Contested Legacy: Marking the 50th Anniversary of Professor Christiaan Barnard’s Pioneering Heart Transplant (Part 4)

This is an excerpt of a paper on Barnard’s legacy in South Africa and my own implication in that legacy. (Part 4/4)

In this paper, I tell the stories of Barnard, Hamilton Naki, Basil Brown, three South Africans whose stories can tell us much about legacy, celebrated legacy, disputed legacy, fraught legacy, enduring legacy.

The Story of Basil Brown

South African cardiologists have previously warned that there are not enough professionals to serve the country, especially in the public healthcare sector.

Let me tell you about one of my heroes. Dr Basil Brown, 71, is a cardiologist who trained at UCT and is employed by the department of health at the Provincial Hospital in PE. Basil has been head of cardiology in the public hospitals in PE since 1990. The Provincial cardiac unit has existed since 1963. For many years and until a couple of months ago, Basil was the only hospital cardiologist in the Eastern Cape public sector and Provincial the only cardiac unit in a government hospital in the province able to do open heart surgery.

Let’s imagine you were indigent without any medical aid cover, lived in Mthatha, Aliwal North or any other part of the province outside of PE. And you suffered a heart attack. You would have to endure up to a 6-hour road trip by ambulance to PE, hope that Basil could see you immediately and admit you. He might then have to rearrange his hectic catheterisation laboratory (cathlab) slate to squeeze you in so that he can check your heart or arteries.

If he found even the slightest problem which required corrective surgery, you would have to wait for a theatre slot with one of the private cardio-thoracic surgeons who do two public service slots a week at Provincial Hospital.

Provincial does about 600 Cathlab procedures a year, of which about 200 are procedures on paediatric patients. About 20% of the cases seen in PE originate from East London.

The Provincial unit should be capable of doing 20 open heart procedures a month. Instead, they do about 12.

Basil, who trained at the hospital in 1978, officially retired at 65 in 2011 but continued to work on contract. He says (I believe jokingly) that he can’t afford to retire. I think his intention to continue working has less to do with financial wellbeing.

I think the man is shit-scared – he can’t afford to retire because more people will die once he vacates his position! He realises his obligation to the people of the province is all that stands in the way of more cardiac deaths. Very few people (except perhaps his colleagues in private practice) appreciate the extent of his challenge or his commitment to facing it each day.

Government has now appointed a cardiologist in the Mthatha academic hospital and equipment for a cathlab has been installed and tested. It would be churlish and inaccurate to say, “too little, too late”. But it is incredibly late.

On the surgical front, officially Provincial has two surgeons in posts, but due to action by Brown and others the doctors remain forbidden to operate due to the quality of their work, an issue which the Health Professions Council of South Africa has not yet resolved.

It’s not as if government hasn’t been alerted to the crisis. It’s response over the years has smacked of political gerrymandering, first drawing the three public hospitals – Provincial, Livingstone and Dora Nginza – into a hospital complex and then dismantling the complex.

Despite the challenges, Provincial Hospital potentially has one of the best paediatric cardiac units in the country. Inaugural dean of health sciences at the Nelson Mandela Metropolitan University and cardiac paediatrician, Prof Lungile Pepeta, has contributed to the excellent work which has come out of the public sector in this field.

But that will all be meaningless unless government recognises that, as Basil says and his colleagues in private practice concur, we are on the cusp of a heart disease epidemic.

Sources in public sector healthcare say that Basil Brown has indicated he will retire from Provincial Hospital at the end of 2017, but this could not be confirmed.

Asked to comment, provincial department of health spokesman Sizwe Kupelo would only say: “As and when positions become vacant recruitment processes ensue to fill the vacated position.”