Professor Lydia Cairncross is a sharp thinker and a straight-talker. Whether it is on issues of equity and social justice or on how to strengthen quality healthcare - Cairncross speaks her mind.
She says a big part of being a head of department at an academic hospital is working with and managing lots of people. "We all have a dual mission - of caring for the individual patients we see, providing the best possible clinical service, and simultaneously teaching, training and mentoring the health workers of the future," she says.
Cairncross says healthcare workers can influence the quality of care provided in South Africa. "Particularly if we can infuse - in our teaching and learning - that healthcare workers are leaders who can promote quality healthcare, equity, and social justice in everything they do. So, whenever I get a bit bogged down by the more bureaucratic aspects of my work, I try and hold up that bigger vision - that we are training the healthcare workers of the future and this is a tremendous privilege. The quality of that training, not just the technical quality, but the ethos of what and how we teach can potentially impact thousands of lives," she says.
"I don't think we have as yet the health service and training platform that I would like to see, but I can begin to see it growing. It starts with how we treat each other and our patients, how we become consciously respectful and caring, and how we intentionally build a working environment where each person has a sense of belonging and purpose."
She says she spends quite a lot of time thinking about this and how they work in the shadow of the past with its disparities based on race, class, and gender. "That, while we have inherited these health systems - and there is no one specific person who is at fault for that - if we are not active in promoting change, if we remain neutral, we become culpable too," she says.
So, whenever I get a bit bogged down by the more bureaucratic aspects of my work, I try and hold up that bigger vision - that we are training the healthcare workers of the future and this is a tremendous privilege.
Growing up in Zimbabwe
When she was five, Cairncross moved to Zimbabwe with her mother, who was a doctor, and her father, who was an engineer. The move in 1981 was shortly after Zimbabwe gained its independence. Both Cairncross' parents were politically active and have been and continue to be a major influence in her life.
"They were very excited about the promise of a new Zimbabwe," she says with a smile. "Also, my parents were very involved in the South African liberation struggle and South Africa in the late 1980s was becoming difficult for them. Helping to build an independent Zimbabwe represented a great hope for that country and also for the changes that could be brought about at home too.
"Zimbabwe is a very beautiful country with a very good education system. I went to public schools there. It was a different environment there - a country that was finding itself. It was a very vibrant place to be even as a child," she recalls.
There were always people visiting their home, she says. "It did not matter which particular political party they were from, for they were united by a vision of a democratic South Africa. Seeing and hearing those discussions, in themselves, shapes a particular perspective of the world," she says.
Coming back to South Africa in 1990, they stayed in Johannesburg - in a time of political turmoil. "I loved political debates and school," she says. She also chaired the Student Representative Council (SRC). "At that time, SRCs were illegal," she recalls, "In the early 90s, there were a lot of teacher strikes and I remember one in particular in 1993 where we organised a class boycott and taught an alternative curriculum to each other - history in particular. It was an interesting time."
Choosing a career path
Cairncross started studying medicine in 1994 at the University of Cape Town.
It was not easy to decide which career to pursue," she says. "I thought about being a journalist mainly because I loved the idea of travel and an astrophysicist because it sounded very difficult to do, but medicine is so multi-faceted you can actually do many things - travel, work in war zones, be a laboratory scientist, lead an academic department." Most importantly, she says, she knew that she wanted to work with people.
"My mom actually discouraged me from studying medicine, saying it was a hard life and I should rather dance or do music, but I did it nonetheless as many children of doctors tend to do," she says.
It was when Cairncross did her first Caesarean section as an intern that she realised she loved theatre and operating. "I loved that sense of the visible impact that surgery brought and for a time, as a junior doctor, I was deeply moved by the romance of operating in war zones believing that, in a crisis situation, it doesn't matter just what you know but also what you can do with your hands."
Since the field of surgery is still dominated by men, she saw it as a welcome challenge. Cairncross admits it was a bit of an unusual choice for her because she has a public health perspective on things and traditionally, surgery is not seen in that way.
"It is not seen as part of the broader health systems delivery of comprehensive care. Only now is there a growing understanding and acknowledgement of the huge contribution surgical care makes to health in society. But for a long time surgery was seen as an elite service only treating one individual at a time while other aspects of primary health care, like infectious diseases, were seen as having greater impact on the greater good. But treating surgical conditions and providing safe, quality surgical care is an integral part of primary health care," she says. "And the corollary is that quality surgical care can only be delivered when we collectively prioritise and build strong primary healthcare systems. So, in a sense, perhaps it is good that I did surgery, as I am part of this more systems approach to what it means to be a surgeon," she says.
