November 2010

Fakulteit Gesondheidswetenskappe TYGER Faculty of Health Sciences Universiteit land

Volhoubaarheid

Onderrig en Opleiding - 'n Evolusionêre benadering

Food Security - A basic human right

Sustainable Health - Is Africa facing a tsunami of chronic diseases? 'n Nuwe dekaan vir Gesondheidswetenskappe Die Gesondheidskompleks

In die middel van die foto is die Tygerbergkampus se grys Fakulteitsgeboue reg voor die bruin geboue van die Tygerberg Akademiese Hospitaal en regs in die voorgrond is die Karl Bremer-hospitaal. Inhoud - Contents

TYGERland Bl. 4: Landelike Kliniese skool op Worcester Voedselsekuriteit - p 20

2 Van die Dekaan se lessenaar 4 Prof Jimmy Volmink

Onderrig en Opleiding 6 Training trends and challenges to improve health care delivery 7 The shift towards rural education and training 10 Skills training: ‘The student cannot know, unless he knows how’ Voorblad 12 Geriewe om nagraadse vaardighede te slyp 'n Nuwe dekaan vir 12 Training for ENT surgeons Gesondheidswetenskappe 13 Vaardigheidsopleiding in Mikrochirurgie 14 Half a century of change and transformation Redakteur 16 Patologie - nuwe uitdagings en geleenthede in onderrig Sybelle Albrecht 18 Department of Medicine: Moving away from paper-based exams Bladontwerp Mandi Barnard Focusing on Human Nutrition Druk en bind 20 Confronting hunger and malnutrition Shumani Print World 22 Nutrition security in communities 23 Nutrition scholarship – integrating nutrition and human rights Tygerland word uitgegee deur die Afdeling Bemarking en Kommuni- Artikels kasie van die Universiteit Stellen- 9 VSA skenk $10 miljoen aan US Gesondheidswetenskappe bosch se Fakulteit Gesondheids- 24 Africa is facing a tsunami of chronic diseases Die Tygerberg Gesondheidskompleks wetenskappe. Die tydskrif word 25 Do you know your diabetic status? gratis aan oudstudente van die 28 Meeting new and evolving HIV challenges fakulteit en ander belanghebbendes 30 SU researchers identify first new TB pathogen in two decades gestuur. Indien u kommentaar wil 32 Unique partnership benefits orthopaedic training lewer op die inhoud van die tydskrif, 34 Paediatric Surgery: Training programme offers special skills of voorstelle maak ivm toekomstige 35 Pharmaceutical Medicine now a medical speciality uitgawes, kontak ons gerus. Indien u 37 Sport and HIV - a new, research-based partnership Tygerland gratis wil ontvang, kontak Mandi Barnard, Fakulteit Gesond- 40 New milestones on the road to infection prevention and control heidswetenskappe, Posbus 19063, 43 New lung cancer treatment procedure Tygerberg, 7505. Tel: 021 938 9505 Faculty News Faks: 021 931 0088 36 Excellence rewarded epos: [email protected] 38 In Memoriam Foto's: 39 Quinette Louw: Our first professor in Physiotherapy Dekane: voorblad en inhoudsblad 42 New book: Understanding Infection Prevention and Control Kampus op teenblad 42 Kliniese Assistente presteer in Kollege Eksamens Anton Jordaan Voedselsekuriteit op inhoudsblad 43 New Book: Clinical Nurse Practitioner’s Manual Mnr HJ Lombard 44 Prestasies en toekennings

Tygerland 2010 Van die Dekaan se lessenaar

’n Tyd om te kom ... en ’n tyd om te gaan

s alles sy bepaalde uur het, en daar ’n tyd vir elke saak en vir elke werk onder die hemel is, dan is daar ook ’n Atyd om te kom – en ’n tyd om te gaan. Ek het 1994, aan die vooraand van die demokratisering van Suid-Afrika, mededekaan geword van die destydse Fakulteit Geneeskunde en is vanaf 2001 aangewys as dekaan van die Fakulteit Gesondheidswetenskappe. Saam met die transformasie en demokratisering van die land, het die Universiteit Stellenbosch ook in hierdie 17 jaar ingrypende veranderings en omwentelings deurleef. Danksy die hulp en bydraes van talentvolle en toegewyde kollegas, glo ek ons het dit tog reggekry om ’n aansienlik beter plek van die Fakulteit Gesondheidswetenskappe te maak, met meer geloofwaardigheid nasionaal en internasionaal. Die aanmoediging en ondersteuning van u as oudstudente, en van heelwat oud-kollegas, was deurgaans ’n riem onder die hart. ’n Mens kan egter net soveel verander en innoveer, en dan bereik jy ’n punt waar jy besef dit het tyd geword vir nuwe idees en ander visies. Dit is hoekom ek besluit het om nie aansoek te doen om vir nog ’n termyn as dekaan te dien nie. Dit was egter ’n besluit wat deur persoonlike, eerder as professionele redes gemotiveer is. Ten spyte van die plesier wat ek uit my werksaamhede as dekaan geput het, was die 17 jaar aan die stuur van sake nie aldag goed vir die gesondheid nie – en met ons kinders wat nou almal uit die huis is, sou ek graag nog ’n klompie goeie jare saam met my vrou, Carina, wil deurbring.

Wegwysers na die toekoms Ek glo dat die hoogtepunte en selfs die enkele laagtepunte wat die Fakulteitsgeskiedenis gedurende my termyn as dekaan gekenmerk het, vandag dien as aanduiding van die toekoms van gesondheidswetenskappe-opleiding aan die US, in Suid- Afrika en selfs internasionaal. Hierdie uitgawe van Tygerland fokus op die evolusie van onderrig en opleiding aan die FGW oor meer as ’n dekade. In die Fakulteit het hierdie proses reeds in 1996 begin toe ek as mededekaan gevra is om weer die MB,ChB- kurrikulum onder die loep te neem om te verseker dat dit tred hou met globale tendense in onderrig op die gebied van die gesondheidswetenskappe en die ontploffing van nuwe kennis. Die veranderings en aanpassings wat ons destyds begin maak het, het intussen die norm geword in gesondheidswetenskappe-onderrig – nie net in Suid-Afrika nie, maar ook internasionaal. Dit is ’n proses wat steeds voortgaan en in die FGW word dit gedryf deur ons gerekende Sentrum vir Gesondheidswetenskappe Onderrig (SGWO). As dekaan was ek ten nouste betrokke by twee

 Tygerland 2010 Van die Dekaan se lessenaar herstrukturerings van die Fakulteit. u The huge improvement in student represent a logical extension of the Dit, meer as enige van die ander diversity that started in 2001 when Faculty’s new curricula and teaching omwentelings, het heelwat kalk in my we changed the Faculty’s selection and and training philosophy. Furthermore, kroonare neergelê! recruitment policies to improve ac- the role of the Rural Clinical School cess for promising students from aca- is of crucial importance in initiatives Herstrukturerings demically disadvantaged communities. of the University regarding wider Die samesmelting van die fakulteite Admittedly there was pressure from sustainable rural development. Some of Geneeskunde en Tandheelkunde aan government, but I truly believe that it these initiatives, particularly in the field die einde van die 1990’s was ’n posi- was also a moral issue and the right of food security, are highlighted in this tiewe ervaring en die nuwe Fakul- thing to do. For the past five years, 60% edition of Tygerland (see p. 20-24), and teit Gesondheidswetenskappe, met sy of all our MB,ChB students, as well as form part of SU’s wide-ranging Project vier Skole, is staangemaak met goeie more than 50% of students who com- Hope. samewerking en kollegialiteit. Hierdie pleted their studies during this period, As dean, I have been grateful and struktuur is egter deels ongedaan ge- were generically black. In fact, more truly appreciative of the Faculty’s strong maak toe die destydse nasionale minis- coloured medical students are trained and loyal corps of alumni. You have ter van Onderwys, prof Kadar Asmal, by the SU FHS than any other health always done us proud – as was again twee jaar later besluit dat Mond- sciences institution in South Africa. illustrated when the Orthopaedics heelkunde aan die US moet saamsmelt u The growth of postgraduate Division upgraded its facilities in met die Fakulteit Tandheelkunde aan programmes and students has been ex- Tygerberg Hospital recently (see p. 32). UWK as deel van die regering se her- tremely encouraging. When I became I hope the selection of articles in this organisasie van tersiêre opvoeding in dean of the Faculty, we had 824 edition of Tygerland, together with the Suid-Afrika. Hierdie besluit en baie van postgraduate students; these numbers news we have shared with you through die ander besluite wat destyds geneem have increased to 1 903 today. More our electronic newsletter, Tygerberg is, is vandag nog moeilik verteerbaar en than 50% of these students are not e-Gesprek, has given you a fairly ’n mens kan selfs redeneer dat dit aan white and 10% are from other African thorough outline of new developments die hart lê van baie van die probleme countries. and achievements at the SU FHS over wat tans hoër onderwys in Suid-Afrika u The recognition of the SU FHS as the past year. in die wiele ry. an international research partner. I was Die tweede proses was deel van die appointed deputy dean of the Faculty A new leader for a new decade finansiële herstrukturering van die US during a time of turmoil when there was Although this will be the last letter en hoewel dit onafwendbaar was, was intense pressure from government and from the desk of this particular Dean, dit waarskynlik een van die moeilikste other institutions for the amalgamation the new designated Dean of the FHS, en mees traumatiese periodes in my of the health sciences faculties of the Prof Jimmy Volmink, will take up the termyn as dekaan. Dit het gelei tot SU and the University of pen in the next edition. As you will die verskraling van die Fakulteit se 33 (UCT) into one faculty, with Groote see from Prof Jimmy’s profile on p. 4, departemente tot tien, tesame met Schuur Hospital as the only teaching he is ready and fully equipped to lead ander besparingsmaatreëls. hospital for postgraduate medical the Faculty into the second decade of Gevolglik het ons in 2006 opnuut students. Today, the idea of such a the 21st century. While he may need begin met ’n nuwe fakulteitstruktuur merger is out of the question; even the to grow some extra skin to protect en die bestuurspan soos wat dit vandag politicians have come to realise that it himself against some of the trials and daar uitsien. Teen die einde van 2006 will be a huge mistake. tribulations of the job, I am sure that het dit reeds baie beter gegaan. Die u Against this background, I am it will give him as many moments of nuwe bestuurspan het hul portefeuljes particularly proud of the bridges built pleasure and fulfillment as it has given besonder goed bestuur en belangrike across the over the me over the past 17 years. bydraes gemaak tot die Fakulteit se past decade. Whereas relationships To each of you, our much valued prestasies oor die laaste jare. with UCT have been strained and even alumni and other partners and friends hostile at the beginning of my term as who share our quest for academic Special achievements dean, there is know a spirit of mutual and research excellence, as well as These are some of the achievements respect and fraternity. I believe there optimal health care for our country that inspire pride and a lot of confidence is now a realization at both institutions and continent – thank you for all your in the future of this institution. They that the individual interests of the two support over the years. It has been a include: faculties are, in fact, locked in a mutual source of encouragement for myself u The phenomenal growth in external interest. and the Faculty. research funding, from R20 million in u The evolution and development 2005 to some R120 million in 2009. of rural health training and the With warmest Tygerberg regards, At the same time we have seen a pioneering role played by the Faculty marked growth in research outputs in establishing the first Rural Clinical with publication units rising from 127.5 School in South Africa, have been in 2005 to 183.41 in 2009, a growth of a source of tremendous pride and Wynand van der Merwe 44.8% over four annual cycles. pleasure over the last few years – and Dean

Tygerland 2010  A new dean with an agenda for people and nation building

rom a career in health scienc- ally acclaimed researcher in health the Faculty since it was established in es that has taken him from sciences, has been designated by the 1956 as the SU Faculty of Medicine, fol- F the Council of Stellenbosch University lowing in the footsteps of Profs Francie to the depths of rural Swaziland and (SU) as new dean of the Faculty of van Zyl, Andries Brink, Bok Wasser- the hallowed academic halls of the uni- Health Sciences. He joined the faculty man, Vaatjie du Toit, Jan Lochner and versities of Harvard and Oxford, Prof as Deputy Dean, Research, in 2006 and Wynand van der Merwe. Jimmy Volmink will now take up the will officially take over from the current Prof Jimmy says he will approach reins as the new dean of the SU Faculty dean, Prof Wynand van der Merwe, on his position as dean with a ‘people first’ of Health Sciences. 1 January 2011. agenda, focused on an inclusive envi- Prof Jimmy Volmink, an internation- He will become the seventh dean of ronment “where a diverse community

 Tygerland 2010 Prof Jimmy Volmink of students and staff feel supported, respected, affirmed, ac- will strive to promote and sustain a strong research cul- knowledged and valued.” ture, encouraging research productivity and visibility in both This agenda will include nation building, “and I would like clinical and pre-clinical sciences. “We will seek to attract and us to talk honestly about how we as South Africans - regard- recruit top-class researchers, retain and develop promising less of skin colour, language, culture, religion, or any other postgraduate students and researchers, and develop the re- factor that has divided us in the past – can unite to build a search infrastructure. healthy and prosperous country for ourselves and our chil- “At the same time, we will monitor the external envi- dren. I believe Stellenbosch University, with its unique his- ronment to ensure that research is aligned with the health tory, now has an historic opportunity to create a culture of needs of the population and that research opportunities in reconciliation and harmony that can serve as a model to the the form of large-scale funding and research partnerships rest of South Africa and the world.” are identified early.” A Capetonian to the bone, and the middle child in a fam- The faculty experienced significant development and ily of seven siblings, Prof Jimmy grew up and completed his growth in research since he was appointed to the Research schooling in Athlone, in the shadow of the old ‘twin tow- portfolio on the management team. This included a 30% ers’. growth in publications in accredited journals; as well as a “To see them go down was a sad moment, and I hope substantial growth in grant applications, with a concomitant not a bad sign,” he says jokingly. While neither of his parents increase in success rates. The procurement of large grants had much education, they instilled a respect for education has, for example burgeoned from a total of R20 million in in their children - encouraging and supporting them to the 2005 to around R120 million in 2009. extent that all seven of them received a tertiary education Two significant initiatives during his term as deputy dean of some sort, Prof Jimmy says. At the same time, their in- included new courses in research methodology which have volvement in the community has left a lasting impression on been offered to more than 200 Masters’ degree students the children - so much so that Prof Jimmy chose to spend and a new, internationally bench-marked, Masters’ degree in his post-internship in the depths of rural Swaziland, at the clinical research which is flourishing. Emkhuzweni Rural Health Centre, where at night he often In further strengthening clinical research, Prof Jimmy had to work in lamp light to tend to his patients, and find his would like to see the establishment of a Centre of Excel- way back to his living quarters through long grass, infested lence in Clinical Research in the Faculty, offering amongst with snakes! other things, on-site epidemiological, biostatistical, data Prof Jimmy worked in the community as a family doctor management, grant writing and publishing support, to re- and district surgeon for a number of years before he devel- searchers across the Faculty. oped an interest in research that took him to the MRC for In the field of education, Prof Jimmy sees the Centre for five years, to Harvard for a Masters degree in Public Health Health Sciences Education becoming a world leader in the and eventually to Oxford University in the UK where he scholarship of teaching and learning in the health sciences. completed his doctorate in Cardiovascular Epidemiology. “As dean I will actively support the Centre’s development On his return to South Africa, he set up the SA Cochrane by, inter alia, ensuring a critical mass of researchers, and facili- Centre (SACC) - an intramural MRC unit which plays a lead- tating research collaborations, as well as other partnerships ing role in advancing evidence-based medicine on the con- with leading institutions in the field.” tinent. The SACC - one of 13 such centres worldwide - is He points out that a Faculty’s interaction with this envi- the only one in Africa. He also spent a year in Washington ronment - i.e. the public, alumni, government, business are- DC in the US where he was invited by the Global Health na, professional bodies and other academic institutions - Council to set up a Division of Research and Analysis in can have a powerful influence on its ability to carry out the global health. business of teaching, research and service. “The underlying As Deputy Dean, Research, Prof Jimmy has been great- philosophy driving our engagement simply put would be: it is ly encouraged by huge strides made by the Faculty in this better to be an agent of change than an object of change.” field. He says he will strongly encourage a mindset that fa- “It is encouraging that our institution does not behave vours adaptiveness and innovation over resistance and bu- as if it has nothing to learn. We realise that we can still do reaucracy. Thus he will ensure, inter alia, constructive dia- better. logue with Provincial authorities to address conflicts around “I believe we have the building blocks in place to become posts, beds and budgets. a truly great university in the field of research. While we cur- “My vision for the Faculty of Health Sciences’ future is rently have world class expertise in areas such as HIV and shaped by life experience in South Africa and abroad, and by TB, I would like to see this excellence spread to other areas knowledge gained from various writings. It is also informed as well - like chronic diseases, non-communicable diseases by the existing Faculty vision and SU’s Vision 2012, as well and health systems research, for instance.” as by the recently formulated faculty values – commitment, With this strong commitment to research, Prof Jimmy integrity, accountability and excellence.”

