Dr Robert Caldwell (Mullins 1962) with a PhD on his 50th Anniversary as a Medical Doctor

UKZN Staffer Graduates with a PhD on his 50th Anniversary as a Medical Doctor

Specialist physician, Dr Robert Ian Caldwell from UKZN’s School of Clinical Medicine graduated with a doctoral degree in Medicine in the year that he celebrates his 50th anniversary as a Medical doctor. Caldwell’s study is entitled: A Description of Specialist Outreach in Western KwaZulu-Natal (2007-2015), with Assessment of its Functioning and Prognosis. The research is the first of its kind in South Africa and it is hoped that its findings will influence the inclusion of a permanent multifaceted specialist outreach programme in the National Health Insurance.

Medical specialists’ services are rare in rural KwaZulu-Natal and non-existent in many hospitals, prompting patients to travel long distances to the city to obtain treatment. Specialist outreach services are described as a range of services offered in outreach areas where patients do not have access to a central or tertiary hospital with in-house specialists. Outreach, including specialist outreach, is defined by the World Health Organization as ‘any type of health service that mobilises health-workers to provide services to the population or other health-workers, away from the location where they usually work and live’.

Caldwell explored the use of multifaceted specialist outreach (MSO) which includes two or more discrete interventions, such as liaison with medical staff, ‘problem’ ward-rounds, formal teaching, etc, in western KwaZulu-Natal as a means of providing equitable healthcare to disadvantaged rural citizens.

Commented Caldwell: ‘MSO is not a new concept in South Africa or in the province. Pioneers like Drs Neil McKerrow and Jim Muller started the service at least 30 years ago. In 1998, the project received a boost with the signing of a 10-year contract between the Department of Health and the Red Cross Air Mercy Service, which enabled the regular flying of groups of doctors to a succession of hospitals in the course of a day. Unfortunately, this contract has lapsed and limps along from month-to-month. It is hoped that this thesis will facilitate its resumption.’

Caldwell was appointed as an Outreach Consultant for the Pietermaritzburg Department of Internal Medicine in 2007 to provide specialist cover for peripheral hospitals in western KwaZulu-Natal. From 2007 to mid-2014, he made 481 hospital visits, which included visiting seven hospitals (out of 21) more than 40 times each. A total of 3 340 medical personnel contacts were made, and 5 239 patients were seen. This involved almost 200 flights and 300 road trips. Other internal medicine specialists from Pietermaritzburg undertook an additional 199 visits, during which they made 1 157 personnel contacts and saw 2 020 patients.

Recalling his experiences: Caldwell said, ‘The planned visits to hospitals took place on a specific day of the week and were designed not to coincide with visits from other specialties. Visits were occasionally cancelled because of bad weather when travel took place in single turbo-prop Swiss Pilatus aeroplanes. An AMS road vehicle was provided where no suitable airstrip was available. The visits were extremely successful and included ward rounds, meetings with other doctors regarding difficult cases and teaching of medical students.’

The overall results of the study indicate that there is a permanent need for MSO, together with a reliable air and road transport system. Specialist outreach services benefit rural patients as travelling long distances for these services is no longer required, resulting in better health outcomes. However, Caldwell believes that further research is required to ascertain if MSO should be a prerequisite for all specialists; one would still need to determine how much of their time should be dedicated to outreach activities.

He dedicated his thesis to the Red Cross AMS, especially Mrs Kogie Naidoo who heads up the Durban operation. Caldwell also thanked his wife, ‘Dr Patricia Caldwell is a UKZN staff member – Honorary Researcher in Plant Pathology with a Distinguished Teacher’s Award, and a PhD graduate of Natal University. I am always grateful to her for her support and sound academic advice.’

Caldwell’s supervisor, who is featured as one of UKZN’s Top 30 researchers, Professor Colleen Aldous commented, ‘What’s remarkable about Doc’s story is that this is his 50th year since graduating as a doctor. That makes his thesis a great gift to our science, based on years of experience and development of deep wisdom.’

Words and photograph: MaryAnn Francis