For anyone who donates their time, money or skills to a worthy cause, it’s tempting to wish that it was possible to fix the world. For some, there are so many problems to overcome – many of which are so overwhelming – that it’s difficult to know where to begin.
At the Tshemba Foundation, we have a different view: small things can make a big difference with a slow but exponential impact over time. You just have to find the right levers.
Find small changes for a big impact
After many years of working in primary healthcare, I have been privileged to conclude my career with the Tshemba Foundation, a medical volunteer programme that gives medical professionals from around the world the opportunity to share their knowledge, skills and experience with primary healthcare providers.
The foundation was launched as a direct result of the founders recognizing that there was a need – specifically within the primary healthcare system in rural areas – and a belief that that they could find a way to contribute positively to improving rural health care by adding real, meaningful and measurable value to the deep and often systemic issues that our local healthcare system faces.
The founders engaged with the Mpumalanga Department of Health and the volunteer programme was established to collaborate with Tintswalo Hospital and the surrounding clinics in the area. Through a process of mutual learning and engagement, the programme has been fine-tuned since it was launched in 2017.
Finding the right ways to make a sustainable impact
The challenge with any volunteering programme is to have a sustainable impact, however. It’s important to be able to recognize the difference between big interventions that do not have longevity and the interventions that will measurably improve patient care and the lives of the nurses, doctors and staff in local hospitals and clinics.
This is a lesson I learnt for the first time four decades ago, but it’s as relevant today as it was then. In the 1980s, there was a passionate doctor who lived and worked at Tintswalo. He revamped the clinic and to secure a regular supply of medicines to every clinic in the area, he had a schedule that nurses had to follow each week to ensure timely delivery. When everything works, morale goes up. It was an incredible, cohesive team.
Unfortunately, within six months of that same doctor leaving, everything went back to the status quo. It was heartbreaking, but there was a clear takeaway – changes need to be sustainable. They can’t rely on a passionate champion who drives the entire initiative personally. It also gave another key insight – not every intervention needs to be huge and sweeping. Sometimes, it’s the small changes that can make the most significant differences.
Small levers, big wins
It all starts with the right attitude. Volunteers come with passion, fresh eyes and can immediately see the stumbling blocks and problematic processes that the local healthcare staff have learnt to deal with or just ignore.
The reality is that when you are working in an under-resourced system it’s all too common to find yourself in a rut, accepting the way things are instead of finding those small levers that will have a big impact. For example, recently a volunteering doctor noticed that the nurse’s cupboard in the surgery ward was in disarray and cost the nurses a lot of time and stress – something they had come to live with. But he didn’t accept it. He reorganised it for them. This may seem like a small thing, but there are two significant impacts. First, he actively improved the nurses’ lives and freed up time for them to focus on patient care. He also showed them that he cares – that type of morale boost is immeasurable. The nurses could not believe a busy doctor had taken time out to support them, which is team building at its best.
Everything we do tries to encompass how we can support local staff and boost patient care. At a clinic level, Inez Allin, a volunteer and our PHC Coordinator, has taken on a teaching role. She’s adding huge value, not only because of the patients she sees at the clinics, but because she is actively training nurses and clinic staff, giving them additional skills, boosting their careers (and confidence) and ultimately improving clinic care. Inez regularly shares how energised she feels when she interacts with patients and nurses, but what we see time and again is how that energy motivates the staff she works with.
The power of passion
It never ceases to amaze me what people can achieve if they are dedicated and passionate. Here’s just one example: In early 2020 at the start of theCovid-19 pandemic, everyone was trying to figure out what the local community needed. Nurses had high anxiety, not only because of the risks of Covid-19, but because they needed to be able to diagnose and test for a virus that no-one had encountered before.
Inez and five other volunteers had to determine how they could make the biggest and most sustainable impact, and it wasn’t through treating patients themselves – it was by assisting the 40 clinics in the area to be better prepared.
First, they designed a clinic manual that detailed how to treat patients with respiratory symptoms. Then they trained nurses in dealing with patient flows, administering Covid-19 tests and managing the entire process of patients coming in during a pandemic when social distancing needed to be maintained. Six volunteers ensured that we were able to put skills on the ground where they were desperately needed at short notice. Clinic staff felt very supported in an anxious time, and a whatsapp group kept everyone connected.
Yes, primary healthcare in South Africa still faces incredible challenges, which are complex in the extreme. Notable deficiencies relate to governance, leadership, staffing, equipment and infrastructure. At Tintswalo, we are thrilled to say that our hospital management is growing in confidence and capacity and we are happy to be supporting them wherever and whenever we are able. Improvements are slow but real and rewarding.
With the support of volunteers, we are able to keep our health workers motivated, plug key gaps and deliver a better overall health experience to rural communities.