Dr Adam Asghar gives quality care to patients in rural KwaZulu-Natal

Dr Adam Asghar, a family medicine registrar in Durban, will use his Discovery Foundation Rural Individual Award to do research on ways to improve maternal and perinatal care at Bethesda Hospital, a rural hospital deep in northern KwaZulu-Natal, where he was based for five years.

Although he is currently rotating between hospitals in Durban, Dr Asghar keeps connected to the realities of healthcare in rural settings as part of his role as vice-chair of the Rural Doctors Association of Southern Africa.

Dr Asghar was involved in treating pregnant women a number of weeks before and after they give birth at Bethesda Hospital. He left with a lingering sense of curiosity about how the clinical practices influenced patient outcomes in this underserved and resource-challenged area.

"This is how my research topic came about, which aims to describe and compare the outcomes of the obstetric practices from the time of onset of labour to the delivery of the placenta at Bethesda Hospital in 2018," he says.

The Discovery Foundation Award will help him continue his research for his MMed Degree in Family Medicine. His research aligns with the UN's sustainable development goal to end the preventable deaths of newborns and children under five and to reduce the maternal mortality rate by 2030.

Inspired by a connection to South Africa

Born in the United Kingdom in 1983 to migrant parents - his father was born in Pakistan and his mother in Poland - Dr Asghar studied medicine at Oxford University and Imperial College London. He completed his internship in West Yorkshire.

"During this time, I developed an interest in global health, and like many others at the start of their careers, had a somewhat romanticised notion of working in a resource-limited setting," he says.

"During a two-month stint in Haiti, where I struggled to communicate with both patients and colleagues despite my reasonable grasp of French, I made plans to work in a setting where English was more commonly spoken. South Africa was a natural choice."

He initially planned to spend a year in South Africa, but a decade later he is still here - along with his family. He and his wife Jacinth have two sons, Gabriel and Luca. When he is not working, Dr Asghar enjoys being outdoors and loves running and cycling.

Pursuing higher-quality care for patients

Although his direct outreach work has been limited until now, Dr Asghar has always had a desire to become more involved in engaging and uplifting communities.

"I have always devoted my attention to patients as individuals, rather than members of the community at large. Now that I am a family medicine registrar, my frames of reference are changing, and I look forward to developing more of a community-oriented primary care mindset in myself in the coming years," he adds.

What made him develop a special interest in obstetrics? "When I worked at Bethesda Hospital, my interactions with patients and colleagues there were the source of inspiration to pursue specialist training, in the sense of wanting to offer a higher quality of care for my patients, while being sensitive to their family and community context," he says.

There are many challenges to providing a high standard of healthcare in rural communities. Patients sometimes present late with symptoms or they don't get to see a doctor in time, for various reasons, including the size and topography of the area that the hospital serves. Transport is costly, and in many rural areas, the social determinants of health - the conditions in which people are born, grow, live, work and age - play a huge part in the choice of treatment options.

"There is also a relative lack of appropriately trained staff in rural areas compared to urban areas. A commonly quoted statistic is that South Africa's rural areas are home to 43.6% of the country's population, but are only served by 12% of the country's doctors and 19% of its nurses," he says.

"Those healthcare workers have fewer resources than staff in urban areas. Services, such as those of the blood bank, could be many hours away and in the case of medical emergencies that require specialist intervention, help may not be reached in time."

He commends the medical management at Bethesda Hospital for being visionary in trying to achieve good quality care for patients and he hopes his research will make a difference to both staff and patients.

This article was created for the 2020 Discovery Foundation Awards and has been edited for the Discovery Magazine.