JOHANNESBURG, 19 August 2012 (IRIN) - In South Africa’s Zithulele Village, the local hospital services 130,000 people - but operates without enough health workers.
It is part of a countrywide healthcare worker shortage, but rural areas, where about 40 percent of the population lives, bear the brunt of this problem.
Doctors in rural areas like Zithulele don’t simply miss the conveniences of urban life; they also face difficult working conditions and under-resourced healthcare facilities.
Zithulele Hospital's 28-year-old Liz Gatley, who was recently recognized as the Eastern Cape's rural doctor of the year, spoke to IRIN about why she chose to stay when so many don't.
"I came here as a student in 2005, and then I came back as a community service doctor in 2009. I never thought I'd stay more than a year. Towards the end of that year, I thought I'd stay on and help at least with the transition stage, so I stayed for an extra five months.
"[Then] one of the antiretroviral (ARV) counsellors - she's been here for ages and she's awesome - phoned me and had this long conversation. She told me, 'You need to stay, you can't leave.' Actually, that was one of the big reasons why I stayed. This is my third year.
"It's a really cool place to work. Although there are enormous challenges, it is still small enough that you can actually have an influence, make a difference.
"One of my best moments has to be a woman who had literally been put on every treatment we had - she was on tuberculosis treatment, she was on antibiotics, we checked her for meningitis. She just got worse and worse. Eventually, I was counselling the family that she was probably going to die, that there was nothing else we could do.
"I saw her in the ARV clinic two months later. She had survived. She's at one of my clinics now and we see each other there.
"I'm lucky that I was put in the ARV clinic and I just love it. I really do. That's been a huge area of growth in the hospital. We've managed to put a lot more patents on treatment [than neighbouring hospitals], and from this year [2011??], we've started ‘down-referring patients’ - essentially allowing our patients to collect their treatment at their [local] clinics.
"You can see how difficult it is for people to access healthcare, and how difficult it is to get here. There are a few roads where [mini-buses] go, but a lot of patients walk through rivers; they arrive wet because they swam through a river. They've walked across the hills to access their treatment.
"It's the most incredible thing to allow patients to get their treatment where they live. People who literally could not get their treatment so they defaulted, or they just never came because they couldn't afford to get here, or they couldn't walk here - now they can actually be started [on medication] at the clinic, get their counselling at the clinic, get their treatment at the clinic. For me, it's the most exciting thing.
"We used to just watch people die from HIV, and it was one of the most depressing things. Working in a medical ward was so bleak at Edendale Hospital in KwaZulu-Natal, where I did my internship for two years. That was in 2007. I just signed hundreds of death certificates of people my age dying of HIV, when you knew there were ARVs available, but the systems weren't there to support them. People were waiting six months, eight months to get ARVs, and dying while they were waiting.
"Here, we're a small enough team, a small enough hospital, that we can just go into the wards and start people [on ARVs] and have a big push to get more people onto treatment. In KwaZulu-Natal we couldn't do that - the infectious disease doctors had to start patients on treatment and you had to go through that clinic.
"It was just so depressing. You knew there was treatment, and you're just watching [patients] die. Trying to change the system is a lot more difficult in a huge hospital where you're just a tiny minion, as opposed to here, where, as a team, you can actually change stuff.
"I think for a lot of people, [working in rural health] is a really overwhelming experience, particularly if you don't have senior support. I don't know if I would have been brave enough to come here as a student and then intern, and then be sent out into the wild by myself.
"It gets overwhelming if you're always feeling out of your depth. A guy who I did an internship with ended up at a hospital where, at night, you were literally by yourself. There was no single person you could call to help you. He actually left and went to Australia and never finished his community service.
"We don't always have the answers, but we've got a good team now. Just having that security of people with a wide range of experience, who are always available to ask, is literally invaluable."