Valedictory Lecture UCT
22nd January 2015
A valedictory lecture of this nature is a challenge. I have had a career spanning 40 years as a public servant, doctor, academic and manager. What does one say and what would be of interest to anyone other than me? It has been a long road and fate has led me down some unexpected roads. I would never have thought at the outset of my medical career that I would be standing here today about to retire as the Head of the Western Cape Department of Health. In fact if you had told me that when I was 30 I would have said you are crazy! I am not a religious man in a formal sense but I do believe in a higher sense of purpose and that my life in retrospect seems to have been subject to the forces of fate governed by that purpose. So I invite you to take a journey with me through some aspects of a 66 year personal and 40 year public service journey.
I was born in Princeton New Jersey in the United States on 15th October 1948. That makes me part of the baby boomer generation born in the immediate aftermath of the Second World War. I am the only child of academic parents – my father was a mathematics professor at UCT for 26 years and my mother a school principal. I matriculated at Rondebosch Boys School in 1966 and underwent 9 months compulsory military service before entering medical school in 1968. I enjoyed my schooling but the military service less so. I graduated from UCT as a doctor in 1973 and started my career as an intern at Groote Schuur Hospital in 1974. Followed by 1976 in a mission hospital in the then Transkei.
Returning to Cape Town, I worked in Groote Schuur, Somerset, City, Peninsula Maternity, Mowbray and Red Cross Hospitals during my term as a registrar during which time I qualified as a paediatrician in 1981.
Thereafter I left the Western Cape in 1983 for the Free State where I worked in the Department of Paediatrics and Child Health at the University of the Free State until 1995. I completed my MD degree at UCT in 1986 and was appointed as Head of the Department of Paediatrics and Child Health at the University of the Free State in 1988. I left the university department to become Head of the Free State Department of Health in 1995.
I left the Free State in 2001 and was appointed initially as Deputy Director General Administration in the Western Cape department of Health and then as Head of the Western Cape Department in October 2002 where I have remained until now. I am currently the longest serving Head of Health in the country and the only remaining incumbent from 1995.
That in brief is my personal history and career in the public service as doctor, paediatrician and for the last 20 years as a manager of health care services. I might add I also ride a Harley-Davidson and I am happily married!
I can still vividly remember meeting in the E4 lecture theatre shortly after graduation to hear whether I was “lucky” enough to have been allocated an intern post at Groote Schuur Hospital. I was not quite in the very top echelon so I was allocated Medicine under Professor Len Eales and Surgery under Professor John Terblanche. I regret to say that other than learning how to fill out the requisite clinical notes and forms, fill numerous tubes with blood and hold a retractor as third assistant I am not sure how valuable this year was! It was however a rite of passage between being a student and accepting some of the responsibility of being a doctor.
My second year as a senior house officer was far more valuable and I spent 6 months in the Cardiology Department learning a great deal from people such as Professor Wally Beck, Dr Brian Kennelly, Dr Pat Commerford and Dr Bernie Gersch. Professor Beck was an exceptional teacher and unravelled the mysteries of cardiac blood flow and murmurs for me often on the back of a cigarette box! In fact my teaching style later in my career was modelled to a great extent on the lessons learned from Professor Beck. Thereafter I spent six months at the Red Cross Children’s Hospital which was hard work but in an exceptionally pleasant and positive environment very different from what I had experienced up on the hill. My decision to become a paediatrician was made during this time.
This was further strengthened during the just over a year that I spent working in a mission hospital in the then Transkei where poverty, malnutrition and infectious disease were a daily reality. During this time I diagnosed a case of acute leprosy with the confused patient sitting in a tree with the classic leonine (lion-like) face. Leprosy at that time was still endemic in the Pondoland region of the Transkei. The experience sharpened my clinical and practical skills but also matured my approach to both life and clinical practice.
I returned to Cape Town and as already mentioned joined the paediatric registrar rotation. It was hard work and the long hours at times were debilitating. Did I enjoy the work? To be honest often not but the experience was invaluable and it was a relief to finally achieve the fellowship in Paediatrics after four years. I remained for another two years and worked as a research fellow studying the epidemiology and consequences of acute diarrhoeal disease in children which led in the end to the body of research work submitted for my MD degree. Even at that time I was outspoken and possibly as a result of publicly challenging the then Head of Department, Professor Boet Heese, on an issue that I regarded as important, he indicated that I should seek a future elsewhere. He suggested that I consider the University of the Free State, which option I would not have considered on my own but which in hindsight was the best advice I could have been given and for which I remain grateful to this day.
