Getting Rural Right

Getting rural right is a 40 minute documentary which focuses on the key challenges in rural healthcare in the Transkei, which is in the Eastern Cape province of South Africa. With honesty and passion, this documentary examines the harsh reality of rural healthcare in the Transkei, and across the country. A must see, this humbling piece of film will make you question what you know about rural life and healthcare in South Africa:

Getting rural right – Part 1:

Getting rural right – Part 2:

Getting rural right – Part 3:

Inspired by this documentary AHP wanted to know more about the people behind the camera. AHP spoke to Bart Willems and Arne von Delft, to find out how this documentary came about, what it means to them and what the future holds.

Hailing from the Eastern Cape themselves, Bart and Arne are cousins who have been great friends since childhood. Bart was born in Port Elizabeth, grew up in Stellenbosch, Worcester and Durbanville and after school found himself at the Tygerberg Medical School of Stellenbosch University. Here he was joined by Arne a year later. Arne was born in East London and as a child moved to the Western Cape with his family after his father, who was a medical officer in East London, decided to specialise in paediatrics at Tygerberg.

Getting Rural Right was filmed in 2005, but this story started long before that. Bart explained that one of his choices for their fourth year electives was to work in St. Elizabeth hospital in the Transkei. Seeing this as an excellent opportunity, Bart and three of his peers, Sameer Surka, Jamie Shelly and Bradley Griffiths were soon on their way to the Wild Coast. The Hospital is located just outside the small, but economically significant town of Lusikisiki in one of the most rural and underserved parts of South Africa. As Bart explains; “being in a place that rural is like being in a different country”.

During their month at this facility a great deal was learnt about the hospital itself, its peripheral clinics and the community it serves. Bart recalls that while he was “amazed by the amount of people in dire need of medical care, the beautiful new healthcare infrastructure and the fantastic natural beauty of the area,” it was the “the total lack of medical personnel” in these facilities that struck him the most. This was the start of things to come.

On the way back to Cape Town after the elective, with his experience from Lusikisiki fresh in his mind, Bart and two of his mates set off through the Transkei in on a surfing trip. En route they decided to stop at as many hospitals as possible in an effort to get a clearer understanding of the challenges facing these facilities. Bart recalls; “what struck me the most was that there were no doctors to talk to” indicating the seriousness of the problem.

Moved by the experience of his first trip, Bart initiated a second trip to the area two years later bringing with him; Oliza Boshoff, James Taylor and Arne (pictured in order). According to Arne, Bart organised everything for the trip from planning the route, taking care of logistics and recruiting friends (“the GRR Team”) to join him. Permission was granted by the Eastern Cape Department of Health, and reaffirmed later by the MEC for Health during a chance encounter and subsequent interview at Nelson Mandela Academic Hospital. Arne also told AHP: “I was easily recruited – a few weeks of surfing, with some work in between, sounded pretty good to me. For me we were breaking new ground by going to the Transkei. Bart was enthusiastic about the area, and health but mostly rural health, so I went along for the experience of a lifetime”.

So off they went – on a surfing holiday/epic road trip/documentary mission. Bart with the plan and map, James as the “multimedia boffin”, with Oliza and Arne “along for the ride”… The rest is history and the documentary is proof of what they found along the way.

For two weeks these four travelled from one healthcare facility to another to record the stark reality of life and rural healthcare in this region. This involved a great deal of travelling, filming and hospital visits. During this trip they managed to visit and film at Elliotdale Clinic and Madwaleni, Isilimela, St. Elizabeth, Zithulele, Nelson Mandela and Canzibe hospitals as well as the Conference on Rural Health held by the Rural Doctors’ Association of South Africa (RuDASA) and hosted for the first time by a Rural Transkei community.

Their mission was simple; to expose the situation in the Transkei to other medical personnel, friends and classmates.

