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03 July 2020 | Story Dr Nico Jooste and Cornelius Hagenmeier
Cornelius Hagenmeier,left, and Dr Nico Jooste.

South Africa has established itself as a regional higher education hub, which has until the recent COVID-19 pandemic been hosting increasing numbers of international students. The vast majority hails from the neighbouring countries in the Southern African Development Community and includes increasing numbers of postgraduate students, specifically doctoral students. The country has become one of the global epicentres of the pandemic. We argue that while the country is grappling with combating the virus, its higher education system and stakeholders must keep focusing on the post-COVID-19 future. The way the country and its higher-education system treat international students in the present crisis may determine whether it will be able to retain its position as a regional higher education hub, and whether it will be able to be a driver for PhD capacity development in the SADC region and Africa following the pandemic.

South African higher education has promoted ethical practices that govern their engagements with international students. The Code of Ethical Practice – accepted by all South African universities, guide the university’s actions for all phases of study, including the phase where students would be required to go home and return for studies. The common obstacles influencing international student mobility to and from the country caused by the lack of cooperation by government departments, should not have been a problem in this case, as all activities are coordinated by the South African National Coronavirus Command Council (NCCC). According to South Africa’s President, Cyril Ramaphosa, “the NCCC coordinates government’s response to the coronavirus pandemic. The NCCC makes recommendations to Cabinet on measures required in terms of the national state of disaster. Cabinet makes the final decisions”. (Written response by the President to written question NW 725 by Adv. G Breytenbach dated 5 June 2020.)  

International Students in the Initial Phase of the COVID-19 Crisis
The lockdown that the country imposed in March 2020 to combat the pandemic, resulted in a large part of its international student population returning home, particularly those hailing from neighbouring countries for whom travel was easy to organise. At the time, it was anticipated that students would be able to return after a three-week lockdown of the country. Most universities expected that their international students would come back to campuses after an extended recess in April 2020. At many universities, international offices assisted international students with travel arrangements and organised for those unable to travel, mostly students from other regions of the world, to remain in university residences until campuses would reopen. International students expected to be able to return to their universities soon, resulting in many travelling light and leaving essential learning, research, and personal items behind in residences.

However, controlling the COVID-19 pandemic proved far more complicated than anticipated, and the lockdown was replaced by a risk-adjusted strategy that provides for five alert levels, of which level five has the most severe restrictions on public life. As the country progressed to level four on 1 May 2020, South African universities were permitted to resume face-to-face classes for final-year medical students. On Wednesday (13/5), directions were gazetted that “allow for the once-off travel of final-year medical students studying at a public higher education institution to travel from their homes to the university campus where they are registered for study during the period 8-31 May 2020” (GG No. 43319 of 13 May 2020). No clarity was provided on whether this would include international students; the wording was at least wide enough to allow for this. Stakeholders interpreted the regulations in different ways, but at least a limited number of international final-year medical students returned from Lesotho. 

Preparation for the Resumption of Select Face-to-Face Classes 
When the South African Minister of Higher Education and Training, Dr Blade Nzimande, charted the way forward for South African higher education during the COVID-19 pandemic, he enunciated the principle that “all students should be given a fair opportunity to complete the academic year 2020” (speech on 23 May 2020). In this political announcement, he stated that final-year students in programmes requiring clinical training (e.g. nursing, and dental sciences) would begin from 1 June 2020. He postulated that other critical groups of students, including final-year and postgraduate students who require access to laboratory equipment, should be allowed to return to the country’s campuses. He did not refer in any way to a planned exclusion of international students, and at least some universities included international students in their planning for the resumption of select face-to-face classes in June 2020. 

International Students in Basic Education
When the teaching of select grades in basic education resumed in South Africa in June 2020, students from neighbouring countries were allowed to resume their daily commutes across the South African border according to regulations gazetted on 28 May 2020 (GG No. 43364 of 28 May 2020). It appears from individual reports received from border posts that boarding school students are returning from Lesotho and Botswana.

International Students in Higher Education   
As the country moved to alert level three on 1 June 2020, some stakeholders in South Africa’s higher education system anticipated that at least international students from neighbouring low-risk countries such as Lesotho or Botswana would be allowed to return when their face-to-face classes would resume. Directions issued by the South African Department of Higher Education and Training on 8 June 2020, however, unequivocally stated that ‘international students who returned to their home countries during the lockdown will only be permitted to return to campuses when Level 1 of the strategy is announced’ and explained, without elaborating on detail, that ‘these international students will be supported through remote learning until they return. Tailored catch-up plans will be implemented when they return.’ Consequently, many international students are likely to return after face-to-face classes in their modules have recommenced, and it is left to individual higher-education institutions to ensure that they are not ‘left behind’. Core challenges to ensure this include the cost of data in the main source countries of international students, as well as limited internet speed. Some universities are trying to alleviate this by providing data allowances for international students; however, this is not yet practised uniformly throughout the sector. 

Core Challenges 
To avoid harm to South Africa’s reputation as a preferred destination for international students, the country and its higher-education system will have to find satisfactory answers to critical questions:

• How can the South African higher-education system ensure that no international student is left behind in modules for which face-to-face classes resume, especially considering those who require clinical/laboratory training? A recent webinar between Vice-Chancellors from six SADC countries highlighted the fact that connectivity and data availability throughout Southern Africa is still one of the biggest challenges facing all higher-education systems. Not only the South African system, but all other SADC universities will have to be innovative to resolve this problem, especially where all have committed themselves to not leave any students behind.

• Who will bear the considerable cost for necessary interventions, such as the provision of data to international students abroad?

• How can the training of critical professions for combating COVID-19 in Southern Africa be sustained at South African higher-education institutions when degrees such as medicine (MB ChB degree) require clinical training and examinations through a practical component?

• How can reputational damage to South Africa as a destination for international students be avoided when, apparently, high school students from (at least) Lesotho are allowed to enter the country and return to boarding schools, but students in critical health science degrees are not allowed to return to classes?

Way forward
We posit that careful balancing of the often conflicting priorities of combating COVID-19, ensuring that no international students are left behind, and sustaining the training of professionals who are critical in the fight against COVID-19 in Southern Africa, is necessary to ensure that South Africa contributes optimally to the fight against the pandemic in Southern Africa and sustains its position as a preferred destination for international students post-COVID-19. It will be important to demonstrate to the world that the country is living up to its world-renowned Constitution, which entrenches equality as a fundamental right. Any differentiation between international and local students, as well as between secondary and tertiary education students, which does not have a rational connection to a legitimate government purpose such as protecting public health, may infringe the country’s internationally celebrated Constitution, taint South Africa’s standing as a higher education hub, and jeopardise its existing reputation as a preferred destination for international students. Moving forward, thoughtful action is required to ensure that future generations of international students choose to study in South Africa following the pandemic, and to encourage those who left in haste when the COVID-19 crisis intensified, to return to complete their studies. 

 

Opinion article by Dr Nico Jooste is Senior Director of the African Centre for Higher Education Internationalisation (AfriC) and a Research Fellow of the University of the Free State (UFS) South Campus. Mr Cornelius Hagenmeier is Director of the Office for International Affairs at the UFS and serves on the AfriC Board of Directors. Both are writing in their personal capacity.

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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