“Mentoring keen young doctors really energises me” – Dr David Stead

Junior doctors who are eager to learn give Dr David Stead, Infectious Diseases specialist and Head of Medicine at Cecilia Makiwane and Frere Hospital in East London, the greatest joy in his pressured daily work. “Mentoring keen young doctors really energises me,” he says.

Alongside Dr Andy Parrish, a veteran at Cecilia Makiwane Hospital for 25 years, and Dr Jenny Nash, the Amathole District Family Physician, Dr Stead will start an ambitious three-year programme to support inexperienced district clinicians.

With the Discovery Foundation Rural Institutional Award, they will support district clinicians at 12 district hospitals, five community health clinics and 150 clinics serving the estimated 900 000 people in the Amathole District. Cecilia Makiwane and Frere Hospital are the only regional and tertiary hospitals in the region. The population has high rates of HIV, TB and opportunistic infections that often overlap with lifestyle-related hypertension and diabetes.

Creatively supporting district clinicians

“Ideally, complex cases require specialist care. Because it’s so rural and with limited access to ambulances, many patients are treated at primary healthcare level and at district hospitals. These young doctors shouldn’t be handling these patients without senior support, but they simply have to,” Dr Stead says.

Dr Stead plans to put in place a structured rural training and support programme over three years. The three colleagues will make monthly visits to district hospitals and visits to smaller hospitals twice a month, assessing their clinical needs and challenges, improving communication, building relationships and helping them manage and learn from difficult cases. Four district clinicians will spend a week every month at Cecilia Makiwane Hospital to get training according to the skills they need most.

“We must understand their limitations in resources and what they have to work with. We have to adapt the training to the resource gaps,” Dr Stead says. District clinicians will also get a handbook about internal medicine tailored to the Eastern Cape, and connectivity for weekly Skype-based discussions.

Ideal mentoring skills and expertise

Dr Stead has a deep academic knowledge of infectious diseases and HIV medicine. He also worked as the Principal Medical Officer in HIV services at the former GF Jooste Hospital, which provided HIV and trauma care to people living in the Cape Flats. He joined the Medicines Sans Frontiers team in Khayelitsha to start giving antiretroviral (ARV) treatment well before 2004.

His experience is what the Eastern Cape desperately needs. The HIV prevalence in the 15 to 49 years age group reached an alarming 25.2% in 2017, according to the SA National Household HIV Survey. The same local survey from five years earlier showed HIV prevalence in the Eastern Cape to be 19.9%. The World Health Organization’s TB incidence figures for the province in 2015 were the highest in the country at 692 cases for each 100 000. “So we’re keeping more people alive on ARVs, but have made little progress in preventing new HIV infections,” Dr Stead observes.

Making a plan in low-resource settings

Before this initiative, Dr Stead says there were additional district clinical support teams that made about three visits to district clinics a year. “The consultants tended to get a heavy work load when they arrived, instead of teaching. We want to create the opposite of dependency through building skills and hopefully taking some pressure off the regional hospitals,” he emphasises.

Dr Stead was born in and grew up in Cape Town, the son of a biochemist father who did computer-based training and set up rural computer-skills training in the Eastern Cape. Dr Stead’s wife is an ordained minister who runs a counselling practice.

About his biggest influence in rural medicine, he says, “As interns, a friend and I chose East London, knowing we probably wouldn’t get a post in Cape Town. I remember the paediatric and medical outreach trips over bumpy roads to sites like Cofimvaba with some legendary tutors. It got under my skin. That’s why I came back.”