CORRESPONDENCE

 

Capacity building during COVID-19: Utilising South Africa's underutilised international medical graduates

 

 

To the Editor: The coronavirus disease 2019 (COVID-19) pandemic has wreaked havoc on global healthcare systems, with even well-resourced healthcare systems in Western Europe, the UK and the USA being significantly affected.^[1]

Although official data are difficult to obtain, a UK media statement^[2] suggests that 25% of the UK's doctors are absent due to COVID-19, with European figures^[3] just as alarming. The concern is such that the UK recently provided temporary registration to 11 800 doctors,^[4] while Harvard^[5] is contemplating the early graduation of medical students to improve capacity in the USA. Numerous South African (SA) healthcare workers have already been quarantined.^[6] Trying to expand SA's healthcare capacity while simultaneously contending with a loss of healthcare staff due to COVID-19 could pose a significant challenge to a system already under strain.

SA international medical graduates (IMGs) could potentially assist. The integration of these doctors has long been problematic for the Health Professions Council of South Africa (HPCSA)^[7] and the National Department of Health (NDoH), with the matter previously ending up in parliament.^[8,9] A 2018 NDoH policy,^[10] aimed at bridging their integration, has yet to be implemented. Regardless, SA has a significant pool of underutilised IMGs. A recent petition and survey in the UK'^[11,12] called for IMGs awaiting UK registration to be allowed to assist, while amended legislation^[13] already allows specific unlicensed IMGs to serve during the COVID-19 crisis in New York. Analysis of IMG availability in SA was lacking, so we conducted an online survey.^[14]

The survey generated 644 responses within 48 hours (Fig. 1). Of these IMGs, 458 are currently in SA, and are either unemployed or working in non-medical roles. Almost all are willing to serve during the COVID-19 outbreak, but conditions such as brief orientation training or working near to home would ideally need to be considered. Although the demographics and registration statuses vary, many are registered with international councils or are awaiting HPCSA board examination results or registration. Currently, HPCSA IMG administration is on hold during the lockdown.^[15] In contrast, other medical regulators, like the Medical Board of Australia,^[16] are streamlining their processes to expedite IMG registrations.

 

 

Utilising unregistered doctors is not without risk. Limited quality control could potentially compromise patient care. However, this could be mitigated by deciding on minimum standards during recruitment, as done in New York,^[13] and limiting their scope of practice to very specific, in-hospital roles.

Should the COVID-19 situation in SA deteriorate, intensive care unit (ICU) capacity will need to be expanded, as already seen in many countries.^[17,18] Staffing of such facilities could become the biggest challenge. Incorporating IMGs into specific roles would free up experienced doctors to staff more specialised departments, like ICUs. Perhaps the NDoH could consider incorporating final-year medical students, recently retired doctors and IMGs in a tiered call-up strategy, should the situation necessitate. As previously discussed, similar approaches are being trialled globally^[4,5,13] We suggest that the NDoH acts proactively by identifying all available medical human resources for future call-ups, including underutilised IMGs, a potentially vital asset.

Jehane Michael Le Grange, Sean James Dickinson

South African international medical graduates, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China jehanelegrange@gmail.com

Jacques Robert Jeppe Davis

South African international medical graduate, Department of Paediatric Orthopaedics, Royal Childrens Hospital, Greater Glasgow and Clyde NHS Trust, Glasgow, Scotland

 

References

1. World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report-69. https://www.who.int/docs/default-source/coronaviruse/situation-reports/202 003?sitrep-69-covid-19.pdf?sfvrsn=8d6620fa_4 (accessed 30 March 2020).         [ Links ]

2. Johnson J. One in four doctors off sick or in isolation due to Coronavirus. Telegraph, 30 March 2020. https://www.telegraph.co.uk/news/2020/03/30/one-four-doctors-sick-isolation-due-coronavirus/ (accessed 30 March 2020).         [ Links ]

3. Minder R, Peltier, E. Virus knocks thousands of health workers out of action in Europe. New York Times, 24 March 2020. https://www.nytimes.com/2020/03/24/world/europe/coronavirus-europe-covid-19.html (accessed 30 March 2020).         [ Links ]