My time at the Free State University was a happy and productive one but certainly challenging at first since my Afrikaans was to say the least rudimentary. It was a shock after around three years to realize that I was even dreaming in Afrikaans! I co-authored and edited an Afrikaans paediatric textbook, now out of print, and in one year received the Golden Ventricle award as the best lecturer in the Faculty as voted by the under graduate students! I undertook research and published two papers on the consequences of kwashiorkor on the brain of young children, a severe form of malnutrition prevalent in the Free State at that time, on the brain as well as another on the possible role of aflatoxin exposure in the aetiology of kwashiorkor. The late Professor Ralph Hendrickse, a South African academic then based in Liverpool had published articles proposing aflatoxin as a possible causative agent of kwashiorkor. My research conclusively proved this not to be the case and I must admit when visiting Professor Hendrickse some years later in Liverpool I received a rather frosty reception! Such are the realities of academic medicine. It interesting and to an extent satisfying that many years later these and other articles that I published during that period are still cited in current scientific articles.
It was during this time that I headed a community project in Mangaung Bloemfontein later significantly funded by the Kellogg Foundation, which still exists today. This was the first initiative that brought together the majority African black population of Bloemfontein and the University of the Free State. This achievement was acknowledged by the university with the award of the honorary professorship that I hold at the university and the Centenary Medal awarded to me in 2004. The citation for this award of which I am very proud reads, “For his leadership and pioneering work in transformation through the establishment of the first true partnership between the UFS, the community of Mangaung and the Free State Department of Health.”
Also as a result of this I became increasingly politically active joining the ANC formally around 1990. It was also this connection that resulted ultimately in my becoming the Head of the Free State Department of Health in 1995. Last year now Deputy Minister Mcebisi Skwatsha, then in the Provincial Legislature, complimented me on the work done by the department during my term and reminded me that I owed my position to the ANC! Going back to the Free State and the invitation from the then ANC Premier of the Free State, Mosiuoa Lekota, to head the Free State Department of Health, which changed my life, there is an element of truth to his statement. However, I need to stress that ever since my appointment as a senior public service manager I have not been a member of any political party as in my view such membership is incompaitble with the role of a head of department who must remain distant from party politics.
Lifting out some events of this time, I recall on one of my first visits as the Head of Department to a hospital in a small rural town being confronted by a small but well appointed “white” ward at the front of the hospital and a larger “black” ward situated at the rear of the hospital in an appalling state where many of the patients were naked. On enquiry the matron informed me that this was how it had always been and that “black” patients did not wear pyjamas as it was not their culture. Needless to say I was less than happy with the situation and said so. Six years later when I was preparing to leave the Free State, my secretary came into my office and told me that there was someone who wanted to see me. It was the matron from the small hospital who had travelled of her own accord to Bloemfontein to say goodbye and thank me for what I had said at her hospital on that day to show her that she had been wrong and to assure me that she had worked tirelessly to right the wrong for which she had been responsible. I can attest to the fact that indeed that small rural hospital became a model of good quality fully integrated health care and what happened reaffirmed my belief in the inherent good of the majority of people.
Since in the Free State there had been almost no people of colour in government management positions, I was faced with the task of recruiting an integrated management team from people with little if any experience in management. I literally scoured the province and in the end was able to appoint a team of competent although in many cases inexperienced managers. My task was then to integrate the health services of the ‘homeland” segments of Qwaqwa and Bophuthatswana into the then Orange Free State province maintain and improve the health services as well as mentor and build capacity in my management team. It was a formidable task and work days were often 20 hours long and weekend days became work days. At this time I learnt the value of always getting the basics right. I realised that while healthcare appears complex the trick is to reduce it to its simplicity. It is easy to get lost in the complex which can become paralysing particularly for the inexperienced manager. Look for the simple in the complex because it is there if you look for it and once you have identified the key issues deal with them. This lesson has served me well in my management career and it is something that my management team has heard me say often.
Another lesson that I learnt during this time was to take constructive criticism but ignore criticism that is destructive and personal. One needs a thick skin and such negative criticism is often difficult to accept but I have learnt a lot from the constructive criticism that I have received from inside, outside and the coalface. Often the health worker has the solution but the managers are not listening. Hearing what people around you are saying is absolutely key to knowing what direction to take.
