Health sciences
Wynand van der Merwe
At one or another time, each of us has been ill and has visited a doctor and other health workers. Medicine is one of the oldest professions and originated in the earliest times in Egypt and Greece. It soon spread worldwide and today, thanks to research that has been done through the ages and has been based on scientific testimony and facts, medicine and the other health occupations are highly specialised and evidence-based occupations.
“Health sciences” is a comprehensive term which includes all professional occupations that play a role in the maintaining of health, prevention of illnesses, diagnosis and treatment of illnesses and rehabilitation in the process of recovery. The occupations that can be included are therefore those of doctors, dentists, nurses, pharmacists, clinical psychologists, physiotherapists, occupational therapists, dieticians, speech therapists and audiologists.
On receiving a degree in any of the health occupations and when entering the occupations, each of the graduates commit themselves to a code of conduct or professional oath (in the case of Medicine it is a modern version of the centuries-old Hippocratic oath), in which service to fellow people through the promotion and maintaining of welfare and health and through the conscientious carrying out of the occupation in all its facets is spelled out. All the health occupations are also subject to a strict occupational code and each graduate must register at a national occupational council in order to be able to practise the occupation in South Africa.
The personality and characteristics of a person considering a career in the health sciences
One should be very careful not to make a career choice based on the romanticising of the profession (as often portrayed in television series and movies); because a parent or family member is in the profession; or last but not least, because you expect to earn a big salary in that profession. Firstly it is therefore important to know exactly what the specific job entails, as well as to be aware of its good and bad components. Talk to people who practise the profession and ask probing questions about the positive as well as the negative aspects of such a career. If possible, “shadow” someone in the profession for one or more days, so you’ll get a firsthand idea of what is possibly in store for you.
Something else that might help you in your decision is to get an idea of the characteristics necessary for a person in order to be successful in the health sciences and to enjoy it. These characteristics include the following:
An empathic attitude toward people and communities;
Readiness for unselfish service and involvement in a community;
The ability to think scientifically, logically and solve problems;
The ability to work in a team and be subservient;
Good social skills;
A philosophy of life which makes it easy to function within strong ethic guidelines and norms;
Diligence and the willingness to work irregular hours;
A strong sense of responsibility;
The ability to function in very stressful situations;
The talent to apply self-discipline.
Admission requirements
Since the health sciences in broad are seen as a field in the applied natural sciences, it is understandable that a scientific foundation at school is necessary in order to successfully study one of the health sciences. It is also reflected in the requirements with regard to which subjects the school leaver must take in grade 12 in order to be considered for one of the programmes in the health sciences. Often a certain minimum achievement in the science subject(s) at school is required and a mere pass is not satisfactory. Currently one or more of the subjects Biology, Mathematics or Science are required matric subjects for nearly all programmes in the health sciences in South Africa.
The minimum achievements required of individuals in these subjects differ depending on the specific course/programme and there sometimes are differences between different universities (even for the same course/programme). It is therefore necessary for learners to study the information on the different universities’ websites, or to contact the administrative departments of the university directly in order to find out exactly what the required subjects are, as well as the minimum achievements necessary in these subjects in order to apply for a specific programme in the health sciences. If by grade 9 you already know what profession you want to work in, it would be ideal that you already find out the information at that time so that you can choose the correct subjects for grade 10 to 12.
With the change of school curricula to the current National Senior Certificate (NSC) system, all universities are busy adapting their admission requirements with regard to compulsory subjects (and achievements in these subjects) for the first school leavers within the current NSC curricula who will apply to universities in 2009. For learners within the new curriculum it is even more important to contact universities of their choice in advance to find out what the new requirements will be.
Due to the fact that only a limited number of students are admitted to nearly all courses in the health sciences, only a limited number of students are admitted to these programmes at each university. The students who are admitted are appointed through a selection process. This implies that you won’t necessarily be admitted to the programme that you apply for, even if you meet the admittance requirements.
