January 22, 2004
By Philippa Garson
WITS University's Donald Gordon Medical Centre in Parktown will secure Joburg's position as the medical capital of Africa and help stem the exodus of South African doctors from the country.
Main entrance to the DGMC
This is the view of the centre's new chief, Michael Eliastam, who was lured from a stellar career in the US to take up the post here. The DGMC, modelled on the renowned Mayo Clinics in the US, was born out of a vision to restore South Africa's track record of medical excellence by offering a training environment for super-specialist doctors (specialist doctors who have gone on to specialise further in their field). The more pressing priorities of Aids and tuberculosis and the increasing demands for primary and secondary health care is fast eroding this environment.
The first independently owned and privately funded university hospital in Africa, the DGMC is to function as a not-for-profit hospital, where patients receive top-quality specialist health care in a climate of training and peer review. This translates into better care for the patients and a model training environment for the trainees.
Named after its main benefactor, Donald Gordon, whose foundation donated R100-million to the venture, the DGMC will cater to patients in need of highly specialised treatment. It will also offer academic doctors who find themselves in very difficult work environments a chance to bridge the private sector and academic milieu. "They can balance their public sector work with private practice, maintaining their scholarly focus in both places, and with access to technology and patients not available in the public hospitals," says Eliastam.
The DGMC will be a "fuel injection" for the refurbishment occurring around the city, says marketing coordinator Joan Macgregor. Incorporating the Kenridge Hospital and several adjacent buildings bought by the university, the medical precinct is expected to cost a total of R225-million once construction and purchase of state-of-the art equipment is complete.
Many facilities are up and running, others are opening soon. The new Radiology and Imaging Centre, which boasts the latest technology for image-guided surgery, is now open and the new ICU, casualty and upgraded operating theatres will open next month.
Eliastam, a specialist physician and graduate of Wits Medical School, has an impressive 35-year career history. He has practised medicine and was a senior manager in several hospitals in the US, including Stanford University and Boston City hospitals. He has two business degrees from Harvard University and has held several academic posts, including associate professor of surgery and medicine at Stanford University hospital and associate dean and professor of medicine and public health at Boston University School of Medicine.
Eliastam says he "did everything" he wanted to do in the US and was keen to come home. "It's the most exciting place in the world," he says. Being part of an ambitious plan to bring back cutting-edge excellence to South Africa's over-extended health system is likely to up the excitement stakes for this father of three who lives in Parktown North.
Comments Eliastam: "Currently, training of specialists is confined to public hospitals, which lack enough resources to provide all the care and to train the super-specialists. The only way to address the training deficit is to expand training of super-specialists into the private hospitals, where the money and technology are. This is the model the United States uses. In the rest of the western world, except for the US, teaching is done only in the public sector on poor people." In the US, however, every medical school has a troika of teaching hospitals - a public, a military and a private hospital. Like the DGMC, the private hospital is always a not-for-profit hospital.
Unlike private hospitals in South Africa, where profits go to shareholders, those from DGMC - wholly owned by Wits University - will be ploughed back into the hospital initiative. Although the hospital must run like a business, primarily catering to patients with medical aid or those who can pay, other patients may be donor-funded or paid for by the hospital because of the teaching value their cases offer.
For example, in the first of four operations funded partially by the Children's Trust, Professor Sydney Biddulph, orthopaedic surgeon and renowned hand specialist, recently operated on six-year-old Katlego Modisane, born with deformed arms and hands, at the DGMC. Wits' DGMC provided the care at cost and helped to raise the funds.
South Africa's medical schools have produced some of the world's top specialists. Wits' DGMC is now advertising for specialist South African doctors to return from places like the US, Britain, Canada, Australia and New Zealand. "Several people are coming back to take up positions here," Eliastam says, confident that Wits' DGMC offers a model of super-specialist medical training for replication in other major South African cities.
What is special and different about the DGMC is that it will offer the patient the benefits of a multi-disciplinary specialist team reviewing his or her case. No undergraduate students will receive training at the centre at this stage. All the trainees are qualified doctors, and some are even specialists training to be super-specialists. "When you go to a private teaching hospital, you will get more people involved in your care, more minds thinking about you. Your doctor will also be more challenged to ensure that the treatment you receive is right."
The climate of peer review will ensure that treatment is "legal, ethical, current and scientific", continues Eliastam. This approach has helped keep medical costs down in the US by reducing medical mistakes and lessening complications, resulting in less wastage and shorter periods of hospitalisation.
Patients will receive top-quality care at the hospital, built in the 1970s by a Catholic order. Many of the nurses have worked at the hospital for 20, even 30 years, and it now has a reputation for "offering the best 'old-style' nursing care in Johannesburg," says Macgregor.
As part of the DGMC's aim to be patient-centred and to suit patients' individual needs, a new menu has been introduced which offers healthier choices - like herbal teas and decaffeinated coffee - not found on the menu of most private hospitals. Also the patients, who order from an a la carte menu, will have the freedom to eat their meals when they are hungry, not at scheduled times.
Eliastam is emphatic that First World healthcare is an essential component for any country wanting to be a player in the global economy. "South African doctors have always had great reputations world-wide and we need to maintain that level. In order to do so we need to have the ability to train super-specialists as well as the clinicians needed for primary care and community health."
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