It was a baptism of fire and I certainly made mistakes and did things that I later regretted but overall I was satisfied that we did the best we could during those exciting and tumultuous times that followed the democratic transition in 1994.
I came to the Western Cape with a reputation of fiscal discipline having brought the Free State Health Department within budget after taking unpopular steps to curb expenditure which included the regulation of RWOPS and Commuted overtime in the Free State. Some of you may remember epithets such as “axe man” and “butcher” that were mentioned by some on my arrival in the province. This reputation resulted in approaches to the then Premier prior to my appointment suggesting that my appointment would be to the detriment of health services in the Western Cape. Some of you may remember the anger that result from the decision to reduce the number of beds, albeit it marginally at Groote Schuur Hospital. Doctors in white coats protested in the Palm Court, a senior colleague who is present today commented both in the Provincial Legislature and the National Parliament that “Househam puts cash before care!” and even the then CEO of the hospital was at odds with me regarding the decision. I was accused of destroying a national asset!
I will be the first to acknowledge that some of my actions at the times may have been or appeared precipitous and indeed poorly communicated, but I was appointed by the then Premier and MEC for Finance with a clear mandate and that was to stabilize the financial position of the Department of Health. This was achieved within two years and the department has subsequently remained within its allocated budget to date and our audits have been unqualified for a decade. This is an achievement unrivalled in the other health departments in the country. The consequence of achieving financial stability was the stabilizing health service delivery in the Western Cape. Sadly the reality in many of the other provinces where this has not been the case, is health workers not receiving their salaries, unserviceable critical equipment, unavailability of essential medication and significant fraud and corruption.
This brings me to another important lesson that I have learned as a manager in health services and that is the need to tightly manage the finances of a health department. The fact that one cannot purchase what one cannot afford or appoint staff whose salaries one cannot afford seems simple but difficult to implement when the health and even lives of people are at stake. The utilitarian approach to the allocation of resources within the health sector in essence conflicts with the unique doctor-patient relationship in which the doctor will strive at all times to do the best for his or her patient. As a doctor who was in clinical practice for 20 years I am acutely aware of that responsibility but as a health manager who is a doctor I have had to elevate my view to deal with the greater common good. This has led to a situation which placed me in direct conflict with clinical colleagues at this and other faculties.
If one cannot purchase what one cannot afford, it is also important that what one can afford must be what is essential. Shortly after my appointment Professor James invited me to visit the Department of Anaesthetics showing me anaesthetic machines that were only kept operating by cannibalizing other machines endangering patient’s lives. In another visit Professor Werner showed me an obsolete LINAC that limited his ability to manage patients with cancer. Despite the need to address budget shortfalls the department began to address the equipment backlog through prioritization and in both cases new equipment was acquired. The key to the management of managing health budgets is determining the correct priorities and ensuring that these are funded, however, this also requires decisions on what cannot be funded. It has been my mission over the last few years to involve clinicians to a greater degree in this decision-making.
An initiative that I have personally managed is the development of what we have termed a Functional Business Unit. (FBU) Within a hospital doctors in large measure create expenditure because they issue instructions that cost money. They order X-ray investigations and blood tests, they prescribe medication and determine whether surgery should undertaken all of which generate expenditure. Within the FBU the clinician who accepts responsibility for the FBU is allocated a budget with staff to deliver an agreed amount of service with a suite of data that allows the clinician to measure, monitor and manage the service for which they are responsible. I have been encouraged by the instances where clinicians have enthusiastically accepted this responsibility instead of being frustrated by the “pen-pushers” sitting in Dorp Street! By giving the doctor the opportunity to be more involved in the decisions that affect their practice, it has given them control over and responsibility for their own destiny.
Returning to bed reductions at Groote Schuur Hospital, I can now reveal that this was part of a pre-determined strategy to force the National Department of Health and the National Treasury to review the funding to the Western Cape for highly specialized care. The furore created by the announced decision to reduce bed numbers at both Groote Schuur and Tygerberg Hospitals created such discomfort nationally that the end result was an increased allocation to the Western Cape and the ability to retain specialized services at these hospitals. In effect the bed reductions were reversed and funding to the Western Cape secured. So in retrospect I would like to thank the Professors, amongst whom as I recall were Del Kahn and Bongani Mayosi, doctors and nurses who populated Palm Court on that day for their assistance in stabilizing health funding in the Western Cape!
