IZINDABA

 

Obituary - Prof. Herman van Coeverden de Groot (1932 - 2022)

 

 

 

It was with great sorrow that the departments of Obstetrics and Gynaecology, and the divisions of Neonatology as well as Nursing and Midwifery at the University of Cape Town (UCT) learnt of the passing on 29 November 2022 of Emeritus Professor Herman van Coeverden de Groot, who had served the department of Obstetrics and Gynaecology as a specialist consultant and subsequently associate professor for 32 years, from 1965 to 1997.

Born in Java, Indonesia, he, with his brothers and parents were survivors of a Japanese internment camp during the second world war.

The family relocated to Cape Town in 1951 when he was 19 years old, and he completed his medical studies at UCT in 1957. He acquired the MRCOG specialisation in London in 1964. He was appointed junior consultant in the Department of Obstetrics and Gynaecology, UCT, in 1965. Following a year in the UK as senior lecturer exchange in Newcastle-upon-Tyne, he returned to Cape Town in 1971, and became head of firm and subsequently deputy head of department and associate professor, where he remained until his retirement in 1997.

He is well known locally and nationally as one of the fathers of community obstetrics in South Africa (SA) and for the development of primary care midwife obstetric units (MOUs) in Cape Town.

Inspired by the vision of Prof. Hugh Philpott from Harare, Zimbabwe, and supported by Profs Atties Malan from the neonatology division and Dennis Davey from the obstetrics department at UCT, Prof. de Groot oversaw the opening of the first MOUs in the southern suburbs of Cape Town in 1971. Several MOUs, three secondary hospitals (Peninsula Maternity Hospital, New Somerset Hospital and later Mowbray Maternity Hospital), St Monica's Hospital and the tertiary hospital (Groote Schuur) became integrated in 1980 into a single regionalised service known as the Peninsula Maternal and Neonatal Service (PMNS). Prof. de Groot spearheaded and sustained the obstetrics component while Prof. Atties Malan, Dr Steve Delport, Prof. Dave Woods and Dr Dave Greenfield were key in developing the neonatal component. The opening of the MOUs, together with training of midwives working in them, and outreach support by medical officers, was associated with increased access to maternal and neonatal care for disadvantaged pregnant women and their babies residing in the communities where the MOUs were situated. This resulted in a significant reduction in maternal and perinatal mortality in the 1970s and first half of the 1980s.

The key features of the PMNS included: a regionalised integrated comprehensive maternal and neonatal service including different levels of care; agreed-upon referral criteria; regular outreach; emergency transport; training and teaching; and ongoing audit of outcomes. This maternity health system model has been commended and replicated nationally and internationally, as a cost-effective relevant model for low-and middle-income countries. Its successor today, now known as the Metro West Service, includes several district hospitals and the establishment of greater horizontal linkages with the community health centres in the districts where the MOUs are situated.

Prof. de Groot was both a practical service implementer and an academic. He published many articles on the PMNS and perinatal/maternal audits that were relevant for communities where women lived, thus expanding access to maternity care and providing many lessons on how to both set up and sustain a regionalised integrated maternal and neonatal service.

Perhaps most of all, Prof. de Groot will be remembered as a dedicated and influential teacher, particularly of midwives, junior doctors and medical students, whom he empowered by his dedicated teaching, and also for his dry humour and jokes. This and his likeable, quirky character inspired many stories. He was a well sought-after speaker, particularly at academic meetings and year-end functions.

His Scottish dancing moves at Priorities in Perinatal Care conferences, at which he was a regular attendee and speaker, were taught by his wife Aileen, who sadly passed away several years ago. She was a midwife and inspired his respect for midwives, for whom he was a champion.

His commitment to midwifery education and empowerment is reflected well in the following tribute from Prof. Sheila Clow from the Department of Nursing and Midwifery, UCT, and other Western Cape midwives with whom he worked:

'Emeritus Assoc. Prof. Herman A van Coeverden de Groot must have one of the longest names on the UCT staff roll. He casts a long shadow over many years for his pioneering role in establishing community obstetrics alongside Dr John Smith, who was pioneering the day hospitals service in the early 1970s. This aimed to bring health services closer to the people who needed them (many of whom had been forcibly removed in the previous 10 years and found themselves at great distances from these services), reducing load in secondary and tertiary health institutions, and providing care by appropriately qualified people with appropriately resourced services. This predated the Alma Ata Declaration regarding primary healthcare in 1978 which, inter alia, promotes values of accessibility, affordability and acceptability.'