4. General Medical Council. Coronavirus - CMC grants temporary registration to 11,800 doctors. https://www.gmc-uk.org/news/news-archive/coronavirus---gmc-grants-temporary-registration-to-11800-doctors (accessed 30 March 2020).         [ Links ]

5. Buckley MRR An option to serve in COVID-19 light. Harvard Gazette, 30 March 2020. https://news.harvard.edu/gazette/story/2020/03/med-students-offered-early-degree-option-to-hefp-in-covid-19-nght/ (accessed 31 March 2020).         [ Links ]

6. South African Government. Minister Zweli Mkhize confirms 2nd death and total of 1280 cases of coronavirus COVID-19. https://www.gov.za/speeches/niinister-zweli-mkhize-confirms2nd-death-and-total-1280-cases-coronavirus-covid-19-29-mar (accessed 30 March 2020).         [ Links ]

7. Shaikh N. Look Foreign-trained doctors take on HPCSA. Sunday Tribune, 4 March 2020. https://www.iol.co.za/Sunday-tribune/news/look-foreign-trained-doctors-take-on-hpcsa-13585648 (accessed 31 March 2020).         [ Links ]

8. African National Congress Parliamentary Caucus. National Assembly debate on registration of foreign qualified doctors by the HPCSA by Deputy Minister of Health Dr MJ Phaahla. 13 March 2018. https://ancparliament.org.za/content/national-assembly-debate-registration-foreign-qualified-doctors-hpcsa-deputy-minister-0 (accessed 31 March 2020).         [ Links ]

9. Parliamentary Monitoring Group. Question NW888. Singh, Mr N to the Minister of Health. 7 October 2019. https://pmg.org.za/committee-question/12375/ (accessed 31 March 2020).         [ Links ]

10. National Department of Health. Policy Guideline on the Requirements for Practice of Medical Professionals in South Africa. Pretoria. NDoH, 2018. http://www.health.gov.za/index.php/2014-03-17-09-09-38/policies-and-guidelines/category/460-policy-and-guidelines-2018?download=2851.policy-guideline-practice-of-medical-professional (accessed 31 March 2020).         [ Links ]

11. Scott T. Allow doctors living in the UK waiting for GMC registration to assist against COVID19. change.org. https://www.change.org/p/general-medical-council-gmc-nhs-uk-government-allow-doctors-living-in-the-uk-awaiting-for-gmc-registration-to-assist-against-covid-19 (accessed 31 March 2020).         [ Links ]

12. Anonymous. Can you help? https://docs.google.com/forms/d/e/lFAIpQLSdiZs4gY0wxvow3Q4kCTrjR5zcgicTk-ITS6eESFrMxziYDCg/viewform (accessed 31 March 2020).         [ Links ]

13. Cuomo AM, Governor, New York State. Executive Order No. 202.10. Continuing Temporary Suspension and Modification of Laws Relating to the Disaster Emergency, https://www.governor.ny.gov/news/no-20210-continuing-temporary-suspension-and-modification-laws-relating-disaster-emergency (accessed 31 March 2020).         [ Links ]

14. Le Grange JM. The availability of doctors to assist in South Africa during COVID-19 pandemic, https://docs.google.com/forms/d/e/lFAIpQLSf0M2-FhAT-0TJ84ICK0EiN188hlFhEQtZaLMlq4pMKVoLr0w/closedform (accessed 30 March 2020).         [ Links ]

15. Health Professions Council of South Africa. Communique on the lockdown period. https://www.hpcsa.co.za/Uploads/Events/Announcements/Notice_Communique_on_the_Lockdown_Period.pdf (accessed 31 March 2020).         [ Links ]

16. Medical Board of Australia. Medical Board of Australia responses to COVID-19 pandemic, https://www.medicalboard.gov.au/News/2020-03-30-COVID19-Board-response.aspx (accessed 31 March 2020).         [ Links ]

17. Remuzzi A, Remuzzi G. COVID-19 and Italy. What next? Lancet 2020 (epub 13 March 2020). https://doi.org/10.1016/s0140-6736(20)30627-9 (accessed 30 March 2020).         [ Links ]

18. Murray CJL. Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator days and deaths by US state in the next 4 months. http://www.heaithdata.org/research-article/forecasting-covid-19-impact-hospitai-bed-days-icu-days-ventilator-days-and-deaths (accessed 30 March 2020).         [ Links ]