Browsing by Author "Schaefer, Rachel"
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- ItemReflections on the illness experience of a family physician(Taylor & Francis, 2015-02) Schaefer, Rachel; Jenkins, LouisTuberculosis is such a part of our everyday lives that I have never stopped to consider the illness experience regularly lived by our patients. As a seasoned family physician in public service, I have initiated hundreds of patients on tuberculosis treatment, simply informing them of their diagnosis and advising them to go to the clinic to obtain their medication. Even with the use of a patient-centred approach and shared decision-making, I did not give much thought to understanding the implications of how this diagnosis impacts on a patient’s life. That was until I was faced with tuberculosis myself.
- ItemRetaining doctors and reducing burnout through a flexible work initiative in a rural South African training hospital(AOSIS, 2021-03-23) Schaefer, Rachel; Jenkins, Louis S.; North, ZillaBackground: South African doctors work up to 60 h per week to ensure 24-h service delivery. Many doctors are physically and emotionally exhausted, neglecting families, self-care, patient empathy and innovative thinking about complex health issues. Exposure to clinical work hours demonstrated a dose effect with burnout, suggesting cause and effect, affecting up to 80% of doctors. To retain good doctors, their complex needs must be recognised and allowances made for flexible work options. Taking a risk: George Hospital, a large regional training hospital in a rural district, converted some full-time medical officer posts to part-time posts. This was in response to doctors’ requests for more flexible work options, often after returning from maternity leave or in response to burnout. Perceived risks revolved around institutional resource security and that part-time post vacancies would be difficult to fill. Reaping the benefits: Employing doctors in part-time posts has created stability and continuity in the health team. The hospital had generated a cohort of young professionals who care with empathy and have emotional resilience to train others and plough their skills back into the healthcare service. Conclusion: Reducing working hours and creating flexible options were concrete ways of promoting resilience and retaining competent doctors. We recommend that training and work of doctors be structured towards more favourable options to encourage retention, which may lead to better patient care. Keywords: part-time posts; resilience; burnout prevent; training; flexible work; retention.
- ItemA review of the implementation of the prevention of mother-to-child transmission program in the George sub-district, Western Cape(Stellenbosch : Stellenbosch University, 2012-03-15) Schaefer, Rachel; Jenkins, Louis; Stellenbosch University. Faculty of Health Sciences. Department of Interdisciplinary Health Sciences.Introduction The most common cause for HIV infection in children in developing countries is the vertical transmission of HIV from mother to child. Without any intervention the vertical transmission rate from mother to child will be between 15-50%, depending on a number of factors. An effective prevention of mother-to-child transmission (PMTCT) program can dramatically reduce this transmission rate to as low as 2-5%. There appears to be a gap between PMTCT policy guidelines and actual implementation, and while the reasons for this are multi-factorial, one facet may be local shortfalls in the program. Aim: To review the implementation of the PMTCT program in the George sub-district for 2010. Objectives: To assess whether the PMTCT program is being conducted according to established provincial protocol; to describe possible local shortfalls in the PMTCT program; to make recommendations to improve the identified shortfalls. Methods A retrospective descriptive study, based on a record review of patient files, the PMTCT register, and birth registers in the labour ward of George provincial hospital. Every HIV positive pregnant woman from the George sub-district who delivered at the George provincial hospital obstetric unit during 2010 was included. Missing files and medical records were excluded. Data was collected from each record in the registers according to set criteria, and entered into a Microsoft Excel data sheet. Results 95% of women in the study had an HIV test at the clinic, and 93% had a CD4 count. This shows good initial uptake and acceptance of the program. However, 28% did not receive adequate antenatal PMTCT cover, 33% of patients who required highly active antiretroviral treatment (HAART) did not receive it, and 34% of women did not receive adequate PMTCT cover during labour. 86% of babies received their initial PMTCT medication within 72 hours of birth. The one month zidovudine treatment for babies (before October 2010) and six weeks nevirapine treatment (after October 2010) was not documented in 30% and 74% of cases respectively. Discussion While many aspects of the PMTCT program are being well applied in the George sub-district, there are significant shortfalls in the implementation of the program. These need to be addressed to ensure optimal prevention of HIV transmission from mother to child. Particular points which need to be focused on are improved record keeping, increasing the percentage of HIV positive women receiving adequate antenatal and intrapartum PMTCT, and increasing the percentage of HIV positive women receiving HAART.