More recently in 2013 I for the first time in my career went on record in the media disagreeing with the National Minister as regards a proposed cut of R173 million to the conditional grants for the Western Cape to fund highly specialized services and in addition the intention to “centralize” the management of hospitals such as Groote Schuur and Tygerberg Hospital under the National Department. The Minister responded angrily in the media that the Western Cape was going to war with the National Department but within a day reversed the proposed funding cut. I also indicated in that interview and I quote, “I have the greatest respect for the Minister and many of the proposals driven by him are very good but how can hospitals be managed at a distance of a thousand kilometres. I feel a strong, personal, almost moral need to speak out about this issue. I firmly believe the decision, in the current context, is a mistake” I use this example to indicate that senior managers must even in a democratic dispensation be prepared to speak out when they perceive something to be wrong although it will be an unusual step. Clearly I am still in office but would that be the case if I was appointed elsewhere? I sincerely hope that it would!
It is often said that the Western Cape is a privileged and well-resourced province that did not have the legacies of apartheid of other provinces. While there was certainly some truth in the statement, in my view 20 years after the democratic transition that argument to justify the challenges faced in the health sector in other provinces is less convincing. During my term as Head of Department in the Free State, we achieved financial stability after a shaky start and on my departure in 2001 the department was within budget with a competent management team. Sadly within three years that had largely been dismantled and the current state of public health in the Free State is far from what it could or should be. An analysis of why this happened and what could have prevented similar situations elsewhere is essential both for an effective government in South Africa but also for the future of democracy in this country.
Competent management with effective systems are the key to any organization private or public and are what are needed in South Africa to make any large organization and government work. I am afraid that in many health departments a great deal of time is consumed sitting in meetings, strategizing, writing documents and talking about the problems. Individuals take decisions and my recipe for effective service delivery is empowering people in management to make decisions and then take responsibility for them. Support people if they make a genuine mistake … we all make mistakes! I have an intolerance of incompetence but a greater intolerance of people who just don’t care. I spent some 20 years in clinical practice and I have the same attitude to running a health department and management as I did when treating a single patient in that if I do something wrong or worse don’t care someone will suffer, and I have expected my whole management team to have the same view.
Another lesson from particularly the last 18 years is the importance of managing the interface between the political office bearer and the department. In most instances the person appointed as the MEC or in the Western Cape, Minister, is not an expert in the field, but immediately on appointment becomes an expert in the eyes of the public. I have worked with 4 National Ministers, 8 Premiers and 7 MEC’s during my term of office, all with very different personalities and skill sets. The role of a Head of Department is to facilitate the interaction between the MEC and the department. Some MEC’s wish to manage the department while others adopt a more distant relationship and seek only to provide political guidance. It has been important in my career as a Head of Department to define and establish that relationship and build trust with the MEC. An important principle is that while one may have personal views on an issue and advise the MEC accordingly, the final decision particularly in a matter of political principle rests with the MEC and the Premier. While one may disagree having advised the politician, he or she takes that final decision which as Head of Department you are bound to implement. If the decision contradicts one’s personal view, the decision is then whether one can accommodate that view within your value system and if not whether you should then resign.
The political managerial interface in the South African Government system remains challenging. As mentioned earlier I am the sole survivor of those appointed as Heads of Departments of Health immediately after the period of transition that followed the 1994 elections and the Government of National Unity. In most provinces there has been little or no continuity of management as with the appointment of a new MEC in many cases this has heralded the replacement of the Head of Department. Most recently in Gauteng there have been four heads of department within the last four years. The problems being faced by Gauteng in terms of public sector health service delivery can to a great extent be attributed to the lack of stability in the management of the health department in Gauteng and indeed elsewhere.
