MEDUNSA - an unusual University

MEDUNSA is an unusual university. The acronym stands for the Medical University of Southern Africa. Its graduates are almost exclusively trained in the health sciences, including medical doctors. It has no Arts Faculty. It was set up to cater for students who have passed their final school examinations, or matriculation, but were not accepted by any other South African university. Under the apartheid regime, MEDUNSA was a so-called homeland university, established next to Bophutatswana. The exclusively black students were supposed to work exclusively in black health institutions treating black patients.

When Nelson Mandela became President in 1994, it was first thought that this institution would be quickly closed down. It was an apartheid institution based on racist assumptions of "black inferiority". However, it was quickly realised that all South African institutions were racially based, whether as "superior white" institutions or otherwise. Pragmatism prevailed. The teaching staff pointed out that they had many years of experience of teaching black students disadvantaged by the social and educational policies of apartheid. There were financial sponsors who had endeavoured throughout the apartheid years to raise the standards of teaching at MEDUNSA and now wanted to be of some real help under the new government.

Medunsa now enjoys great popularity. This is due in part to the relatively low student fees and the special educational support programmes. Government instructions to open the historically whites-only universities and schools to people of all races has led to tensions in some of those bodies. At Medunsa, where the racial separation had been rigorously applied, the new policies have improved the atmosphere of teaching and learning quite markedly. Help for disadvantaged students has been expanded, and a commitment to improved health care in the black communities has resulted from the duty to overcome the second-class health service previously provided in "black-only" areas.

The seven million people who live in the region around the university benefit from the help that Medunsa gives. The Ga-Rankuwa hospital is the teaching hospital next door to Medunsa. All the students do their clinical training there. It is the second largest hospital in South Africa, after Baragwanath in Soweto. It is the referral Centre for 39 rural clinics. It has 38 departments with 150 full-time and 52 part-time doctors. 1.500 operations are carried out every month. There are 300,000 in-patient admissions per year and the outpatients department looks after about 600 patients per day. Ga-Rankuwa is the only hospital in the region providing specialist treatment for HIV/AIDS patients in the district.

MEDUNSA now belongs to Gauteng Province, where Johannesburg is the main city. Medunsa is about half an hour's drive away from the South African capital, Pretoria and an hour and a half from Johannesburg. Gauteng, includes the largest and richest gold mining and industrial region of South Africa. It is still the magnet drawing its workforce from all parts of the country and from neighbouring countries. The shantytowns lining the highways between the industrial areas with their cooling towers and slagheaps seem to go on without end.

On the way to MEDUNSA from Johannesburg in a small car I could not only see the industrial landscape, I could feel it and smell it too. Along the whole route I felt we were squeezed between huge trucks and buses full of workers. The air is polluted by exhaust gases, and the sun shimmers through dust clouds. The heat is oppressive, though in winter it is bitterly cold. Sometimes there is snow, and often there is an icy wind. On turning off onto narrower country roads, there is a vista of yellow dried-up grass, but soon there appears a complex of modern concrete buildings and I knew that I had arrived at MEDUNSA, the Medical University of Southern Africa.

The site is like a small town, stamped into the ground on 350 hectares of "nothing". Although 3,000 students live and learn there and even though each of the faculties is bursting at the seams, a student from Europe would feel lost because of the wide expanse and emptiness of the area. Here I also realised that the ideas people have about scale in a giant country are quite different from ours in crowded little Europe.

The deficiencies in the wide-open spaces of South Africa relate to equipment and the teaching staff. The halls of residence are also very modestly furnished. The deficiencies are particularly clear when compared to the luxurious furnishings of the venerable English or Afrikaans speaking universities for the formerly "white-only" elite. As long as South Africa has such discrepancies between the institutions certainly no white South African student will want to register with Medunsa. However Medunsa now has students from the Indian minority. The new mixture of 90 percent African and 10 percent Indian students is a first step in the direction of the Rainbow Nation.

