[modified transcript of original interview]
Why did you choose to specialise in this field?
So I think that it was fairly thrust upon me in that I always thought I’d be a trauma surgeon or a vascular surgeon, but then one of the consultants in the breast clinic fell down the stairs and I landed up as the senior registrar at the breast clinic and I actually thought that what the women were going through was more than what I’d seen in trauma. They were lined up in rows, there was no communication or understanding and the concept was of ‘just take the breast off’ – I thought this cannot be happening everywhere in the world and I did some research and saw that the rest of the world were doing immediate reconstruction and realised that life is not just about the disease. Life is about the person and making the person’s life worthwhile.
So then I got training overseas and brought it back into the country. The first time I ever engaged in this topic, I was actually booed off the stage. One of the things they said is: “You’ve got to survive for a year before you can have your breast reconstructed” – and that’s absolute rubbish. Then what I did was I went to Bara and I set up a clinic there.
There were two women that I was seeing per week, right next to the urology cubicle and then I realised that the lack of attendance indicates the need to raise awareness – awareness out in the community. So we went to Soweto and suddenly we realised that this is not a disease of elderly white women, this is a disease of ALL women, young and old. We saw everything from 23 year old black girls to Indian girls.
We have breast problems and we see lots of breast cancers, particularly in youngsters but people are not aware. So the first thing was getting awareness and getting what I call ‘cultural navigation’ set up, which means that people are navigated around disease options and choices by people from their own communities – that’s really the best way. You don’t want a 50 year old white lady saying: ‘Oh well, you must do this’. What right do I have in saying this when I don’t understand the depth of people’s cultures. It’s really about holistic medicine, understanding that 6 out of 10 ladies that get breast cancer have no risk factors. So it is important to make people realise that even though it affects the people you least suspect, can be managed using a multidisciplinary approach.
The concept is that no man is an island. This concept of a doctor going out and practising alone is not accurate. You practice within a team of people that have special interests from different aspects of the field. So you’re looking at it from different sides with the patient being in the centre and that is the best way that you can ensure holistic care. I also don’t like what I call ‘vertical medicine’.
People put doctors that say: “This is what you must do” on pedestals. Doctors don’t have a right to do that, unless you are sitting in someone else’s shoes. That’s why I encourage patients to just call me Carol. So medicine must be ‘horizontal medicine’ in which a two dimensional approach is taken by using your expertise as a doctor but also taking the patient’s experience into consideration. We’ve seen this approach have better outcomes in that 9 out 10 patients with breast cancer are well 10 years down the line after treatment, which is quite exciting.
As a woman in surgery, have you ever been victim of stereotyping or the ‘glass ceiling’ phenomena?
Absolutely! So when I was a registrar, my senior registrar said to me:” I’m not prepared to teach you, I’m prepared to date you.” So I used to sit in on meetings and I was the only female and the guys would talk right through me. Even today. I was offered a professorship by the deanery at the age of 35 but then I was told I was too young to accept the offer, so I waited and waited until the current dean said: “It’s an embarrassment, you have to take this”.
But yes absolutely 100%. (Referring to the original question)
The thing is, if there is a problem you must see past the problem. You must never let it stop you from doing anything. There is always another solution by using another way. It may still be a male dominated specialty, in terms of headships and who gets what, but that doesn’t matter. You need to define what your best role is. So is your best role in administration or is your best role in being a voice?
I think that sometimes when things happen that you don’t want or don’t expect, you must not take it as: ‘Well it’s everyone else’s fault’. Rather, have a look and see if you’re actually not supposed to be in a different space yourself. I don’t think we must ever accept any form of prejudice, but what we must always be aware of, is that there are always other ways of achieving goals that may be slightly out of the box.
What sets you apart from other surgeons?
I genuinely care about my patients. For me they are part of my family.
Medicine is a service profession, it’s about working as a team and never underestimating the fact that you’re not the person in control. You must really be aware of all the parts that play a role and really realise that we are here to create service and change people’s lives for the better.
How are you affected by the resource limitations in the public sector?
Well I think that for me my private practice generates my work in the public sector. There’s a lot of goodwill. I have the most amazing breast unit, I have a breast health foundation, I have counselling etc. That doesn’t come from the public sector, it comes from private goodwill. So the patients I have treated have had contributions from private and corporate entities. So I think we should look at the two in synergy and not as an opposition. So I can say: “Steal from the rich for the poor.” You always have to be able to overcome. Which is why I can genuinely say you can get equivalent care at Helen Joseph as compared to the private sector.
What piece of advice do you wish you had gotten whilst still a medical student?
I was fortunate to have some very good mentors. The advice I would have liked to have and would like to give is that I think there needs to be more open communication and mentorship with students. In other words, working on the concept of feeling less like you’re struggling on your own by challenging why we are not working as a team.
A student is not below a consultant or professor. People are equal in their own right and there has to be more open communication and understanding. My heart breaks when I see that students have to leave and people don’t understand their funding issues and other issues that apply. There has to be more open communication. There’s always a solution. I think it’s just difficult as students to know who to take your problems to.
What would you change/improve in the medical school educational system?
Mentorship. Absolute open mentorship. I often have this discussion in my department. How do you know how many people someone mentors and who mentors who. I think mentorship is like respect, you must want to mentor and it doesn’t matter if you mentor 1, 10 or 100. The concept is that you then set up systems. If 100 people require mentorship around one person, that is an opportunity for a system to be set up. There needs to be more of what I call: “Electronic white boards of need.” in which we can ascertain the needs of the students, for example: “Who needs to carpool?”
I think we are such a small world village in terms of social interaction and communication, yet we are still so isolated in terms of helping each other, and that for me is quite sad. There needs to be more generosity of spirit in the medical school environment.
What do you do for fun?
I “Run Forrest, run!” I love running.
I love reading around things like Dr Seuss
I just love fun – so reading and going out to dinner with people. I love people.
What is your favourite thing about your job?
Every moment of the day. Treating people, I have huge respect for my patients. To go through chemo is like climbing Mount Kilimanjaro – it’s so hard! I am humbled by what I do.