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Prof. Keith Bolton talks about his role at NMCHT and plans for the children of Africa

We had an interesting conversation with Prof. Keith Bolton who is an academic Paediatrician with 30 years attachment to the Department of Paediatrics, Faculty of Health Sciences, at the University of Witwatersrand in Johannesburg.

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The Nelson Mandela Children’s Hospital is best described by SibongileMkhabela who is the CEO of the Nelson Mandela Hospital Trust, “The Nelson Mandela Children’s Hospital is a single facility which will – through its training and research – build human capacity and spread the ethos, values and approach of Mr Mandela throughout Southern Africa and abroad. It will act as a hub for health centres throughout the region. The Nelson Mandela Children’s Hospital will shift the way Africa views its children by providing state-of-the-art specialist care to all children – no child will be turned away due to an inability to pay.”

Let’s find out a bit more about Prof Keith and his exciting future collaboration with NMCH.

Tell us what you’ll be doing at the Children’s Hospital?

I am the Lead Clinician designated to liaise between the Clinical Steering Committee made up of Paediatricians, Surgeons, Radiologists etc and the NMCH Trust.

Tell us what Wits’ relationship with NMCH will be?

NMCH will add another teaching platform to the Wits Paediatric Department in the specific areas of the ‘Centres of Excellence’; Paediatric Oncology, Paediatric Surgery, Cardio-thoracic, Neonatal and Paediatric ICU, Paediatric Nephrology and Transplant, Radiology and Imaging.

What need, in your own opinion, will the NMCH fill in this country and all of Africa?

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Since democratisation, to some extent, tertiary and quaternary Paediatric care has ‘fallen off the table’ as primary and secondary care has been properly favoured. The NMCH will correct that deficit, not only for RSA but also for the region. South Africa has the skills and facilities to provide state-of-the-art, appropriate care for our children. Poor African children with cancer, kidney failure, complex congenital anomalies etc deserve the best care possible. We cannot simply ignore them and concentrate only of safe water, vaccines and insecticide-impregnated bed nets. We need to provide for the whole ‘pyramid’ of services.

What made you decide to go into such a specialised field of medicine?

I always wanted to do medicine, which is surprising as there aren’t any doctors in the family. Despite wanting to be a GP at first, I decided to follow a career in Paediatrics only after completing my internship and commencing a six-month post in Paediatrics at Baragwanath Hospital. I found I loved the kids. If and when they got better, they didn’t have to be told to get out of bed and get on with life, it’s a spontaneous thing! Sure there are terrible tragedies, but the successes easily make up for this.

What specific conditions in South African children’s health care make you sad and what are you hoping for from the new hospital? What would you make sure all children had access to?

My real sadness regarding the plight of children in South Africa is the degree of suffering which they are forced to endure. The number one scourge is poverty. There are increasing levels of malnutrition, which is secondary to poverty but also as a consequence of AIDS. Thank goodness that the Prevention of Mother to Child Transmission (PMTCT) is now paying off with a dramatic drop in infected children. There is nothing sadder than watching a child literally getting consumed by AIDS.

Another disaster of our time is child abuse – physical, sexual and emotional. We pay lip service, as a society, to the idea that children are ‘our future and to be treasured and protected’ but this is clearly not true. We seem to have lost our way as parents and there is a widespread near absence of male role models (fathers or even grandfathers). This is probably one of the worst legacies of the disruption of the Nuclear Family and it was a consequence of Apartheid. Of course these are not ‘health’ problems per se, but the social determinants of health.

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South Africa has the dubious honour of displacing Brazil as the ‘world’s most inequitable country’ with the rich getting richer and the poor getting poorer. This has given rise to a two-tier health system where our privately funded patients (20% of the population) have access to the world’s best care while the vast majority gets pretty mundane care. Yet, we have the skills and wherewithal to provide excellent care to all. South Africa’s poor and indigent also have the right to excellent health care at all levels.

Immunisation and clean water is essential but this is a cold comfort to a child with congenital heart disease or leukemia or kidney failure. The NMCH will provide CURES for these children. The NMCH will be integrated into the existing health care system and this will ensure equity of access to all children. A major spin off will be the training capacity of the hospital. Paediatric nurses, therapists and medical specialists will return to their homes in different regions and take their skills with them.

What is the peak and what is the pit of your day working in children’s healthcare?

 My frustrations are generic rather than specific. Drug stock-outs, deteriorating infrastructure and the like. Poor management and corruption has bedeviled the public sector but there seems to be light at the end of the tunnel. Things are improving. The global economic down-turn has not helped. Funders and NGOs have pulled back and this has had a very negative effect on the creation of the NMCH.

The peak of my day lies in training. At this stage of my life, I am more involved in organizing care and passing on the knowledge I have accumulated in caring for children for over 40 years, than in hands-on individual care. It is a huge source of joy to me to see the enthusiasm and skill of the medical students and young doctors as they take the baton and run with it. I am completely optimistic regarding our future healthcare workers!