The Donald Gordon Medical Centre

South Africa is unique. Other countries have survived massive Social Engineering experiments but none has ever had to live with the consequences of a massive and deliberate under-education of, and inadequate provision of basic services for, the vast majority of its people.

The majority of advances in health care have accrued to a very small fraction of humankind. Progress in health has not been equally distributed, either among or within countries. In South Africa 35% of the doctors cater for the 35 million people who use public sector health care. 65% of our doctors cater for the 7 million people who belong to medical aid schemes. Access to specialist clinicians is even more slanted. Simply put, the poor have very little chance of being treated by a specialist.

We, the Universities, the medical profession and the informed public have become increasingly concerned about the poor state of health care infrastructure, education and research in Africa. Tertiary medical education is in serious decline. Over the past few years the government’s focus has understandably shifted onto primary health care in order to serve the greatest number of people. The consequences for tertiary health care, however, have been dire and alarming. Our teaching hospitals are state owned and inadequately funded and staffed. Simply put, how are we to train specialist clinicians in this country in the future?

The Wits University DGMC The Wits University DGMC The Wits University DGMC

First, the public sector is not investing in the new and advanced technology required in tertiary medicine. For example our teaching hospitals have no modern imaging equipment. How are our Universities to train Radiologists and the many specialities that depend on imaging and other technology?

Second, the salary gap between public and private sector specialists is such that neither the Universities nor the Provinces are able to keep the best clinicians in academic medicine.

Third, the declining resources for state teaching hospitals have resulted in a reduction in the number of medical posts. Consequently the remaining doctors have a crippling workload with inadequate time for teaching and research.

Fourth, South Africa has suffered an endless and irreplaceable loss of medical expertise and talent to emigration. This is because those who wish to be academics find they are in a below-standard hospital environment with no time to pursue their academic and professional interests. (The socio-economic and political environment over the past fifty years has undoubtedly also been a major contributory force propelling the ‘brain drain’ of medical professionals from South Africa).

Fifth, as a result of all of the above, many procedures are infrequently, if ever, performed in state hospitals (which are our academic hospitals). For example, the number of cardiac catheterisations performed annually has dropped dramatically due, in part, to the cost of consumables. The level is now so low that accrediting bodies consider it insufficient to maintain the necessary level of skill and certainly insufficient to offer training.

Finally, the international focus on the HIV and AIDS pandemic in Africa has resulted in other equally important medical, social and economic issues being ignored.

The future is bleak for Africa if we cease being able to offer high level health care. Africa’s rich will still continue to enjoy the best medicine that money can buy – wealthy Senegalese and Ivorians will continue being treated in Paris and moneyed Ghanaians, Kenyans and Nigerians will remain patients in London’s clinics. Confidence, however, will dissipate and the brain drain out of Africa will accelerate. Who invests in countries with inadequate health care infrastructure? We wish to see a new health world in which poor and excluded people can achieve their full health potential. We don’t know how it can come to fruition, though, if we allow the infrastructure we have to teach specialist doctors to wither and die.

It therefore became a priority in the University’s strategic plan to develop a private teaching platform to supplement the public sector academic hospitals.

South Africa, whilst being in dire need of development funds, remains the powerhouse of Africa and Johannesburg is the most important city in the Continent. Without this intervention the prognosis for healthcare in Africa is very bleak indeed. Where will Africa’s doctors be trained? The cost of a four year post-graduate residency program at the University of the Witwatersrand is, in total, R 80,000 (approximately $ 8,000). The equivalent training in Europe, the UK or the USA would be prohibitive. Moreover, the cost of living for a medical student in a ‘hard currency’ environment would be impossible for the vast majority of African countries to carry. Currently approximately half the doctors specialising at the University of the Witwatersrand are from elsewhere in Africa. Perhaps the strongest argument for strengthening the ability of South African medical schools to train specialists from the entire continent is that these trainees are more likely to stay in their home countries. In Mozambique the doctor to population ratio is 1:50,000, in Zimbabwe it is 1:62,500, in Nigeria it is 1:66,670, in and in Kenya there is 1 doctor to serve 71,430 people (according to The Economist). Is this equitable?

Given our distance from major research centres and the unique conditions we face, we believe Africa needs the tools to help solve its own problems. In our case, that means our own properly trained and qualified physicians who can not only cure illnesses and teach the next generation of medical practitioners, but make a contribution to research on vaccines for AIDS, Malaria, Tuberculosis and other diseases debilitating our continent. To prevent the loss of sub-Saharan Africa's ability to educate and retain specialist physicians, The We have partnered with the University of the Witwatersrand to revitalise its once enviable post-graduate medical teaching facilities. To this end the University has purchased the Kenridge Hospital, a medium sized hospital and is in the process of up-grading it to meet the rigorous academic and research goals set.

This initiative is a rare example of public/private partnerships in operation. In addition to our support for health care and medical education, we are also trying to expand private giving through our own philanthropic example. Although South Africa does not have a great tradition of private individual philanthropy, we are hoping to nurture this spirit. Thus, our partnership with the University of the Witwatersrand is conditional upon the project raising private funds beyond our contribution. The new teaching medical centre will need a minimum of R 180 million. We at The Donald Gordon Foundation have committed R 100 million, the University of the Witwatersrand has committed R 40 million and they need to raise at least R 40 million from other private donors both in South Africa and abroad.