Rural or urban, country or town, the big city or bigger views? Would you prefer to live in a city with all of its amenities and attractions, or instead opt for living out in the stix away from the rat race, where you predominantly have animals for neighbors?
That’s the question many of us ponder (especially as we grow older) and it’s safe to say that for much of the Media MICE writing team, the idea of living in a rural idyll is pretty compelling. Of course, that’s as long as we can get there before AI takes over and we become redundant…
This all sounds like first-world problems though doesn’t it? And of course, it is, and in urbanized societies many people dream of getting away from the cities. In other parts of the world however, the opposite is true and millions yearn for the chance to move to the city because they live in rural areas without running water, electricity, amenities, and most importantly, healthcare. In Africa, where millions of people continue to live in communities that are isolated, the challenge of being able to provide proper optometry care remains considerable.
So what’s to be done to improve access to optometry in a continent characterized by weak governments, massive income inequality, and severe problems in accessing medical treatment? Well, according to a number of studies originating the answer might be to encourage individuals from rural areas to take up optometry. It might sound like a simple idea but there is a growing body of research that indicates that optometry students from rural, isolated communities are much more motivated to practice in such locations after they have completed their training.
‘South Africa belongs to all who live in it’
For example, South Africa is one of the richest countries on the African continent yet despite its relative wealth millions of the country’s citizens continue to live in rural areas and receive little to no ocular healthcare. Opinions of South African Optometry Students About Working in Rural Areas After Graduation was one study that aimed at better understanding how the 42% of the South African population living in rural areas could receive better healthcare and optometry care.
A cross-sectional quantitative study survey instrument, containing both closed and open-ended, semi-structured questions, was used to gauge how the country’s optometry students could help alleviate treatment gaps in isolated areas. All in all, 438 students from all four institutions offering optometry courses in the country, namely the universities of Free State (UFS), Johannesburg (UJ), KwaZulu-Natal (UKZN), and Limpopo (UL), responded to the questionnaire.1
Firstly it should be noted that most respondents reported that they had no desire to establish their first (66%) or second (64.6%) practice in a rural area, which highlights just how difficult it can be to provide medical care in such locations. However, most respondents from rural backgrounds reported that they would open their first (77.2%), or second (79.4%) practice in a rural area, with few if any students from urban areas even expressing interest in working in such locations. Of those who did not intend to work in rural areas, most cited finances (81.2%) and personal safety (80.1%) as being major concerns.1
They say that every man has his price and perhaps in optometry one might be able to say that ‘every clinician has their grant,’ as many respondents indicated that they would accept an offer from the government (67.8%) or a non-governmental organization (NGO) (63.9%) to work in a rural area, with no significant difference between urban and rural respondents in this regard. Sixty-one percent of respondents indicated that a good salary would be a motivation for them to accept a government job offer in the rural area, a figure that was the same for both population groups. Also, most respondents (69.6%) did not agree with compulsory community service for graduating optometrists, which has been proposed as a solution for addressing healthcare access gaps.1
‘Ghana is improving the quality of man’s humanity to man’
Could this study highlight the path forward for training optometrists across the continent, and encourage them to open practices in rural areas, or is it a flash in the pan that’s specific only to South Africa? Happily, the answer looks like its the former and we can point to the study, Factors Influencing the Decision of GHANAIAN Optometry Students to Practice in Rural Areas After Graduation, which investigated the specific reasons why students are more likely to open their clinics in rural areas post-graduation. All in all, 333 (87.4%) participants out of 381 Ghanaian optometry students who were registered in one academic year completed the questionnaire included in the study.2
Echoing the results of the South African study, the survey of Ghanaian students found that students of rural origin had the greatest desire to practice in the rural setting when employed by the government (78.9%) or by an NGO (80.3%). Although more than half of the respondents (54.4%) come from urban communities, this proportion was not significantly greater than those of rural background (45.6%) and the majority of the total number of respondents would accept postings to the rural areas from either the government (75.2%) or an NGO (79.9%). While a significant majority of the total student group (65.8%) were not keen on the idea of establishing their first practice in a rural area, most of the respondents said they would consider establishing their subsequent second (86.6%) practice in a rural area.2
So while there are a number of issues that currently (and will continue to affect) the proliferation of optometry treatment across the African continent, there is room for hope, as many students from rural areas want to return to provide treatment. Other students, even those from urban areas, appear willing to work in rural areas with government or NGO funding or look forward to doing so after they’ve established their first clinical practice. With more support for new optometry students, and crucially for those from rural areas, more people than ever should be able to access proper ocular healthcare in the cradle of humanity.
- Mashige KP, Oduntan OA, Hansraj R. Opinions of South African optometry students about working in rural areas after graduation. Afr J Prim Health Care Fam Med. 2015;7(1):799.
- Boadi-Kusi SB, Kyei S, Okyere VB, Abu SL. Factors influencing the decision of GHANAIAN optometry students to practice in rural areas after graduation. BMC Med Educ. 2018;18(1):188.