The growing need for the field of Physical and Rehabilitation Medicine in South Africa: A mixed methods analysis
G. Ross Malik1,2,3, Grant Schleifer1,2, Virgina Wilson3, Francois Theron3,4, Helen Mach3,5, Miriam Chun3,6, Andrew Haig3,7
1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
2Spaulding Rehabilitation Hospital, Charlestown, MA, USA
3International Rehabilitation Forum, Middlebury, VT, USA
4Department of Orthopaedics, University of Pretoria, SA
5Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI
6Gwangju Institute of Science and Technology, Gwangju, South Korea
7Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
Keywords: Africa, disability, education, fellowship, rehabilitation.
Abstract
Objectives: South Africa, unlike most nations with advanced medical education systems, currently does not recognize the field of Physical and Rehabilitation medicine (PRM). International medical education institutions such as the International Rehabilitation Forum (IRF) have developed PRM fellowship training programs across Africa. In this study, we aimed to demonstrate the significant need and desire for rehabilitation medicine in South Africa, describe how the IRF could assist with recognition of PRM by creating training opportunities, and report on current experiences of South African physicians taking part in the IRF fellowship program including how this program advanced their abilities to provide and advocate for rehabilitative medical care.
Materials and methods: This mixed-methods study was conducted in collaboration with the IRF between August 2024 and September 2024 to describe the current landscape of PRM in South Africa and the utilization of international training programs, such as IRF, to augment training in this field. The first part of this mixed-methods study involved qualitative interviews from physicians involved in PRM, who are considered experts (n = 2) in the South African healthcare system, to help support the quantitative survey study data discussed next. The second part of the study was a cross-sectional survey study of current IRF fellows (two-year program) from South Africa, including both quantitative and qualitative responses. The quantitative survey data and open-ended, qualitative questions were collected via anonymous Google surveys sent to fellows currently enrolled in the IRF two-year fellowship program and practicing medicine in South Africa (n = 16).
Results: A total of 63% of fellows enrolled to train future generations in South Africa. The majority of fellows (75%) reported that the program enabled them to take on leadership roles within rehabilitation medicine in South Africa. All fellows agreed that the fellowship motivated them to advocate for rehabilitation treatments. Qualitatively, fellows reported functional limitations within their home country including resources and capacity. Rehabilitation medicine experts in South Africa emphasized the numerous sociopolitical hurdles limiting government recognition of rehabilitation medicine and preventing the allocation of much needed resources to the field.
Conclusion: There is a substantial unmet need for rehabilitation medicine in South Africa. Formal recognition of the field could facilitate the allocation of essential resources, ultimately improving access to and optimizing the delivery of medical care for the South African population. International training programs, such as the IRF fellowship, appear to provide effective preparation for rehabilitation physicians in South Africa, equipping them with the clinical skills necessary for patient care as well as the knowledge and competencies required for advocacy at the national level.