Tygerland 2010  Health Sciences Education

Training trends and challenges to improve health care delivery

“The central mission of medical education is to improve the qual- rigid and static entity, the SU’s health ity of health care delivered by doctors and we must never fail sciences educators are continually to remember the central role played by patients as the ultimate monitoring, evaluating and adapting the recipients of our skills – what doctors do, and how and when they course content in response to changes in the health care environment, spe- do it, depends on the quality of medical education. We need to get cifically to ensure that Stellenbosch- it right.” trained health care professionals – be they doctors, nurses, physiotherapists, entiments such as these, by the issues such as the previously lecture- occupational therapists, dieticians or prominent British educational- based teaching that overwhelmed stu- speech-language and hearing therapists Sists, Bligh and Parsell, have been dents with information that they were – are equipped with excellent clinical, as at the crest of a tidal wave of global then expected to ‘memorise, recall and well as people-centered skills that will curricula reform that swept across regurgitate’ to pass their exams; disci- enable them to provide caring and ethi- health sciences faculties over the past pline-specific curricula that comparte- cal health care to the people of South 10 to 15 years. mentalised learning and stripped stu- Africa. The most recent changes to the In this regard Stellenbosch Univer- dents of the ability to integrate, evalu- curricula comprised the development sity has been no exception. ate and apply their knowledge across of a joint programme of six months Over the past decade, the curri- disciplines to solve common problems; for students in their first year of study, cula of the Faculty’s medical students, and teacher-centered education that known as the Foundation Phase. These as well as students in the allied health seldom allowed students any involve- changes are aimed at enhancing per- sciences, were comprehensively over- ment in the learning process and con- sonal and professional development on hauled to ensure that what they learn sequently counteracted the need for an interprofessional basis; the advance- and how they learn, will equip them continuing life-long learning which is ment and optimization of interdisci- with the best knowledge and skills to crucial to good medical practice. plinary learning and teaching, and the work as competent and caring health Over the past decade, medical edu- integration of the basic sciences into care professionals who can improve cators of the SU Faculty of Health Sci- the clinical content of the curricula. the quality of care delivered to their ences have addressed these shortcom- This phase is fully shared by MB,ChB patients. At the same time, the revised ings through changes to the curricula and Physiotherapy students while Oc- curricula were designed to teach them that incorporate – cupational and Dietetic students share how to practice their professions in . problem-based educational strate- some of the modules. On the level of a health care environment marked by gies that promote problem-based personal and professional development, continuous change and an explosion of learning in small groups; specific areas of competence were in- new knowledge and technology. . integrated, interdisciplinary curri- corporated into the curricula, i.e. sci- Curricula reform at the SU Faculty cula, and ence writing skills, stress management of Health Sciences and at the country’s . more student-centered learning. and language skills in Afrikaans, English other health sciences faculties have not Furthermore, education and train- and Xhosa. been confined to South Africa. On the ing have increasingly moved from the Since implementation, the curricula contrary, medical educators worldwide hospital to the community, focusing on changes have been carefully monitored have expressed concerns about the primary health care, interdisciplinary and researched and the results pre- shortcomings of traditional medical edu- learning and teaching and rural training. sented to much acclaim at national and cation over many decades, focusing on Instead of viewing the curriculum as a » p26

 Tygerland 2010 Health Sciences Education The shift towards Training trends and challenges to improve health care delivery rural education and training motion, illness prevention, population at these sites where they are exposed and community needs and an aware- to the full spectrum of health care ser- ness of environmental and social fac- vices – including primary health care Prof Hoffie Conradie tors in disease. platforms such as community health Although some departments in the centres, primary care clinics, mobile n the Faculty of Health Sciences, SU FHS provided opportunities for ru- clinics, home visits, NGO encounters the shifting of educational para- ral training in the past, it only became and the private health sector. Thus they I digms is clearly illustrated by a an integral feature of training when gain first-hand experience of the reali- growing emphasis on rural training for the Faculty’s new curricula were intro- ties of working and caring for patients doctors and allied health care profes- duced more than a decade ago. In 2002, in resource-limited environments. At sionals. the divisions of Family Medicine and present, some 970 undergraduates ro- With its decision to establish a ru- Primary Care, Community Health and tate to rural towns for periods of two ral clinical school to provide clinical the Centre for Rehabilitation Studies to six weeks per year. training to students at rural hospitals introduced a 2-week clinical rotation Another important educational is- and health care facilities, Stellenbosch that exposed all undergraduate medi- sue that is addressed during rural train- University also hopes to contribute cal students to training in rural areas at ing, comprises interdisciplinary teach- towards a solution for the growing health care facilities. ing and training. On the educational shortage of doctors and other health Since 2008, student interns of these level, this principle is incorporated in care professionals in rural areas of the divisions have been doing a five-week the foundation phase of the Faculty’s country. combined rotation. They have been giv- first year curriculum which is fully Research and the experience of en the opportunity to do the rotation shared by MB,ChB and Physiotherapy countries like Australia have shown that at rural sites in the Western Cape and students while Occupational and Die- students trained in rural areas are more at Madwaleni Hospital in the Eastern tetic students share some of the mod- inclined to settle and practice in those Cape. Presently, approximately a third ules. It then extends into practical train- areas, says Prof Hoffie Conradie, direc- of student interns elect to do the rota- ing during rural rotations when the stu- tor of SU’s Ukwanda Centre for Rural tion in rural areas. dents work in teams that may combine Health. As a specialist in rural edu- two or more disciplines such medicine, cation, Conradie was recently invited to Laying the foundations dietetics, physio-, occupational- and spend five weeks in Australia as part of To provide the logistics for rural train- speech therapy. a team tasked to review the rural clini- ing, research and community interac- Ukwanda also incorporates a re- cal schools of Monash and Flinders uni- tion, the FHS established the Ukwanda search arm and employs two research- versities. He also visited training sites at Centre for Rural Health in 2001 to ers whose work is directed by Ukwan- the rural clinical school of Deakin Uni- train health care professionals with ap- da’s director, Prof Conradie, who has versity in Victoria. The twelve medical plicable knowledge and hands-on expe- devoted most of his medical career to schools in Australia now have 17 rural rience of the health issues facing rural rural health. He says that his interest in clinical schools. and underserved communities in South a South African rural clinical school was Conradie says the motivation for Africa. born during an annual rural conference the Australian model of rural train- Ukwanda co-ordinates transport, of WONCA – the acronym for the ing was, amongst others, to encour- accommodation and other facilities for World Organization of Family Doctors. age more students to practice in rural students at training sites in the towns “It was an inspiring idea and I realised areas. “International evidence suggests of Bredasdorp, Caledon, Ceres, Citrus- that South Africa was the ideal country that students who grew up in rural dal, Grabouw, Hermanus, Malmesbury, for such a venture.” areas and were recruited in those areas, Montagu, Paarl, Robertson, Somerset were more inclined to return to their West, Stellenbosch, Swellendam and To grow and develop in the com- roots when they started practicing.” Madwaleni in the Eastern Cape. Aca- munity However, the rural training model demic disciplines on the Tygerberg Cam- The SU’s Rural Clinical School (RCS) also addresses many of the other cri- pus are responsible for the selection comes into operation in 2011 and rep- teria set by experts in health sciences and accreditation of mentors/supervi- resents and expansion of the work of education to meet the ever-increasing sors who oversee the students training the Ukwanda Centre for Rural Health. demands on health care delivery sys- » p8 tems worldwide. This includes adapting clinical teaching to provide experience Recent trends in medical education reflect major shifts in educational paradigms of primary care and community health arising from reappraisals of the relevance and the effectiveness of traditional services and giving prominence to pub- medical education in the context of fast changing, complex and ever increasing lic health that encompasses health pro- demands on the health care system.” (Prof Matthew CE Gwee)

Tygerland 2010  Health Sciences Education « p7 “Firstly, it offers the student much Government in 2007, will play a vital more continuity with patients over a role in the new rural training models. It will also be known as the Ukwanda period of one year. Secondly, it ensures The new speciality represents a ma- Rural Clinical School. Ukwanda is a year-long continuity with a single men- jor change in health sciences in South Xhosa word that can be translated as tor and since the student and mentor Africa and has put Family Medicine on ‘to grow and develop’ within the com- work together throughout the day, the par with other specialities in Medicine. munity; to make a positive difference. student gets much more one-on-one SU training of registrars in this field is In terms of bricks and mortar the attention from the mentor. Finally it progressing well with five registrars RCS is due to be completed towards ensures continuity with the community currently working at the Worcester the end of 2011 adjacent to the Worces- and the student learns what it means training complex. The new speciality ter Hospital, says Dr Frans Krige, who to live within the community that he or was preceded by a Masters degree in was recently appointed manager of the she serves.” Family Medicine This means that many project. During his Australian visit, Conradie of the doctors who have completed “This will comprise a modern and was struck by the amount of hands-on this degree, as well as those currently well-equipped academic building and a experience students get when they training as Family Medicine specialists residence for up to 40 students. How- are trained in terms of the longitudinal will act as mentors for students of the ever, the School will also utilise Ukwan- model, and how much exposure they RCS at district hospital level. da’s well-established platform for train- get to the full spectrum of diseases that The RCS is not only for medical ing purposes. This includes all the health affects rural communities. students, but will also train students in facilities and services established in the “This aspect is of cardinal impor- the Allied Health Sciences. eastern half of the Cape Winelands tance for health sciences training in the Interprofessional learning and district, as well as the whole Overberg Western Cape where the Provincial teaching will be an important element district”. Government’s 2010 plan determines in the various programmes. “As it is, Against the background of interna- that 90% of all patients should be Occupational Therapy students spend tional research and experience of rural treated on the primary care level while seven weeks of training in Worcester. training – and the Australian experience 8% must receive treatment at district The Rural Clinical School will be able in particular – Stellenbosch University’s to accommodate them and other stu- hospitals and only 2% on the tertiary rural training plans were developed to dents in the Allied Health Sciences for level.” include a one-year clinical rotation for longer rotations. final year medical students. “We would also like the school A winning concept for all Although the University plans to to become involved in the training of While rural training is of benefit to select 30 students per annum for rural nurses, as well as paramedics. This will health sciences students, Conradie says training, the first group to start their create ideal conditions for interprofes- it represents a win-win situation for training in 2011 will comprise 10 stu- sional learning.” dent volunteers who have expressed all concerned. “It has a positive influ- an interest in rural training. Two mod- ence on health services in rural areas els of training will be utilised for these and the doctors involved in the training find it very stimulating. For many family students. One group will train at the Ukwanda Worcester regional hospital and will physicians the academic element repre- rotate through the various specialist sents a new lease of life in their pro- fessional careers, which contributes to The Ukwanda Rural Clinical departments but will be exposed to School (RCS) is one of the 22 projects primary care throughout the year. the retention effect. At the same time, communities are glad to have the stu- that form part of SU’s Overarching “The second group will be trained Strategic Plan (OSP) – the vehicle in terms of the so-called continuous dents, especially since they know that the students may come back as fully used by the University to achieve its longitudinal integrated clerkship (CLIC) vision of becoming significantly bet- fledged health professionals.” model which represents an entirely new ter, significantly different and more To accommodate Stellenbosch Uni- paradigm in medical training. This mod- relevant to the context in which it versity’s venture into rural health, the el was so successful in Australia that it operates. The OSP is focused on the academics concerned have done ex- is now regarded as just as good as and five development themes which will tensive curriculum planning under the even better than the traditional medical drive its pursuit of the Millennium auspices of the SU Centre for Health training offered at teaching hospitals.” Development Goals. It is envisaged Sciences Education. This took place According to Conradie, the SU that the Ukwanda RCS, through the during three workshops, attended model involves continuous, year-long development of its rural campus, by specialists from the Tygerberg and training of student interns at any of five will provide the leverage for SU to Worcester Hospitals, as well as family participating district hospitals, namely engage with strategic partners in Ceres, Robertson, Hermanus, Caledon physicians from the five participating the region to drive sustainable rural and Swellendam, under the mentorship hospitals. This forms part of an action development. As such, the project is of a Family Physician, with regular inputs research project to adapt the present a pivotal part of the SU’s wide-rang- from visiting specialists. curriculum to the RCS. ing Project Hope. He says there are three important Conradie says the new Family www.thehopeproject.co.za principles underlying this model: Medicine speciality, promulgated by the