I was faced with such a situation regarding the position of the then National Minister of Health and President with regard to HIV, AIDS and the use of antiretroviral therapy. You may remember names such as Dr David Rasnick, Dr Peter Duesberg, Dr Matthias Rath and the Rath Foundation as well as the Presidential Advisory Panel which submitted a report to President Mbeki in March 2001. I sat through numerous National meetings where presentations were made promoting “quack” cures and where those denying the link between HIV and AIDs were granted an opportunity to motivate as to why antiretroviral therapy was both toxic and dangerous. It was a surreal experience to be present at some of these interactions and some of my academic colleagues sought me out to try to understand what was going on. I remember being confronted by an incredulous Professor Jerry Coovadia, a fellow paediatrician, seeking advice on how to approach the then National Minister on the issue. Needless to say I was not of much assistance. For me the ultimate humiliation as a South African was to witness the fracas around the South African exhibition at the 2006 World AIDS Conference in Toronto when then Minister Tshabalala Msimang taunted the international media with cloves of garlic.
Should I have resigned? I in fact considered resignation but discussed my concerns with the then Premier, Ebrahim Rasool, and he persuaded me to stay and work in the Western Cape to provide antiretroviral drugs to AIDS patients through various trials and NPO’s. Working with Dr Fareed Abdullah, the Western Cape pioneered the provision of antiretroviral therapy to HIV positive pregnant mothers to reduce the transmission of the virus to their new-borns as well as the treatment of people living with AIDS. I must also give credit to the then MEC, Minister Pierre Uys, who despite pressure from the National Minister allowed the department to proceed. As a result the Western Cape has consistently achieved the lowest levels of mother to child transmission in the country reducing the transmission from double figures to the current around 1%. I am still troubled that I as doctor participated in a system, albeit not directly, that allowed people to die and babies to be unnecessarily infected as a result of the unavailability of anti-retroviral therapy. My justification for my decision to stay was that I could do more working within the system than I would have been able to achieve outside the system. I leave it to others to pass judgement on the validity of my decision.
In 2009 I faced one of the most difficult decisions of my career when I was approached by the National Minister to accept the post of National Director-General of Health. There was considerable media speculation at the time and it was assumed in many media reports that I had accepted the appointment. I considered many factors before making my decision but most importantly whether I was the correct person to manage the political interface to which I have referred and whether as Director-General I would have been in a position to directly influence health care delivery in the provinces. Despite the fact that I felt that I had the competencies to undertake the task as a result of my view that in neither of the above was the answer affirmative, I decided to withdraw from the process just before the interview stage. Thereafter many people indicated to me in no uncertain terms that I had let them and the country down by not taking the position. I was even accused of being unpatriotic! Do I regret this decision? No, I believe it was the correct decision at the time and that I was able to contribute more to the health system by remaining in the Western Cape as I have done.
My advice then as now to the National Minister has been to focus on the basics with regard to financial and human resource management within a stable management environment. If this were done many of the challenges facing public health in this country would be addressed. However, if the current instability, particularly in the provinces, persists despite the best policies and legal frameworks his frustration with the ongoing problems across the country will likewise persist. To the National Minister’s credit, for whom I have only the greatest respect, despite our differences we have remained on good terms even when those differences have entered the public domain.
On a positive note I recently met with groups of young doctors working in the public service in the Western Cape from across the province. It struck me in these interactions how in some ways much had changed but in others it had not. The long hours, the exhaustion, the repetitive drudgery, the loneliness of the young doctor on the front line and the hierarchical nature of the profession were what I remembered of my experience as a young doctor and appeared not to have changed. While the disease profile and the management options differs greatly from my time as a young doctor the manner in which hospital “firms” function and medicine is practised today, had also not changed. Clearly technology has made a major impact on the manner in which medicine is practised mostly for the better although in my view nothing can replace the person to person contact that is essential to clinical practice. I was however impressed and heartened that the overwhelming majority of the young doctors with whom I interacted were positive about the future and indeed their future in clinical practice in South Africa in the future despite the fact that South African medical qualifications make South African doctors and health professionals exceptionally mobile.
What has changed dramatically since I was a young doctor are the demographics of the medical profession. Whilst the composition of the cohorts of young doctors now reflect to a greater extent the demographics of South Africa, the predominance of young women doctors in the health services is striking. The challenges faced by these young women are an issue that the public service and the profession have not adequately addressed. Whilst women are prepared to work on a full-time basis for the first few years of their careers in many cases they indicated that beyond this period they would consider either leaving the profession or seeking part-time employment due to relational and family obligations. This militated against them specializing in a particular field of medicine due to the rigid approach of both the employer and the educational institutions with regard to the need to be employed on a full-time basis. I am of the view that the public service, the Health Professions Council and the universities will be obliged to review the requirements for employment, study and registration to meet this new dynamic within the profession.
