Private healthcare for the people
A doctor has launched a scheme that links sound medical practice with healthy lifestyle choices
In between the close-packed houses of Soweto’s Zone 9, Meadowlands, a small clinic has opened its doors to provide private healthcare that teaches people to take better care of themselves.
Smelling of fresh paint and cleaning chemicals, the U-Care Walk-In clinic couldn’t be more new. The white walls gleam and the shelves in the doctor’s office are stocked with rows of medicines.
Dr Dulcy Rakumakoe and her business partner, Pascal Fröhlicher, set up the private clinic with their own funds, supplemented with revenue earned at their other medical practices.
Similar to other private practices around Soweto, the clinic charges a R300 fee, which include a consultation, diagnosis and acute and chronic medication from the government’s essential medication list. Pensioners and young children pay a reduced amount of R250 for the clinic’s services.
“The idea behind it is empowering patients to take care of their own health. We see ourselves more as educators in the healthcare field,” Rakumakoe, a general practitioner (GP) says. “We’re doctors, but the most important part of what we do is the education.”
The name of the clinic sums up its purpose: it’s a primary healthcare centre where patients can simply walk in and there they’ll learn to care for themselves; the patients don’t need to make an appointment to get access to the clinic’s services.
The consultation takes up most of patients’ time at the clinic, during which they are advised on how they can make better lifestyle choices when it comes to dieting and exercise.
Chronic diseases such as hypertension and diabetes are common in poor areas of South Africa, but Rakumakoe’s philosophy is that, if people make sound daily health choices, the money they spend on medicine will be significantly reduced.
“We grew up in this [kind of] community so we know that people can afford to eat healthily. It’s not an excuse to say that because we are poor we cannot eat healthily,” Rakumakoe says. “When you empower people with that type of knowledge, they become healthier. When they see the results from making the right choices, they stick them out.”
She says she has seen a difference among people in Carltonville, a goldmining town in west Gauteng, where the first U-Care Walk-In clinic was opened. Rakumakoe advised her patients, many of them miners, on healthy eating and safe sex.
According to Rakumakoe, her patients took up her suggestions and passed them on to their families and fellow miners and the prevalence of HIV in the area has dropped.
Rakumakoe and her team gather statistics every month to ascertain how much medication people use, how much they’re spending on medication, and the rate at which they are admitted to hospital. She says they have seen “great improvements”.
“What I like about working with communities is word of mouth. People teach each other. If I teach you, you have children, you have friends, so the effect is really amazing,” she says.
Originally from Hammanskraal, Rakumakoe didn’t always dream of dedicating her time to community work. Initially, she saw medicine as a way to live the good life, but her experiences in rural public hospitals quickly changed her plans.
“I was inspired to go into medicine by a local GP when we were growing up in Temba in Hammanskraal. I used to watch my grandmother always dress up to go to the doctor and I saw that doctors are quite an important part of the community,” she says.
“I saw doing the whole medicine thing as prestigious — you earn money, you’re able to live the fancy life — until I got exposed to the injustices of the healthcare system in Vryburg. Just seeing how people did not have access to healthcare, my whole motivation was changed in that one year.”
As a student doing her community service in Vryburg, North West, Rakumakoe saw people struggling to travel up to 300km to get access to medical services. She saw this as an injustice and, through the U-Care Walk-In clinics, she is using her skills to try to make a change so that quality private healthcare becomes a norm rather than a privilege.
“It’s because of the injustice of the whole public/private healthcare system where for a normal person the private healthcare system is very inaccessible, but at the same time you have a public healthcare system that is so overburdened,” Rakumakoe says. “It’s just a conscience thing to say that you cannot sit back and continue in your little bubble and think that things will somehow be okay in the country if you don’t try and make a difference where you can.”
The clinic has reached out to the people in Zone 9. Rakumakoe hired residents to build the shelves and paint the walls. On its first day of business on Monday, patients seemed happy with the service.
Lena Mokhatsane says: “They are friendly. My brother came through to ask if they are open today for my mum’s sake and they said, ‘Yes, we are open’. They [said they will come] to collect my mum, so that’s the welcome that we receive.”
Mokhatsane, whose home is opposite the clinic, brought her granddaughter for a check-up on Monday. She says she would have had to take a taxi to the nearest clinic, which is in another zone of Meadowlands.
“It wasn’t good at all before. We had to get transport to Bara [Chris Hani Baragwanath Hospital] or maybe Jabulani Hospital [Bhekizizwe Mlangaeni Hospital]. From the reception, if you go to Bara, it’s not a good place,” Mokhatsane says. “That’s why we sometimes prefer going to private clinics because that is where you get all that attention and that care. But I think we will get it here.”
She jokes with the staff as she prepares to leave, saying she will come back soon to collect a business card. “It’s my first time so I think I will be watching them,” Mokhatsane says.
Rakumakoe is delighted that her first patient at the centre was a baby, whose first birthday is on Friday.
“I think it was nice that the first patient was also a baby,” she says. She is cutting her teeth, just like the new clinic is. “I just felt it was symbolic somehow.”
Although not many patients were at the clinic on Monday, Rakumakoe says, as with her other clinic, the foot traffic will pick up as the weeks wear on.
The U-Care clinics have a system of clinical associates who work under the supervision of a medical doctor. This means Rakumakoe will soon be spending all her time as the supervisor of the clinics in Zone 9 and Carltonville. She is in the beginning stages of establishing another Walk-In clinic, this one at Park Station in central Johannesburg. From where she sits, the future of building community health through patient education is bright.
“It is a passion, it is realising the impact. If I’m sitting with you and I’m having this conversation, it doesn’t cost me much. I have seen the impact that that has had in the communities that I have worked within,” she says.