Students offer remedies for health care in Cape Town

By: Cindy Schwartz, WG'05

Posted: 10/4/04

This August, for the fourth year running, a joint student/alumni team from Wharton's Healthcare International Volunteer Program (WHIVP) returned to South Africa for a whirlwind two week project with a lofty goal: recommend improvements for the delivery of health care in Cape Town.

Since 2001, WHIVP has been working with Cape Town City Health and its Director, Dr. Ivan Toms, who is responsible for overseeing 118 clinics that serve 3.1 million people. Each clinic provides free medical care for any Cape Town resident, including vaccinations, emergency services, chronic care for patients with diabetes, asthma and other long-term conditions, as well as the treatment of everyday illnesses. In all, the system handles 5 million visits per year, completely free of charge to patients.

What's more is the staggering array of challenges facing Dr. Toms and the Cape Town health system. Take tuberculosis, a contagious bacterial disease that attacks the lungs: Cape Town is the TB capital of the world, averaging 533 cases per 100,000 people. In poor black areas, however, this number skyrockets to 1,300 per 100,000. HIV incidence is also alarmingly high, particularly in the informal settlements comprised of make-shift shacks constructed of whatever material is handy and free. In these areas, an estimated 28% of adults are HIV positive.

Participants felt that the chance to volunteer in Cape Town was a unique opportunity to see South Africa. "Having read about the political changes in South Africa for years, it was great to be able to experience the culture myself, not just as a tourist, but as someone who worked with and interacted with locals," WHIVP Co-Chair Terence Yap said. "The best part of the work we did out there was having the hands-on experience in the clinics of the townships, being able to work with staff as well as patients. You can't get that experience from reading books or watching TV."

While WHIVP's recent efforts have focused on Cape Town, the WHIVP program itself has been around since 1993. Open to students and alumni from Wharton's Health Care Management Department, the program takes on projects to improve health care services in developing countries. Past projects have been located in Guatemala, Cost Rica, and the Philippines.

WHIVP is made possible by the generous support of corporate and other sponsors. This year's sponsors included the Kaiser Foundation, Genentech, Cephalon, Medtronic, Marsh, and Microsoft. Donations included funds as well as equipment such as educational materials for teaching computer skills to clinic staff.

This year's team of 24 volunteers included four alumni and one professor, providing an opportunity for students to work closely with other members of the Wharton community. The presence of several alumni who had made the trip to Cape Town with WHIVP in previous years allowed for a sense of continuity with the work of past teams, making it easier for participants this year to get their bearings and dive right into their projects from the very first day in Cape Town.

The projects focused on clinic operations, cost accounting, and teaching Microsoft Excel to clinic staff. Building on the work of previous year's WHIVP projects, the team focused on providing detailed plans for implementation of its recommendations and leaving behind tools that clinics can use to put these plans into action.

One example is the work undertaken by the cost accounting team. Previously, Dr. Toms and his managers were unable to track the costs to treat each disease, such as HIV or TB. To address this, the cost accounting team developed a system to allow the clinics to budget by disease state, as well as an automated system for ordering drugs, which will help clinics allocate drug costs to the appropriate disease.

A second project involved analyzing the operations of the Cape Town clinics to look for ways to improve their efficiency and impact. Team members on this project spent several days at clinic sites observing how they functioned, mapping the key processes, and interviewing staff members and managers. From these sessions they developed recommendations on a range of issues such as patient demand, patient throughput, staffing mix, physical layout and organizational structure. To compliment these tactics, they developed a set of tools to help senior management implement and track their progress towards the recommendations they chose to adopt.

The remaining WHIVP team members had the chance to work directly with clinic staff, teaching four types of classes on Excel, catering to different skill levels. In all, 159 clinic employees attended one or more Excel classes.

Outside of the clinics, the team had the chance to explore the sights of Cape Town and the surrounding areas. Highlights included a trip to the vineyard of Wharton alum Anthony Hamilton-Russel, CEO of the Hamilton Russell Vineyards, and a meeting with the Archbishop Desmond Tutu (winner of the Nobel Peace Prize in 1984).

Excel team captain Alexander Buzik, a.k.a. el Capitan, summed up the trip as follows: "Everyone had various reasons for participating, but when we left, we all shared a similar sentiment. We walked through the townships, saw the poverty and the disparity between the haves and the have-nots. We knew the statistics of the rising incidence rates of TB and AIDS. But we also saw the spirit and drive of these people desperately fighting to overcome these challenges. People welcomed us into their homes so we could get a better understanding of their lives. We worked side-by-side with a group of people so dedicated to the Cape Town community that I was simply humbled."