With the onset of winter in South Africa, the time of the “sere and yellow leaf”, I am in a reflective mood as my 74th birthday looms later in the year.
I retired from a full-time career as a specialist paediatrician and then a senior government bureaucrat in 2015 having headed a university department of paediatrics and managed two provincial departments of heath in South Africa. Subsequently I have remained busy as a consultant and on the boards of various entities. 2023 marks 50 years since I qualified as a doctor in 1973 and the world around me has changed dramatically since that milestone and as befits that anniversary a reunion is planned. I am ambivalent about a gathering of seventy year-olds many of whom like myself are retired and most scattered across the globe with a minority like me still resident in South Africa. There are a number of my classmates no longer with us as age and illness has taken its inevitable toll, but a surprising number remain and of those a remarkable number, God willing, intend to be at the reunion, many traveling from distant locations to meet in Cape Town.
So what will we talk about when we meet, many not having seen each other since either graduation or the initial years of our careers as junior doctors?
The health system in which we were trained was segregated which impacted on some of my classmates, who as people of colour were prohibited from interacting with patients who were white. This lead them to boycott the final year dinner to emphasise to the majority of us who were white, how apartheid had impacted on their time as medical students. Even before 1994 when the democratic transition occurred this had changed in the Western Cape, but the hurt of this injustice remains as recent communications between colleagues testifies. As I experienced, apartheid and the segregation of health services persisted in the Free State province until after 1994 which I describe in more detail in my book.
Technology has made dramatic strides since 1973 when personal computers, cellphones, the internet, fibre-optics amongst others were as yet unknown. We listened to music on record players and the “new” technology of the audio cassette, which allowed us to listen to our favourite music while driving a car … Bob Dylan, John Denver, The Carpenters were amongst the tapes in my first car with a cassette player. These were superseded by the CD and now music downloaded from the internet with the demise of “record shops” in which I enjoyed browsing on an off day as a young doctor and even in later life.
In hospitals technology has made similar strides exemplified by the fact that while I spent much of my time as doctor working in intensive care units (ICU), that if I was today enter an ICU I would not recognise much of the equipment that is now used routinely in these areas of a hospital. Much of this sophisticated equipment depends on computer technology that did not exist when I qualified in 1973. I recently underwent a laparoscopic hernia repair which left me with minimal surgical wounds and a short post-operative recovery, an operation that when I was a junior doctor was undertaken through a large incision with significant post-operative discomfort and longer recovery time.
As a junior doctor I worked for a time in the cardiology department and prepared patients with ischaemic heart disease for coronary bypass surgery. The operation involved opening the chest and the grafting of a vein to bridge the narrowed or obstructed coronary artery with the possibility of significant post operative morbidity. Today a young doctor in a similar department would witness the treatment of a patient with a similar condition effectively managed in most cases by angioplasty with the insertion via an artery of a “stent” to relieve the obstruction with a much shortened recovery period.
New therapies in the last 50 years have made the cure of some previously untreatable diseases and the effective treatment of other chronic and degenerative diseases possible. I recall as an intern watching an orthopaedic surgeon at Groote Schuur hospital perform one of the first hip transplants which have now with other joint replacement procedures become routine with an excellent prognosis.
As a paediatrician I managed children with cystic fibrosis (CF) which inevitably even with my best efforts lead to their early demise. The diagnosis was made utilising a sweat test to measure the sodium levels which are elevated in the sweat of individuals with the disease. Today the identification of the defective CFTR (CF transmembrane regulator) gene definitively confirms the diagnosis. Using a drug that “modulates (modifies) certain of the defective CF genes it is now possible to significantly reduce the impact of the disease on individuals when these drugs can be used. A lung transplant is now a realistic option for those patients with terminal lung disease as a result of CF, which was a distant possibility 50 years ago despite the fact that the first heart transplant was undertaken at Groote Schuur Hospital a year before I commenced my medical training.
Another significant advance in the last fifty years has been the treatment of childhood leukaemia which was previously an almost certain death sentence that now with early diagnosis and effective therapies has an average 5-year survival for all types of childhood leukaemia over 90% and even higher if the diagnosis is made under the age of five years. Sadly, the therapies and expertise necessary to effect many of these new therapies remain inaccessible to many children across the world due to increasing levels of inequity and poverty in many countries including South Africa.
So when my classmates and I reflect at the UCT Medical Class Reunion on the past 50 years will we agree that all of this progress has made the world a so much better place? Like older persons across the decades we will be tempted to say that our generation was better than those that followed! I am certain that we will all agree that the demise of apartheid was an event that, while seemingly far away in 1973 and a factor that lead many of my classmates to look for a future elsewhere, has made South Africa a better place. Whether the government that followed that momentous event has lived up to the heady expectations of 1994 is less certain.
More of interest to me will be whether we feel that the technological advances in the medical field over the last 50 years have improved the care that people receive from their doctors. I fear that modern medicine, dominated as it is by technology, has lost its way somewhat as a caring profession. Not only technology but the importance of time and money has altered the approach of many in the profession. I do believe that many young doctors retain that idealism with which we commenced our careers 50 years ago but that it fades as the pressures of modern medical practice take their toll and as it did with many of us as our careers progressed.
Looking back in my interactions with patients and their families, and indeed my colleagues in the management of health services, I am aware that when I took the time to determine how they felt about their disease or situation, how often that was more effective than the procedure, treatment or decision that was the reason for our interaction. Maybe we will talk about this at the 50th reunion in 2023? Although I am not certain that will be the case, it would make the event more meaningful to me.