Different universities have different selection processes, but the academic achievement of applicants is a determining factor throughout the selection process. In many selection programmes the non-academic merit factors are taken into account along with the academic achievements. In order to position yourself as well as possible in order to be selected for the subject field of you choice at the university of your choice, it is once again important that you find out in advance from the university/universities what exactly the factors/criteria are that are taken into account during the selection process.
Undergraduate programmes in the health sciences
Pharmaceutics
Pharmacists are important participants in the health care chain and in the process of therapy/treatment of illnesses by the administering of medicines. The pharmacist is usually the person responsible for the providing of medicines which have been prescribed by the doctor or pharmacist. Although pharmacists aren’t qualified to prescribe certain medicines, they are very capable of advising patients on these medications and their usage, as well as give advice on what the correct counter medicines (medicines that you don’t need a prescription for) are for general illnesses. They also advise doctors on the correct dosage and possible negative side-effects of medicines. Most qualified pharmacists find a career in the pharmacies of hospitals or other healthcare facilities, or in private pharmacies in the community. In the latter cases the pharmacist is often also the owner and manager of the pharmacy, although these pharmacies are increasingly owned by pharmaceutical chains or even store groups.
A four year Bachelors degree in Pharmaceutics (BPharm) is offered at nine universities in South Africa. Since pharmaceutics is the occupation which forms the link between the health sciences and the chemical sciences the subject or module content of the training programme is a combination of these two sciences with subjects like Organic Chemistry and Inorganic Chemistry, Biochemistry for Health Sciences, Pharmaceutics and Pharmacology which form an important part of the programme. Details in this regard are readily available on the websites of the different universities.
Occupational Therapy
Occupational Therapy involves the rehabilitation of people who are physically or mentally disabled, either acutely or chronically. Its aim is to help to lead the person/patient back from the illness or disability to mainstream society where he or she can once again make a normal or at least a productive contribution and lead a full life.
It typically entails actions like the evaluation of a person’s different work abilities and advice and therapy to develop such abilities; advice and training in the use of apparatus which make work and even normal actions and tasks possible and easier; purpose-driven treatment programmes in order to carry out daily activities; advice and support for family or caregivers; and much more.
In South Africa, the training of an occupational therapist consists of a four year Bachelors degree programme. The first year of study mainly consists of modules which provide the scientific basis for the ensuing theoretical and practical training in the professional field. The practical training takes place over a wide platform which includes hospitals, clinics, schools (also for the disabled), old age homes and work centres. On completion of study the qualified occupational therapist must do one year of community service, with compensation, somewhere in South Africa. Thereafter he or she is a fully independent therapist who can practise his or her occupation either in the public or the private sector.
Dietetics
The dietician looks after the nutritional state of a patient, but often also looks after the preservation of nutritional health in communities and other groups such as sport teams and athletes. On completion of studies dieticians can work in different fields. The most common is probably clinical dietetics, where the dietician works as part of a health team and plans medical feeding schemes which are suitable for the different state of diseases of patients in hospitals. Food service managers or dieticians plan and manage food services in large institutions like hospitals, schools, restaurants, et cetera. Their responsibilities include the coordinating and management of the supply, preparation and serving of food and the staff members involved. Community dieticians provide services to the broader community, sometimes including clinical dietetic help to patients at their homes. Otherwise they also transfer their knowledge and plan and coordinate feeding programmes for large organisations like schools and other organisations in the public sector.
In South Africa a person can qualify and register as dietician by following one of two routes. The first is a four year Bachelors degree of which the first part strongly focuses on the basic sciences underlying to the discipline, while the more dietetic subject content follows in the senior years of the course. The other option is to first obtain a general BSc degree and then do a Masters degree in Dietetics. Different universities offer different options in this regard.
After qualifying and obtaining a degree in dietetics, dieticians must do a year of community service in South Africa. The sub-subject fields ensure that it is an occupation with a variety of career opportunities in the public as well as the private sector.