The story line of Getting Rural Right was largely inspired by the Director General of Health’s vision for rural health, as presented at the RuDASA conference. During filming it became clear that “there was no long-term planning or structure in place for rural health and mismanagement was rife”. Bart also mentioned that although these issues were easy to identify, he “found it hard to conceptualise how to develop rural areas like the Transkei” – people live everywhere and very spread out, there are no towns and therefore access to basic things like water, sanitation, education and clinics are difficult. “Rural infrastructure is almost non-existent.” Bart went on to describe that the more facilities they visited, the more obvious it became that “there was a great disconnect divide between health planning and what is actually gets delivered to patients, what was needed by patients and what patients perceived to be necessary”.

Post-filming, the editing process took Arne nearly a year to complete as he was a complete editing novice and busy with his final year of medical studies. Following closely upon a greater awareness of the need and opportunities presented by the rural Eastern Cape, the Department of Family Medicine at Stellenbosch University developed a five week final year medical student rotation at Madwaleni Hospital in the deep rural Eastern Cape. Arne and his future wife, Dalene du Plessis, were privileged to be the first students to pioneer this rotation. During their rotation there they developed a research protocol designed to test the impact of the film on the attitudes of healthcare students and young professionals towards Rural Healthcare. Bart joined them at Madwaleni from East London (where he was doing his internship) and together they took the film to the subsequent tenth Annual RuDASA Conference held in Natal in 2006, where it was premiered and reviewed. The research protocol was informed in a large part by the staff at Madwaleni as well as rural healthcare stakeholders attending the RuDASA Conference. The protocol was subsequently implemented at Tygerberg Medical Campus among junior and senior medical students and the findings were written up as a final year medical dissertation (available on request).

During this time of production, research and subsequent further promotion Arne and Bart tried repeatedly to bring the Department of Health of the Eastern Cape on board. The film was screened at various staff induction functions, workshops and conferences, but unfortunately plans to distribute it on a larger scale at various medical schools and to the broader medical community never came to fruition. Suffice to say the human resource department failed to deliver on repeated promises spanning from 2006 to 2010.

Bart and Arne ultimately decided to promote the film and message on a more independent basis and launched an internet campaign early this year. If you would like to help the team behind Getting Rural Right with this mission to improve the standard of healthcare in the Transkei contact them on their Facebook page:

After the movie was filmed, Bart worked in East London for two and a half years, worked in Ireland for six months, and then started locuming in the Cape Town area, but is now back at Stellenbosch medical school completing his MMed in Public Health. “I don’t know where the road will lead, all I know is that I want to end up in public health, I want to assist communities with healthcare… I’m just not sure how I will eventually fit in”. One of his special interests is the way(s) in which health is affected by the environment, how we can reduce human impact by planning, innovation and regulation and hopefully in the future ensure a healthier environment with healthier humans living in it.

Arne and Dalene subsequently joined Bart in East London for their two years of medical internship. It was during this time; Arne told AHP that “I lost that positive energy I had when we were filming. It is just so hard not to lose it when you see such poor management and poor planning. You have state-of-the-art equipment, or new theatres without any doctors or nurses to use them. Rural health is so dependent on dynamic individuals to help make it work. These are the people who get lots done, but the sad reality is that their hard earned individual gains in service delivery are not sustainable if they were to leave again and they are frequently guilted into staying. This coupled with poor or non-existing support can easily transform positive energy into resentment and eventual abandonment of rural health altogether. As somebody trying to improve the system, I quickly got a taste of this disillusionment that kills off the youthful energy and naïve enthusiasm of so many of our peers.”

Arne is currently working at Tygerberg hospital in the field of Haematology and explains that he is not entirely sure what direction his life and career will eventually take, but admits “I am more suited to the academic side of medicine, while Bart is suited to public health as he sees the big picture and is able (and willing!) to handle big and complex problems”.

The potential of Getting Rural Right is huge, particularly in terms of creating awareness around the challenges and rewards that exist in rural healthcare. “At the moment rural areas appeal to a certain subset of healthcare workers in South Africa. What we intend to do is foster this interest and perhaps push those on the fence over.”

Filming: James Taylor (main), Arne von Delft, Bart Willems

Editing: Arne von Delft (main) and Bart Willems

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