 Tygerland 2010 Strategiese Vennootskappe $10 miljoen Fakulteit ontvang befondsing van $10 miljoen vir mediese onderrig en navorsingsopleiding

ediese onderrig en navorsings- As ontvanger van een van die MEPI 1. Kliniese Vaardigheid in Antiretrovirale opleiding in Suid-Afrika het ’n befondsingstoekennings, sal die Stel- en Tuberkulose Behandeling vir profes- Muitsonderlike befondsingstoeken- lenbosch Universiteit se Landelike Ge- sionele gesondheidswerkers (verpleeg- ning van $10 miljoen ontvang, toe die neeskunde Onderrig-vennootskap Ini- kundiges, dokters, aptekers, ens.) (Prof Universiteit Stellenbosch as deel van ’n siatief (SURMEPI), jaarliks $2,000,000 Cheryl Nikodem, Dr Jantjie Taljaard); mulitmiljoen dollar projek van die VSA oor ’n tydperk van vyf jaar, dus ’n totaal 2. Uitkomsgebaseerde Geneeskunde aangewys is. Die VSA-projek het ten van $10,000,000 oor vyf jaar, ontvang. (Dr Taryn Young en Prof Jimmy Vol- doel om kapasiteitbou in die veld van “Die Universiteit Stellenbosch-span mink); mediese onderrig in sub-Sahara Afrika is geëerd en dankbaar vir die vertroue 3. Gesondheidsisteemwetenskap- te bevorder. wat daar in ons navorsing en opleiding navorsing (Proff Lilian Dudley en Mer- Die VSA se Department of Health gestel is. Heelwat van ons navorsers is rick Zwarenstein); and Human Services, in vennootskap werksaam by goed gevestigde navors- 4. Farmakologie (Prof Bernd Rosen- met die US President’s Emergency Plan for ingsinstellings in stedelike- en lande- kranz); AIDS Relief (PEPFAR) beplan om $130 like gemeenskappe, terwyl ander by 5. Epidemiologie, Biostatistiek en Ge- miljoen oor ’n tydperk van vyf jaar te toonaangewende laboratoriumnavors- meenskapgesondheid (Dr Neil Came- belê en sodoende mediese onderrig ing betrokke is. Die insluiting van in- ron en Prof Jean Nachega); in Afrika te transformeer en die aantal noverende geneeskundige kennis en 6. Infeksievoorkoming en -beheer (Prof gesondheidsorgwerkers aansienlik te vaardighede in ’n landelike opset, waar Shaheen Mehtar); verhoog. die grootste behoefte is, tesame met 7. Infeksiesiektesopleiding (Dr Jantjie Die Medical Education Partnership kliniese en gemeenskapsgesondheid- Taljaard en Prof Jean Nachega); Initiative (MEPI) program is ontwerp navorsingsprojekte, het ons aansoek 8. Familiegebaseerde Model vir MIV- om PEPFAR te ondersteun om hul kompeterend en uiteindelik suksesvol sorg (Prof Mark Cotton) doelwit te bereik, naamlik die opleiding gemaak,” het prof Jean Nachega, Di- 9. Landelike Kliniese Skool (Prof Marie- en behoud van 140 000 nuwe gesond- rekteur: Infeksiesiektes Sentrum van tjie de Villiers en dr Therese Fish) heidsorgwerkers en kapasiteitsver- die Fakulteit van Gesondheidswetens- betering van vennootlande om primêre kappe, en hoofnavorser van die SUR- Ingevolge die toekennings, sal die gesondheidsorg te lewer. MEPI-toekenning gesê. Universiteit Stellenbosch saam met Toekennings word deur die MEPI- Die befondsing sal aanvanklik ’n aantal eksterne gesondheidsinstel- platform, wat in vennootskap met ge- vir kapasiteitsbou in geneeskundige lings werk, insluitend die Johns Hopkins neeskundige skole en universiteite in onderrig en navorsingopleiding by die Universiteit in die VSA; Makerere Uni- die VSA is, direk aan Afrika-instellings Landelike Kliniese Skool in Worcester versiteit in Uganda; die Universiteit van in twaalf lande gemaak. Die inisiatief aangewend word, waarna dit na ander Kaapstad se Lung Institute’s Knowledge bestaan uit ’n netwerk wat naastenby landelike areas uitgebrei sal word. Die Translation Unit en die Karolinska Insti- 30 plaaslike vennote, regeringsgesond- spesifieke voorgestelde projekte en hul tuut in Swede. heid- en onderwysdepartemente en leiers is: meer as 20 VSA medewer- kers insluit. MEPI is ’n samewerkings- inisiatief waarby die US Office of the Global AIDS Coordinator, Health Resources and Services Administration (HRSA), en die National Institutes of Health (NIH) se Fogarty International Centre betrokke is. Die All- MEPI Coordinating Centre is aan die George Washington Lede van die MEPI-werksgroep Universiteit, onder leiding van druk in gesprek tydens die eerste drr Fitzhugh Mullan en Seble beplanningsessie wat in November Lemma, toegeken. gehou is.

Tygerland 2010  Skills Training (objective structured clinical examination) technique will be used to assess the students,” she says. ‘The student cannot know, “The curriculum was introduced for third years in 2010 which means that the students will be doing a prac- unless he knows how’ tical exam for the first time this year. Further implementation will continue next year and in the following years, n the training environment where modern, highly sophisticated models with questions on skills appropriate to South African students acquire and computerized simulators to hone all the work the students have learned practical skills in health sciences their clinical skills, long before they during the year,” Archer says. I As part of the University’s CHSE, disciplines, learning how remains a chal- are exposed to real patients in a clini- lenge. cal setting. This may involve basic skills the Centre is playing an increasingly im- In terms of SU health sciences cur- associated with students just enter- portant role in all teaching and learning ricula, students are expected to acquire ing the clinical phase of their training, activities in the SU FHS. The main types basic clinical skills much earlier in their such as the attachment of a drip, the of skills taught by Archer and the CSC training. However, with the move to- stitching of a wound or doing a lumbar team include procedural, physical ex- wards primary care, more patients are puncture. However, over the past few amination and communication skills. treated at community and regional hos- years, lecturers have also been utilizing pitals and primary care clinics and few- the facility to introduce senior students Changing and rearranging er at tertiary teaching hospitals. Con- and even postgraduates to areas of Since it came into operation in 2001, sequently learning opportunities for medicine that require special skills – i.e. the CSC as a dynamic learning area, students in the earlier years of study anaesthetics, laparoscopy, bronchos- has kept pace with new development are limited. copy or difficult obstetric cases where in skills training, as well as new tech- The University addressed this chal- problems like shoulder dystocia may be nology. Here students have access to lenge with the establishment of a state involved. “ a wide variety of simulated models to of the art Clinical Skills Centre (CSC) According to Archer, clinical skills learn the skills that they will require as on the Tygerberg Campus in 2000, when training was initially presented in a health sciences professionals. The mod- the Faculty of Health Sciences (FHS) relatively unstructured fashion by the els range from tiny babies to others as first introduced curricula reforms that different departments and divisions but big as life with beating hearts, bowel included earlier clinical training. Since this is set to change with the recent in- and breathing sounds and dilating pu- then the CSC – whose work is over- troduction of a structured curriculum pils. Also included are disembodied seen by the Centre for Health Sciences for clinical skills training. arms that allow the attachment of a Education (CHSE) - has provided stu- drip or the drawing of blood; heads and dents with a safe learning environment A practical skills exam torso’s for the insertion of chest tubes where they can learn essential skills Archer, together with the CHSE and the and other airway devices and special without compromising themselves or MB,ChB curricula committee, designed apparatus which can be strapped to a a patient. the curriculum to promote uniformity simulated ‘patient’ to teach students “The practical exposure that stu- and ensure that MB,ChB students have how to deal with difficult situations, dents get is often limited. The CSC is mastered all the necessary clinical skills such as a patient pulling his arm away where it can be done in a standardized when they complete their training. It in- while blood is drawn from a vein or fashion. Here they learn textbook tech- cludes logbooks of a wide range of pro- during the attachment of a drip. niques and are then send out to prac- cedures that the students must master “Needle-stick injuries represent a tice the techniques,” says the manager during different years of study. To en- constant danger for students and health of the facility, Sister Elize Archer. sure compliance, the logbooks must be care workers since they may expose Today, the CSC logs in some 13 000 signed off by the lecturer responsible them to blood-borne diseases such as student visits during the academic year. for the training. HIV. Such injuries require immediate The Centre presents the students with “At the end of the year, the OCSE prophylactic HIV treatment which not

Far left: Using a CSC de- vice, Prof Gerhard Theron, Head of Obstetrics and Gynaecology, teaches the group of Cuban trained medical students. Left: Lyneth Bailey, post- graduate midwifery nurs- ing student, busy doing episiotomy suturing during an OSCE examined by Sr Sophia Basson.

10 Tygerland 2010 Skills Training only causes emotional strain for the “In 2009/2010 we have used funds, role in the training activities of the CSC, person involved, but also has financial allocated to the CSC from the DoE A special room was therefore installed implications for the . funds for clinical training, to upgrade to allow Anaesthesiology registrars to That is why we have acquired addition- equipment. At the same time, depart- learn difficult airways procedures, using al special arms that allow students to ments and divisions such as Physio- and a simulated model. Another valuable practice the skills that are required for Occupational Therapy, Postgraduate resource is a simulated operating thea- the drawing of blood or the insertion Nursing, as well as Speech-Language tre, equipped with models for training of drips.” says Archer. and Hearing Therapy, have also bought in anaesthesia techniques. All medical The students also have access to new skills training equipment.” students are required to complete a models that breathe like athletes and Some of the latest acquisitions for training course in this theatre before have airways that can be accessed with undergraduate training include models, they start their anaesthesia rotation at the latest airway devices. Others have simulators and other equipment for the Tygerberg Hospital. cardiac rhythms and synchronized puls- practical procedures, including cardio- One of the special facilities installed es that allow students to interpret and pulmonary resuscitation (CPR) models during the expansion comprises an in- intervene, using defibrillators and other of adults and babies. tensive care unit which is regularly uti- devices, and some have pupils that can “CPR is one of the classic proce- lized by the Emergency Medicine divi- demonstrate the difference between dures to be taught in simulation. Our sion. This division, in cooperation with normal, constricted or dilated pupils. students are spending a lot of time the University of Cape Town, has been A number of these devices and learning how to do CPR on the baby offering specialist training in Emergency equipment have been upgraded over models in particular,” Archer says. “We Medicine since 2004. the last two years and at the same time also have a new underwater drain mod- In 2009, Archer and her team also the Centre’s physical space was ex- el, as well as an apparatus for shoulder acquired video equipment and a com-

In educational terms, medicine and the health sciences demand more of students than just watching, learning and memorizing; they also require practical application of classroom knowl- edge. Or as Abraham Flexner wrote as long ago as 1910: “An education in medicine nowa- days involves both learning and learning how; the student cannot effectively know, unless he knows how.” tended to include several new facilities and knee aspirations. Our new Prompt puter programme, used by the CSC for undergraduate as well as postgrad- Simulator for shoulder dystocia is used and the Centre for Teaching and Learn- uate training. Archer says the CSC is on undergraduate and postgraduate ing to film practical procedures and to changed and rearranged on an ongoing levels to teach student how to deal edit and publish these procedures on basis, often to meet the needs of lec- with difficult births.” Webstudies – a SU learning resource turers and students. She also visits the on the Internet. hospital on a regular basis to see how Postgraduate skills training “The aim of initiative is to enhance things are done. “We want our teaching One of the aims of the CSC is to get the learning experience and to encour- to reflect the context of the hospital more involved in postgraduate training age self-directed learning. Students can where our students work, and iden- and with the recent expansion of fa- access the learning resource through tify areas that require special attention, cilities, special arrangements have been the student portal and revise the learn- such as methods to promote infection made to accommodate postgraduates. ing material as often as they like.” prevention and control and the elimi- Thus a laparoscopic simulator – known Although health sciences education nation of needle stick injuries. Thus we as the LapSim – was acquired at a cost is the primary task of the CSC, Archer use simulated ‘patients’ to create real- of R1 million to familiarize registrars and her team are also involved in other life situations such as the difficulties ex- and others in Urology, Surgery and educational activities, including re- perienced by a health care professional Obstetrics and Gynaecology with lapa- search about health sciences education when he or she tries to attach a drip to roscopic surgery techniques.” and short courses for CPD purposes a drunken patient.” Anaesthesiology plays an important – in relevant clinical skills.

Far left: The head of the Cen- tre, Sr Elize Archer, explains bag mask ventilation to a group of MB,ChB students. Left: Dr André van der Merwe demonstrates the laparo- scopic simulator which is used to familiarize registrars and others in Urology, Surgery and Obstetrics and Gynaecology with laparoscopic surgery techniques.

Tygerland 2010 11 Nagraadse Vaardigheidsopleiding Geriewe om nagraadse vaardighede te slyp gange tot sekere dele van die brein en die opskerping van essensiële vaardighede in neurochirurgie,” sê die hoof van die Afdeling, prof Bennie Hartzenberg. “Daar is waarskynlik nie nog so ’n laboratorium in Afrika nie.” Hy sê die laboratorium stel kliniese assistente in staat om seldsame operasies op kadawers in die laboratorium te oefen, vòòr dit op pasiënte gedoen word. Die laboratoriumgeriewe maak dit moontlik vir dokters om kraniale sowel as spinale werk op kadawers te doen. Dit is spesifiek ingerig vir die opleiding van kliniese assistente en is reeds ’n integrale deel van Neurochirurgie se nagraadse program. Die laboratorium word ook vir voortgesette pro- fessionele ontwikkeling gebruik. “Ons het in Julie ’n baie suksesvolle werkswinkel aange- bied wat spesifiek gerig was op endoskopie en ’n span ken- ners het nuwe tegnieke met endoskopiese lumbale dissek- sies op kadawers gedemonstreer. Die Storz-maatskappy het Die hoof van die Afdeling, prof Bennie Hartzenberg en die instrumentasie vir die werkswinkel verskaf en dr David dr Armin Gretschel, ’n kliniese assistent in die Afdeling, demon- Welsh van Groote Schuurhospitaal het ’n lesing oor die teg- streer die apparaat tydens die opening van die nuwe kada- nieke gegee.” werlaboratorium van die Afdeling Neurochirurgie. Dr Ian Vlok, ’n spinale neurochirurg in die Afdeling Neu- rochirurgie, en konsultante van Storz was die fasiliteerders. enewens die nagraadse opleidingsgeriewe wat die Prof Hartzenberg, dr Hanno Vivier – ook ’n konsultant in die Kliniese Vaardigheidsentrum tot die beskikking van stu- Afdeling - en ander lede van die span het ook endoskopiese Bdente stel, is daar ook departemente en afdelings in die derde ventrikulasieskopie op kadawers gedoen, sowel as Fakulteit wat eie geriewe tot stand gebring het om aan na- pituitêre endoskopiese chirurgie (dr Gary Croukamp); an- graadse studente en kliniese assistente die geleentheid te terior skedelbasis-chirurgie (prof Hartzenberg) en pedikel- bied om hul vaardighede in bepaalde spesialisgebiede te slyp. skroef-fusies (dr Ian Vlok) met toerusting van die SA maat- skappy, Southern Implants. Kadawerlaboratorium vir Neurochirurgie Volgens Hartzenberg maak kliniese assistente in Neuro- ’n Nuwe vaardigheidslaboratorium is in 2010 vir die Afdel- chirurgie vir die afgelope drie jaar reeds gebruik van die dis- ing Neurochirurgie in die Fisangebou bekend gestel en word seksiegeriewe in die Afdeling Anatomie. Daar is tans vier sedertdien aktief gebruik vir die opleiding van kliniese as- kliniese assistente in Neurochirurgie, sowel as twee bo- sistente en die aanbieding van spesiale werkswinkels in neu- tallige kliniese assistente en twee mediese beamptes. rochirurgie. Navrae kan gerig word aan prof Bennie Hartzenberg, “Die fasiliteit is gerig op opleiding, die oefening van toe- [email protected] Ear, Nose and Throat Surgery Training for ENT surgeons

ue to the complex anatomy of the petrous temporal bone, where several important soft tissue structures Dsuch as the ear, the facial nerve, the sigmoid sinus and the carotid artery course through this hard bone, it is essential that Ear, Nose and Throat (ENT) surgeons are well-trained in this important area. Recognizing the deficiencies in such training in SA, the ENT Division in SU FHS nine years ago decided to offer regular workshops on temporal bone anatomy and surgery. Since it was first held, the course has attracted increasing Prof James Loock, head of the Division, assisting a international recognition – so much so that the workshops delegate during a recent workshop. are now attended by participants from all parts of South Africa and as far afield as Canada, Australia, Hong Kong, amongst others, Prof George Browning of Glasgow, who Bahrain, Germany and the UK. jointly presents the course demonstrations and lectures Head of the Division, Prof James Loock points out with Loock; Profs Don du Toit and Ben Page, of Anatomy that the success of the course is due to teamwork and who prepare cadaveric temporal bones which are a signifi- co-operation. The Division has been greatly assisted by, cant attraction of the course, as well as several sponsors.