Physiotherapy
A physiotherapist provides services that promotes health, prevents illnesses, are therapeutic or rehabilitating. The therapeutic and rehabilitating interventions are largely aimed at achieving the normal functioning and movement of patients with illnesses or injuries that affect the cardio-respiratory, neurological and musculoskeletal system. Although the physiotherapist often works in a team along with the doctor, he or she generally functions independently, which means that he or she fulfils a diagnostic as well as therapeutic role. The therapeutic regime often includes, except for mobilisation and manipulation techniques, the prescription of advice on the use of supporting technology and apparatus. The mobilisation and manipulation techniques sometimes make use of electrophysical modalities like heat therapy, electrotherapy and cryotherapy.
The undergraduate programme in Physiotherapy is also a Bachelors qualification (usually a BSc) over a period of four years. Like the other above mentioned professional programmes, it has a strong basic scientific component, mainly during the first year, followed by the subject and occupation-related theoretical and practical training. Completion of the degree is followed by a year of community service after which the physiotherapist can practise independently in South Africa. Besides a career in a hospital or other health facility in the private or public sector, physiotherapy services can also be provided to other institutions like schools, old age homes and sport teams and clinics. It is therefore realistic to expect a diverse and exciting professional career.
Medicine
Becoming a medical doctor is a dream that many young learners have. Often this dream is based on a romanticising of the career without an understanding of its demanding nature. Despite the demands it is still a career which can provide a lot of job satisfaction to a person who has the right temperament, attitude and commitment.
A present-day medical doctor’s practice focuses strongly on a so-called holistic approach which places emphasis on the handling of patients, on all facets of the prevention of illnesses, preservation of health, healing of illnesses and rehabilitation. The largest part of most doctors’ practices still consists of the diagnosis and treatment of illnesses. The two most important and most common treatment modalities are the administering of appropriate medication or the execution of surgical procedures or both.
As with most other professions the explosion in new scientific knowledge and technological development has drastically changed the physician’s practice during the last century. Although the taking down of a thorough history of illnesses and the carrying out of a just and equally thorough physical examination is still the most important part in making a diagnosis, the accuracy of difficult diagnoses are now a lot easier thanks to a series of biochemical tests which can be done on bodily excretions, blood and organs as well as sophisticated x-ray and image modalities. Treatment methods and techniques have undergone revolutionary changes in the past few decades. The knowledge of human physiology and anomalies during illness has developed dramatically. Along with a growing knowledge of biochemical manipulation of physiological and pate physiological processes led to the development of new medications with which illnesses can be treated much more successfully, without too many unwanted side-effects. Surgical procedures have also changed notably, especially thanks to the development of endoscopic apparatus which make it possible to do operations through a “telescope” in body cavities and wounds without making big and drastic operation cuts and wounds which lead to bigger tissue damage and need more recovery time.
In South Africa there are eight universities who train medical students to qualify with a MBChB degree (Bachelors of Medicine and Bachelors of Surgery). At three of the universities the duration of the programme is five years, and at the other five it is six years. The University of Witwatersrand also offers a four year programme for students who already have a BSc degree. All the programmes have a strong foundation of the basic health sciences, along with all the clinical health sciences (which among others include Family Doctoring, Internal Medicine, Paediatrics and Child Health, Psychiatry, Obstetrics and Gynaecology, Narcoses, Orthopaedics and all the surgical subjects).
On completion of the degree the graduate does a two year internship where the application of knowledge and the further development of clinical skills take place. Thereafter follows a further year of community service, as is the case with all the other health professions. The internship and community service take place in hospitals and other institutions in the public sector and the young doctor does earn a salary during the three years. Only after completion of this phase can the doctor practise independently in the public or private sector. In order to specialise in one of the fields of medicine, a further period of in-service training is necessary (see below).
Speech, Language and Hearing Therapy
The speech, language and hearing therapist is a key person on the terrain of prevention, diagnosis, treatment and rehabilitation of a wide variety of pathology of communication and communication abilities. This includes the full extent of speech, language, and hearing, fluency, feeding and swallowing deficiencies which form part of the professional field.
