keikelame was on sabbatical from June completing her PhD through
publication on ‘Perspectives on epilepsy on the part of patients and carers in a SA
Urban Township’. She has had 3 articles accepted for publication in peer reviewed
journals.
Dr Karl le Roux an Honorary Lecturer in the PHCD, was the principal investigator in
the Zithulele Birth Follow Up Study (ZiBFUS) in the Zithulele and neighbouring regions
of the Eastern Cape Province that has been designed to gather information about
infants in the first year of life. Due to a lack of resources and limited infrastructure,
there is little existing data about some of the most basic indicators of quality of life in
this region. The study, following mother and child for a period of one year, aims to
build a comprehensive picture of infant disease and mortality. It also examines a
wide range of topics such as access to healthcare and immunizations, feeding
practices, HIV status and care, social support, maternal mental health, food security,
and more.
Claudia Naidu was engaged with her PhD research on ‘An evaluation of the
development of social accountability of medical graduates at UCT’.
Sarah Crawford-Browne continued with her PhD research on ‘Meaning constructions
about violence and psychological adjustment amongst women residing in a high
violence community’ and in conversation with post-doctoral fellow Alex Muller,
considered the role of critical theory in health education. With Marion Heap and
Rulisha Chetty, she considered the value of digital storytelling in health education.
Christolene Beauzac continued with her PhD research on ‘Regulating the body:
health promotion and diabetes in the Western Cape, South Africa’.
SOCIAL RESPONSIVENESS
James Irlam represented UCT on the Climate Change Committee and the Climate
Change Adaptation Working Group in the provincial government. He co-convened
a provincial workshop on Energy and Health, which culminated in an oral and
written submission to the Dept of Energy on the public health implications of the
Integrated Energy Plan (IEP) and the Integrated Resource Plan 2010. He co-hosted
and presented at a workshop on the Health Effects of Climate Change at the
annual conference of the Public Health Association of South Africa (PHASA) and
published the summary findings of the three provincial Energy and Health workshops
in the PHASA newsletter. He addressed meetings of the Centre for Environmental
Rights (CER) and the One Million Climate Jobs (OMCJ) campaign about this work.
He was a member of the CHEER peer review team at UWC in February 2013 and
reported back on the team’s findings in September 2013 to the executive members
of the UWC faculties of health sciences
Claudia Naidu’s PhD will contribute to a longitudinal view of the development of
social accountability in medical students and graduates as they progress through
the system.
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Sarah Crawford-Browne was a consultant for the Worcester Hope
Reconciliation Project’s support of survivors and victim-offender dialogue.
and
AWARDS/HONOURS
Prof Reid and Dr Vivian are NRF C-rated researchers recognized by their peers as
leading international scholars in their field for the quality and impact of their
research outputs.
NEW DEVELOPMENTS
World Universities Network (WUN) Resilience in Young People
The theme of “Resilience in Young People in Different Cultural Contexts” was
conceived at a Washington DC meeting in 2013, and a small group headed by Prof
Reid put together a RDF proposal to WUN which was successful, backed by pledges
from a number of WUN universities. This allowed a group of 15 to meet for two days
in Cape Town just prior to the larger conference on Climate Change and Public
Health, in order to develop the initial ideas into feasible research projects. Two
research projects were conceptualized - one focusing on resilience in young people
and the promotion of positive adaptation, resilience and well-being in migrant
youth; the other focusing on the resilience of professionals (such as teachers and
health workers) who promote the health of young people and how they adjust
positively to occupational adversity over time.
Clinical Teaching Platform
As chair of the Clinical Teaching Platform Committee, Prof Reid has been responsible
for assisting the Faculty with interrogating the needs and development of the clinical
teaching platform, together with Frank Molteno.
The above diagram illustrates the current platform (at the top of the diagram) and
the planned expansion (at the bottom of the diagram). The implementation of this
has been delayed by the Multi-Lateral Agreement (MLA) process with the Provincial
Government Department of Health.
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The following key questions were raised in 2013 and continue to be grappled with:
 What is the right balance in teaching capacity at different levels of care?
 What teaching & learning activities are currently happening at each
level/site?
 What should the size and shape of teaching at the level/site ideally be?
 What are the next steps to facilitate the establishment? Of the ideal learning
site, and how could this be funded and sustained?
 Does the clinical teaching platform at community, district, secondary and
tertiary level need to expand, stay the same, or decrease?
 If it does need to change, in which departments and by how much?
A number of iterations of a business plan have been put forward for the
development of a campus in the George “complex” in the Eden district which
includes Mossel Bay, Knysna, Oudtshoorn and Beaufort-West district hospitals. These
include the placement of final year medical students in a longitudinal integrated
curriculum for the whole year in the complex, which requires changes to the MBChB
curriculum in order for the experience to be equivalent to that offered in Cape
Town. The components of the plan are illustrated in the diagram below.
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