On-line version ISSN 2078-5135
SAMJ, S. Afr. med. j. vol.98 n.5 Cape Town May. 2008
One of South Africa's most dedicated modern-day doctor activists and Cape Town's Health Director, Ivan Toms, died suddenly of meningococcal meningitis at his Mowbray home, on 24 March, evoking shocked tributes from all quarters.
Toms' body was found on his bed by police at about 09h00, the Tuesday after the Easter long weekend, after worried city council executive managers asked them to check his home when he failed to attend an important meeting. Professor Lorna Martin, head of UCT's forensic medicine and toxicology and a friend of Toms, helped colleague Dr Linda Liebenberg conduct the post mortem on his body and confirmed to Izindaba that the notifiable disease had caused his death. Toms' successor as City Health Director, Ivan Bromfield (acting), called a media conference the next day to request anyone who had been in close and prolonged contact with Toms to consider preventive medication and to be on the lookout for symptoms such as sudden fever, intense headaches, nausea, vomiting, stiff neck or a pink rash.
Toms was in excellent physical condition, having recently completed the Argus/Pick 'n Pay cycle tour, but experts confirmed that the contagious disease can develop rapidly, causing headaches, sleepiness, coma and death within 8 - 12 hours. Dr Andrew Whitelaw, a senior specialist in the department of microbiology at Groote Schuur Hospital, said it was generally accepted that a person could go from asymptomatic to critically ill in even less than this time. Toms not calling for help would be consistent with his last having been seen socially the (Sunday) evening before his death. He speculated that Toms had gone home, 'felt a bit groggy, taken a headache pill and lain down'. Overnight, the rapidly ensuing brain swelling could have caused confusion, with Toms lapsing into a coma some while before death. Infectious disease expert Graeme Meintjes confirmed that confusion was one of the common manifestations of the disease. Whitelaw said predisposing factors included viral respiratory tract infection, being in a smoky environment and/or smoking, and some immune deficiencies.
Struck down by long odds
Bromfield said there were 74 cases of meningococcal meningitis in Cape Town last year of which 8 were fatal, and that in 95% of cases there was no identifiable source of infection. The disease was most often caused by a common bacterium lying dormant in the nasal passages.
The diminutive 54-year-old UCT graduate's fierce sense of justice and strength of character kept him at the centre of social justice issues for his entire professional career. He pioneered primary health care in Cape Town's strife-torn townships, initiated the End Conscription Campaign, crusaded for gay rights and was at the centre of finding innovative responses to the HIV/TB pandemic. Toms risked life and limb at the SA Christian Leadership Assembly (SACLA) clinic in Crossroads where he regularly confronted police and soldiers hunting down Crossroads and Guguletu township residents they had shot during violent confrontations in the 1980s.
I was among several who would dodge Casspirs, teargas canisters, buckshot and petrol bombs to meet Toms at the clinic for a daily count of fatalities and injuries that would feature prominently on the Cape Times front page the next day. His setting up of the clinic and fearless, outspoken treatment of the township 'comrades' among the 60 000 residents for whom he was initially the only doctor for nearly 4 years, quickly earned him 'enemy' status in the state security hierarchy.
The SADF seized control of the clinic in 1986 during the infamous security force backed 'Witdoeke' attack on Crossroads and razing of the KTC squatter camp, leading to a community boycott of its services. Having earlier been conscripted into the army as a non-combatant doctor in Namibia (1978), Toms' experience of the police and army brutality in Crossroads led him to refuse an obligatory 1-month SADF camp call-up to the Namibian border soon after the clinic takeover. This defiance, in July 1987, gave the authorities the excuse they needed and he was charged and tried under compulsory conscription legislation. In his celebrated trial, during which his sexual orientation was gratuitously questioned, he was jailed for 21 months, of which he served 9, in Pollsmoor Prison. He was both sexually molested and raped during his incarceration.
Jailing judge praised Toms
In sentencing, the judge described Toms as the antithesis of a criminal and bemoaned the law that forced his jailing, adding, 'jails are there for people who are a menace to society - you are not a menace to society ... in fact you are just the opposite, you have always been an asset to society in the services you have rendered'.
In 1991 Toms became the national coordinator of the National Progressive Primary Healthcare Network and 2 years later Director of the Students' Health and Welfare Centres Organisation (SHAWCO) - an NGO linked to UCT that became a model for primary health care delivery in Cape Town's townships. His sudden death stunned friends and professional colleagues, prompting an outpouring of accolades from all sectors of a society he had so selflessly and passionately served.
Archbishop Desmond Tutu said he 'thanked God for having known' Toms and described him as 'a prime example of Ubuntu'. 'He was utterly selfless. Knowing him makes one feel proud.' A 'terrifically shocked' Justice Edwin Cameron (who was Toms' trial lawyer) said he last saw him at the finish line of the Argus/Pick 'n Pay cycle race where they joked about their good health and compared finishing times (Toms' time was 4.5 hours).
Cape Town Mayor Helen Zille said Toms led his department to exceed its own targets for reducing the city's HIV/AIDS and TB infection rates, achieving the best successes in the country. Long-time friend and fellow activist, Dr John Frankish of the Western Cape's Global HIV Fund, said that over 20 years 'Ivan made a sustained and significant contribution to public health services in Cape Town, his province and nationally'.
'He was passionate about the advancement of the public health service in general, and in particular of services to address the HIV/AIDS epidemic - his passing will be sorely felt for a very long time.' Joint work by the TAC, City Health, the Provincial Health Department and Médecins sans Frontiêres as partners on TB increased the cure rate from 53% to 68%. With Toms at the helm, City Health was also pivotal in increasing the number of Western Cape antiretroviral rollout sites, once again leading the way nationally.
Zackie Achmat, TAC Deputy General-Secretary who first met Toms in 1982, described him as 'an energetic, humorous and dedicated activist. Anti-apartheid activists will mourn his premature death.'
Toms was awarded the Order of the Baobab in Bronze for his 'outstanding contribution to the struggle against apartheid and sexual discrimination'. In the citation he was described by the Presidency as 'a remarkable individual who has always had the courage of his convictions. He could easily have lived a life of privilege and comfort but opted instead to reflect on the realities of the country and to take a bold stand against the injustices he witnessed.'
He is survived by his brother in Australia.