The Role of Social Support in Medicine

I sat attentively at the renal replacement meetings in South Africa where difficult decisions were made weekly. I quietly waited, pen and paper on my lap, as the social worker, dietician, nephrologists, nurses, residents, and fellows filed in to get a seat in the conference room.


Over the last five years, I have spent my postgraduate training exploring ways to increase access to and equity in organ transplantation. I, therefore, sat bewildered as I witnessed patients being denied access due to a lack of social support.


At this meeting, the transplant candidates were determined if they would end up on the waiting list. In this particular case, it was decided to deny a medically suitable patient a spot on dialysis. In South Africa, for patients without medical insurance, dialysis is an extremely limited resource. For patients to be accepted for dialysis, they are assessed both from a medical and social point of view. They need to be deemed good transplant candidates; be medically well, have good social support to ensure that they will come for their post-operative appointments, and adhere to the medicine regimen so as to not reject their newly transplanted kidney.


The medically suitable patient presented during the meeting was denied because they did not meet the social criteria. However unfortunate, this approach is employed to ensure that not only are patients given the best chance at clinical improvement but that limited resources are allocated where they will be most effective and beneficial.


“Throughout my medical education, I have seen

how these often-overlooked social factors influencing health care

– when recognized and addressed appropriately –

are instrumental in managing the patients’ medical problems.”

Hlohonolofatso Bookholane


Though many may look at this situation and jump to criticize it, I learned from it. When you are strained with limited resources you start to look into other factors that could help you tip the balance between beneficence and justice. Working in South Africa expanded my definition of innovation, one that emerges from a lack of resources rather than abundance.



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Komal Kumar

Komal Kumar obtained her MPH in Epidemiology & Biostatistics from Johns Hopkins Bloomberg School of Public Health. She is a researcher, public health advocate, and a 2017-2018 Fulbright Scholar to South Africa.