A humbling experience in Durban

Published: 04 November 2009

Jill Hill reports on the International Council of Nurses Congress in South Africa, and describes a very different health care system from our own.

I was very privileged to be invited to speak about diabetes management in the UK at the 24th Quadrennial Congress of the International Council of Nurses in July, held in Durban, South Africa. Mind you, when I agreed to do it, I didn't realise how far away Durban was!

The conference ran from 27 June to 4 July 2009 and attracted nurses from all over the world. Some nurses worked in very sophisticated health care systems, with plenty of resources like our own NHS. However, some nurses worked in incredibly difficult situations, particularly those from Africa. Listening to stories of a single nurse caring for a ward of 90 patients, half of them lying on the floor, made the concerns we have working in the NHS seem very trivial.

Change is coming

The health care system in South Africa is set to undergo a radical overhaul. Interestingly, there is a drive away from all nurses being registered and being university trained, and a commitment to the re-opening of colleges of nursing and the revival of the enrolled nurse. The use of physician assistants will increase too. The shortage of nurses and doctors means South Africa cannot always afford the luxury of highly qualified staff. Under the apartheid system, most black South Africans were not able to study subjects like mathematics and sciences in much detail at school. This meant that many very capable nurses could not access university training to become registered nurses, and the effects of this are still being felt today.

More resources have been promised to improve primary care, with a move back to community clinics staffed by local experienced "hands-on" nurses, so patients do not have to travel long distances to hospital clinics for relatively minor treatments and investigations.

Inequality

There is huge inequality in the country's health system, which is a mixture of public and private. A total of 8.5% of GDM (gross domestic product) is spent on health, with 5% of GDM spent on the 14% of the population who are in the private health system, while the remaining 3.5% is spent on 86% of the population who rely on the public health system.

Losing nurses and doctors to the developed world is still a big problem. There are four universities that train 1,200 doctors annually in South Africa, but only 25% of the newly-qualified doctors from one of those universities remain to work in the country.

A rapt audience

HIV/AIDS and TB were the big topics of the conference as you can imagine. Diabetes is a growing problem too, and the room in which I spoke was packed with people sitting on the floor and crowding in the entrance! Speaking about the availability of insulin, devices, and oral medications in the UK was almost embarrassing in the presence of the African nurses. However, being able to talk about the economies of scale achieved through group education, and the use of our Band 4 staff to educate people with type 2 diabetes, instead of expensive nurses, was relevant in a health economy that has to use scant resources wisely.