"What's my purpose?" Dr Leigh Wagner champions healthy behaviour change in Khayelitsha

Unless motivation comes from within, no amount of resources, equipment, facilities or staffing can enable a doctor to make a real difference in their community. That's the view of family doctor, Dr Leigh Wagner, who trains primary healthcare professionals to teach lifestyle changing behaviours to patients living with diabetes in Khayelitsha.

It's an attitude shared by a special breed of healthcare workers countrywide, particularly those making the biggest impact in under-resourced, short-staffed and overburdened facilities. They adapt, innovate and build resilience, the latter being the subject of Dr Wagner's family medicine thesis. Her view on life has served her well in fostering resilience in herself and her peers.

Dr Wagner is the clinical governance chief at the Khayelitsha Site B Community Healthcare Centre, where she oversees 10 medical officers, two community service officers and rotating interns. She also mentors, tutors and lectures at the University of Stellenbosch.

The nearly two million-strong Khayelitsha community has attracted the attention of the world's virologists for its COVID-19 infection profile during South Africa's second and third wave.

COVID-19: a nightmare for people with diabetes

There's growing consensus that a combination of high-density-living-acquired general immunity plus immunity from the first wave, which hit the community hard, is responsible. The irony in Dr Wagner's work is that COVID-19 is diabetogenic - meaning it has caused full-blown diabetes in residents who were already vulnerable to the condition. This has made her work as a behaviour change agent even more vital.

"Diabetes is our most common non-communicable disease," she says. "Up to two thirds of our patients have uncontrolled diabetes. With COVID-19 we've seen an increase in uncontrolled type 2 diabetes. Studies have shown that COVID-19 infection triggers new-onset diabetes, while people with diabetes are more likely to die from COVID-19," she says.

Dr Wagner adds that Khayelitsha is the only subdistrict in the Cape Town Metropolitan Municipality, and one of the few countrywide, with a reversal in COVID-19 infections between the first and next infection waves. None of which helps her much in her educational task, because the damage was already done in the first wave.

Living Great with Diabetes

The Discovery Foundation Rural Institutional Award of R123 000 will help Dr Wagner and her team to build capacity in her Living Great with Diabetes project. Initiated in 2018, the project provides training at nine primary healthcare facilities in Khayelitsha and the eastern Metropole sub structures, stretching from Macassar to the Strand, Helderberg and Gordon's Bay. The goal is to train healthcare workers to educate patients on how to manage their diabetes to improve outcomes, using facilitated peer support groups of 10 to 15 people at a time.

COVID-19 impacts diabetes training

"Right now, COVID-19 treatment and vaccination has tied up many of our aspirant healthcare workers, but we're increasing our supply of training materials like booklets, pamphlets and flip charts to run a three-day course for 27 healthcare workers, three from each of our nine sites. We have two dietitians and hope to finalise a date soon," Dr Wagner says.

"We don't take the time to show patients what to eat"

"We sometimes think that poor outcomes are a reflection of poor-quality healthcare, but I think we're not telling them enough," she adds. "I look at my own father who just loves malva pudding. He's well-controlled and in private healthcare. I find myself thinking if we could just get enough insulin - but then we don't take the time to explain to each and every one in their mother tongue what to eat and what not to eat."

"I mean, tell patients not to eat pap and vetkoek, they look at us as if we come from another world! So instead of continually bashing them about diet, perhaps we ought to also look at other behavioural change and let them know what diabetes is and how it works," she adds passionately.

For Dr Wagner, attitude is everything.

"I ask myself, why am I here, and what am I contributing, in spite of my circumstances and background? Just having more won't bring about change," she says. "We need to foster an attitude of resilience. I encourage my colleagues to ask, 'How can I find motivation within myself and beyond myself, and what's my sense of purpose?'"

This article was created for the 2021 Discovery Foundation Awards and has been edited for the Discovery Magazine.