12 Tygerland 2010 Nagraadse Vaardigheidsopleiding Vaardigheidsopleiding in Mikrochirurgie

’n Laboratorium vir die verfyning van mikrochirurgie vaardighede, wat in 2008 weer onder die leiding van prof Frank Graewe, hoof van Plastiese en Rekonstruktiewe Chirur- gie op die Tygerbergkampus herleef het, bied nie net geleenthede aan US-studente en klinici nie, maar ook aan studente en opgeleide klinici uit ander dele van Afrika.

ie US het ’n lang geskiedenis van mikrochirurgiese nuwe vaardighede aan te leer,” sê Engelbrecht. opleiding binne die Afdeling Plastiese en Rekonstruk- Hy wys daarop dat mikrochirurgie baie goeie hand-oog- Dtiewe Chirurgie. Die eerste kursusse van hierdie aard koördinasie vereis. Tydens werkswinkels werk die kursus- is trouens op gereelde basis aangebied nadat die eerste vrye gangers hoofsaaklik met simuleerders en rotmodelle. “Ons weefsel-oorplantings, oftewel mikrovaskulêre weefseloor- gebruik byvoorbeeld ’n handskoen om hulle te leer hoe om planting, in 1976 by Tygerberghospitaal gedoen is. baie klein stekies onder die mikroskoop in te sit. Wanneer “Daar is ’n groot behoefte onder mense in gesondheids- hulle op lewendige materiaal moet werk, gebruik ons mees- beroepe om hul vaardighede in hierdie veld te slyp en te tal rotte, veral vir die heg van are en slagare wat so klein is verbeter,” sê die be- as .5mm.” stuurder van die labo- Die laboratorium ratorium, mnr Gert bied ook op aanvraag Engelbrecht. Dit is een werkswinkels aan in van die redes hoekom spesialisprosedures veral dokters uit alle op rotte en muise, dele van Afrika – en onder meer hartoor- nou selfs uit Europa plantings (rotte); nier- – ons werkswinkels oorplantings (rotte); bywoon. Die 15, drie- nefrektomies (rotte tot vierdaglange kur- en muise) hipatekto- susse wat ons in 2010 mies (80% rotte, sowel aangebied het, was lank as muise) en onder- vooruit volbespreek huidse inplantings van en onder diegene wat konstante binne-aarse dit bygewoon het, was infusie pompe (rotte dokters uit Ghana, en muise). Senegal, Zambië en Die laboratorium Malawi.” Groeiende getalle studente uit Afrika woon US-werkswinkels, gerig op mikro- beplan om twee kur- Hy verduidelik dat chirurgiese vaardighede op die Tygerbergkampus by. Op die foto, vlnr is dr Pat- susse per maand in die werkswinkels gerig ric Noah van Malawi, mnr Gert Engelbrecht, hoof van die Mikrochirurgie labo- 2011 aan te bied, behal- is op die tegnieke en ratorium; prof Frank Graewe, hoof van Plastiese en Rekonstruktiewe Chirurgie; we tydens die somer- vaardighede wat vereis dr Francis Qayson van Ghana; mnr Willem Reyneveldt, laboratorium assistent, vakansie in Januarie en word wanneer chirur- en voor by die mikroskoop, dr Evelyne Diom van Senegal. Desember. Spesifieke gie met die hulp van ’n datums moet nog operasie mikroskoop bepaal word. of loupe onder baie sterk vergroting uitgevoer word. “Dit Die Afdeling Plastiese en Rekonstruktiewe Chirurgie bied sluit borsrekonstrukies in, sowel as kop en nek-kanker- ook in 2011 ’n vrye flap-kursus aan, met kadawer-disseksies, rekonstrukies; handchirurgie, rekonstruksie van die laer eks- sowel as ’n mikrochirurgie kursus met lewendige chirurgie. tremiteite, re-animasie van die gesig, rekonstruksie van die Spesifieke datums vir hierdie kursusse is nog nie vasgestel manlike en vroulike genetalië en ander. Daar is byvoorbeeld nie. ’n groeiende vraag na omgekeerde vasektomies, en dit vereis Die opleiding word gratis aangebied vir werknemers en spesifieke mikrochirurgiese vaardighede.” studente van die Universiteit Stellenbosch. Vir buitemense Hoewel mikrochirurgie veral in plastiese chirurgie ge- is die koste van ’n basiese mikrochirurgie kursus R2000 vir bruik word, word dit ook deur die meeste ander chirurgiese drie dae en R2 500 vir vier dae. dissiplines gebruik, onder meer Pediatriese Chirurgie en Vir verdere navrae en inligting oor die kursus-skedule vir Oor-, Neus- en Keelkunde. “Baie van die kursusgangers uit 2011, kontak mnr Gert van Zyl by (021) 938 9582, of per Afrikalande is bv pediaters wat hierheen gestuur word om ePos by [email protected]

Tygerland 2010 13 Centre for Health Sciences Education

h en Stellenbosch Uni- versity’s first medical stu- W dents started their train- ing some fifty years ago, the lecturer was the ‘sage at the centre of the stage’ – in the classroom or amongst the students accompanying him on ward rounds in – and later in Tygerberg. A student’s first encounters with disease were in textbooks and lecture notes, neatly pigeon-holed in subject disciplines. Practical encounters with the same diseases would follow much later when a faceless patient, confined to a hospital bed became his reference point for the nature and treatment of a The Centre for Health Sciences Education team are fltr: Front: Dr Alwyn Louw, Sr Elize specific disease. Archer, Ms Lorraine Louw Middle: Dr Aziza Bawoodien, Mss Lesinda Daniels, Tracey Piet- Today, half a century later, this ap- ersen Back: Mss Martie van Heusden, Myrna van Zyl, Prof Ben van Heeren, Dr Stefanus proach has changed significantly – not Snyman and Sr Adele de Villiers. only at SU, but at other medical schools in this country and overseas, says Prof Ben van Heerden, who is the Direc- starts much earlier when the students “In terms of the old curriculum, all tor of the Centre for Health Sciences are only in their second year, and the training took place in Tygerberg Hospi- Education (CHSE) and Programme Co- student intern year has been extended tal. Today, a significant period of training ordinator for the MB,ChB degree. by an additional six months. Previously, takes place in communities where pa- “Today, the lecturer is ‘to a larger student contact with patients started tients live. It is, in fact, our intention to extent the guide on the side’, a facilita- only in the 4th year, on an intermit- do 50% of all our clinical training out- tor who is there to guide the student tent basis between lectures. Today’s side the Tygerberg academic complex take responsibility or ownership of the curriculum follows a more integrated by 2017. Half a century of change and transformation

learning process. This has significantly approach with a period devoted solely “Community training is facilitated terminated the use of the traditional, to theoretical training, followed by a pe- by Ukwanda, the Faculty’s Centre for formal lecture and has made way for riod devoted entirely to clinical work in Rural Health. The Worcester Hos- new educational techniques like group a health care. At the same time, clini- pital forms the centre of Ukwanda, work and guided self-study. cal rotations are no longer interrupted but other facilities connected to the “In contrast to the previous by lectures and other commitments, Worcester hospital, such as district MB,ChB curriculum, where training enabling students to spend the whole hospitals, as well as community and – both theoretical and clinical - was days in a health care environment. Ear- primary health care centres and even pigeon-holed in subject disciplines, the lier exposure to clinical training is also mobile clinics, are utilised for training different organ systems now form the contributing to the development of purposes. Undergraduate as well as basis of theoretical training. For in- skills during the early years of training. postgraduate students receive training stance, all aspects of the heart are dealt By their third year, students can handle in rural health and add value to these with in an integrated fashion – from basic procedures such as, applying intra- communities through service delivery. anatomy, physiology, microbiology and venous drips, drawing blood etc. A special aspect of training offered on pharmacology to diseases of the heart. The same applies to heart disease as it presents in different disciplines, i.e. Today, the lecturer is ‘to a larger extent the guide on the side’, a facilita- Paediatrics or Internal Medicine.” tor who is there to guide the student to take responsibility or ownership At the same time, clinical rotations, of the learning process. i.e. students’ contact with patients, - Prof Ben van Heerden

14 Tygerland 2010 Centre for Health Sciences Education this platform, is the opportunities it af- Certain core competencies run like fords students to train in interdisciplin- golden threads through all of this and ary teams that may include students in become recurring themes throughout Physiotherapy, Occupational Therapy, the whole MB,ChB course and all its Rehabilitation, Speech-Language and modules. These include Ethics and evi- Hearing Therapy or Nutrition. A range dence-based medicine. of other facilities outside of Tygerberg The outcomes expected from stu- 50 Hospital are also utilised for commu- dents pertain to knowledge, attitudes nity-based training. and skills and is summarised as follows: Van Heerden explains that the The newly qualified Stellenbosch doctor ARBEIDSTERAPIE medical curriculum is also outcomes- must possess the necessary knowledge, STE based, which means that students are skills and attitudes to optimally utilise 50 guided through their studies to achieve the opportunities available during the clearly formulated outcomes. For each intern year in order to be able to function of their modules, a study guide was de- autonomously in the primary health care Bestaansjaar veloped which spells out the aims of sector after this period, and must also be module and themes within the module equipped with the necessary ability and Dagboek and tells the student exactly what he insight to develop further as practitioner or she must know on completion of at secondary and tertiary level. 14-16 Julie 2011 the module. “In our Profile of the Stellen- “In a professional environment as bosch Doctor outcomes have been for- complex and dynamic as the health sci- Navrae: mulated which represent the end point ences, a continuous process of change [email protected] toward which all our students should and transformation is inevitable,” says be striving.” Van Heerden.

VPO VPO VPO StellMed Die Afdeling StellMed by die Fakulteit Gesondheidswetenskappe op die Tygerbergkampus is die amptelike diensverskaffers van VPO Aktiwiteite vir die Wes-Kaapse Departement van Gesondheid.

Ons bied aan gesondheidspraktisyns die geleentheid om VPO-punte op drie wyses te verdien nl:

Webblad: Ongeveer 900 artikels waarmee u al dertig VPO-punte, insluitend etiek, kan verdien sonder om u tuisdorp of praktyk te verlaat.

StellMedboek: Wat ’n verskeidenheid artikels bevat waarmee u 19 algemene punte en 2 etiek punte in harde kopie kan verdien.

VPO Kursusse: Ons bied maandeliks 4 tot 6 praktiese en interaktiewe kursusse aan regoor die Wes-Kaap, insluitend: Opknappingskursus vir Algemene Praktisyns, Kleiner Chirurgiese Prosedures, Asma & Diabeteswerkswinkels, Noodgeneeskunde Vaardigheidswerkswinkels, Beroerte: Fisioterapie Behandelingswerkswinkels, Handterapie aan Arbeidsterapeute, Diagnose en Behandeling van Akute Vergiftiging, Tandheelkundige Noodgevalle, Dermatologie vir Verpleegkundiges en Dokters, Pediatriese en Neonatale Resussitasie Werkswinkels, Ultra- klank Werkswinkels en vele meer.

Vir verdere inligting besoek www.stellmed.com of kontak Marjorie van Rooy by 021 938 9183/[email protected] VPO VPO VPO Tygerland 2010 15 Gesondheidswetenskappe Onderrig

’n Spieël vir nuwe uitdagings en geleenthede in gesondheidswetenskappe onderrig

Met gewilde lektore en kenners op die gebied van leer en onderrig aan die spits van sake, weerspieël die Departement Patologie se onderrigprogramme die nuwe benadering tot gesondheidswetenskappe opleiding wat in die laaste dekade by die US en wêreldwyd inslag gevind het.

oe die FGW in 1999 ’n nuwe deur die personeel 'opgevoer' word dien trouens as ’n brug tussen die pre- MB,ChB-kurrikulum geïmple- en deur middel van die konsert, vertel kliniese en kliniese fases. T menteer het, was dit duidelik ons die storie van ’n pasiënt, vanaf die Omdat studente in terme van die vir die onderrigkundiges in die De- oomblik dat hy in die bed wakker word geïntegreerde en stelsel-gebaseerde partement Patologie dat dié departe- tot hy sterf. Dit gee konteks aan alles MB,ChB-kurrikulum minder nabye kon- ment – soos al die ander departemente wat die studente gaan leer en hoekom tak het met die Patologie-dissiplines in in die Fakulteit - sy programme sou hulle dit gaan leer, sowel as dinge soos die pre-kliniese fase van onderrig, doen moes aanpas om die nuwe benadering etiek, tydsbestuur, streshantering, taal die studente ’n weeklange Patologie- tot gesondheidswetenskappe onderrig en kommunikasie.” rotasie tydens kliniese opleiding in die te akkommodeer. vierde en vyfde jaar. Dit inkorporeer Vandag weerspieël onderrig en die probleem-gebaseerde benadering, opleiding in die verskillende Patologie- wat inherent is aan die nuwe benade- dissiplines al die beginsels wat hierdie ring tot gesondheidswetenskappe on- nuwe onderrigbenadering kenmerk: derrig. gemeenskapsgebaseerde onderrig- en “Die studente moet elke dag ’n opleiding, probleemgebaseerde onder- kliniese ’papierstudie’ voltooi. Dit be- rigstrategieë wat geïntegreerde leer hels ’n gevallestudie wat soveel van die bevorder; vroeë kliniese blootstelling patologie dissiplines as moontlik inte- waar die student prakties kennis maak greer om die inter-afhanklikheid van met die basiese beginsels van siekte- die verskillende dissiplines te illustreer. prosesse; selfleer; die bevordering van Elke 'geval' is ontwikkel om met ’n kritiese denke; ’n holistiese benadering werklike pasiënte scenario ooreen te tot pasiëntesorg; interdissiplinêre leer stem. Dit kan X-strale en EEG’s insluit en onderrig; bewysgebaseerde genees- wanneer nodig, asook konsultasies met kunde; kommunikasievaardighede en Prof Juanita Bezuidenhout patoloë. veel meer. Die studente werk saam in groepe Prof Juanita Bezuidenhout – een van van vier en ontvang chemiese patologie drie uit die Fakulteit se ses FAIMER/SA- "Patologie speel ’n rol in al die ver- tutoriale, besoek die verskillende labo- FRI-genote wat aan die Departement skillende opleidingsomgewings in die ratoriums, en kry praktiese opleiding Patologie verbonde is – verduidelik dat Fakulteit en die Departement met sy in fynnaald aspirasie en laboratorium- US-studente trouens reeds op die eer- verskillende dissiplines is betrokke by toetse – nie soseer om hierdie toetse ste dag van hul opleiding aan die FGW, onderrigverwante aktiwiteite op alle te leer doen nie, maar om insig te kry in kennis maak met hierdie beginsels. vlakke en in al die verskilende onder- die funksionering van ’n laboratorium. As voorsitter van die Fondasiefase - rigfases – vanaf die ses-maande lange Die studente se hantering van die ge- wat die eerste ses maande van die eerste- Fondasiefase, die pre-kliniese en die vallestudies word op die laaste dag van jaarskurrikulum beslaan en waarvol- kliniese fase.” sê sy. die rotasie beoordeel en bespreek.” gens MB,ChB- en Fisioterapiestudente Bezuidenhout sê hierdie benadering saam onderrig ontvang, terwyl Dieet- Probleem-gebaseerde onderskryf belangrike beginsels van kunde- en Arbeidsterapiestudente aan onderrig die nuwe benadering tot gesondheids- sommige van die modules deelneem “Anatomiese Patologie is byvoorbeeld wetenskappe onderrig, onder meer ak- – verduidelik Bezuidenhout hoe hier- betrokke by die opleiding van voor- tiewe deelname (in teenstelling met die die onderrigbeginsels op unieke wyse graadse Fisio- en Arbeidsterapiestu- student wat passief na ’n lesing luister ingeskerp word wanneer gesondheids- dente, terwyl MB,ChB-studente reeds en notas neem), en dit skep meganis- wetenskappe-studente hul heel eerste aan die einde van hul eerste jaar in die mes vir onmiddellike terugvoer oor klas aan die FGW bywoon. pre-kliniese fase kennis maak met die die probleem wat die student moet “Die klas begin met ’n konsert wat Basiese Beginsels van Siekteprosesse. Dit hanteer. “Die uitkomste fokus ook »

