RURAL HEALTH CHAMPION: tackling TB one patient at a time

For doctors working in South Africa’s rural areas, TB remains a significant challenge. Aside from the immense geographical barriers, which means that patients often needing to walk hours to reach the nearest clinic, there are also infrastructure issues  which complicate diagnostics and a lack of data which makes it hard to understand the disease burden, to name but a few.

These are just some insights from Dr John-D Lotz, a dedicated family physician, who has been making significant strides in providing healthcare at Madwaleni Hospital in the rural Eastern Cape. Dr Lotz is also a lecturer at Walter Sisulu University.

He will be at the 8th SA TB Conference next week to participate in TBAC’s satellite session titled The State of TB in South Africa: A report exploration of the care cascade. He spoke about his rural health experience ahead of the conference.

His journey from urban hospitals to a small rural clinic is driven by a passion for making a tangible difference in underserved communities.

“Finding the people is really hard, especially in rural areas. Many patients are still sitting at home, waiting to access care,” Dr Lotz notes. The geographical barriers are immense, with patients often needing to walk hours to reach the nearest clinic. Once there, accessing specialised services like X-rays is also difficult.

“Doctors often end up using their personal cars to transport patients to the hospital, which is tricky when dealing with TB,” Dr Lotz explains.

The systemic challenges in rural healthcare are numerous. Infrastructure issues, such as frequent power cuts beyond loadshedding, complicate basic diagnostic procedures. Furthermore, data management in rural settings is a major hurdle. “We struggle with data, not knowing the burden of TB and where patients are. This makes it hard to address the problem effectively,” he says.

But it’s not all doom and gloom. There are some positives, says Dr Lotz. Working in a rural setting presents unique rewards. He finds great satisfaction in the effort to reward ratio at a smaller hospital. “Patients have really suffered from a lack of service provision for so long, stemming from historical inequalities. It’s incredibly rewarding to pull a team together who trust each other and care for patients as a cohesive unit,” he says. This team-based approach, involving nurses, community health workers, and data capturers, is essential in addressing the healthcare needs of the community.

How do we improve the TB response in the country?

Dr Lotz suggests two key changes. Firstly, a fundamental shift towards community-oriented primary care (COPC) is needed. “Healthcare needs to be holistic, with community health workers embedded in the community, addressing a spectrum of conditions including TB,” he explains. Secondly, better data collection and accessibility are crucial. Transitioning from paper-based to electronic data and making this data available to clinicians at the coalface would allow for dynamic, real-time responses to healthcare challenges.

Dr Lotz’s commitment to rural healthcare and tackling TB in the Eastern Cape exemplifies the impact of dedicated medical professionals working in underserved areas. His journey and insights highlight the critical need for systemic changes to improve healthcare delivery and outcomes in rural South Africa.

At the TBAC satellite session next week Dr Lotz will be  joined by Samantha Maughan, Prof Neil Martinson, Andrew Marino and Camren McAravey.