Honouring struggle doctors

At the centre of the old black-and-white photograph a woman stands defiant. She is wearing an old-fashioned floppy straw hat, the sort reminiscent of a day on the beach or a stroll through the rose garden in the 60s.

But there is something deeper, more menacing in the air. Above her, protest banners cry out for better health care for South Africans, regardless of race or colour. These were the days of underground anti-apartheid activism, when overt opposition to the government, such as this march by doctors and health-workers through the streets of Durban, carried a heavy price.

For medical academics Zena Stein ?– the central figure in the black-and-white picture ?– and her husband, Mervyn Susser, the cost of their tenacious fight to establish a system of basic health-care for disadvantaged black South Africans had already been too high. Fears of imprisonment, house arrest, even torture, hung like dark shadows over their lives, as they did for anyone who attempted to push the equality goal-posts during those years.

?”One doesn?’t like to dwell too much on those bad old times,?” said Zena, in Durban this week with her husband on a visit that combined work with a ?“nostalgic journey?” to the country?’s turbulent past. ?”Let?’s just say that we had no option but to get out of the country ?– and very quickly.?” But their flight from South Africa four decades ago, however sudden, could not erase the work they had already done in laying the foundations for a modern public health care system in the country.

It also didn?’t stop them from returning to the country and participating in that legendary protest march by the activist medical community through the streets of Durban shortly before the end of the apartheid era.

With them on that historic occasion were some of the pillars of South Africa?’s modern health-care, including Prof Jerry Coovadia, today one of the country?’s leading HIV/AIDS research scientists. ?”We had to make our feelings known,?” said Mervyn. ?“We knew the risks, but there was no other way of speaking for those who needed to be heard.?”

This week the couple, now in their 80s, pulled back a red silk curtain at the Doris Duke Medical Research Institute at the Nelson R Mandela School of Medicine in Durban, revealing a plaque bearing their names, in honour of their ?“extraordinary and selfless?” commitment to basic human rights.

Said Prof Salim Abdool Karim, Deputy Vice-Chancellor (Research) of the University of KwaZulu-Natal, at the celebration of the Institute?’s new video-conferencing centre which now carries their names: ?“Mervyn Susser and Zena Stein have reshaped our understanding of how politics, science and human health are all integrally connected. The efforts made by them to address the health of black communities, like Alexandra and Cato Manor, are of historic importance.?”

The high-profile naming celebration, attended by national and international leaders in the health arena, was a far cry from the undersung, almost undercover work done by the two young medical graduates from Witwatersrand University, who decided that their skills would not be channelled to well-appointed surgeries but to areas where the ?“poorest of the poor?” were denied the basic right of health-care. Much of their early work was done in the sprawling townships of Alexandra, sandwiched between the wealthy suburbs of northern Johannesburg.

?”When we began our work the conditions were abysmal,?” said Mervyn Susser, currently Professor Emeritus of Epidemiology and special lecturer at the Joseph L Mailman School of Public Health at Columbia University. ?”We had to start literally from scratch. The government provided funds for the control of tuberculosis and venereal disease, but that was about it. Antibiotics, surgical instruments, all had to come from private donations.

?”As you can imagine, we were looked upon with great suspicion by government officials who were frankly mystified as to why two young white people were spending so much time in those squalid areas, where basic sanitation and running water were almost non-existent.?”

Faced with massive problems of malnutrition and kwashiorkor ?“with its telltale signs among children of bloated bellies and reddish hair?”, the couple, together with like-minded colleagues, set about establishing a rudimentary standard of care and awareness, and in doing so undertook some of the earliest epidemiological studies in the country ?– a legacy that is still relevant today.

The publication during the 50s in The Lancet of their paper entitled "Medical Care in an African Township" was a major breakthrough in alerting the world to conditions under which millions of South Africans were living.

?”One can never erase these memories, the pitiful sights of families, of newborn babies living under such terrible conditions,?” recalled Zena, currently Professor Emeritus of Public Health (Epidemiology) and Psychiatry at Columbia University and co-Director of the HIV Center for Clinical and Behavioural Studies, New York State Psychiatric Institute. ?”In those early years even bandages and dressings were looked upon as a luxury.?”

During their early medical years in South Africa, investigating the sources of illness and disease was a key part of their initial epidemiological studies. These, they admit, were ?“in many ways learnt on the wing?”.

One of these medical conditions originated in KwaZulu-Natal and was commonly referred to as the ?“Durban mystery disease?”. ?”We were working at Durban?’s King Edward VIII Hospital at the time,?” said Zena. ?“A number of patients were presenting a neurological condition which nobody could identify.

?”The patients were disorientated and unable to function normally. Sometimes whole families were affected.?” After several months the source was eventually discovered, when a friend of one of the hospitalised patients was tracked down to a shack in Cato Manor. ?“I never forget his name was Edward,?” said Zena. ?“We found him sitting, very sad and mournfully, on an old chair, so disorientated. We then discovered a drum at his home filled with home-made beer. On inquiry he said that he had brought back an empty drum from the paint factory where he worked, to be used as a container for his brew.?”

When the drum was examined in a laboratory, it was found to contain traces of toxic paint chemicals which, when ingested even in minute quantities, would cause all the symptoms of the mystery disease.

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