Convened to celebrate World Family Doctor Day 2026: Compassionate Care in a Digital World and Africa Month against the backdrop of the African Union's Agenda 2063, the Division of Family Medicine's session evolved into a candid two-hour conversation about identity, inequality, technology and the courage it takes to train doctors for the communities that actually need them.

"We Can't Allow the Leadership to Come from Contexts Very Different to Our Own"

The opening reflection came from Professor Tasleem Ras, Head of the Department of Family, Community and Emergency Care, who challenged participants to interrogate the discipline's foundations. South Africa, he argued, will probably never train family physicians in the numbers needed — training pipelines are too slow and public health budgets too constrained. That reality demands a response rooted in local conditions.

"In low-resource contexts, we can't allow the leadership of what family medicine looks like to come from contexts which are very different to our resource realities," he said. "We need to be thinking about task shifting, interdisciplinary models of care, community-orientated types of care."

He also questioned the intellectual origins of family medicine itself — consultation models, communication frameworks and even the term "patient-centred care," coined by a British psychoanalyst in 1969. "We have to ask ourselves to what extent are we engaged in decolonising family medicine," he said, "from the perspective of being true and grounded in our kind of real context."

The clearest signal that something is wrong, he suggested, is the cognitive dissonance students carry back from placements. They are taught consultation frameworks that assume resources and time that don't exist at community health centres. "They come back and say: this is impossible in our context. And that should be causing significant cognitive dissonance for us."

Learning Where Life Happens

The curriculum question ran through much of the session. Dr Sentebaleng Seitshiro described medical students who had joined her for school-based health visits — including a session two weeks prior with learners managing chronic conditions. What struck the students most was not the clinical work, but the discovery of what a doctor's presence could mean outside a hospital.

"We know about health promotion, we hear about health promotion," students told her. "But it's the first time we actually get to see what influence we can have as doctors on young people at a school."

Yet the same students arrived expecting to check blood pressures and hand out prescriptions, missing the educational opportunity in front of them. They also struggled in interprofessional settings, hanging back while occupational therapy and physiotherapy students engaged with community members. "Those are the things students can only learn when you are in a social context," Seitshiro said. "You're not going to learn them from the book."

She raised a sharper challenge: when she asks students where they plan to do their internship and community service, the answers cluster around the Western Cape, Gauteng and KwaZulu-Natal. Out of a group of twelve, all twelve nominate those same three provinces — the ones where they trained. "Are we creating a generalist who will only work in the big cities," she asked, "or do we want our students to go out there in the provinces where there is a need?"

Innovation as Liberation — But Not the Whole Answer

Digital innovation was a thread of its own. Dr Roland Kroukamp described the efficiency gains possible through digitised systems — proactive prescription management, digital referral workflows, automated notifications — that reduce burden on both clinicians and patients. He also pointed to AI as a tool for cutting administrative work so clinicians can spend more time where it counts.

One vivid example came from a simulated consultation using an ambient AI scribe: a five-minute-47-second encounter produced a complete clinical note without the clinician writing a word. "The consult felt long to them," he said of the observers, even though the clock showed under six minutes — because the clinician was fully present. "You can just listen to the patient. It's liberating."

But Dr Angela De Sá offered an important counterweight. Systems are made of people, she argued, and the human dimension — emotional strain, burnout, interpersonal dynamics — tends to get systematically avoided because it's harder to measure and more uncomfortable to address.

"We are the system," she said. "Each of us as individuals are the system. And if we keep avoiding the sticky, uncomfortable, interrelational, human support kind of stuff, then it becomes very difficult to shift that system." Students, she noted, can see colleagues disengaging under pressure and recognise the need for support — but that recognition rarely translates into structural change. The objective aspects of healthcare — systems, skills, innovations — draw intense focus. The subjective ones rarely do.

What Does It Mean to Build Family Medicine That Belongs Here?

The session closed without neat conclusions, which felt appropriate. But a shared question had emerged: can family medicine in South Africa develop an identity that is genuinely rooted in African realities — rather than adapted from models built for very different contexts?

The challenge is not to choose between technology and compassion, or between innovation and human connection. It is to hold both together, and to build training environments that produce doctors capable of doing the same. Doctors who can listen without writing notes because an AI scribe is working in the background — and who can also recognise that a dusty hospital fan above a child with asthma is a clinical issue too. Who understand that going to a school is a medical act. Who know which provinces most need family physicians, and might actually choose to work there.

As Africa imagines its future through frameworks like Agenda 2063, conversations like this one are a reminder that health systems transformation is not only about infrastructure, policy or technology. It is also about identity, values and the willingness to ask whether what we are building is genuinely responsive to the communities it is meant to serve.