16 Tygerland 2010 Gesondheidswetenskappe Onderrig

« op die vaardighede en kritiese den- todologie, laboratoriumbestuur, goeie projekte oor onderrigverwante onder- ke wat nodig is om optimale resultate laboratoriumpraktyk en etiek.” werpe,” sê Bezuidenhout. “Een daarvan uit die patologielaboratorium te kry, en Die departement speel ook ’n rol in is ’n internasionale, multi-institusionele die rol wat hierdie resultate speel in die nagraadse programme in Chirurgie. samewerkingsprojek.” hantering van ’n pasiënt.” In reaksie op die tekort aan patoloë Terselfdertyd kry personeel gereeld In die verlede het studente, selde, en mediese navorsers in Suid-Afrika, erkenning vir hul bydraes op die gebied indien ooit, die patologie laboratoriums het die Departement in die afgelope van Onderrig. So het dr Walter Lieb- besoek en daar was geen geleenthede paar jaar ook begin om groter getalle richt van die Afdeling Geneeskundige vir konsultasies met patoloë nie. “Die nagraadse studente te akkommodeer Virologie vanjaar die Akademiese Jaar- rotasie integreer patologie met kliniese en meer opleidingsposte vir patoloë te dagprys vir die beste plakkaat op die praktyk en illustreer die gebruik van skep. As deel van hierdie inisiatief word gebied van onderrig verower, terwyl laboratoriumgeneeskunde in die han- suiwer wetenskaplike programme aan- Bezuidenhout die prys vir die beste tering van baie van die siektes waarmee gebied, soos die BScMedSc in Patologie plakkaat gewen het by die SA Associa- die student as dokter in hierdie land te wat spesifiek fokus op die opleiding van tion for Health Educationalist (SAAHE) make gaan kry.” mediese wetenskaplikes in patologie. ’n se kongres en dr Johan Dempers van Student wat ’n suiwer BSc Honneurs- Geregtelike Geneeskunde, die beste Nagraads graad voltooi het, kan aangaan met ’n voordrag van alle fakulteite gelewer het Op nagraadse vlak bied die Departe- MSc. by ’n kongres van die Sentrum vir On- ment MMed-programme in module Die Departement se MSc in Sitopa- derrig en Leer op Stellenbosch. formaat in die verskillende dissiplines tologie is wêreldwyd die enigste graad- aan. “Daar is egter vier modules wat program van hierdie aard en word deur Die impak op gesondheid al ons kliniese assistente moet doen prof Colleen Wright van die afdeling Die belangstelling in gesondheids- – molekulêre biologie, navorsingsme- Anatomiese Patologie aangebied. ’n wetenskappe onderrig van Patologie- Student wat reeds in personeel, lê aan die hart van die uit- Anatomiese Patologie stekende onderrig- en opleidingspro- gekwalifiseer is, of ’n gramme wat deur die Departement persoon wat as medie- aangebied word. se beampte in Patolo- Toe die FAIMER-instituut in Ameri- gie werk, kan aansoek ka in 2002 gestig is met die spesifieke doen vir toelating tot doelwit om onderrigkundigheid en die die kursus, wat deur vaardighede van opvoedkundiges wat afstandsonderrig (met in ’n gesondheidswetenskappe-omge- behulp van CD’s, papier wing werksaam is, te verbeter, is Prof en ePos-kontak) aange- Elizabeth Wasserman as een van die bied word. Dit is veral eerste FAIMER-genote wêreldwyd aan- gewild onder studente gewys; Bezuidenhout het daarna gevolg. uit Afrika-lande. Hulle was ook onder die stigterslede “Die Departement wat in 2008 ’n FAIMER-streeksinsti- is op navorsingsvlak tuut vir Suider-Afrika (SAFRI) tot stand ook betrokke by 10 gebring het. Dempers, ’n derde lid van die Departement, het intussen ’n SA- FRI-vennootskap voltooi. Soos die FAIMER Instituut en haar mede-FAIMER-genote, is Bezuiden- hout oortuig daarvan dat voortreflike onderrig in gesondheidswetenskappe uiteindelik ’n impak sal maak op die ge- sondheid van die land in sy geheel.

Foto’s: Links bo: Prof Johann Schneider, hoof van die Departement Patologie, bespreek ’n histologie monster op ’n glasskyfie met ’n nagraadse student.

Links: Dr Johan Dempers en Prof Juanita Bezuidenhout met hul wentjek.

Tygerland 2010 17 Health Sciences Education Department of Medicine: Moving away from paper-basedexams

In the Department of Medicine, Prof Rafique Moosa has taken full advantage of the opportunities offered by the digital age to enhance the country’s educational environment with an innovative and cooperative system that utilises new technology to move away from paper-based examinations for final year medical students.

esting the knowledge of MB,ChB students in their Two years ago, Moosa set the wheels in motion to es- final year rotations in Internal Medicine have always tablish a national, multiple-choice questions (MCQ) bank T posed a challenge to the lecturers in this large de- for Internal Medicine departments in health sciences facul- partment. ties in South Africa – and even beyond our borders. He first Since each group, rotating through the Department for broached the idea with the relevant departments at the vari- a six week period during any given year, must write a test ous universities and in the end, all of them – with the excep- involving multi-choice questions at the end of the rotation, tion of Pretoria University and the Walter Sisulu University the lecturers with their busy clinical and teaching schedules, in Umtata, which does not use MCQs – agreed to participate have been required to compile a fresh set of questions every and contribute questions to the bank. six weeks, year after year. With Moosa and an SU team running the project, that This problem is not unique to the SU Faculty of Health was the beginning of a huge task to ensure that the questions Sciences; it affects all medical schools in the country, says were conforming to specific standards, and establish tech- Prof Moosa, the leading light behind a new, national bank nology to ensure easy access and the strictest security. of multiple-choice questions for final-year students in Medi- In 2009, Moosa and his team received the first questions cine. from the participating universities, namely the universities The idea of a national bank of questions is not entirely of Cape Town, KwaZulu-Natal, Free State, Witwatersrand, new, he says. “There is such an international bank in Singa- Stellenbosch, Limpopo and the University of Zimbabwe. The pore and one or two universities in South Africa have sub- next step was to convene a workshop in Johannesburg where scribed to it, but we needed something more pertinent to educational experts, together with various departmental and our needs.” discipline heads were asked to edit and refine the first 700 questions that were due to go into the bank. “We categorised the questions in terms of the relevant categories such as heart, lungs, blood etc.; we looked at the content and style of each of the questions and graded them as difficult, easy and average.” Moosa then asked the Information Technology Centre of Stellenbosch University to assist with the development of an IT structure for the bank. “JP Bosman guided us in setting up the structure which will be housed on the main campus of the University. Once that was done, we had to train one or two coordinators from each of the participating institutions, who will have the task of organising and running the system in their depart- ments. “We have been acutely aware of security throughout the process and several measures have been built into the sys- tem to prevent unauthorized entry – for instance, only the limited number of authorized people will have access.” At the end of 2009, Moosa and his team were ready to do a trial run which involved SU and the University of Kwa- Dr JP Bosman, Prof Rafique Moosa and Dr Erné Richter show- Zulu-Natal, and in August 2010, all systems were in place casing the new MCQ bank. when the national MCQ bank was officially launched. »

18 Tygerland 2010 Health Sciences Education

Department of Medicine, Faculty of Health Sciences PHYSICIANS REFRESHER COURSE 3 – 4 JUNE 2011 NH The Lord Charles Hotel, , Cape Town

The theme of the course will be “HIV in Internal Med- Please join us at the impressive, new facilities at NH icine” and will aim to address the changing face of the The Lord Charles Hotel, Somerset West and become part epidemic. of the growing number of clinicians that are informed Prof Francois Venter, president of the Southern Afri- and “activated” to take on the challenge of managing can HIV Clinicians Society, will be the guest speaker for chronic HIV disease in an environment where ART is now the mini conference. widely available.

MARKETING & ADMINISTRATIVE (exhibitors, general que- ries & marketing) Jennifer Stopford, Tel: (021) 938 9074, Fax: (021) 938 9870, Online registration will be open shortly Email: [email protected] keep visiting FINANCE & REGISTRATIONS www.sun.ac.za/medicine-refresher Sunelle Hanekom, Tel: (021) 938 9372, Fax: (021) 938 9870, Email: [email protected]

« “We have technical support in place to assist all the coordinators and HISTOLOGY LABORATORY we have encouraged all the depart- STELLENBOSCH UNIVERSITY, Faculty of Health Sciences ments to utilise the bank and provide Department of Biomedical Sciences, Anatomy & Histology me with feedback on its use. We will audit the bank at the end of the semes- The histology laboratory of Sample Preparation: ter and make the necessary changes to the division Anatomy and Histology Sections improve it,” Moosa says. Histology, offers a comprehen- Processing & Embedding: R20.00/block However, the project remains a sive service of tissue analysis (dehydration, clearing and infiltration huge, ongoing task. Quality assurance including routine histological to block) and how to deal with it, is an important processes (paraffin, frozen), Unstained slides: R10.00 /slide priority. “For instance, we will try to de- and many special staining tech- Staining (H&E) & mounting: R15.00/slide termine how the questions ‘performed’ niques (including IHC, ICC) Staining (special) & mounting: R25.00/slide during exams.” for histological or pathological *Immunostaining: R45.00/slide (own “Once the bank was set up, we studies. Digital image acquisi- antibodies) also drew up a blue print and found tion & analysis of high quality Full processing to one that there were insufficient questions are available on modern ste- H&E slide is R35.00/slide. in some areas; this will have to be cor- reo and compound micro- Frozen Sections rected. At the same time, we hope to scope systems and the laser H&E stain: R40.00 /slide supplement the bank with an additional micro dissection microscope Unstained slide: R30.00 /slide 50 - 100 questions every year. All de- can rapidly and accurately Special Services partments have been asked to make isolate single cells or groups Serial sections (ribbons): R20.00 /slide contributions – some in specific areas.” of cells from a broad range *Membrane slide prep: R185.00/R50.00 The launch of the project was fund- of sample types by using an Microscopy/Morphometry: ed from the pool of funds, allocated to inverted fluorescence micro- *Laser dissection system: R90.00/hour SU from the Department of Education scope, solid-state UV laser and Fluorescence microscopy: R50.00/hour with the aim of improving clinical train- unique isolation technologies. Image analyses: R50.00/hour ing. *dependant on reagents/consumables use In the light of his experience with Contact: Reggie Williams the MCQ bank, Moosa is continuing to urge and encourage all departments to Tel: 021-938-9425 / move away from paper-based examina- 021-938-9397 tions and to make use of the wealth of E-mail: opportunities offered by the electronic [email protected] technologies of our time.

Tygerland 2010 19 Human Nutrition Confronting hunger and malnutrition

“Food security exists when all people, at all times, cy-makers as well as the news media to the issue of global food security,” says have physical, economic and social access to Volmink. sufficient, safe and nutritious food to meet their The goals to be addressed by the dietary needs and food preferences for an active various research projects include - • Improving the understanding of so- and healthy life.” cial, economic and political aspects – UN Food and Agriculture Organization, 2002 of food and nutritional insecurity in Southern Africa; orldwide, a child dies from Known as the Food Security Initia- • Promoting the utilization of safe hunger every six seconds, and tive (FSI), the project forms part of the and nutritious food; Win developing countries alone, wide-ranging HOPE Project, launched • Empowering small scale farmers 907 million people do not have enough by Stellenbosch University (SU) in through appropriate new tech- to eat – more of 60% of whom are 2010. nologies; women. Headed by Prof Jimmy Volmink, • Reducing food losses in the farm “For the last 40 years we have been designated dean of the Faculty of to fork chain; working towards reducing and turning Health Sciences, the project is closely • Improving crop production and around these figures to move towards aligned with the South African govern- water use efficiency; a more food secure world. This has not ment’s priority to address the issue of • Understanding environmental and been realized and we are thus work- food security, particularly in the light of climatic changes and their impli- ing towards a greater understanding of a changing climate, and to address is- cations for agricultural policy and the complex causes of food insecurity sues of human dignity. It is estimated practice. and the much needed ability to achieve that in South Africa approximately 14 food security,” says Mrs Julia Harper, million people are food insecure and “The initiative also incorporates re- project manager of a new SU research that 1.5 million children suffer from search synthesis, appropriate communi- initiative that comprises nine research malnutrition (Report to the Office of cation of results, and other knowledge projects spanning different faculties and the Presidency, June 2007). translation activities to ensure that departments including health sciences, “Recent food price increases and research findings are actually used to agricultural sciences, engineering, and a time of economic vulnerability have motivate and justify policy change and social sciences. drawn the attention of the world’s poli- evidence-based practice.” »

Communicating New Advances Exposing Nutrition Misinformation The Nutrition Information Centre of Stellenbosch University (NICUS) was established in 1997 to act as a reliable and independent source of nutrition information in South Africa. The Centre has amassed significant experience since its inception in the dissemination of scientifically independent and correct nutrition information to both the scientific community as well as the lay public at a national and international level. Supported by the University’s Faculty of Health Sciences, NICUS is committed to the provision of up-to-date, credible and authoritative information in order to pro- mote a scientifically sound nutrition culture. Aims Target populations • Provide and disseminate an accurate and balanced • The general public. perspective in the field of food and nutrition. • Health Professionals. • Expose nutrition misinformation. • Publishers of nutrition related books. • Communicate new advances and promote sound • The media (to ensure that correct nutritional informa- practices in the field of food and nutrition. tion is published in magazines, newspapers, on radio and • Provide a comprehensive information service to the TV). public and the media. • The industry (as a service on a consultative basis). • Advise health professionals on matters relating to nutrition and nutrition support. • Identify needs for nutrition education. Contact details: Tel: 021 933 1408, Fax: 086 581 8641 • Create a supportive environment for research. E-mail: [email protected], Web: http://www.sun.ac.za/nicus

20 Tygerland 2010 « Projects were officially launched at the start of the 2010 academic year. According to Volmink, community- malnutrition based nutritional researchers will be assessing food and nu- tritional security status and work to identify and implement appropriate interventions. “The complex social challenges, intertwined with issues surrounding food security, will form an integral element of all the projects." Other projects will be focusing on agricultural losses and ways to add value to the fruit, vegetable and meat chain; effective storage and transport of produce as well as plant breeding efficiency; examining food safety issues including the entrance of melamine into the food chain and enhancing the nutritional benefits of meat, meat products and organ meat; improving crop production efficiency and empowering small scale farmers through appropriate technologies; developing additional methods of water supply; working with resource poor fishermen- and women and examining inputs that lead to carbon sequestration in the soil to increase production and to study the microbiology and environmental implica- tions of such additions. New projects, due to be launched in 2011, will be looking at access issues as well as working on the complexity of what food security is and a better under- standing of the issue. “We hope that research at the regional level, relating to climate change, will soon receive funds to add to this impor- tant initiative and that results of the research will inform a regional strategy for ensuring adequate supply and access,” says Volmink. According to Harper, food security is not an abstract concept. “The ideal of having enough of the right food on one’s plate instead of going hungry is very concrete. Working to achieve this goal is extremely complex and requires thor- ough and rigorous interdisciplinary research.” Photo: Mr HJ Lombard Photo:

Division of Human Nutrition, Stellenbosch University, RSA Committed to Research, Training and Service Overview Analytical Capabilities Starting out in the mid seventies as the for- The AMRG is well equipped in the field of mer Metabolic Research Unit, the African liquid chromatography HPLC and UHPLC, Micronutrient Research Group (AMRG) was off-line and in-line solid phase extraction established in 1996. The laboratory runs (SPE), complemented by nephelometry, ISO/IEC 17025 accredited methods for UV-visible spectrophotometry and attenu- Vitamins A and E in plasma and serum with reg- ated total reflectance infrared spectros- ular participation in the Micronutrient Measure- copy (ATR-FTIR). ment Quality Assurance Program of the Nation- al Institute of Standards and Technology (NIST), Current assays include: and the Vitamin A Laboratory External Quality Vitamins A, C, D & E, ferritin and CRP. Assurance Program (VITAL-EQA) of the Centers Other micronutrients and nutritional mark- for Disease Control and Prevention (CDC). ers can also be analyzed upon request.

