British doctors’ experiences of working in rural South Africa: The London GP Out of Programme Experience

Background: A paucity of research exists that has examined temporary placements of foreign health professionals in South Africa (SA) as a possible strategy for addressing health worker shortages. The Out of Programme Experience (OOPE) initiative, run by the London GP Deanery, aims to provide a sustainable inflow of British, trainee GP doctors into rural public health facilities in SA. Objectives: The present study explored the experiences of these British doctors working in rural hospitals in SA as part of their OOPE. The reasons and motivations underlying their decision to come to SA were also examined. Methods: In-depth interviews were conducted with fifteen British doctors who were currently working, or had worked in the past, as part of OOPE in rural health facilities in SA. Interviews were transcribed and analysed using thematic analysis. Results: The first theme that surfaced from the interviews was that the most common reasons underlying these doctors’ motivations for coming to SA related to: the type of diseases and advanced pathologies that they would encounter; the challenge and opportunity for professional growth; and the difference in work environment that would confer on them greater responsibility and autonomy, compared to working in similar positions in the British National Health Service. The second theme, central to the participants’ narratives, was the accelerated period of learning that they experienced whilst in SA. Exposure to new and unfamiliar medical cases, a greater level of autonomy and decision-making authority, and resource shortages forced greater reliance on their clinical skills and judgment, which contributed to their professional development. Conclusion: The doctors’ believed the OOPE enhanced their clinical skills and competencies. The findings provide some evidence that attests to the OOPE’s potential to benefit both host facilities and the participating foreign doctors. The findings of the study have practical implications for the further development of programmes to fill vacant posts for health workers in rural South African hospitals. Agtergrond: Daar bly ’n gebrek aan navorsing met betrekking tot tydelike posisies vir buitelandse professionele gesondheidswerkers in Suid-Afrika (SA) as ’n moontlike strategiese oplossing vir die tekort aan gesondheidswerkers in die land. Die ’Out of Programme Experience’ (OOPE) inisiatief, wat deur die ‘London GP Deanery’ georganiseer word, se doel is om ’n volhoubare invloei van Britse dokters-in-opleiding aan plattelandse openbare gesondheidsfasiliteite te voorsien. Doelwitte: Hierdie studie het die ervarings van hierdie Britse dokters, wat as deel van die OOPE-program in plattelandse Suid-Afrikaanse hospitale gewerk het, verken. Die onderliggende redes en motivering vir hul besluite om na Suid-Afrika toe te kom, is ook ondersoek. Metodes: In-diepte onderhoude is met 15 Britse dokters gevoer wat huidiglik, of in die verlede, in plattelandse gesondheidsfasiliteite in SA gewerk het as deel van die OOPE-program. Die onderhoude is getranskribeer en tematiese analise is gebruik om dit te analiseer. Resultate: Die eerste tema wat uit die onderhoude geïdentifiseer is, is dat die mees algemene redes hoekom hierdie dokters na SA gekom het verband hou met die tipe siektes en gevorderde patologie wat hulle in SA sou teëkom. Die tweede tema wat geïdentifieer is, is die versnelde leerkurwe wat hulle ervaar het in SA. Gevolgtrekkings: Die dokters het geglo dat die OOPE-program hul kliniese vaardighede verbeter het. Hierdie studie getuig van die OOPE se potensiaal om beide die plaaslike gesondheidsfasiliteite sowel as die deelnemende buitelandse dokters te bevoordeel. Die gevolgtrekkings van die studie het praktiese implikasies vir die verdere ontwikkeling van programme om vakante poste vir gesondheidspersoneel in plattelandse hospitale in SA te vul