Prof. de Groot actively promoted ongoing professional updating for midwives in the PMNS through annual MOU training days. Beyond the PMNS, he established the Continuing Obstetric and PErinatal care programme (COPE) for the (then) Cape Province. This included co-ordinating multiprofessional/disciplinary teams (consisting of an obstetrician, midwife, neonatologist and neonatal nurse), which would visit centres throughout the province for several days at a time. This involved updates for hospital staff as well as sessional medical staff in the surrounding areas, supportive visits to clinical managers as well as hands-on skills updates. Some of the centres visited included Kimberley, Vryburg, Knysna, East London and Grahamstown. At this time he established the COPE magazine to support ongoing learning in perinatal/midwifery care, as well as the annual modern midwifery symposium in which he strongly encouraged midwives across the province to participate and present. He also found opportunities for some midwives to present in international workshops.

His commitment to improving educational opportunities for midwives was demonstrated in his commitment to teaching in the advanced midwifery programme offered locally. A later initiative included the establishment of the Perinatal Trust along with Prof. Dave Woods, Prof. Gerhard Theron from Tygerberg Hospital and Stellenbosch University, and Dr Dave Greenfield. This resulted in the development of the perinatal education programme, which started with maternal and neonatal manuals in which midwives and neonatal nurses were involved as authors of chapters. This programme enabled groups of midwives with a local facilitator at their home base to work systematically through a range of topics, with associated clinical skills chapters. This initiative has developed far beyond what was originally envisaged under the leadership and zeal of Profs Woods and Theron, with manuals in perinatal HIV, perinatal mental health, audit and feedback, among others.

Colleagues from obstetrics, neonatology and midwifery of the Health Science Faculty at UCT would like to acknowledge the huge contribution made to maternity care in SA by Prof. de Groot, and convey their condolences to the de Groot family:

Prof. Sue Fawcus (emeritus professor and senior scholar, UCT Obstetrics and Gynaecology), Prof. Zephne van der Spuy (emeritus professor and senior scholar, UCT Obstetrics and Gynaecology), Prof. Edward Coetzee (emeritus associate professor, UCT Obstetrics and Gynaecology), Prof. Dennis Davey (previous head of department and emeritus professor, UCT Obstetrics and Gynaecology), Prof. Sheila Clow (associate professor, Division of Nursing and Midwifery, UCT), Prof. Dave Woods (emeritus professor, UCT Neonatology) and Prof. Mushi Matjila (professor and head, UCT Obstetrics and Gynaecology).

Prof. de Groot made outstanding academic contributions to the field of obstetrics and gynaecology and several of these contributions (listed below) have been published in the SAMJ over the years.^[1-7]

Mushi Matjila

Department of Obstetrics and Gynaecology, University of Cape Town mushi.matjila@uct.ac.za

 

References

1. Van Coeverden de Groot HA. Amoebic vaginitis. SA Tydskrif vir Geneeskunde (Byvoegsel Suid-Afrikaanse Tydskrif vir Obstetrie en Ginekologie) 2 March 1963.         [ Links ]

2. Van Coeverden de Groot HA. Sterilisation in relation to family planning. S Afr Med J 1973;47:2304-2306.         [ Links ]

3. Gunston K, van Coeverden de Groot HA. The Cape Town obstetric flying squad. S Afr Med J 1975;49(28):1147-1148.         [ Links ]

4. Van Coeverden de Groot HA, Davey DA, Smith JA, Vader CG, van der Merwe FW. The midwife obstetric unit. S Afr Med J 1978;53(8):706-708.         [ Links ]

5. Van Coeverden de Groot HA. Trends in maternal mortality 1953 - 1977 in Cape Town. S Afr Med J 1979;56(14):547-552.         [ Links ]

6. Van Coeverden de Groot HA, Davey DA, Howland RA. The Peninsula Maternal and Neonatal Service. S Afr Med J 1982;61:5.         [ Links ]

7. Fawcus SR, van Coeverden de Groot HA, Isaacs S. A 50-year audit of maternal mortality in the Peninsula Maternal and Neonatal Service, Cape Town (1953 - 2002). BJOG 2005;112(9):1257-1263. doi.org/10.1111/j.1471-0528.2005.00601.x        [ Links ]