Hearing therapy includes a variety of treatment options for disabled people, including hearing apparatus and strategies to promote functional communication. Speech and Language Therapy includes the handling of speech deviations (like stuttering and other pathology), language (which includes language phonology, syntax, et cetera) including the comprehension and conveying of language in conversations, written and other forms. Neurological reasons for language deficiencies in children (for example cerebral palsy cases) and older people (for example after a stroke) form an important part of the therapist’s patients. The internet dictionary Wikipedia provides a comprehensive explanation of a speech, language and hearing therapist’s spectrum of practice and professional activities.
The speech, language and hearing therapist’s training also entails a four year Bachelors degree programme. Although the basic scientific foundation of the course includes elements of the natural sciences, it also includes modules like General Linguistics and Psychology, which provide an important foundation of skills for the communication and language deficiencies that form part of the professional subject field. Clinical and practical training is not restricted to hospitals, but mostly take place in clinics, schools (for normal and disabled children), rehabilitation centres and old age homes. It is also in these institutions where the qualified therapist later finds career opportunities.
Dentistry
Dentists are practitioners who are responsible for the prevention, diagnosis and treatment of diseases in the mouth cavity (of which the teeth form the most important part of their practice), as well as the other structures of the so-called maxillary facial part of the face. As in Medicine the most common functions are those of diagnosis and treatment. Dentists also readily make use of dental technicians and mouth hygienists to help and support them in especially the treatment methods they use.
Dentists who do not undergo further training in one of the dental specialist areas still have the benefit that they can make diagnoses and give treatment that is relevant to the specialist areas (but only if they have adequate experience). Their practice therefore often entails a spectrum of therapy which includes teeth extractions, repair work (the “filling” of teeth), teeth bridge work, dentures (“artificial teeth”), root canal therapy, treatment of gum diseases, and even the “straightening” of teeth (orthodontics) and implanting of (artificial) teeth in the jaw.
The training of dentists in South Africa consists of a five year Bachelors degree of which the basic section on health sciences corresponds greatly to that of Medicine. The clinical/practical training takes place in dentistry hospitals, clinics and practices. An inherent “dexterity” is a very good attribute for a prospective dentist, since the finer technical work forms an important part of a dentist’s therapeutic work. Graduate dentists must also complete a year of (paid) community service in the public sector before they can start working as independent practitioners.
Nursing
It is probably apt to describe Nursing (and therefore nurses) as the backbone of the health services in South Africa and elsewhere in the world. Nurses form an essential part of the health team and are key players – sometimes independent, but usually in a team – in the processes of prevention of diseases (just think about their responsibility in the maintaining of sterility in hospitals, their leading roles in vaccination programmes, et cetera), the care for and treatment of sick people in their initial process of healing and recuperating, as well as through support, accompaniment and advice on long term rehabilitation where necessary. They fulfil these functions in health facilities ranging from the most sophisticated tertiary hospitals to the humblest of primary care clinics in remote rural towns.
Often, especially in primary health facilities in communities, nurses also play an important role in the management of the services and facilities. Nurses in specialist fields which require special knowledge and experiences, are a worldwide tendency in fields like intensive care units, operation theatres, obstetrics wards (where normal and complicated births and caesareans are performed), psychiatric wards/hospitals and oncology clinics and wards (where patients receive radiation, chemotherapy and other treatments for cancer). These nurses receive additional training in the specialist field after receiving their initial training, and often receive a postgraduate or post-basic diploma.
Nursing, which enables a person to register at the South African Council of Nurses as a “registered nurse”, can follow one of two routes. The first is a Bachelors degree (BCur or BTech) at a university or a Diploma in Nursing at a nursing college. Both these training programmes stretch over four years.
Postgraduate programmes
In all the health sciences there are postgraduate programmes where you can either become better qualified in your main subject, or specialise in a discipline (or subsection) of a main subject. In Medicine and Dentistry specialisation also enable you to register as specialist at a professional council and have a career in the specialist field. This type of specialist training usually stretches over four or five years, depending on the subject field.
Naturally postgraduate studies also open up to the door to another career option, namely to join the university as academic and/or researcher in that particular health science.
Medicine can be a very exciting and rewarding job. However, it also requires sacrifices. Ensure that you are truly suited for the job, because only then will you enjoy it. Good luck with your decision!