Becoming a better surgeon
Cairncross likes to see and make things happen and surgery does that for her.
"It is such a big thrill and, of course, a lot of responsibility. You do an operation and when it goes well, you feel proud of the achievement. But when it doesn't go well, that also feels very personal. It's a big responsibility to carry when an operation goes wrong," she says.
"Taking on that responsibility and managing the impact of things going wrong is one of the skills that we, as surgeons, learn with experience but one of the skills that we should teach more intentionally. A big part of what happens is individual and technical. There are other components as well, but sometimes you have just done something wrong - a technical error - and then you have to take responsibility," she says.
"We don't want surgeons who are not affected by that. For patient care, it's important that you do feel distress and acknowledge it. Every single error that happens needs to be a catalyst to making you a better surgeon next time. It's not easy, but going through that complexity of thinking is very important."
The COVID-19 backlash
As with most health services, surgeries have taken a big knock during the pandemic, as many elective surgeries were put on hold.
Cairncross says that the first three waves of COVID-19 were terrible. So many patients arrived at the hospital, gasping for air and needing help, and it was necessary to divert resources from other health services to manage the impact of the pandemic.
"I was a COVID doctor, as were most of my colleagues, and it was back to basics while we learnt about a new disease and new machines," she recalls. "By the third wave, we were decimated as a health workforce - all of us, including nurses, doctors, physiotherapists, occupational therapists, and psychologists. As surgeons, we were also in despair over our untreated patients. So many people needed help during the peaks of the waves and so many suffered, including the thousands of patients whose operations had been cancelled. It was a depressing time."
It was during this time that she started thinking about how we would recover from this. "We shifted resources from other conditions to COVID-19 and we needed to invest in shifting resources back after COVID. We just couldn't go back to what we had before," she says.
Cairncross is now leading the surgery recovery project at Groote Schuur Hospital to catch up on the surgery waiting lists. "We designed a project to run an extra two theatres a day for one year at the cost of about R15 million. It was when Gift of the Givers donated the first R5 million rand that we began to see this could be possible. The rest has come from the provincial department of health and from public donations. We are now running two extra theatres a day from Monday to Thursday," she says.
She says the aim is to also support other institutions in the province and other provinces across the country to do something similar. "I have sent our project proposals to our colleagues in Eastern Cape and Gauteng. People are looking into this to see what they can do. I know it is not easy to get the alignment of factors, including the incredible support we have had from our hospital management, which may make it difficult to replicate everywhere," she says.
"Surgical recovery is not just about having a surgeon do the operation. It's about the nursing staff, the wards, the theatre, and the equipment. Our biggest bottleneck in human resources is the scarcity of our nurse colleagues. We simply do not train enough nurses in the country, placing the entire health system in crisis as nursing is the bedrock of any health system. Yet our nursing colleagues do not get the proper support and the acknowledgement that they should. We should train more nurses," she says.
Sign up for free AllAfrica Newsletters
Get the latest in African news delivered straight to your inbox
Mbasa - the isiXhosa bride
Cairncross is married to a surgeon from Tsomo in the Eastern Cape, and they have two kids aged eight and ten.
"They keep me very busy. This morning I did lunch boxes and school drop-off and everything that goes with getting the day started," she says.
Cairncross says she was a consultant when she gave birth to her first child. It was through the support of her department head at the time, as well as her immediate colleagues, that she was able to juggle work, breastfeeding, and getting to some of the school events over the years. "I think this kind of support is essential for women."
"Women with small children work phenomenally hard and sacrifice, really their own personal leisure, to give to their work and their children," she says. "I see this with many of my younger women colleagues who are currently training to be surgeons - working long shifts, while still taking excellent care of their small children at home. They are truly incredible."
When asked about being a Xhosa makoti (bride), she smiles. "I was fortunate that my husband's family was very warm and welcoming and I made a conscious decision to respect his culture, his family, and the African traditions in our country. My mother-in-law is an incredibly wise, graceful, and dignified woman and so I have learnt a lot from her."
In the isiXhosa culture, a bride gets a new name given to her by the family-in-law. Her isiXhosa name is Mbasa, meaning a medal.
They travel to the rural Eastern Cape at least once or twice a year.
"This is also important for me because it is important for all of us to understand and acknowledge the unique skills and talents of others," she says. "For example, planning and arranging a huge traditional ceremony and cooking for hundreds of people in massive cast-iron pots on an open flame - this is a very particular set of skills, no less than managing a complex surgical department. I am grateful to experience different roles in the different parts of my life."
*This article is part of Spotlight's 2022 Women in Health series.
