Nurse Zee - Telehealth Implementation Researcher.

One thing that surprised me during my Master’s research was that young people were not asking for teleconsultations to replace clinics, they were asking for a starting point. Many participants described teleconsultation as a way to get advice, understand whether their symptoms were serious and decide if they needed to go to a clinic. They saw it as a guide, not a substitute for healthcare.

Sometimes we debate whether digital health should replace conventional care, young people seem to be asking a different question “What can help me access the right care, at the right time, without unnecessary barriers?” Perhaps the future isn’t digital healthcare versus conventional healthcare, perhaps it’s both.

Today for the first time I typed “Happy International Nurses Day” differently. I sent that message to one of our nursing WhatsApp communities, but it didn’t sit comfortably with me. It felt like saying “happy birthday” to a child from a child headed home, a child carrying responsibilities far beyond their age, uncertain of where the next meal will come from, exhausted by survival itself. You say “happy birthday” knowing very well that for them there is very little to celebrate. Sometimes the day is acknowledged simply because it exists, not because it feels joyful. That is what it feels like being at the centre of uncomfortable nursing conversations for me.

As much as my own career may seem to be in a better space now, I remain deeply connected to the realities nurses face daily. Particularly nurses on the ground in public healthcare facilities and the truth is, very little currently makes many nurses feel proud, celebrated or valued in a system they serve so tirelessly.

We work in an overloaded healthcare system with overwhelming patient volumes and severe resource constraints, a system that often does not financially value the work nurses do. A system that expects more from nurses while their growth, wellbeing and professional development are often not prioritized. A system that declines study leave, limits opportunities, and leaves many nurses feeling professionally stuck and emotionally exhausted.

So today I found myself asking, how do we genuinely say “Happy Nurses Day” to nurses carrying all of this? Nonetheless I still pen these thoughts because I remain proud to be a nurse. And I hold onto the hope that one day international nurses day will truly feel like a celebration for nurses everywhere, not just a symbolic acknowledgement on a calendar.

Until then may we continue fighting for the liberation, dignity, development and recognition of our profession.

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Inequalities in our country are not just high, they are violently disproportionate! South Africa has over 60 million people, yet only around 9 million people access private healthcare; while over 50 million rely on the public healthcare system. Almost half of the country’s healthcare spending serves that smaller private sector population.

A minority accesses a greater share of specialists, infrastructure, technology and healthcare workers, while the majority depend on an already overburdened public system. These are not just statistics to me, they are lived realities. This is why to me the conversation of NHI matters, not because NHI will magically fix healthcare overnight and yes concerns around corruption, governance and implementation are valid.

But I sometimes wonder ukuba when everyone depends on the same healthcare system, does accountability start to change? Because right now many people making decisions about the public healthcare system often have the option of private healthcare when the public system fails. But what happens when we are all in the same boat? Would we protect the system differently? Would we demand better leadership? Would we tolerate dysfunction the same way?

At its core the NHI conversation is not just about politics, it’s about whether quality healthcare should depend on what people can afford.

One of the biggest things research has taught me is this, let people speak for themselves. As researchers and healthcare workers, we often walk in thinking we understand. We’ve read the literature, we know the guidelines, we’ve seen similar cases. But the truth is, our lens is not their lens.

The person sitting in front of you understands their environment, their challenges and their reality in a way you never fully will. Research demands that we don’t impose meaning, it requires us to listen, allow participants to describe their own experiences, their own perceptions in their own words.

And sometimes what they say will not match what you expected, it might challenge your assumptions or might even contradict what you thought was the “real issue.” But that’s the point If we override their voice with our own interpretations, we’re no longer understanding the problem. We’re just reinforcing our bias.

On this page, I’ll be sharing and breaking down my research work in a way that connects with real world healthcare. I just completed my Master of Philosophy in HIV Management at the Africa Centre for Inclusive Health Management, Stellenbosch University. My research looked at Youth Perceptions of Teleconsultations to Improve Access to Healthcare in Rural and Urban Areas of South Africa.

And I am now pursing my doctoral studies in Public Health within the Division of Health Systems and Public Health, at the Faculty of Medicine and Health Sciences, Stellenbosch University.

My hope is that this space becomes more than just sharing research but a place where community members, healthcare workers and researchers can learn from each other, challenge ideas and think differently about how we strengthen our public health system.

One thing we don’t talk about enough as healthcare workers is that, the patient in front of you is not just a diagnosis. They are a product of where they come from, how they live, what they can afford, what they’ve been exposed to and what they are dealing with outside of your consulting room. This is what we mean when we talk about social determinants of health; things like income, education, employment, housing, transport, family support, even safety in their community. These are not “extra” factors, they shape health outcomes just as much as the medication we prescribe.

So when a patient misses appointments, defaults treatment or doesn’t follow advice, the question is NOT ALWAYS “why are they not compliant?” Sometimes it’s: They don’t have transport money, they are choosing between food and medication, they are hiding their condition at home or they don’t have the kind of support we assume they have.

If we are not paying attention to these realities, we end up designing care that only works on paper, not in real life.

PS: Can you believe this picture was taken 10 years ago, when I was a new grad nurse.🤭

Healthcare workers, I’m curious about your reality on the ground. In a high volume public facility in South Africa, it’s not unusual to see 40 to 50 patients a day, often with limited staff and time.

Now imagine this; Out of those 50 patients, about 15 have stable conditions or minor alignments that could be managed through an online consultation neh. Tell me, if the right systems were in place; would you be open to managing a portion of your patients through an online system, while keeping physical consultations for those who truly need to be seen in person?

Or do you feel that all patients should still come into the facility, regardless? I’m not asking from a theory point of view bethuna, I’m asking from your everyday experience in your facility.

Masincokoleni, and no I am not collecting data for my PhD.😂

You miss clinic appointments not because you don’t care, sometimes there’s no transport money and the clinic is too far for you to walk and at times life just happens. I’ve sat in consulting rooms and seen this over and over again, patients who wanted to come back… but couldn’t and as a nurse, it always left me wondering what happens to them after they leave?