Core Services include: Contact details: • Micronutrient analysis for population-based Marietjie Herselman and clinical studies Professor and Head: • Advice on analytical techniques Division of Human Nutrition • Participation in micronutrient research Tel: +27 21 938 9259 • Teaching and training on analytical tech- Fax: +27 21 933 2991 niques. E-mail: [email protected]

Tygerland 2010 21 Human Nutrition

illa McLachlan, who was ap- participatory approaches to recreat- pointed professor in SU Di- ing sustainable local food communi- Mvision of Human Nutrition in ties can facilitate reweaving the social 2010, is an expert in the field of nutri- fabric and contribute to optimal child tion security and heads one of the re- growth. search projects that forms part of the “Our studies will contribute to the SU’s new food security initiative. development of local models for action Working in cooperation with Uk- to address nutrition security challeng- wanda, the rural health training and es and will generate recommendations research platform established by the for national, district and municipal-lev- University, McLachlan’s research focus- el policy change as well as appropriate es specifically on nutrition security in forms of international collaboration to rural and peri-urban areas of the Wine- facilitate system transformation.” lands (East) and Overberg districts of While the research will initially the Western Cape. be conducted in the Western Cape, She points out that nutrition secu- McLachlan and her team plan to ex- rity relates to all of the United Nation’s tend their work to include rural com- Millennium Development Goals, in- munities in the Transkei area of the cluding relieving hunger and malnutri- Eastern Cape. tion, improving education and women’s “Through our collaboration with position in society, addressing maternal the universities of Oslo and Akershus health and child survival; and establish- in Norway, as well as Kyambogo and ing effective partnerships for develop- Makerere (Uganda) in the field of nu- ment. trition, human rights and governance, “Furthermore, nutrition, food secu- we are also planning to extend the

security in communities

rity and the environment are intimately food security initiative to African coun- connected. If we cannot think of ways tries as part of the NOMA grant (see to produce our food without harming following article), awarded to SU for the planet, we will not have a sustain- postgraduate studies.” able food system in the long run,” she While the groundwork has been says. laid in 2010, the project will be set in McLachlan’s Community Nutri- full motion in 2011, McLachlan says. tion Security Project aims to deepen our understanding of the conditions in South Africa and the rest of the Af- rican continent that contribute to the persistence of malnutrition, and to test policy and programme innovations to create conditions for community nutri- tion security. “We approach the problem with the hypothesis that stunted growth of young children is a marker of marginal- ization and exclusion at multiple levels, including at the level of the individual, household, community and nation. We Photos: Mr Jaco Minnaar Photos: are interested in understanding how Prof McLachlan and her team went on a fact finding mission to Avian Park in "Improved nutrition contributes not only to the alleviation of hunger Worcester. In the centre of the photo is Mr and malnutrition in communities; it also plays a vital role in education, Madoda Allam from the Cape Winelands Municipality, who accompanied them, with women’s position in society, maternal health and child survival." the principal of the Educare Centre. – Prof Milla McLachlan.

22 Tygerland 2010 Human Nutrition

scholarship Integrating nutrition and human rights

Food is a basic human right and the South African constitution asserts that the State has an obligation to respect, protect and fulfil the right to adequate food and water to enjoy [nutritional] health for all.

ith people’s right to adequate be followed by a six week rotation at cal implications this may have for na- food and nutritional health SU in South Africa, and a further six tional public policy and international Wenshrined in UN’s Universal weeks at the two universities in Ugan- development efforts; Declaration of Human Rights, and in da, focusing on the application of human • The relationships between right- South Africa’s constitution, there is “an rights principles in sub-Saharan Africa. holders and duty-bearers, and especial- urgent need to strengthen the capacity “While they are in South Africa, we ly obligations of the State in respecting, of individuals and institutions to apply want to send the students to Worces- protecting and fulfilling the right to ad- a rights-based approach to promote ter where Prof Milla McLachlan will equate food and nutritional health for food security as well as policies and be conducting a food security study in all; programmes or interventions to en- communities and students will be en- • Opportunities, constraints and fu- hance processes towards achieving the couraged to conduct their research in ture challenges to facilitating the devel- UN Millennium Development Goals,” these communities.” opment of a rights-based approach to says Prof Marietjie Herselman, head of The first cohort of students will food and nutrition relevant in globaliza- the Human Nutrition Division in the include four students from SU and tion; SU Faculty of Health Sciences. five from Uganda. The programme will • A contextualization of theoretical It was against this background that commence in 2011. knowledge on human rights and gover- SU, in collaboration with universities in The module is being developed by nance issues in the sub-Saharan Africa Norway and Uganda, has introduced a Ms Maritha Marais of the Human Nu- situation, with special emphasis on the special postgraduate module integrat- trition Division after she had received rights relevant to food security and ing nutrition with human rights and two month’s training at the University nutritional health - particularly among governance theory and practice. of Oslo, in collaboration with interna- economically and socially vulnerable Nutrition, Human Rights and Gover- tional experts in human rights from groups in these populations. nance is a postgraduate module that Norway and Uganda. “We hope to de- Prospective applicants must have a forms part of the Division’s Master of velop the necessary capacity within the bachelor degree in Human Nutrition Nutrition programme. This innovative Division to offer a similar module in or documented equivalent degree. new academic venture, known as the collaboration with South African duty Successful candidates qualify for a full NOMA track, consists of three sub- bearers.” scholarship for the 2-year Masters units jointly offered by the universities The following aspects will be cov- degree fully funded by Norway’s Cen- of Oslo and Akershus in Norway, Stel- ered by the module: tre for International Cooperation in lenbosch University in South Africa and • An overview of the right to ade- Higher Education. Herselman says the the Makerere and Kyambogo universi- quate food in the context of the pro- scholarship, which provides for two ties in Uganda. motion and protection of international years of full-time study for a Masters Students from the various institu- human rights; degree in Nutrition, also provides an tions will be exposed to human rights • The relevance of human rights for excellent opportunity for capacity de- concepts in Norway for six weeks food security and nutritional health; velopment. The total budget for the where they will receive tuition in the • The meaning of a rights-based ap- project amounts to approximately R8 theoretical part of the module. This will proach to nutrition analysis, and practi- million.

For more infor- mation, contact Janicke Visser [email protected] or Maritha Marais [email protected]

Photo's: UNICEF photographer, Giacomo Pirozzi

Tygerland 2010 23 Research

Africa is facing a tsunami of chronic diseases

The photo above was taken during the Harvard faculty's visit to the Minister of Health. From the left are: Prof Melvin Freeman, cluster manager non-communicable diseases; Dr Confidence Moloko, special adviser to the Minister of Health, DoH staff member, Dr Shona Dalal, epidemiologist Harvard; Dr Jessica Paulus, epide- miologist Harvard; Prof Michelle Holmes, associate professor of Epidemiology Harvard; Prof Jimmy Volmink, deputy dean, Research, Minister Aaron Motsoaledi - minister of Health, Department of Health; Professor Hans-Olav Adami, chair of Epidemiology, Harvard School of Public Health; Mr David Havelick, executive as- sistant, Harvard; Michelle Coleman, director of Administration, Harvard; Ms Shireen Pardesi, chief of staff.

n important research initiative, rica. By 2030, according to the World and lifestyle risks threatening Africans strongly supported by the South Health Organization, three of the top as “they reap development’s benefits AAfrican government, was launched four causes of death in low-income and, paradoxically, suffer from its unin- this year when the African Cohort Col- countries will be heart disease, stroke tended consequences.” laboration Initiative on chronic non- and chronic lung disease.” According to the Harvard group, communicable diseases was established Known as PaCT (Partnership for the project will be an investment in Af- between the Harvard School of Public Cohort Research and Training), the rica’s scientific future, and a landmark Health, Stellenbosch University and ac- partners will enroll thousands of par- study with immense capacity to influ- ademic institutions in Nigeria, Tanzania ticipants in the various countries and ence health in Africa and around the and Uganda. ask them questions about what they world, well into the 21st century. It will The Harvard research group met eat, how much they exercise and smoke, also be used to educate scientists at with the SU Deputy Dean, Research, as well as their family and reproductive tertiary health institutions everywhere Prof Jimmy Volmink, and government histories. They will then be followed on the effective management of chronic leaders earlier this year to discuss the and tracked for decades to collect ad- diseases in resource-poor settings. huge epidemiological study which is due ditional information and data. According to the SA Minister of to start in four African countries early The researchers will make innova- Health, Dr Aaron Motsoaledi, a study in 2011. The group pointed out that aid tive use of technology to collect data. such as this is well overdue since the to Africa usually focuses on infections For example, they plan to use cell information currently available is in- such as malaria, TB and HIV. However, phones – which are widely used across hibiting evidence-based planning. “The “such efforts will soon be overshad- all of Africa – to retrieve data and con- Department of Health will therefore owed by the swirling sea of emerging duct follow-up surveys with the partici- provide all the necessary support to modern diseases, similar to those in pants. facilitate the study and, where needed, the USA,” the group says. “A menac- Instead of focusing on expensive I will liaise with my colleagues in the ing epidemic of chronic diseases such treatment programmes, the aim of the Human Development cluster to ensure as heart disease, mental illness, cancer, study is to develop a comprehensive that the study proceeds with maximum diabetes and obesity is growing in Af- knowledge base of multiple diseases efficiency,” he said.

24 Tygerland 2010 Chemical Pathology Do you know your diabetic status?

While huge research grants to academic institutions usually go to studies on infectious diseases such as TB and HIV, ex- perts worldwide have warned that these diseases will soon be overshadowed by a new epidemic of chronic diseases which are emerging at an alarming rate in African countries. These include heart disease, diabetes and obesity, which are the fo- cus of large epidemiological studies conducted by Stellenbosch University’s (SU) Chemical Pathology division, in collaboration with other academic institutions in the Western Cape.

ccording to Prof Rajiv Erasmus and Mr Shafick Hassan of CPUT and the same group of children, aged 15-18 – head of the Chemical Pathol- Dr Sue Bassett of UWC. years old, for the chemical markers of Aogy Division in the Faculty of Lead by Erasmus, the researchers diabetes. They tested the children for Health Sciences (FHS) and the National have been focusing the spotlight on obesity and the metabolic syndrome, as Health Laboratory Service (NHLS) – diabetes and obesity in adults and chil-??well as for C-reactive protein (CRP) – numerous sources, including the World dren, including the environmental and a blood marker for inflammation which Health Organisation (WHO) have re- genetic factors which contribute to is thought to play a role in many chron- ported that a global diabetes epidemic, childhood obesity in urban, semi-urban ic diseases, including heart disease and with a parallel rise in obesity and in- and rural areas of the Western Cape, as diabetes. sulin resistance, is currently enveloping well as the metabolic consequences of “In the group, one percent of the the world. childhood obesity. children who were of normal weight, “Diabetes Mellitus Type 2 accounts Much of their work comprises com- also had high levels of CRP – again in- for 80% of all diabetics in most coun- munity based studies, particularly in the dicating a threat of diabetes and heart tries and its prevalence is increas- Cape Town suburb of Bellville South disease even in children of normal ing at a rapid rate in both developed and schools in the greater metropole, weight” and developing countries,” he says. “In where they have screened 946 adults South Africa, the incidence of diabetes and 1 300 children for metabolic syn- Maturity onset diabetes of the varies from one province to another drome – a combination of medical young and within different population groups. disorders that increase the risk of Erasmus points out that a subtype of The highest rates have been reported developing cardiovascular disease and diabetes, known as maturity onset dia- among Asian Indians and mixed ances- diabetes. betes of the young (MODY), is inher- try populations. There are also indica- ited as a result of mutations of specific tions that the coloured population, like Children with metabolic syn- genes. This occurs in one to two per- other mixed race populations, have drome cent of all cases of diabetes. MODY is more diabetes than any of the races In the schools of the greater metropo- the term given to a group of autosomal from which they originated.” le, they found that 6,5% of the children dominantly inherited disorders of non- In 2006, Erasmus established a col- had the metabolic syndrome. “This fig- insulin-dependent diabetes which usu- laborative, inter-institutional and multi- ure is very high and could serve as an ally affect people before the age of 25. disciplinary research group, represent- indication that many of these children It is often misdiagnosed as either type ing the University of Stellenbosch, the may develop cardiovascular disease.” 1 or type 2 diabetes. University of Technol- Erasmus points out that obesity is Dr Mariza Hoffmann, who is in- ogy (CPUT) and the University of the a key feature of the syndrome. How- volved in research in this field, says a Western Cape (UWC) to study vari- ever, despite the importance of obesity, molecular genetic diagnosis of the dis- ous aspects of the disease and the epi- patients that are of normal weight may ease is important as if confirms a diag- demic. also be insulin-resistant and have the nosis of MODY, classifies the subtype, Apart from Erasmus, SU research- syndrome. And this was indeed one of predicts the likely clinical course and ers in the group include Dr Annalise the significant findings of their study. may change a patient’s treatment. “In Zemlin and Dr Mariza Hoffmann of This was confirmed in a second some diabetic patients, when MODY is Chemical Pathology; Prof Tandi Matsha study when the researchers examined » p26

Tygerland 2010 25 Chemical Pathology « p25 tion groups. Once specific mutations preceded by a glucose regulation disor- diagnosed, you can stop treatment and are known, we can set up a step-wise der commonly referred to as impaired in others you can switch to more effec- testing protocol to minimise costs in glucose tolerance which may last for tive medication,” she says. future,” she says. several years. “Another form of glu- However, genetic testing for MODY In this regard Prof Erasmus and his cose metabolism disorder, other than is not available in South Africa or in Afri- team will collaborate with scientists at diabetes, is impaired fasting blood glu- ca, and to have patients tested overseas the University of Ibadan in Nigeria and cose level”. can be prohibitively expensive. That the Aga Khan and Nairobi universities While some cases of diabetes are is why Dr Hoffmann and the Chemi- in Kenya – two African countries where often undiagnosed, Erasmus and his cal Pathology division are endeavouring diabetes is increasing at a high rate. team have conducted another large to set up facilities and build capacity “Collaborating with these coun- study to determine, amongst others, for genetic testing for MODY in South tries means that they will not only have how many people have undiagnosed Africa. “This will enable us to provide access, but we can also describe the diabetes.” patients with correct diagnoses which mutations found in their unique popu- Again working in collaboration with in turn will lead to appropriate treat- lation.” colleagues at UWC and CPUT, the SU ment. At the same time, we will be able team conducted the study in Bellville to describe the most common muta- Undiagnosed diabetes South, which comprises a predomi- tions seen in our unique population, Erasmus says before a patient pro- nantly Coloured community of ap- as mutations differ in different popula- gresses to diabetes, the diabetic state is proximately 25 000 people. From this community they have randomly chosen 946 people between the ages of 35-65 years who were screened for diabetes. “The last study on diabetes in the mixed-ancestory community (co- loured) was done about 15 years ago and we wanted to compare the diabe- tes status in this population group to what it was when the last study was done,” Erasmus says. “What we looked for was people with diabetes, and we also wanted to establish the incidence of newly ac- quired diabetes in this community. We also tried to find out who could devel- op the disease.” The subjects in the study group The Erasmus team, fltr.Front Ms Yandiswa Yako (doctoral student) and Prof Rajiv underwent an oral glucose tolerance Erasmus Middle: Dr Mariza Hoffmann, Mr Muiruri Macharia (doctoral stu- test, and several other measurements dent), Dr Annalise Zemlin, Prof Susan Janse Van Rensburg Back: Mrs Sonja Krige and criteria were used to determine » (secreaty), Mr David Soita (doctoral student) and Mr ShafickHassan (CPUT). « p6 Training trends and challenges to improve health care delivery international meetings of health scienc- sciences students will become the es educators. For instance, at an inter- skilled, competent and caring health national conference of the Association care professionals of tomorrow. for Medical Educationalists in Europe In 2008, the Department of Educa- – held in Spain in 2009 – a poster by Dr tion and Training allocated additional Alwyn Louw of the Centre for Health funding to health sciences faculties Sciences Education on the revised cur- to improve clinical training. In the SU riculum was adjudged the overall win- Faculty of Health Sciences, these funds ner from a total of 650 posters. were utilised by various departments After a decade of curricula reform, and divisions to launch a large num- this edition of Tygerland brings the ber of innovative education and train- spotlight to bear on new education ing projects. In the following articles, and training initiatives in the Faculty Tygerland highlights some of these ini- Dr Alwyn Louw presenting a poster on the and how they were developed to sup- tiatives. While they were developed by revised curriculum at the faculty which port and enhance the curricula and in- SU, all of these initiatives reflect the was awarded first prize at an international crease the relevance and effectiveness global paradigm shifts that took place conference of the Association for Medical of health sciences training that was de- in health sciences education over the Educationalists in Europe – held in Spain veloped to ensure that today’s health past decade. in 2009.

