Dr Sinabo Vilakazi was one of the doctors who responded to calls from across the country via facebook pages and WhatsApp groups for health professionals to provide first aid at #FeesMustFall protests. Vilakazi, who graduated from medical school in 2011, joined students during Friday’s march to the Union Buildings.

“We understand the plight of students,” said Vilakazi, who paid his own way through medical school with the help of bank loans. He is still paying off student debt and, with fluctuating interest rates, he has no idea when he will finish.

“It was difficult to pay (fees) but it’s now becoming impossible,” he said.

Across South African universities, medical schools have the most stringent academic requirements and are the most expensive faculties. This year, medical school tuition cost R44,220 at the University of KwaZulu-Natal and R61,500 (first year, increasing to R64,500) at the University of Cape Town. Then students still have to pay for accommodation and living expenses.

Yet the country is in dire need of doctors and universities are coming nowhere near to meeting the need. Around 1,600 doctors qualify every year in South Africa, yet by 2010 there was already a shortage of more than 14,300 doctors in the public sector and 44,780 nurses, according to a Department of Health human resources document based on the vacancy rate in the public sector.

The cost of a health sciences education in South Africa has risen by about 10% every year in recent years – almost double the rate of inflation, according to Gavin MacGregor, the director of the Umthombo Youth Development Foundation. The foundation provides scholarships, mentoring and social support for rural students to study health, and has produced 218 graduates, of which about 30% have become doctors, who are obliged to work in rural areas to ‘pay back’ their scholarships.

While about 40% of the country lives in rural areas, only 12% of doctors choose to practise there, according to a 2009 University of KwaZulu-Natal study.

Dumisani Gumede received an Umthombo Youth Development Foundation scholarship to go to university. He returned to the programme as a mentor and MacGregor credits him for the high success rate among the foundation’s students.

Gumede said students from poor, rural backgrounds face struggles beyond just adjusting to university.

“Our student at uni, he or she knows that at home they suffering – that they have nothing to eat,” he said. “Whatever (stipends) we are giving them for food, they are dividing that money and sending it back home.”

According to Gumede, one student was the eldest in a child-headed family sent almost 70% of his stipend home so his siblings could buy food and school uniforms, and pay fees. Gumede said the student struggled academically because he was hungry most of the time.

“We know that health science students from rural areas are beacons for their communities and more likely to return to serve and lead these communities,” the Rural Doctors Association of Southern Africa (Rudasa) said in a statement of Friday. “However rural students are under-represented at tertiary institutions and denied access precisely because of poverty, and the vicious cycle this creates in preventing access to financial aid.”

The fees may have fallen last week but this won’t help the hundreds of rural students who dream of becoming healthcare workers and who won’t be able to pay tuition next year as scholarship programmes are cut.

“Due to the increased university fees, we may for the first time in our 14-year history not select any new students next year because of a lack of funds,” said MacGregor, who added that the KwaZulu-Natal-based programme typically selects about 65 students annually for scholarships.

Dr Desmond Kegakilwe was born in the rural village of Tlakgameng, North West about 100 kms from the Botswana border. He became a doctor through a mix of luck and chance.

After matric, Kegakilwe made the more than 800 km journey to Durban to apply at Natal Technikon. The school was full but he overheard a group of guys talking about how they would try their luck at ML Sultan Technikon. He joined the crew as they hopped on a taxi to see if the next school would take them and eventually he ended up seeking a spot at Pietermaritzburg technical school.

“I’d never heard of that place before, I’d only seen it on TV,” said Kegakilwe. Eventually, when it came time to pay registration fees, Kegakilwe turned to his father who told him that the family could not afford the fees, but that he could scrape together money for Kegakilwe to come home.

Back home and undeterred, Kegakilwe approached the North West health department. The department said there was only one sponsorship opportunity left: Cuba.

Kegakilwe became part of the first wave of North West doctors to be trained via South Africa’s bi-lateral programme with Cuba, in which South African medical students are trained by the island nation renowned for its public health programmes.

“Everyone has their story to tell,” Kegakilwe said of the struggles of rural-born doctors.

Kegakilwe is now the chairperson of Rudasa but the programme that helped him return to the rural North West as a doctor has been forced to limit opportunities to students. Due to budget shortfalls, the North West will reportedly dramatically cut the number of students it sends to Cuba next year.

The province has also said it is unable to accept any new students into a joint scholarship programme it runs with the University of the Witswatersrand (Wits) according to Dr Ian Couper director of Wits’ Centre for Rural Health.

In April, the North West health, public works and education departments were placed under administration. According to the Rural Health Advocacy Project (RHAP), this means the provincial treasury oversees day-to-day financial management. According to RHAP, the decision was prompted by the departments’ inability to effectively manage budgets and pay creditors, which resulted in massive accruals or unpaid bills.

As part of the scholarship programme, graduates who receive financial support commit to returning to practice in the North West for a set number of years. According to Couper, a freeze in posts in the North West health department due to austerity measures may jeopardise graduates’ abilities to honour their commitments.

“Graduates don’t know whether they will be able to get a post because there is a freeze on new appointments,” said Couper, who adds that the North West-Wits partnership is more effective than the Cuba programme because it trains people in the context in which they will work.

“#FeesMustFall was historic, it was beautiful, it was hopeful and it must be the start of something that reaches beyond campus squares and the Union Buildings to the forgotten corners of our country, “ said Rudasa.

“This movement is representative of a class struggle that recognises one of the roots of social exclusion: lack of access to higher education. We choose to add our voices to this movement for rural students and graduates who persevere despite loans, debt and financial constraints hanging over their heads, and (for the) rural communities battling in the face of the human resources for health crisis.” DM

Additional reporting by Fathima Simjee.

Photos courtesy of Medics4FMF.