Healthcare innovation is on the rise but in South Africa, innovation is lacking in the medical school space. Fourth year UCT medical student and Project Coordinator at Inclusive Healthcare Innovation, Eldi van Loggerenberg, talks about her endeavour to establish a platform for students from different fields to learn about health innovation and promote alternative ways of thinking about healthcare delivery.
I thought that studying medicine would allow me to make a meaningful contribution to society. However, before I arrived at medical school I had a very limited idea of what it meant to be a healthcare professional in 21st century South Africa. Once I started my studies and gained exposure to the health system, I became increasingly frustrated, and often felt that the skills I was learning and the systems I would function in as a doctor, wouldn’t enable creative problem solving or the attainment of the elusive goal of ‘health’. I realised that the way I was being trained to practice medicine often had little to do with ‘health’.
Changing the status quo
I believe the curriculum for medicine needs to change. I’ve experienced too many inefficiencies and missed opportunities in the health system: seeing patients in the end stages of a preventable chronic disease treated at great expense at tertiary institutions; the long lists of chronic medicines prescribed at community health clinics; and the increasing awareness that contextual factors – the lack of access to healthy food, violence, unemployment, lack of adequate sanitation and poor urban planning – often play significant, if not determinant roles in the health of individuals and communities. What can a one-on-one consultation and prescription possibly do if someone lives in a context that makes them ill? What can you do if the assumption is that patients are passive recipients of healthcare and not active participants or contributors to healthcare?
I’ve also become more aware of the experiences of medical professionals: their frustrations, exhaustion, burnout, disappointment, and the sacrifices they make on a daily basis to practice medicine in the public sector. I can’t help but believe we’re missing an opportunity. Of course, robust training in basic sciences and clinical skills are essential in producing competent health professionals and our curriculum has been structured to produce clinicians that deliver safe, evidence-based healthcare. But I also wonder what healthcare might be like if the training of health professionals also allowed for new ways of thinking, creativity, and the exploration of alternative kinds of knowledge? Perhaps if there was more room for exploration and differentiation, we’d produce even better clinicians.
Implementing the change
There is an explosion of new fields related to health – being a physician is simply one of many roles in the complex and growing ecosystem of healthcare delivery. Innovators creating disruptive technologies and solutions didn’t necessarily acquire their skills through formal training, but were exposed to innovative processes and new ways of thinking. My own learning about health innovation happened outside of formal structures. I think there is potential for a ‘complimentary innovation curriculum’ that students could access in addition to formal education, irrespective of their field of study. The solutions required to address the future problems of healthcare will require multi-disciplinary collaboration.
As for how the formal medical curriculum might change, that’s a very challenging question. Having been a ‘guinea pig’ for various curriculum changes, I am unsure how health innovation can become part of the formal medical education. What I can imagine is rigorous training in basic sciences and clinical skills, but also incorporating more space in the curriculum to explore other kinds of knowledge – be that the intersection of the arts in medicine, design and health, health entrepreneurship and innovation, or preventive medicine.
Whatever curriculum changes might occur in the next few years, I think there is an alternative way to approaching and implementing these changes: through co-design. Imagine if clinicians, medical interns, students and faculty staff went through a process of designing changes together? Students, who have experienced the curriculum, and doctors are underutilised resources in terms of understanding what changes need to happen.
There have been a few instances where universities in other countries have undergone such joint initiatives, such as The Ohio State University Department of Design; the University of Gloucestershire; Michigan State University & Columbia University; and the University of Glasgow & Queen Margaret University Edinburgh.
There’s also a programme at Yale University that has an interesting approach of bringing together students, academics and entrepreneurs to rethink healthcare and prevention, including hackathons and events where entrepreneurs talk about their work and mentor budding entrepreneurs. There’s also a $25,000 award for the best student-led venture focused on social innovation in health.
Envisioning the future
In the 21st century we have the opportunity to ask radical questions, such as: what systems should be in place to ensure every (new-born baby) person born into our society remains in optimal health for as long as possible? What kind of knowledge do we need to build such a system? What kind of professional roles would enable such a system to exist? Instead of building systems that respond to disease, could we design and build systems that enable individuals to stay healthy? These questions go beyond medicine and touch on architecture, civil engineering, technology, behavioural economics and social entrepreneurship. We should be creating 21st century services.
I see technology as an incredible enabler because it holds great potential for specific healthcare goals. eHealth can be used to for gathering and analysing health data to increase efficiency in healthcare delivery; to overcome biases in decision-making; to work out diagnostic probabilities; to empower individuals and communities with information; and to increase individual agency in matters related to health.
Never before have we had the tools that we currently have to study human health on a micro to macro scale. Never before have we had the opportunity to harness this knowledge to design our cities, neighbourhoods and services with the purpose of keeping individuals and communities healthy. There are exciting initiatives emerging worldwide to promote human longevity and effective health interventions, from the innovative and unorthodox approach taken by a public health physician in Finland to improve heart health to the IoraHealth model, an innovative approach to billing primary healthcare in the US. In South Africa we have quality education and an innovative spirit, so we need to harness these two entities to develop solutions for the African context.