The category ‘‘challenges encountered by radiographers practicing in rural KZN’’ describes the participants’ views and opinions on the challenges that they face in the execution of radiographic duties in rural areas. Just like challenges identified in in literature, participants in Phase I of this study also identified a number of challenges which they said impact on their ability to practice rural radiography competently. The issues which interviewees identified as challenges or difficulties were grouped into five subcategories. These subcategories are discussed below.
4.2.3.7.1 Subcategory: Lack of appropriate competencies
The interviews revealed that participants encountered a wide range of challenges in the practice of rural radiography. To these effect participants identified some of the competency areas that they thought were lacking in the pre-service training. These include, financial management, human resource management, leadership, communication skills, basic ultrasound scanning and many more.
they expect us to be part of these meetings.’’
‘‘I don’t remember us covering financial issues in our training.’’
‘‘I feel we still need more training because there is a lot of work in rural than in urban.’’
As reflected in the participant’s comments above, many of them did concede that there were some things that they were required to do but were unsure of how to go about. Supportive literature shows that rural health services have faced challenges which include a lack of appropriate competencies (Lloyd et al (2010:172). For instance, one participant pointed out that communication skills were a challenge especially when it comes to communicating with rural patients and he placed the blame on the radiography training institution for not equipping him appropriately. It is evident from participant’s comments that rural radiographers are faced with challenges which are not necessarily radiography aligned. Accordingly, Reid (2006:677) was also of the view that the challenges that are faced by rural health care professionals require specific and wide-ranging skills.
4.2.3.7.2 Subcategory: Lack of proper staff orientation
Lack of proper orientation for both rural radiographers and other health professionals including doctors was identified from the interviews as one the challenges that many rural health professionals face.
‘‘….if they are oriented they will know what type of machines and its’ capabilities. Get an orientation of like this is the X-ray department, we have so-and-so as radiographers, we have these kind of machines, maybe they will know what to order, and not order.’’
The participants’ views and opinions were that lack of proper orientation when one is appointed to the rural hospital is a challenge. They said that radiographers together with the doctors need go through a well-planned orientation seminar where all essential units of the hospital do presentations on what they do and what is expected from the new staff. This was said that it should be a programme that is done each time hospitals have new recruits. Participants noted that such undertaking was bound to expedite integration of new staff in particular radiographers.
4.2.3.7.3 Subcategory: Outdated x-ray equipment
In the subcategory ‘outdated x-ray equipment’ participants revealed that there were differences in the complexity and sophistication of equipment they use during training at tertiary hospitals and the equipment found in rural hospitals. Currently, almost all rural hospitals are still using conventional radiographic film. The interviewees revealed that because of the outdated equipment being used in rural hospitals, radiographers were unable to give a wide range of diagnostic services.
‘‘…we don’t have enough equipment to practice what we know.’’
The participants’ views and opinions are congruent with Thulos’ (2006:1) contention that there was a difference in the rate of advancement of radiography technology between private and public hospitals. The issue of old equipment is even more prevalent in rural hospitals where it is still being used. One participant added that this was more than just a challenge, as it directly impact on the quality of health care services that is rendered to the rural patients.
‘‘…I want to help my community….I know things that they need…but I can’t … no latest equipment.’’
The evidence from literature also confirms that appropriately placed technology contributes toward the enhancement of quality healthcare service delivery (Yadin & Jahnke 2004:73).
4.2.3.7.4 Subcategory: Lack of appreciation for radiographer’s role
Participants identified a lack of appreciation in rural areas as one of the challenges encountered by radiographers in rural hospitals. It was noted that this was very common with doctors with whom radiographers work closely. The participants said that they expected a gesture of appreciation from the doctors more than any other health professionals. Some of the participant’s quotes in this regards were as follows:
‘‘…..you try and do things right but the feedback that you get is not nice and you feel like you are useless.’’
‘‘I think the other thing that is lacking in rural radiography is appreciation from the doctors when you are doing the right thing, they don’t come to you and say thank you.’’
The above comments are supported by published evidence which suggest that the profession of radiography has been a subject of subordination and limitation from other healthcare professions such as medicine (Smith 2006:7). One participant felt that other rural health professions do not know how much effort rural radiographers put considering that the equipment is old. Supportive literature report that unless one has been exposed and worked in both urban and rural context, understanding and appreciating the vital role those rural radiographers play might be difficult (McNinch 2004:4).
4.2.3.7.5 Subcategory: Need for representation of radiography in broader management
Another challenge that emerged from the interviews with the focus group participants was a lack of representation of radiographers at senior levels. Lack of representation at senior levels appears to affect the effectiveness of rural radiographers as reflected in one participant’s comment below:
‘‘…can make us more effective having representation at all levels I mean at the hospital, district and head office.’’
The participants felt that some of the challenges they face in rural areas may be linked to lack of representation at high levels. It was mentioned that considering the environment in which rural radiographers work, representation in the broad management may help to advance their needs and challenges. One participant mentioned that lack of representation at broader management level was not the case with other allied professionals such as pharmacists, physiotherapists and dieticians.
The views and opinions of the participants on this matter came out strongly in favour of having someone of their own representing radiographer’s interest at higher levels. An example of data in this regard was:
‘‘I we had a representative in these levels is the one who is supposed to be consulted…’’
It was mentioned that issues and other related radiographic concerns that affect radiographers and the practice in general can be directed to such a person. According to the participants this representative will be able to appreciate and understand the issues better because of his or her radiographic background.