The building of Medunsa began in 1978. The university was planted in the bare veldt or barren grassland. The first students were able to start attending lectures two years later on what was still a building site. In addition to the problems that the students had as a result of coming from poor families and from bad schools, it was made more difficult as the exclusively white teaching staff only spoke English or Afrikaans. Today the teaching staff has been mixed for a long time, and all eleven of South Africa's national languages are represented, whilst the official teaching language has remained English.

My first goal was to visit the faculty of Basic Studies where a student can retake the school leaving exams in the natural sciences missed out in most black schools, before actual study begins. The Faculty of Natural Sciences was founded in 1989. Originally it provided only one year of study. Now it offers three years of study. In addition it offers evening courses for those who are still at high school to prepare them for the final school exams, and also for practising teachers of the natural sciences who might want to re-take their final examinations. Passing the previously failed or missed exams in the natural sciences will give admission to training at MEDUNSA or at other universities. For those who wish to acquire their BSc in natural science disciplines, there remains the full three-year degree course and that would make one eligible to be a high school teacher in those subjects.

Professor Groenewald, the Dean of the Faculty, received me in his office. He has many plans to expand the faculty further, and above all he wants to institute evening and correspondence degree courses, "for all those who today lack scientific technical knowledge in their professions," he declared. In fact this is true for the large majority of the population, because black students were deliberately cut off from scientific knowledge for many years. Now there are three times as many applicants for the Faculty of Basic Studies as can be accepted.

With the help of Community H.E.A.R.T, a fund registered in both Germany and Britain, the first laboratory "bus" has been developed to overcome this deficiency of scientific and technical teaching. A specialist teacher travels with this vehicle to 15 high schools, mainly in the Soshanguve district. Experiments can now be performed with the help of this science "bus" fully equipped with all the equipment needed, including an electricity generator and a tank of clean water. Learning by rote, the opposite of scientific thinking, can come to an end. Previously barely a half of all students who took the final exam passed. Now there are high hopes that pass rates will improve.

The Faculties of Medicine, Dentistry and Veterinary Science educate students to become graduate doctors, dentists and vets as well as staff for all the related health care professions, including nurses. Technical personnel for radiology, physiotherapy, nutrition, dentistry technicians, and veterinary assistants are trained. The Faculty of Veterinary Science will eventually close for reasons of economy. The students will then be enrolled in the Veterinary Science Faculty of Pretoria University at Onderstepoort, about 20 miles away. That institution formerly admitted white students only. Apartheid ruled that there had to be separate veterinary training institutions, no matter what that cost.

Whilst white-South Africa rejoices in having doctors available to the high levels achieved in Europe, for black South Africans there was only one doctor for every 20 000 inhabitants. This black-white discrepancy in the availability of doctors is still extreme today.

There was also a large discrepancy in the training of doctors. At the end of 1993, there were 25,967 doctors of whom only 4.4 percent were black; of 4,024 dentists only 1.6 percent were black, and of 3,597 vets only 1 percent were black.

In 1982 the first 34 students took their final exams at MEDUNSA in accordance with the guidelines of South Africa Medical Council. In 1987 the first dentists and vets graduated. At the end of 1993 of the 1,150 black South African doctors, 742 were educated at Medunsa. For dentists it was 47 out of 63, and for vets it was all 37. A small number of students also come from South Africa's neighbouring countries, which even today have universities less well equipped. For them the fees are barely possible as a result of the enormous difference in currency.

The Medical Faculty offers a six-year education for doctors, concluding with a Bachelor Degree in Medicine and in Surgery (MB ChB) or in Research as a Bachelor of Medical Science (BSc Med). There are also studies for specialists in almost all important areas. Nurses take Bachelor and higher Degrees in Nursing Science. X-ray assistants, kindergarten teachers and medical administration staff are also educated.

The Dental faculty treats about 600 patients every day. It also has clinical laboratories and workshops for making artificial teeth. It has a dental hospital with three operating areas. The study of dentistry lasts 5 years and the studies for diploma for dentistry technicians, assistants or hygienists is three years.

