In the summer of 2012, I gave up chopping strawberries at Wimbledon to attend my PhD interview. Before I knew it I’d been offered a studentship, generously funded by the Economic and Social Research Council and GE Healthcare Ltd. It was the start of a great three years which would take me back to my birthplace, South Africa, to live on a game reserve like I did during my childhood.
What does my PhD focus on? Well, the way I describe it to my granny is that it’s about ‘global public health and health systems strengthening’. As part of that I’m interested in digital communication technology and the role it can play in improving weak health systems and the delivery of care, in particular for patients with chronic illnesses and antenatal women in rural South Africa.
As part of my PhD I spent 12 months living in Mpumalanga in northeast South Africa, where warthogs, zebras and giraffes lived right outside my house – and even a family of leopards at night!
I carried out my study at the Wits/MRC Agincourt Health and Socio-Demographic Surveillance Site, covering 32 villages and eight public health centres, and drove around in a 43-year-old green Land Rover called Lucy. We bonded over many a breakdown, sometimes in the torrential summer rains!
During fieldwork, I interviewed 227 people, from patients, doctors, and community members to government policy makers and traditional healers (who even shook the bones in their hut). My aim was to try to understand patterns of current and potential uses of technology – predominately mobile phones. For example, how could we utilise phones to improve access to care for those in remote areas? How could we ensure people access their medication and attend their appointments through text reminders? Could people be diagnosed remotely through technology?
It was a fascinating experience, during which I learned to speak Xitsonga, the local language of the Shangaan tribe, and made all the elderly patients laugh when I attempted to tell them stories in their native tongue.
Being back in Africa and working with people who have a passion for community engagement was fantastic. Wits have a strong relationship with the local community as they’ve been collecting census data for over 20 years at the study site.The Learning Information, Dissemination and Networking Team are responsible for community liaison with the village leaders, which is based on trust and mutual respect, so all research is understood and accepted before being conducted. This helped me to gain entry into the clinics and the community, which wouldn’t have been possible otherwise. I enjoyed seeing how welcoming the community were in wanting to learn about the research I was doing and the potential benefit to them in the future in terms of how the delivery of healthcare might change.
There are currently a host of challenges in the area that need to be addressed, particularly governance and accountability issues, poor (but improving) infrastructure and huge unemployment rates. Getting electronic/ mobile health to work and be of benefit to patients and health professionals is very much dependent on breaking some of these barriers. Things are starting to move forward – last year the South African Department of Health launched Mom.Connect, which is a pregnancy registry and staged-based messaging SMS service for all antenatal women. But there’s much more work to be done.
It’s up to the academic community and social scientists like myself to understand why ICT interventions are working, for whom, when and why. I hope to make policy recommendations to the national government in South Africa in the near future about their mobile health strategy given that I have a good idea of what is happening in the rural areas.