What’s Next?

Shabalala plans to continue her studies after she finishes this program. She said she wants to learn more to help her become a better community health care provider, a role that she thinks is particularly well suited to Clinical Associates.

Shabalala envisions Clinical Associates playing a greater role educating young boys and girls about sex, drugs, alcohol, risky behaviors, and other issues young people face in the rural villages, where there is still a lot of stigma associated with talking to parents about such issues.


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Better community education would be more helpful in the overall health of South Africa because it promotes prevention, and creates a relationship of trust between the health care provider and the patient, she said.

In Africa, as much as 80% of rural communities seek treatment from traditional healers.3 It would be more effective to acknowledge the current system and build relationships rather than competing with a cultural strongholds, Shabalala suggested, as a more antagonistic approach would likely result in failure to get villagers the health care they need.  

One of the reasons rural people seek help from traditional healers is the fact that they have developed a relationship of trust with the traditional healer, she pointed out. When patients come to the hospital they are bound to see a different practitioner at each visit, and because the visit is so short, practitioners do not often have time to develop a real partnership with patients, educate them on their disease, the treatment plan, or on the importance of medical adherence.  

All of these factors increase adherence to medical treatment and are the cornerstone to effectively treating HIV – a major public health issue in the region.

Adding a greater focus on community health into the Clinical Associate training program is something Shabalala would like to see in the future.  Many times patients  “need to be treated with words and not medicine,” she said.

It will be interesting to see how the Clinical Associate profession develops in South Africa and to learn how problem based-learning and early clinical exposure impact this emerging field of health care professionals. 

As an American-trained Physician Assistant, I see a lot of potential in this model of education. The earlier we get students learning clinically, the faster they develop good clinical skills. Many of the rotations in our American PA programs can easily turn into shadowing experiences, and don’t provide opportunities for students to independently make clinical decisions. A well-run problem based learning session turns a passive learning situation into a truly active learning experience. 

Marie Meckel, PA-C, MPH, is a physician assistant who works in Western Massachusetts. She spent a year in South Africa at Walter Sisulu University where she taught clinical associates. Marie has spent the last year interviewing PAs and NPs and their international equivalents and American PAs and NPs working abroad.

Podcast produced by Brianne Aiken, Digital Content Editor, and Nicole Blazek, Senior Clinical Content Editor.