Taking care to the people

At 31, Dr Ruben Shaanika Kanime, together with Health Minister Dr Bernard Haufiku and other health professionals, are offering hope to hundreds of Namibians through the ground-breaking National Medical Outreach Service. The young doctor, who hails from the North, speaks candidly to Namibian Sun’s Gordon Joseph about his love for the medical profession, the importance of reaching out to the most remote Namibians and offering hope, as well as tackling the challenges facing the health sector.

When did you develop an interest in the medical profession and how did your childhood affect that decision?
I was born and bred in a rural setting at a village called Omalyadhila in Omusati. In 2004, I came to Windhoek for the first time in search of tertiary education. Growing up in the village everything comes with hardship. My school was 10km from my village and all we knew those days were teachers, and nurses, those who came to give us immunisation and those who used to teach us. Everyone wanted to become a teacher or a nurse. I later went to school at Ruacana and that’s where my dream to become a doctor started. Biology lessons particularly influenced it. My science teacher at the time taught us so much about careers. After finishing Grade 12, I applied for pre-med at Unam. My second option was engineering with the Polytechnic of Namibia. I was accepted for power engineering and I was put on a waiting list for pre-med. I opted to go to Polytechnic where I was already admitted, stayed there for a semester until NSFAF was offering scholarships for students to go and study medicine in Russia, China and Cuba. When I heard about the scholarships I rushed to the ministry, tried my luck and gave in my application. I was in the laboratory at Polytechnic when I got a call saying I had been chosen to go and study medicine in Russia.

As an intern back home following your studies in Russia, you probably saw a lot. How has that affected what you do now?
Even before I came back, I wrote a lot of articles. I’ve always been concerned with things that are affecting us as a nation in terms of socio-economic development. I’ve realised two of the areas Namibia is lacking is education and health. As a student I visited a lot of hospitals. I realised we don’t have enough doctors and to make it worse, we don’t have enough specialists.
I looked at the work load we had to endure as interns. You work 24 hours and the next day still work your normal working hours. It exhausts us, compromising the quality of service. This is in Windhoek, and then we take it to the regional hospitals, where you find that the hospital is covered by two doctors with no specialists and lacking equipment. These are the things that worry me and that’s why I want to go and specialise to so that I can help in our region.

What do you see as the major challenges facing the health sector?
The major challenges are manpower, doctors and nurses. We are still lagging behind. Facilities are also a challenge. Most of our regional hospitals still need to be upgraded to accommodate specialists. One of the things affecting us is equipment. What we have at Central Hospital and Katutura is not what we have at our district hospitals. We also need to continue to empower community health workers. Namibia is a big country with a small population scattered all over and we need to reach people down there in the villages. The aim is to have a network where the clinics become the first referral point. Like mobile clinics. We need to train more people, we are lacking in terms of staff and infrastructure.

Let’s talk about mental health and the lack of access to it for many Namibians, especially those in rural Namibia. How far behind are we from promoting and ensuring mental health?
Mental healthcare has been neglected not just in Namibia but in many parts of the world. Mental patients are human beings. In Namibia, much has been done already, but much more needs to be done. It’s about outreach. Mental health is one of the areas that need special treatment. The ministry is committed to help. I would like to see the national mental centre upgraded to stand on its own, and then we need to branch out to the regions. Of course it comes down to staff again. Do we have enough staff to carry out these duties? Not yet. We need to start building capacity. But it also requires a multi-stakeholder approach. We need to make people aware too through campaigns which the ministry is already doing but corporates should also come on board.

The National Medical Outreach Service has been hailed for reaching out to some of the most remote Namibians. Take us through the journey of the programme.
The National Medical Outreach Service, when it started was the minister’s outreach. It started last year in April with Dr Bernard Haufiku, when he went to Khorixas. Then he suggested that since we have specialists saturating the health sector in Windhoek in both private and state institutions, why not take them to the regions? He tested it in Khorixas. He came back and he invited people to join him in May 2015. I was one of seven people who joined him. We came back, and later he approached me if I could help mobilising doctors and nurses to go to the regions. The next target was Zambezi; he was looking at the needy regions. He said this programme was part of a long-term plan. When we got there we were also assessing the possibility of having regional hospitals upgraded. We assessed what was not there, and exchanged knowledge.

How would you describe the impact of the programme?
Last week, we had a review meeting, where we looked at outreach and its activities in relation to the referrals to Windhoek. We carried out a survey on the outreach, and the results show that the majority of the people support the outreach. We then looked at referrals; it gave us a picture of which regions do the most referrals. Since the outreach started until May, we carried out activities, surgical operations, consultations etc.
During this period, 739 minor and major operations were done. Investigations and consultations were done on more than 2 000 patients.
When we started, less attention was paid to data capturing, but a lot of patients were seen and as such, we couldn’t get a clear picture of how effective it reduced referrals, but we have used what we got as an eye-opener to improve the format of data capturing. We will use this information for review in 2017.

How do you see the programme evolve in the future? Do you see it becoming a full-fledged programme of the ministry?
The programme started as the minister’s outreach and last year it was more like a pilot programme. We have since set down and formalised the programme. We have terms of reference, and it falls under the office of the permanent secretary. The programme is already included in the ministry’s structures. The programme is not a solution to our problems though. The real solutions are to have our hospitals upgraded, have permanent specialists in the regions then we don’t have patients referred to Windhoek.

How has the response been from health professionals, especially those in the private sector?
The outreaches have gained momentum since the inception. It takes time to get the desired results. There was criticism when we started, but the response has been good. We went from one person to seven to 20 to 25 in a team. The next outreach is to Opuwo and Khorixas and we are already 23 participants.
Lastly, being involved in the programme as a Namibian doctor, what personal gratification do you get?
It gives me a sense of joy to be part of a programme that has given hope to many people. I’ve always asked myself what I can do for my country.
I have sacrificed my time, I still work as a medical officer, I still have my calls at Katutura State Hospital.
But this is a good programme for the nation. This programme gave me an opportunity to be successful in the true sense. You are helping other people, and you give hope to other people.

GORDON JOSEPH