Global Engagement Faculty Spotlight

Where did you grow up?

Cape Town, South Africa

How do you think your upbringing influenced your world view? (culture, religion, geography, economics, other factors)

I grew up in South Africa during Apartheid, which was one of the evilest ideologies in history, enforced by one of the cruelest minority governments in history. The only thing in the US which came close to it were the racist, segregationist laws in the South. Growing up in a society that was completely unjust, and that had incredible inequality between Black and White people, turned me into a rather angry young man who railed against the injustices of the world. Paradoxically, it was also fun to grow up as a South African, to live to the beat of one of the most beautiful, happy, friendly countries in the world. Because of international outrage at the Apartheid government, sanctions were levied against South Africa in the 1980s, and South Africa became an international pariah. South Africans responded by becoming more self-sufficient and developing a can-do attitude to solving problems and fixing things. I think that attitude has helped me to adapt to the different countries and US states that I have lived in, but at the same time, I have never lost my sense of identity as an African, and my feeling of being an outsider – with a strong sense of imposter syndrome – in the UK and the US. Although my family has been in South Africa for many generations, I felt an affinity for my ancestor’s roots, so at age 26 I set off to the UK on a 2-to-4-year working vacation. 28 years later – having lived in England, Wales, Michigan, Washington, and now California – I’m still on that “vacation.” After all this time, I still haven’t gotten used to the seasons being the other way round! I have also not resigned myself to seeing injustice and inequality, which sometimes seems to me to be just as bad, if not worse, in the Bay Area as it is in South Africa.

How is healthcare different in other countries where you have lived/visited/worked?

After graduating from medical school in Cape Town in 1992, I worked in Edendale Hospital, in a township on the outskirts of Pietermaritzburg, KwaZulu-Natal. Under the Apartheid system, it was designated as a “Black” hospital i.e. for Black patients only. It was 1600 bed hospital and had the same budget as the “White” hospital in a leafy suburb of the city, which had 400 beds. Edendale Hospital had one CT scanner and no MRI scanners. CTs were only available during office hours, and as an intern, I had to speak to the radiologist in person to plead my patient’s case for a CT scan. Often my request was denied, and then I had to explain to my attending why I hadn’t advocated strongly enough for the scan! I started my anesthesiology training at Edendale. After the first 2 months, I was doing cases on my own, with an attending giving advice over the phone from home at night and weekends. I made some mistakes that will haunt me forever, but I learned from them very quickly! Something that breaks my heart is the disparity in healthcare equipment between high-income and low/middle-income countries. I’ve seen bags and circuits that were patched with electrical tape because they were so old and perished, and ET tubes and LMAs that are washed after each patient and reused until they fall apart.

What lesson or insight would you share with others that you feel could improve the care of our patients in the USA?

Try to keep things simple! Try to limit the number of drugs you use. Apart from helping to reduce healthcare costs, you can avoid complications. If you can avoid giving a muscle relaxant, do so – you could spare your patient an anaphylactic reaction to the NDMR and/or the reversal agent. If you can use an LMA instead of an ETT, do so – you could spare your patient a chipped tooth or a sore throat. Ask yourself whether ordering expensive investigations will really make a difference to the care of patients. Try to minimize the equipment you use and try to recycle as much as you can.

In your opinion, how does a global perspective strengthen the care delivered to patients?  

I think it helps one recognize that being a healthcare provider is about using one’s training, experience, and abilities to provide the best direct clinical care to patients that one is capable of. Meeting, teaching, working with, and learning from healthcare providers in LMICs who give so much of themselves for little financial reward is truly humbling.

Have you gained unique insights or experiences, along your journey? If so, how have these informed your practice?

I’ve learned that arrogance plays no part in clinical medicine. Patients, especially children, don’t care what the title on your badge says, where you went to university, how many publications you have, or where you work now. They care how you listen to them, talk to them, look them in the eye, and promise that you will help them to the best of your ability. They care that you show that you care about them.

What has been your most challenging or surprising lesson learned when engaging with other cultures?

When I was an inexperienced, excitable young anesthesia newbie, I panicked when the laryngoscope light went out while I was intubating a lady for a C-section. In an urgent, raised voice I asked the OR nurse to pass me another laryngoscope. I was a White South African, she was a Black South African. Felling insulted, she let go of the cricoid pressure and stormed out of the OR. Luckily, I intubated the patient uneventfully, but I learned a valuable lesson: not to raise my voice when I feel panicked! It’s a lesson that I constantly have to remind myself to apply!

What has been your most challenging or surprising lesson learned when engaging with other cultures?

Sunsets in Africa

Please share any final thoughts, stories, ideas, and recommendations you would like included.

Don’t stay in the US. Go to work in another country – not on a one-week “mission” with a team and equipment from the US, but for an extended period of time. It will change your life and make you a better doctor.