Developing a FEES service in South Africa: Interdisciplinary reflections for dysphagia care

Dysphagia is a common and serious condition in critically ill patients, often associated with complications such as aspiration pneumonia and prolonged hospital stays. In South Africa, limited access to instrumental assessments such as fibreoptic endoscopic evaluation of swallowing (FEES) hinders accurate diagnosis and management, particularly in public healthcare settings.

This study aimed to critically reflect on the process of implementing an interdisciplinary FEES service in a private South African hospital and to explore how these insights could inform dysphagia care across healthcare sectors.

A duoethnographic approach was used, involving structured reflection among four co-researchers (three speech-language therapists [SLTs] and one otolaryngologist) who co-developed the FEES service. Data were collected through a recorded focus group and analysed using Braun and Clarke's reflexive thematic analysis. Trustworthiness was ensured through triangulation, member checking, and peer debriefing.

Six themes were identified: (1) catalysts for change in dysphagia management, (2) cultivating interprofessional collaboration, (3) navigating logistical and resource constraints, (4) advocating for FEES, (5) enhancing clinical decision-making, and (6) translating FEES into broader contexts. These themes illustrated how FEES improved diagnostic accuracy, fostered interdisciplinary collaboration, and offered scalable potential for public health systems.

Implementing an interdisciplinary FEES service in a private hospital revealed both challenges and solutions relevant to broader healthcare settings in the South African context.Contribution: Fibreoptic endoscopic evaluation of swallowing offers a cost-effective, accessible diagnostic option for dysphagia care and should be considered for wider adoption within South Africa's National Health Insurance framework.