Print version ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.99 no.3 Cape Town Mar. 2009
At the Heart of Healing: Groote Schuur Hospital 1938 -2008
By Anne Digby and Howard Phillips, with Harriet Deacon and Kirsten Thomson. Pp. 398. Jacana, 2008. ISBN: 9781770096424.
Groote Schuur Hospital (GSH) opened 70 years ago as the main hospital for Cape Town and the teaching hospital for the University of Cape Town. The visionary professors at the opening ceremony on 31 January 1938 would have cherished thoughts that the institution would meet the ideals of Flexner for a teaching hospital, but others could scarcely have imagined that its name would become known to virtually everyone, in South Africa and abroad.
The authors, historians Anne Digby and Howard Phillips with Harriet Deacon and Kirsten Thomson, have comprehensively researched, seeking to examine fairly, evenhandedly and critically its travails and successes. Credit is given for its numerous special achievements while confronting the difficulties - administrative, bureaucratic, political and financial. Most particularly, the book examines both the complicity with and determined opposition to the segregation and subsequent apartheid policies in force in South Africa throughout many of those years.
An aspect that seems to have taken the authors by surprise is the sense of loyalty, pride and ownership shared by virtually all members of staff, including those serving in menial roles, and the millions of patients admitted over the years to its beds and clinics. Quoting a senior matron, it is explained that 'The hospital on the hill: everybody saw it, everybody looked at it. It was like - with its arms - embracing us, embracing the whole of Cape Town'. This allegiance among patients and staff has arguably been the hospital's most singular achievement.
Five broad themes emerge from the book:
the administrative and bureaucratic complexities in running a modern hospital, and the dedication with which it has been done in the case of GSH, that has been served by many exceptionally competent chief administrators
the impact on its operations of apartheid policies and the bitterness and anger they fostered, particularly among students and staff who were subjected to such hurtful discrimination
the sense of family referred to above, notwithstanding the hurt
the scientific and clinical excellence that was achieved (and sometimes brilliance), including those surrounding the world's first heart transplant
the financial constraints, particularly in the post-apartheid era since 1994 when government insisted on more equitable allocation of health resources in strengthening primary health care at the expense of tertiary hospitals.
A special feature and critical success factor of the partnership between GSH and the University of Cape Town (UCT) was the joint agreement between the provincial hospital authority and the university. At the heart of that contractual arrangement lay the mutual acceptance that teaching, clinical services and research are inextricably linked and interdependent. It was understood that clinical research often translates immediately to practical benefit at the bedside and clinic, and that excellent clinical services and teaching can only happen where research is robust and flourishing. The early clinical professors were insistent on this, by word and deed. The best teachers, in their version, were also accomplished research workers. With modern financial constraints, the joint agreement and the principles that it espoused have fallen away. The authors, drawing on many sources, report on how regrettable that has proven to be.
The jewel in the historical crown of GSH, and one of its defining moments, was the world's first heart transplant by Christiaan Barnard and his team on 3 December 1967. The authors do not over-emphasise the event, while acknowledging that it was the general culture of excellence that made it possible. The anaesthetists, cardiology team, nurses and exceptional standards of postoperative care enabled the buildup to the famous operation. The book judiciously balances this with the heartache and suffering caused by South Africa's racial policies as played out in health and in the hospital's policies. Recognition is given to the efforts of numerous individuals, divisions and departments to adapt to the changing demands placed on teaching hospitals by the need for stronger participation in and support for primary health care, especially in the past 25 - 30 years. Increasingly, the work of GSH went far beyond teaching and intramural services to prevention, public health and setting standards for care.
The authors have made an extraordinary effort to seek information from those who worked at GSH, not only from the medical elite, which is a common weakness of hospital histories. The story is told through time, as well as through structures and processes, and the challenges of transformation. The role of the community, the people of Cape Town, is examined in giving the hospital its character and accounting for its achievements, which from its inception has been 'the peoples' hospital'. The experience of 'surgeon princes, nurse nightingales and cleaner cinderellas' has been given due attention, and there is careful effort to reflect the experiences of the millions of patients. Approximately 200 interviews were conducted, eight archival repositories examined and 10 seminars conducted with key witnesses of the hospital's past.
Reading At the Heart of Healing one gets the impression at times that GSH continued for much of its first 70 years somewhat cut off from the mainstream events of South African and African history - the civil unrest, the endemic violence, protest, radical disruption, political interference with staff, and changes in the medical politic. Moreover, academic hospitals throughout the world had been profoundly influenced by the seminal report on medical education in the USA and Canada by Abraham Flexner in 1910 and by the progressive evolution of scientific medicine, health services and public health throughout the 20th century. The hospital did, in its search for excellence and international competitiveness, function somewhat in a cocoon, and the book itself has fallen short of meeting such far-reaching expectations. A modern history of South African medicine would be required - that falls beyond the capacity of this already monumental effort.
The authors believe that they have given a 'rounded and balanced account of a multifaceted, complex and distinguished institution'. They have done so, brilliantly, contributing substantially to an understanding of modern South African medical history.
Chief Specialist Scientist, South African Medical Research Council and Professor Emeritus of Pharmacology, University of Cape Town
Genes for Teens
By Nonhlanhla Khumalo. Pp.94. Illustrated. Yigugu Publishers, Cape Town. 2009. ISBN 978-0-62-041012-0.
Genes for Teens is a remarkable book. Nonhlanhla Khumalo conveys a lot of valuable information about genes and genetics, about human reproduction and the danger of infectious diseases, such as AIDS, and about the futility of defining human races by the colour of their skin. (Why not by the shape of their earlobes?) Dr Khumalo writes clearly in an engaging, light-hearted style, and with a pervasive touch of humour. Her style will be quite attractive to teenagers, who are the reading population she targets. The illustrations, all in colour, are lively, beautiful and informative. If my children were now teenagers (rather than the overgrown adults that they are), I would surely give them Genes for Teens to read, and I am sure they would love it and thank me for it - and they would have learned a lot about genetics and other biology, without being aware of how much they had learned. A wonderful little book!
Nonhlanhla P Khumalo is a dermatologist at Red Cross Children's Hospital, Cape Town.
Francisco J Ayala
University Professor of Evolutionary Biology, University of California, Irvine, 2001 US National Medal of Science Laureate, and author of Darwin's Gift to Science and Religion