26 Tygerland 2010 Chemical Pathology

« diabetic status. Personal demograph- from CPUT is looking at certain genes are trying to establish if the activity of ic, family, health and lifestyle data were that may be associated with insulin re- this enzyme is altered in the Coloured also extrapolated by means of a ques- sistance and obesity in the South Afri- population.” tionnaire. can population. Her research focuses • The researchers are also searching The study found that: on a particular gene that has been iden- for a new and more effective diagnostic • 12,2% of the subjects already had tified in Caucasian populations, and she test for diabetes. A fast test, currently diabetes; is trying to find out if the same gene used, could miss a significant number • Another 12.2% did not know that is present in the Coloured population. of diabetics. they had diabetes; The study also takes into consideration Mr Shafick Hassan of CPUT, a doc- • From those with impaired glucose physical activity and diet. toral student and a member of the tolerance, the researchers concluded • Another study is looking at a par- team, is investigating the cardiovascular that 19% of the subjects could possibly ticular enzyme that may modify the risk factors and family history associ- develop diabetes – and constituted a lipid particle, HDL which serves as an ated with metabolic syndrome in the very high risk group. anti-oxidant and plays an important offspring and parents of the present • Compared to the results of the study role in preventing heart disease. “We Bellville South cohort. that was reported about 15 years ago, there has been an increase of 10.4% in Masters in Clinical Epidemiology the prevalence of diabetes in this popu- lation group. Short courses: First semester 2011 “Of great concern was the number Training in Clinical Research Methods? of people with undiagnosed diabetes,” Applications now open for short courses! Erasmus says. Fundamentals of Epidemiology, Biostatistics I, Diagnosis, Screening, He points out that the prevalence Writing and Reviewing Scientific Papers, Clinical Guidelines, of HIV was quite low in the study Teaching Evidence Based Medicine group. “In South Africa, we are always urging people to find out what their Clinical Epidemiology impacts on patient care by providing scientifically valid HIV status is. Looking at this study, I answers to questions concerning diagnosis, prevention, therapy, prognosis think every person of mixed origin in and aetiology. This Masters Programme, with an emphasis on Evidence-Based the country should find out what their Medicine, provides health professionals with the necessary skills to generate diabetic status is.” and apply reliable, up-to-date evidence in clinical practice. Other studies ELIGIBILITY: For admission the prospective candidate shall hold an MB,ChB Linked to these studies, the various or equivalent degree; or at least a 4-year professional Bachelor’s degree in a members of the team are involved in a health-related discipline. Competency in Epidemiology and Basic Biostatistics is number of other studies that focus on required. diabetes and obesity. • A doctoral student and a member Application forms available from Belinda Durelle, Email: [email protected], of the research team, Zelda Vergotine, Tel: 021 938 9157 - Fax 021 938 9166

The museum for Human Anatomy at the Faculty of Health Sciences on the Tygerberg Campus was founded in 1975 by Prof JF van E Kirsten and Ms Linda le Roux and was mainly used for teaching of anatomy to students of the University. In 2006 the museum was changed into the Comparative Medical Morphology Museum as seen today. Although the museum still offers an exstensive series of exhibits for the professional development of our Morphology Faculty’s Medical and Allied Health Sciences students, the museum is also Museum open to the public to be inspired by its collections and exhibitions. At the core of the Museum’s education efforts is a program for school groups visiting the museum.

Discover the fascinating world of the human body and comparative animal biology. Visits to the Museum offer a range of educational and awe inspiring experiences. Our aim is for visitors to leave the museum with more respect for the body.

Enquiries: Ms Lorraine Myburgh, [email protected], Tel: 021 938 9426 or visit www.sun.ac.za/anatmuseum

Tygerland 2010 27 Haematological Pathology Meeting new and evolving HIV challenges In line with global concerns, researchers at Stellenbosch University and Tygerberg Hospital are preparing for the upsurge in the incidence of long- term complications of HIV in the light of anti-virus treatment policies.

he roll-out of antiretroviral aged by HIV, are significantly more sus- Abayomi points out that the South programmes in South Africa is ceptible to certain cancers than those African Department of Health (DoH) Tby far the biggest program on without HIV. This risk can be up to 200 is currently making moves to align its the Continent and has made a major times higher than the risk of a non-in- policies with those of the developed impact in the lives of persons living fected population,” Abayomi says. world and this is a very welcome de- with HIV, retarding short-term mor- “South Africa’s current public health velopment and a step in the right direc- bidity and mortality, “but now we have policy regarding ART is to commence tion, considering the financial implica- to be prepared to cater for a growing when patients have a CD4 count of tions. population living with the virus and its 200 or below - the exception being He says there is an emerging school long-term complications.” those with tuberculosis and in preg- of thought that believes a multitude of This is the view of Prof Akin Abayo- nancy, when a CD4 threshold of 350 factors should be considered to deter- mi, new head of the Haematological Pa- is used. mine when a patient should start ART thology division in the SU Department “However, in reality the average treatment, and it should not depend on of Pathology, who says that some of the CD4 count at commencement of ART a single CD4 measurement. “The impe- complications of HIV are already be- is currently less than 100, suggesting tus rests with us in heavy HIV-burden coming evident in the growing number that the immune system has already regions to acquire a better understand- of blood cancers, developing as a direct suffered considerable damage. The long ing of the epidemic and its long-term consequence of the epidemic. While -term implications of this delay in treat- consequences and help develop cheap the relationship between HIV and these ment on those who survive on ARV and affordable means of triaging pa- cancers is still not fully understood, therapy are not known and could pos- tients for closer attention and possibly Abayomi believes that the cancers de- sibly be creating a large population of earlier treatment”. velop as a direct consequence of the people on ARV who are still susceptible According to Abayomi, early sig- damage suffered by the immune system to developing serious complications in nals indicate that there is already an of HIV patients before antiretroviral the long-term, such as HIV-related can- increase in the number of cancers as- therapy (ART) treatment was started. cers and multisystem inflammatory dis- sociated with HIV/AIDS, such as the “It is also evident from opportunistic orders. lymphomas and cervical cancer. He infections and the inflammation profile “A normal CD4 count, which is the says cancers associated with HIV and of persons living with HIV. cheapest way to measure the robust- AIDS are particularly difficult to treat, “It is a well established fact that ness of the immune system, should not “and yet we owe it to these patients to persons whose immune system is dam- be lower than 500. In developed coun- treat them with the same urgency and tries, treatment usually commences dignity as we treat patients with any with a CD4 count of between 300 and other form of cancer.” 500, in which case immune recovery The Haematological Pathology divi- can be impressive. sion of the FHS and Tygerberg Hospital “While such a policy would be de- has therefore established close collab- sirable it is understandably not a finan- oration with other pathology divisions cially viable option in most of Africa at and clinical sub-specialities to better present.” understand these phenomena. At the

“A direct consequence of the damage suffered by the im- mune system of HIV patients before antiretroviral treatment was started, is the growing incidence of blood cancers”. - Prof Akin Abayomi

28 Tygerland 2010 Haematological Pathology Haematological Pathology Meeting new and evolving HIV challenges

The Haematological Pathology team are fltr: Front: Mrs Fezeka Bam, Mrs Rochelle Van Wijk, Dr Ravnit Grewal, Prof Akin Abayomi, Mr John Forbes, DrTembisa Jobo Middle: Dr Hayley Ipp, Mrs Manogari Chetty, Dr Nomusa Mashigo, Mrs Marieta du Plessis, Dr Thandiwe Adonis, Mrs Avril Somers, Mr Bongani Nkambule, Dr Mark Roos Back: Mr Samuel Mburu, Sr Ester Murray, Mrs Annette Jooste, Mr Stanley Loots, Dr Allison Wiehahn, Dr Arne von Delft and Mr Izgak Barendse.

same time, a Tygerberg Lymphoma seems to be on an upward curve.” procedures coupled with treatments study group was established, as well Working with designated NIH spe- such as smart designer drugs and cel- as an HIV Activation and Inflammatory cialists, based at the University of Ohio lular therapies with stem cells, many group, chaired by Dr Hayley Ipp. in the United States, the SU Haematol- haematological malignancies and dis- Abayomi says one of the targets ogy team has been included in a sub- eases such as sickle cell anaemia are no of the division is to work on haema- Saharan research network, sponsored longer considered fatal. And the dread- tological cancers associated with HIV by the NIH. The network will study ed chemotherapy treatments have im- and he and his team are working with HIV/AIDS-related lymphoma in par- proved to the extent that people can the American National Institutes of ticular on the continental level. now go back to work directly after Health (NIH) to focus the spotlight on “At present, there is almost a void they have received their early morning the evolving epidemic of HIV complica- in our local knowledge of this evolving treatments.” tions. As part of a nationwide collabo- problem. The NIH study is a brand new Even though haematologists in ration with the University of Colum- project aimed at increasing our under- the developing world do not have the bus in New York, SU has also secured a standing and diagnostic capacity on the luxury of sub-specilization in particular development grant specifically to train continent as it relates to a burden of disease groups as is the case in the de- South Africans in the epidemiology and disease that has its largest impact in veloped world, Abayomi feels strongly investigation of AIDS related cancers. Africa.” that collaboration on the continent will This initiative was spearheaded by Drs help overcome the gross human capi- Gerhard Sissolak and Fatima Bassa of Haematology in the developing tal shortage in the discipline. He has the Clinical Haematology division. world therefore made it one of his aims to According to Abayomi, early results As the new head of the division, Abayo- encourage young people to this inter- from the Tygerberg Lymphoma study mi says haematology is an exciting and esting and rewarding field of medicine. group confirm that there has been an rapidly changing discipline, character- The SU Haematological Pathology alarming increase of HIV related lym- ized by important advances in the division has five specialists and seven phomas over the last seven years de- treatment of blood diseases. training specialists, as well as some 20 spite the introduction of ART. “About a “Ten, twenty years ago there was laboratory technologists and a growing third of all new cases of lymphomas are very little one could do about these number of student scientists. It is work- occurring in People Living With HIV depressing conditions. However, with ing closely with its clinical haematology (PLWH). This has grown significantly new advances in diagnostic capacity counterparts to create a more unified from 5% a decade ago, and the trend with flow cytometry and molecular haematology platform.

Tygerland 2010 29 Centre of Excellence in Biomedical TB Research

SU researchers identify first new TB pathogen in two decades

When a mysterious, tuberculosis-like disease reared its head in the banded mongoose popula- tion of northern Botswana, Stellenbosch University scientists discovered that the animals were infected by a previously unknown species in the Mycobacterium tuberculosis complex – the first new organism in this group to be identified in 20 years.

he recent discovery of a new tuberculosis pathogen Virginia Tech’s College of Natural Resources and the Envi- by scientists of Stellenbosch University (SU), in col- ronment – approached him for assistance at the end of 2008. Tlaboration with American colleagues, has made news Alexander and a team of veterinary scientists were working in scientific publications and websites across the world when in northern Botswana where they discovered that banded the results of the two teams’ research were published in the mongoose troops, living in close proximity to humans, were August issue of the journal, Emerging Infectious Diseases. dying from a mysterious, tuberculosis-like disease and they “This discovery has opened up new avenues of research were unable to identify the organism causing the disease. towards understanding the evolution of mycobacterial vir- “They asked for our help since we had the molecular ulence,” says Prof Nico Gey van Pittius, of the DST/NRF tools available to differentiate between members of the genus Centre of Excellence in Biomedical Tuberculosis Research Mycobacterium – the normal causative agents of tuberculous (CBTBR), based in the Division of Molecular Biology and and other mycobacterial diseases. This was the beginning of Human Genetics on the Tygerberg Campus - and a leading an interesting, long-term collaboration with Alexander and member of a team of scientists who identified and named her research group investigating the disease. the new pathogen Mycobacterium mungi. “Initially, we thought that the disease in the mongoose According to his American colleagues, the discovery also was caused by Mycobacterium bovis, the organism causing tu- offers a great opportunity “to learn what drives tuberculo- berculosis in cattle and which is currently causing havoc in sis evolution and ecology, providing possible insight into the buffalo and other wildlife populations in parts of southern control of this important group of pathogens.” Africa. That turned out to be wrong, and we then looked at the possibility of human tuberculosis, spreading to the ani- Mongoose dying mysteriously mals across the human-animal interface. The infected mon- Gey van Pittius, a medical molecular biologist, says an Ameri- gooses were living in close proximity to human waste sys- can research group – headed by Prof Kathy Alexander of tems in the Chobe area.” When that theory also fell by the wayside, and none of the markers for the different known species could iden- tify the organism, Gey van Pittius real- ized that they were dealing with an un- identified new organism that has never before been seen in southern Africa or elsewhere in the world. “All our molecular assays pointed to an organism which has never before been seen anywhere else in the world.”