Attached to the Faculty of Medicine is the Goldfields Institute for Nutrition. Amongst other things it carries out research into health problems related to protein deficiency, Kwashiorkor. It is one of the commonest illnesses in this barren region neglected by the apartheid regime, where the ground does not permit any noteworthy livestock farming. As the people barely make a living, they cannot buy meat, milk or eggs, and children suffer from animal protein deficiency from earliest infancy. Half of all cases of death in small children can be traced back to lack of animal protein. Also half the children taken into the Ga-Rankuwa hospital suffer from this deficiency.

In addition to a program of research into these failings in nutrition, which also result in lowered intelligence and even severe mental impairment, nutritional scientists and vets are together trying to introduce suitably acclimatised hens and goats, and thus little by little, to motivate families to raise animals. A few thousand have already had results from the pilot project initiated and looked after by MEDUNSA. In these on-going small-farming families, there is not only milk for the children but now and then a breakfast egg. As a result of careful management, part of the yield is sold to obtain feed for the animals and the families become independent of animal feed supplied by MEDUNSA when they start.

In the meantime, as the outside projects at Medunsa take up so much space, a further institute has been founded specially for the administration and co-ordination of this communal service. This is called MEDICOS, Medunsa Institute for Community Services. There is a model Centre for the rehabilitation of people with physical and mental disabilities in the Soshanguve district. This is also part of the research program into protein deficiency. A day care centre was started for the very many children with disabilities, especially those with mental disabilities due to protein deficiency. In 1992 a special school was initiated which offers both a programme to promote independence and school lessons, with appropriate professional education. It is at present the only South African school for mentally handicapped black children, which is connected to a university. It therefore offers the advantage of care by child psychiatrists, clinical psychologists and other specialists.

In Winterveldt, a giant squatter camp in the region of Pretoria, MEDUNSA supports the medical care of the more than one million people who live there. In this slum, even the drinking water must be bought by the can. There is neither electricity nor rubbish collection. However the community is very active. Even under the apartheid regime there were many citizens' initiatives, amongst them St. Peters Clinic. This is an outpatient medical practise, which thanks to support from MEDUNSA offers good care and treatment in its still very poor rooms. Its services are very much in demand. Medical students, young doctors, and nursing students complete their practicals here under the direction of experienced MEDUNSA Doctors and Nursing Sisters. As a result it can open all day, including Saturdays. In addition, there is mobile outreach care with a university bus taking student nurses and doctors with their tutors to remote clinics, and a mobile clinic, which regularly travels to further parts of Winterveldt.

"Winterveldt is a stroke of luck for me" disabled Doris told me. She lives with her sister-in-law in a well-maintained little clay house. "We came here to escape the poverty in KwaZulu. Then I became ill with polio. When the young social worker Jane Motau came to the clinic in 1992, she started together with Christa Meyer, the occupational therapist from MEDUNSA, a wonderful project for the disabled of Winterveldt." Polio-damaged Doris not only received splints for her legs, but she was so well rehabilitated that she could move around alone in her house again and do housework without outside help. She was also given a wheelchair from donations, learned to sew and can now support herself again.

Polio and also other very infectious illnesses, such as the feared measles, should soon appear no more in Winterveldt, as all small children are now inoculated in accordance with the World Health Organisation immunisation scheme. The large space in St. Peters Clinic, in which the inoculation day is held, is filled to overflowing with mothers and their children. Sister Thuli Mzamane, the clinic director, apologises for the fact that there is not the private atmosphere to which I am used in Germany. "We can only expand when the money for it is there. However everything is clean and hygienic. It is so important for us that all women come with their children". In fact almost all mothers exercise their new right in Winterveldt to free health care and medications for pregnant mothers and for children up to six years old.

It is a strange university stuck out there in the "middle of nowhere" yet surrounded by a million people who are out of sight of the university. It is a university which has to teach to the highest standards after repairing the poor education provided by the education system inherited from the apartheid era. It is a university which has to provide for the needs of the community surrounding it for there is little else yet in the way of health care. It is succeeding. Most of its graduates remain to provide health care to the people in the region.

(Translated from the German original report by Edelgard Nkobi, who is a member of our twin organisation Community H.E.A.R.T. e.V., Essen, Germany.)