Educating patients and students – a day in the life of a doctor in South Africa (6 min read)

Dr. Mark Sonderup, hepatologist and internist at Groote Schuur Hospital, Cape Town, South Africa
Credit: Sonderup

After 20 years as a doctor in one of the most culturally diverse countries in sub Saharan Africa, Dr.Mark Sonderup has learned a lot while practicing in Cape Town, South Africa. One aspect notably stands out: “One must never assume that people of different social or economic circumstances, don’t have access to information.” Sonderup says that when people are sick, it’s natural that they want to know more about their condition. “They use their smartphones to access information online,” he adds.

He is convinced that informed patients are better patients, but this depends on access to correct medical information, and how patients use what they learn. “People are going to find a way to access information. I’m here to give patients a perspective the internet cannot give,” he says. “I have one simple rule: Whatever you read, please come and discuss it with me. Not everything you read about your condition or disease is correct; and not everything is relevant to your case. Together, we will put the information in context.”

People are going to find a way to access information on their condition. I’m here to give patients a perspective the internet cannot give.

As a hepatologist and internist at Groote Schuur Hospital, a public hospital linked to the University of Cape Town (UCT) Medical School, Sonderup treats patients with liver disease. “Whatever the cause, including situations of patients who drink too much, we try to provide everyone withcare and do everything we can to help,” he reflects. His determination is strong. At the end of apartheid in 1994, the South African government reformed the healthcare system. Since then, over 1,600 new clinics have been built or upgraded with better equipment.¹ Overall, by 2014, the country counted 4,380 public hospitals, health centers, and clinics.² The public healthcare system also developed three tiers to meet different patient needs. As a result, South Africans now have better access to specialists – and are able to access up-to-date medical care.

There was a time, however, where Sonderup could not have imagined himself in this role. As a medical student, he often feared he wouldn’t succeed. Today, he holds degrees in pharmacy and medicine, and he’s also an associate professor of Hepatology in UCT’s Department of Medicine. For these reasons, he says he believes he can relate to his students’ hopes and fears as he prepares them for daily work as South African medical professionals. “Our nation faces big challenges in healthcare access,” says Sonderup. The main disease burdens are infectious diseases, particularly tuberculosis and HIV but also viral hepatitis, followed by rising numbers of noncommunicable diseases such as diabetes and hypertension.

There are also high levels of traumatic injuries coming from accidents and assaults. “And, unfortunately, our healthcare system has an imbalanced distribution of funding and resources,” he says. “The public health sector covers over two-thirds of our population with almost the same amount of money that the private sector spends for less than one-third.” Each public clinic provides access to medical care and information to an average of 13,000 patients every year. Still, this number is 3,000 patients over the level that WHO advises be served per public clinic. And despite capacity building over the past two decades, the public sector lacks medical staff, equipment and medication – which results in an overall lack of access to healthcare. Sonderup, however, deliberately chose to work in the public sector and provide patients with access to advanced diagnosis and treatment as best he could. “I always wanted to help people. That is why I became a doctor.”

Meanwhile, the South African government is currently adopting a national health insurance system. Its goal is to have equal access to healthcare for all 55 million of its citizens by the end of 2025. “This aim is ambitious,” Sonderup says, “but I believe that South Africa’s healthcare system is on the right track.” Just as his nation’s healthcare system tries to meet rising needs, Sonderup also tries to provide as many patients as he can with much needed medical care and information. His own workdays are often split between seeing regular patients, where he spends around 15 minutes with their treatment, and examining newly admitted patients.

No one day is the same because no two patients are the same, although they might have the same condition.

Although there is a basic structure to his clinical work, “no one day is the same,” Sonderup says, “because no two patients are the same, although they might have the same condition. These challenges can make the job extremely interesting.” However, his work can also be emotionally demanding: “Sometimes, the kindest and sweetest patient has the worst diagnosis.” Tending to patients is more than just treating medical conditions, he adds. “As a doctor you are dealing with patients fears, expectations, loved ones and ultimately with life and death.”

While empathy led Sonderup to study medicine, he advises his students not to overly romanticize the profession. “When you are in the emergency room at 2 o’clock in the morning and a drunk person vomits on you, your sense of humor disappears. Then you have to know why you are doing this job.” Sonderup’s advice for his own medical students is universal: “Don't do this work for your ego, for prestige or a high income – there are lots of easier ways to make money. But if you want to help people, and ensure they get access to the treatment that they often desperately need, it’s right for you. It’s no doubt the best job in the world.”

1. https://www.khulumani.net/active-citizens/item/download/225_30267364dfc1416597dcad919c37ac71.html
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777579/