My own experience in clinical practice as a paediatrician emphasized the importance of personal contact between the patient and parents and health care professionals. This is something that is often difficult to achieve within a busy and often overworked public health environment. Some of my most satisfying experiences as a doctor were when I was able to make this personal connection with a patient. Some of these patients remain as sometimes bitter sweet memories after many years. On a lighter note some years ago the then Western Cape MEC for Public Works, a woman in her late thirties, told me that I had been her doctor when she was admitted to the Red Cross Children’s Hospital as a child. I said that I was surprised that she could remember me after so many years and she responded without hesitation that she remembered me for my eyebrows and my hairy arms! So much for my bedside manner and personality!
A lesson that I have learned related to the interaction with patients and their families both as a clinician and manager is the importance of effective communication. Genuine concern and meaningful interaction is often is more important than the actual treatment received hence a recollection of a hospital stay will focus on a kindly word from the cleaner or the ward clerk and not necessarily the doctor. Many are understanding of the limitations of even the most modern therapy and also will accept errors in clinical management that have occurred if they have been adequately informed. In contrast failure to communicate leads to suspicion that information is being withheld and is often the source of complaints to the media about poor quality care. It is informative that the majority of complaints received by the department regarding health care are not about the quality of care but rather the negative and dismissive attitude of staff. While I have an understanding of the heavy clinical load and the consequent “burn out” factor faced by health professionals in hospitals and clinics across the Western Cape, it remains a challenge to improve our communication with the people whom we serve.
Coming more specifically to the Western Cape and health care in the future, I am of the view that the framework implemented with the Healthcare 2010 strategy effectively defined levels of care, staffing and funding norms and laid a solid foundation for the future. Lessons learned were incorporated in the Heathcare 2030 strategy as approved by the provincial government last year. This provides a stepwise approach to address not only the structural issues but also the softer issues of people and systems. The greatest challenge for this province, however, is in my view not the health system as such but rather the growth in patient numbers that has not been matched in recent years by a commensurate increase in the budget. The burden of disease study undertaken some years ago tells us where the problems lie and undoubtedly in the longer term as is outlined in Healthcare 2030, it is essential to address the “upstream” factors to decrease the burden of disease. This however will take time and in the interim the challenge is to be able to meet the need in a rational manner with the resources at our disposal.
I have likened the situation recently to that of an elastic band which will stretch but at a certain point break. My concern is that health services in the Western Cape are without question stretched and if the pressure is not relieved, they will like the rubber band break. We are already seeing signs of the consequences of this increasing pressure and these are warnings that should not be ignored. This situation requires all of us who hold health and healthcare dear to stand together to ensure that the policy makers are aware of the consequences but also to ensure that every resource allocated to health, be it in the private sector or the public sector, is utilized to the best possible effect. I have not mentioned National Health Insurance which is seen by many as the solution to the problem. Personally I support the principles and concept of National Health Insurance but with the caveat that the funds that are collected and allocated to the National Health Insurance Fund are utilized in the most efficient and cost-effective manner possible. To achieve that the country requires a functioning and robust public health system and as indicated earlier we are far from that goal.
On assuming office I arrived from the Free State having successfully negotiated a revised joint agreement between the University of the Free State and the Free State Government. Despite initial probably misplaced optimism, I am afraid that finalizing this matter has eluded me in over 12 years as it had my predecessors. While the signing of a multilateral agreement almost two years ago was a very positive step, negotiations between the universities and the department within various working groups continue without the finalization of new bilateral joint agreements within the MLA framework. I am heartned that as a result of a concerted effort by all parties that relationships between the faculties and the department have improved significantly over the last few years and I trust that my successor will succeed where I have not!
In conclusion I would like to thank Professor Mayosi for the invitation to speak at this forum today. I will retire on 31stMarch 2015 from the public service and it will be strange to wake on 1st April no longer needing to battle the rush hour traffic to reach my office and no longer responsible for what goes right or wrong in Western Cape health services. I will certainly miss the daily challenge of health care management as I will miss the personal contact with so many of you with whom I have worked and differed over last 12 years. I am entering the next phase of my life with optimism both on a personal level but also for this great and wonderful country in which we live and work. Thank you to everyone who has been part of my journey on my well-travelled road and my best wishes to all of you for the future!