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20 April 2020 | Story Prof Francis Petersen | Photo Sonia Small
Prof Francis Petersen.

Our world has changed.  The aspects that we have accepted as daily occurrences, and those that we have taken for granted, are no longer possible.  Anxiety and uncertainty have filled our lives.  After the first infections in China at the end of 2019, the Coronavirus (COVID-19) has continued to spread across the world.  The number of people infected and those who die is increasing daily, and no continent has been able to escape this pandemic.  In addition to the threat to public health, the economic and social disruption threatens the long-term livelihoods and well-being of millions.  It has been said that the rate and global spread of infection by COVID-19, and the impact it could have on a globalised financial, political, and social architecture, sets this particular pandemic apart from any other in modern times.

Not only have governments declared national emergencies and implemented lockdown policies to curb the spread of the disease, they have also taken unprecedented measures to lessen the impact on business, jobs, and the vulnerable communities in our society.   The COVID-19 outbreak has catalysed a crisis, which is questioning the confines of inherited structures that have perhaps lost their intellectual edge and global mandate.

How are universities as global institutions of higher learning managing COVID-19?  

Universities are complex institutions.  I will not attempt to describe the role and purpose of the modern university here – safe to say that the views of John Henry Newman (The Idea of a University) and Wilhelm von Humboldt (his recommended views led to the creation of the University of Berlin) dominated Western thinking about the functions of a university.  Sir Colin Lucas, former Vice-Chancellor of the University of Oxford, remarked “…(universities) are seen as vital sources of new knowledge and innovative thinking, as providers of skilled personnel and credible credentials, as contributors to innovation, as attractors of international talent and business investment into regions, as agents of social justice, and as contributors to social and cultural vitality”.  There is no doubt that universities, through their intellectual knowledge base, can add (and they do) enormously to the science of COVID-19, whether it is developing a new vaccine, modelling, and forecasting skills to understand the spread of the virus in specific regions or innovative methods for supplemental oxygen delivery.  The role played by universities in this context is vast and critical.  

Universities serve a large variety of functions in the delivery of the academic project, which involves teaching, learning, and research to maintain, manage, and develop the physical and digital infrastructure – the engagement with external stakeholders (to foster societal impact) such as alumni, schools, governments, industry, the private sector, commerce, donors, and philanthropic foundations. Many universities are training medical doctors and other healthcare professionals, engaging with academic hospitals and placing them at the forefront of the healthcare system – a very complex organisation to manage, even in times with no crises!

Many universities have disaster management committees that were rapidly activated during COVID-19 to prepare plans for the unexpected.  This pandemic, due to the extent of unfamiliarity and uncertainty thereof, can challenge these efforts and expose limitations in such plans.

It is important that universities have a framework approach of effective coordination, integration, and decision making that is centrally located but can act fast.  Although universities are not the same, there is a common drive for the health, well-being, and safety of staff and students. Typically, such a framework could converge in an Executive Centre (decision-making) or nerve centre, which should preferably be convened by the Vice-Chancellor, and include expertise in areas of scenario planning, project management, science (in this particular case it would be virologists and/or epidemiologists), communication, and institutional culture.  In order for the Executive Centre (EC) to be effective and fast-moving (with urgency and robust thinking), it should be organised around multi-disciplinary task teams, each with key responsibilities:

Teaching and Learning –with the suspension of classes (specifically in countries where there is a lockdown), alternative methods need to be utilised to deliver the academic project, and most universities have moved online (although not online in the purest form, rather emergency remote learning – turning a course virtual in a short period of time, and more importantly, doing it well, is nearly impossible for faculty members accustomed to lecturing in front of students). Based on the extent of the particular lockdown period, academic calendars need to be adjusted. Low-technology approaches to teaching and learning should be developed that are sensitive to the challenges of connectivity, bandwidth, and the type of devices that students use, realising the deep socio-economic inequalities and digital divide in our society. It is critically important to stay in touch with the students, and to provide online assistance with respect to counselling and mental health.

Research – focusing on how experimental research will be conducted during lockdown, how research contracts will be managed during this period and beyond, and whether research funding will be redirected or terminated;

Science – to understand epidemiological developments, verified information on COVID-19 (against the background of fake news);

Operations – mainly focusing on environmental hygiene and the business continuation of the physical and digital plant;

Staff – working remotely, essential services (as defined by government), and crucial university functions, constantly staying in touch with the staff, especially regarding their state of mind (mental health) due to social isolation;  

Students – with a focus on responsible student integration on the re-opening of the campus, where the principle of social distancing need to be adhered to;

Financial and Legal – responsible for financial scenario planning, short-term cash management and risk management, and mitigation; and

Communications – need to be centralised to ensure that it is consistent, correct, rapid and that it takes into account institutional culture when communicating – crises create anxiety, but keeping people informed helps reduce stress.

It is advisable to include a student voice or student input in the Teaching and Learning Task Team, as the living experience of students can thus be captured more accurately, which can enhance strategies.

It is clear that the world will operate differently post-COVID-19 than before the pandemic (‘new normal’); the EC will become the source of scenario planning on how universities will have to ‘re-imagine’ themselves post this pandemic.  It is thus critical to ensure that data, experiences (although a health crisis, an economic, and perhaps a social crisis – an opportunity as a thought experiment), ideas and new networks are captured with a strategic intent and reflection within the EC. Not only has this crisis questioned the neo-liberal economies that traditionally limit government intervention and prioritise market interests, it also asked universities to think differently about their models of teaching, research, and internationalisation, and how co-creation across boundaries and different sectors of the economy need to be imagined.

A crisis is never straightforward to manage, but an Executive Centre-type structure could not only assist universities during this period, but can add valuable strategies to position universities after such a crisis.



Prof Francis Petersen is Vice-Chancellor of the University of the Free State, South Africa. He has extensive experience in scenario planning and systems thinking in both higher education and industry.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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