IZINDABA
OBITUARY

Prof. Lionel Ralph Smith (11 December 1946 - 15 March 2025), Associate Dean, Western Deanery, Walter Sisulu University (2015 - 2020): The lantern bearer, lighting the path of rural anaesthesia

With great sadness, we announce the passing of Prof. Lionel Smith, an anaesthesiologist from Gqeberha (Port Elizabeth), Eastern Cape Province, celebrated and renowned as the doyen of rural anaesthesia in the Eastern Cape and South Africa.

Lionel Smith was born in 1946 in Humansdorp to Gordon and Joyce Smith, well-known professionals in the community, a teacher and a midwife. He studied in Port Elizabeth at the Muslin Institute Primary School and South End High School and passed his matric with flying colours, earning a scholarship to study medicine. He completed his MB ChB at the University of Natal in 1970. Between 1972 and 1973, he was a medical officer at Charles Johnson Memorial Hospital, Nqutu. He was in general practice from 1974 to 1979 in Kobus Road in Port Elizabeth and then trained in anaesthesiology at King Edward VIII Hospital, completing his studies at Groote Schuur Hospital as a Fellow of the Faculty of Anaesthesia, FFA (SA), in 1983.

Lionel started his career as a consultant in Cape Town at Groote Schuur and Red Cross War Memorial Children's hospitals, where he developed a special interest in cardiac anaesthetics. He worked in private practice in Port Elizabeth from 1985 to 2002. In 2002 he returned to the public sector, working with Prof. Dave Morrell as a principal specialist at Livingstone Hospital, a position he held until 2008. He was the chief specialist in the anaesthetics department from 2008 to 2011.

In the next phase of his life, from 2011 to his retirement in 2015, Lionel was an associate professor, academic co-ordinator of postgraduate studies, and Associate Dean at Walter Sisulu University, Faculty of Medicine and Health Sciences Western Deanery.

Despite his visual impairment, Lionel was highly committed to serving the community, criss-crossing the various Eastern Cape district hospitals with his wife, Sandra, as his chauffeur. Owing to ill health, he retired at the age of 74.

Lionel's notable contributions to the discipline of anaesthesiology and South Africa include the following:

• The DA (Diploma in Anaesthetics) training programme started in Port Elizabeth in 1985 and continues to this day. The programme has trained over 200 doctors, with over 60 becoming specialists in the Eastern Cape, the rest of South Africa, and overseas. Forty-eight of the diplomates are still practising as DA anaesthetists, and the rest have gone on to work in other disciplines of medicine.

• He contributed to nurse training by lecturing on the anaesthetic component of the theatre sciences for the Eastern Cape nursing college, Lilitha. He frequently organised training and refresher courses for anaesthetic nurses.

• As an assessor in the National Committee for Confidential Enquiries into Maternal Deaths (NCCEMD) from 2002 to 2012, he started initiatives to address the high local maternal death rates. During this time, the Eastern Cape had one of the highest maternal death rates in South Africa. Unsafe anaesthetics due to inadequate training was one of the contributing factors.^[1]

In addressing the NCCEMD findings, Lionel initiated rural outreach programmes to support safe anaesthesia training in the various Eastern Cape rural hospitals, visiting 32 hospitals. These activities included initiating and running 'inreach for rural doctors' to Port Elizabeth hospitals. One hundred and forty doctors from rural hospitals rotated to Port Elizabeth in this programme, with some passing the DA. He also initiated a telephonic consultation service for rural anaesthetics. This intervention led to the publication of a research article highlighting the benefits and challenges of the programme, with Dr Onke Nqala.^[2] Lionel also organised weekend anaesthetics refresher courses in Queenstown, Aliwal North and Kokstad. In 2013, he was awarded the Rural Distinguished Visitor Grant by the Discovery Foundation. This allowed him to fund monthly visits to Mthatha General Hospital, Dr Malizo Mpehle District Hospital in Tsolo, and St Barnabas Hospital in Libode to support safe anaesthesia. During this time, he also provided mentorship and support to the Nelson Mandela Academic Hospital anaesthesiology department, which was growing as a registrar training site.

Lionel received numerous awards and accolades in his life, which include the following:

• The Port Elizabeth Municipal Bursary in 1959 as the best Standard 6 pupil in Port Elizabeth.

• A Noristan Laboratories Bursary, 1965 - 1970, which paid for his medical education.

• A Danish Lutheran Church Bursary for leadership, 1968. He visited Aarhus University in Denmark, spending two months at Aarhus Kommune hospital.

• A South African Medical Students Association bursary to do a prevalence study of bilharzia in Lower Shire Valley, Malawi, in 1969.

• An OVS Kok Award, 2007, from the South African Society of Anaesthesiologists, for excellence in rural anaesthesiology practice.

• An Excellence Award in 2016 from Walter Sisulu University and Nelson Mandela Academic Hospital.

Outside work, Lionel was an avid storyteller, a historian, and an art and music enthusiast. He loved Indian cuisine, hiking, calligraphy and cricket. We will remember him as a gentle, kind man, a great mentor, and an advocate of Ubuntu. Lionel had many friends and made meaningful connections with every one of them. This quality won him the hearts of his patients and colleagues, even the 'difficult' ones, and unlocked many bottlenecks in this challenging health system. We will miss this quality in him. We thank his family for supporting his noble mission, and all he achieved in his life.

Lala ngoxolo, Lionel.

B Mrara, P Alexandris

Department of Anaesthesiology and Critical Care, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa. busisiwe.mrara@gmail.com

References

1. Gebhardt GS, Fawcus S, Moodley J, Farina Z. Maternal death and caesarean section in South Africa: Results from the 2011-2013 Saving Mothers report of the National Committee for Confidential Enquiries into Maternal Deaths. S Afr Med J 2015;105(4):287-291. https://doi.org/10.7196/SAMJ.9351        [ Links ]

2. Nqala MO, Rout CC, Aldous CM. Remote clinical support by telephone for rural district hospital medical officers in the Eastern Cape. S Afr Fam Pract 2015;57(5):286-290. https://doi.org/10.1080/20786190.2015.1055671        [ Links ]