Wildlife and domestic animals threatened ”We were then able to show that the organism was related to the dassie ba- cillus - another tuberculosis complex species first described in the 1960’s that causes tuberculosis in cape hyrax (dassies). Thus the new Mycobacterium Prof Nico Gey van Pittius explains the significance of the discovery of the new TB mungi - as the organism was named by pathogen. our group - has become the latest »

30 Tygerland 2010 Centre of Excellence in Biomedical TB Research Centre of Excellence in Biomedical TB Research « described species of the Mycobacterium tuberculosis com- These are all questions which he and his collaborators plex, which already includes other animal adapted organisms will now endeavour to answer. The group also aims to de- that infect, among others, seals, dassies, oryx, voles, goats termine the whole genome sequence of the organism to and cattle. gain insight into the mechanisms by which its genome has Like human TB, the incidence of animal TB is on the evolved and the reasons for its very interesting and unique increase, says Gey van Pittius. “Bovine tuberculosis, prob- disease etiology. ably transmitted by cattle, was first detected in the south of the Kruger National Park in August 1990, but has now At the forefront of research swept across the Park and has already reached the north- Headed by Prof Paul van Helden, the CBTBR is at the fore- ern boundary. The large number of animal species infected front of tuberculosis research in South Africa and interna- with TB impacts negatively on animal numbers, health and tionally. the important economic benefits of ecotourism. Losses Scientists and researchers of the Centre and Division due to tuberculosis are also of extreme importance when of Molecular Biology and Human Genetics have published endangered wildlife species are involved. Failure to elimi- more than 430 papers and book chapters and hold a num- nate M. bovis infection in wildlife and wild animals kept in ber of patents in the field of tuberculosis since their work in zoos and parks, is also of serious concern to public health this field started in 1991. With the Faculty’s close proximity officials because tuberculous wild animals could serve as a to a number of very high tuberculosis incidence communi- source of infection for domestic animals like cattle. TB in ties - with and without high levels of HIV infection - and wildlife may therefore complicate control and eradication long-standing links with several wildlife health research as- programmes of TB in cattle and increase public health con- sociated institutions such as the Onderstepoort Veterinary cerns,” he says. Institute and the Kruger National Park, the Tygerberg group Gey van Pittius says there is still much to learn from the is in a unique position to study both human and animal new organism. “For example: why haven’t we seen this or- tuberculosis. The Division has a large number of ongoing ganism before, does it infect other animals or even humans, projects focusing on immunological, genetic, pharmacologi- what is the mode of transmission and where did it come cal, bacteriological and molecular epidemiological questions from?” pertaining to M. tuberculosis infection.

Baromedicine & Occupational Medicine Facility

The Stellenbosch University Baromedicine & Occupational Medicine Facility is located at the Faculty of Health Sciences on the Tygerberg Campus. Baromedicine: Education: The Facility provides provincial, private and Degree programs presented by the facility medical aid patients with Hyperbaric Oxygen include BScMedScHons (Hyperbaric Medicine), Therapy, the three main indications being: BScMedScHons (Underwater Medicine), MSc • Problematic Non-healing Wounds, (Baromedical Sciences) and soon to-be-regis- • Crush Injuries tered short courses in Hyperbaric Nursing. • Radionecrosis; As well as Transcutaneous Oximetry and Wound Care Occupational Medicine Services: Research: • Compulsory occupational fitness examina- The facility is also one of only two tertiary tions for individuals such as pilots and deep institutions (the other in Pretoria) where sea divers, research can be conducted on the effects and • Examinations to determine the occupation- value of HBO in the treatment of various medi- related medical fitness of sick or injured indi- cal and surgical conditions. viduals and disability issues. MoreHBO information, appointments and referrals http://www.divingmedicine.co.za Telephone number: (021) 938 9810 http://www.hyperbaricmedicine.co.za Fax number: (021) 938 9850 Email: [email protected]

Tygerland 2010 31

Orthopaedics Unique partnership benefits South Africa’s first true orthopaedic training facility with a decent infrastructure was recently opened at Tygerberg Hospital, thanks to a unique partnership between Stellenbosch University, Tygerberg Hospital, the Provincial Government and the Private Sector.

nown as the Advanced Or- Vlok and Drs Jacques du Toit and Igna- sector; orthopaedic registrars; ortho- thopaedic Training Centre, tius Terblanche. paedic medical staff from the hospital's Kthe spacious and secure state According to the members of the catchment areas and affiliated ortho- of the art facility on the sixth floor of committee, the need for a centralised paedic staff such as physiotherapists. Tygerberg Hospital provides an excel- orthopaedic training centre in the The division produces three or four lent working, training and research en- Hospital stretches back over many new orthopaedic surgeons every year vironment for the eight specialists, 18 years during which staff and students and provides orthopaedic health care registrars and seven interns who are of the Division had to navigate their to patients at Tygerberg Hospital. currently attached to the Division of way between the Orthopaedics ward, Apart from training provided by Orthopaedic Surgery, headed by Prof situated on one floor of the Hospital the division’s own specialists, super Gert Vlok since 1984. and clinical facilities and operating thea- specialists from the private sector This division is currently the largest tres situated on other floors. are also brought in to provide train- tertiary orthopaedic unit in the West- Now the new centre is within ing in areas such as knee and shoulder ern Cape. It represents years of effort walking distance of the ward and con- surgery. From time to time, overseas and hard work by Vlok and staff of the nected to the operating theatres with specialists in specific fields are also -in division; the willingness of the hospi- an elevator operating from within the vited to the division to present special tal and the Province to contribute to centre. courses. the project; the generosity of the SU’s The Centre comprises a large audi- The 800 square metres on the west orthopaedic alumni, as well as donors torium – named after Prof Vlok – with side of Tygerberg Hospital in which from the private sector – ranging from modern audiovisual facilities that will the Centre was established, was allo- Shoprite/Checkers, who designated its allow medical officers and other staff cated to the division by the then CEO whole building team to work on the at peripheral hospitals to log in on of the hospital, Dr Terence Carter. “In project, to Samsung (who donated flat meetings and lectures. Continuous the past, the area was first used as a screens, fridges and stoves), Frazer tiles, Medical Education programmes will tearoom and later as a facility for hos- Storz, the orthopaedic instrumentation also be presented from this area. Each pital porters,” says Vlok. “It had cost us company who donated instruments one of the comfortable chairs in the a microwave and a fridge to convince for arthroscopic procedures and many auditorium has been donated by a for- them to relocate to other facilities. others. mer student of the division and carries And before we could start building, a “We received donations of R60 the name of the donor. “When we ap- flock of doves moved in.” 000 to R70 000,” says Dr Sean Pre- pealed for funds from alumni, we had The new Centre was designed with torius, a specialist in the division and an excellent 40% response from our the help of architect Mr Kruger Ther- managing director of the committee, old boys,” says Pretorius. on who offered his services at a huge responsible for the management of The Centre is furthermore equip- discount. “Then Mr Whitey Basson the new Centre. Other members of ped with a computer room and library of Shoprite/Checkers offered to help the committee, who also served on with continuous Internet availability; because he wanted to put something the organising committee, include Prof a special workshop and procedures back into education. Eventually the room that will facilitate clinical skills Shoprite building team got involved workshops, practical training on cadav- and they completed the project.” ers and arthroscopic procedures; an According to the members of the area for research; training facilities for committee, the Centre is run as a non- students; storage facilities for reusable profit, public benefit organisation with orthopaedic instrumentation; locker financing for its upkeep sourced from rooms; male and female restrooms and external, tax deductible donations. overnight sleeping facilities for staff on They point out that health care night duty; a tearoom and entertain- providers leave South Africa at an ment area; a small kitchen and a secu- alarming rate, often to receive ortho- rity system to restrict unauthorised paedic training elsewhere. entry. “We hope this initiative will em- The Orthopaedics division, with power the local surgeons to receive its excellent academic record trains internationally equivalent local training Prof Gert Vlok received a 3rd, 4th and final year students and here at Tygerberg Hospital. Maybe that unique keyring as gift at the postgraduates, as well as orthopaedic will help to curb the exodus of health official opening of the facility. specialists from the state- and private providers from our country.”

32 Tygerland 2010

Orthopaedics orthopaedic training in SA

Photos: The AOTC recently held a Paediatric Or- thopaedics Trauma symposium. This sym- posium was directed at registrars from the universities of Stellenbosch and Cape Town as well as medical officers from the Western Cape Secondary Hospitals. Literature based theoretical sessions as well as practical workshops in the newest fixation techniques were presented by Or- thopaedic specialists from Tygerberg Hos- pital, Hospital, the private sector as well as a visiting surgeon from One Military Hospital in Pretoria, Dr Ste- fan Colyn. This course reflects the centre's vision of high quality “outreach” teaching in orthopaedic surgery.

The centre piece is without a doubt the “state of the art” auditorium, were the team can deliver high quality lectures and also interact with peripheral institutions via video interface. The chairs of this auditorium were kindly donated by the “alma maters” of the Division of Orthopeadic Surgery. Dr Vaatjie du Toit welcomes the delegates and faculty to the AOTC during a recent symposium.

Tygerland 2010 33 Postgraduate programmes Paediatric Surgery Training programme offers special skills

where the bowel is almost completely interrupted. Previously, a much more invasive upper transverse laparotomy was required to treat the condition. At the same time, scarless surgery is of enormous advantage in cases of Hirschprungs Disease, a field in which Prof Moore is a leading expert. “This is a disease of the bowel that previously required three operations, as well as stomas such as colostomies. Now a single one hour operation through the anus without any stoma can be done mainly in the neonatal pe- riod. The patient can often be fed on the same day. We have had over ten cases like this at Tygerberg Children’s Hospital since we started doing en- dorectal surgery about three or four The Paediatric Surgery team. In front is the head of the Division, Prof Sam Moore and years ago,” says Sidler. from the left, at the back, are: Dr Nevaleni Tshifularo, a qualified surgeon from Venda He points out that this type of sur- who came to SU to train in Paediatric Surgery; Dr Marianne Arnold, a registrar in the gery is of enormous advantage to the Division; Prof Daniël Sidler and Dr Corné de Vos. child and the parent or caregiver. It is not highly technological or expensive, ith the recognition of Paediat- the SU training curriculum. but it makes bowel surgery much eas- ric Surgery as a medical spe- At present, the division comprises ier especially in our population where W ciality in its own right, the dis- two senior paediatric surgeons; one there is a 20% risk of adhesive bowel cipline has recently come of age at the qualified surgeon who is training in obstruction after laparatomy and a 20% SU Faculty of Health Sciences and the paediatric surgery; one registrar and a complication rate with stomas. Tygerberg Children’s Hospital. medical officer. “There is also cultural and psycho- Now operating as an independent Despite its small size, the new divi- logical resistance to stomas in some division of the Department of Surgical sion has at its command surgeons with of our cultural groups and parents or Sciences, the Paediatric Surgery Divi- special, advanced skills. One of them, caregivers may find it very distressful to sion offers a new MMed programme, Prof Daniël Sidler can perform a num- deal with a baby with a stoma.” designed as a four-year Masters pro- ber of paediatric operations almost Although Tygerberg Children’s Hos- gramme to allow specialization in without any visible scarring. pital is not the only institution where Paediatric Surgery without students “For instance, we do laparoscopic this kind of surgery is performed, Sidler necessarily completing a full training in keyhole surgery on all our patients with believes that it is of special benefit to General Surgery first. This is in keep- high ano-rectal malformations. Also in the people whom we serve, not only ing with the new Health Professionals cases of hypertrophic pyloric stenosis in terms of cost benefits, but also be- Council of SA (HPCSA) regulations. - where the pyloric muscle becomes cause it involves fairly simple, low tech The curriculum was developed hypertrophic and must be cut - we do a procedures. by the head of the Division, Prof Sam peri-umbilical incision when the condi- Moore. In terms of the Provincial plan tion is diagnosed - usually at six to eight for a single clinical service for Paediat- weeks after birth. You can hardly see a For further information, contact: ric Surgery, the Stellenbosch unit has scar after this procedure,” he says. Prof Sam Moore - 021 938 9280; regular joint academic meetings, con- The Division also performs single [email protected] or ferences and academic tutorials with keyhole surgery without laparoscopic Dr Daniël Sidler - 021 938 928; the Red Cross Children’s Hospital, Uni- equipment through the bellybutton [email protected] versity of Cape Town, who also shares for conditions like intestinal atresias,

34 Tygerland 2010 Pharmaceutical Medicine now a medical speciality Profs Stephen Hough (left) SU offers a two-year diploma course in pharmaceutical medicine and Bernd Rosenkranz hile it has been eight years working in the pharmaceutical industry. Rosenkranz says applicants with a since pharmaceutical medi- In South Africa, doctors working in this medical, dental or pharmacist degree W cine became a recognised, industry, are organized in the SA As- can be admitted to the programme on medical speciality in Britain, no efforts sociation of Pharmaceutical Physicians, the basis of the degree, whilst those have been made to recognize this dis- which had 83 members in 2005. with a nursing, biomedical or other rel- cipline as a medical speciality in South Even though pharmaceutical medi- evant science degree need to have had Africa. cine is not a recognized medical spe- two years of experience in pharmaceu- Instead, in 2009 the Colleges of ciality in South Africa, the postgraduate tical medicine. Medicine of South Africa (CMSA) rec- training gap in this field is now set to be “To assess the situation regard- ognized Clinical Pharmacology as a filled by the new, two-year course now ing courses on pharmaceutical medi- speciality in the field of medicine and offered by SU. cine currently planned internationally, the SU Pharmacology Division is set to The full two year diploma course the International Committee of the launch the first full 2-year course in this consists of four modules: An intro- Faculty has asked a working group to field in 2011. duction to pharmaceutical medicine; look at standardized materials used The postgraduate diploma course, non-clinical development of medicines; for teaching and/or exams, e-learning, known as Pharmaceutical Medicine, has clinical development and pharmaco- budgets, sponsoring opportunities, and been approved by the University, the vigilance and marketing. The course in- recommendations for potential syner- South African Department of Education cludes a research project and regular gies. Members of the working group and the SA Qualifications Authority and assessments, including the final exami- are Bernd Rosenkranz (South Africa, since April 2010, the SU Pharmacology nation. The syllabus of the programme chair), Ibrahim Farr (Spain), Raymond Division has been offering individual is based on that proposed by the Fac- Chua (Singapore), Domenico Criscuolo modules of the programme as four ulty and by the International Federa- (Italy), Pankaj Goyal (India), and Pipasha separate short courses. Successful par- tion of Associations of Pharmaceutical Biswas (UK/India). The group is actively ticipants will be awarded CPD points Physicians (IFAPP) to ensure harmony supported by Barry Muzzeroll (Faculty and a certificate of competence. with other existing programmes. administration). Prof Bernd Rosenkranz, head of the SU Pharmacology Division, says For more information, please contact Prof Bernd Rosenkranz, pharmaceutical medicine, as a medical tel: 021 938 9331, e-mail: [email protected], or the programme speciality in Britain, is aimed at doctors coordinator, Prof Stephen Hough, tel: 021 938 9044, e-mail: [email protected]

Stellenbosch University - Faculty of Health Sciences BSc Honours Medical Sciences (Epidemiology) Essential skills for those who want to get involved in health research!

This programme is aimed at health professionals and Admission Requirements: Applicants must have MB,ChB, designed to increase their skills in epidemiology, research B or ChD or at least a bachelor’s degree in a biologically-re- methodology and statistical methods. This degree pro- lated discipline or suitable post-matric qualifications coupled vides an understanding of epidemiology and its role in with relevant experience in a health-related research field as health to a level that enables critical appraisal of the med- assessed by the University. In the case of an applicant not in ical research literature and it will enhance skills in con- possession of a formal bachelor’s degree, the University will ducting of projects. The aim of this course is to add skills assess the student’s qualifications and may require a tenta- to each student, regardless of speciality field, so that they men (oral examination) to assess the candidate’s ability to can carry out aspects of their speciality with a better sci- meet the course requirements. The course is offered part- entific knowledge base and judgement. The programme time over two years to enable students to carry on with is offered by the Division of Community Health of the their employment while studying. There is one class of two Faculty of Health Sciences at Tygerberg. hours per week at the Tygerberg campus. For more details and application forms, please contact Dr Jo Barnes (021 9389480) or Mrs Marie Kotze (021 938 9120, mornings only).

Tygerland 2010 35 Faculty news Excellence rewarded

The outstanding work that Prof Colleen Wright, head of the Anatomical Pathology division in the SU FHS has been doing in the field of fine needle aspiration and placental pathology received special recognition when the SA Medi- cal Association honoured her with a special Medical Service Award.

he award specifically acknowledges contributions She has a research and diagnostic interest in perinatal that, at the time of their execution, have made a and placental pathology, and is a co-investigator in the PASS positive difference to the practice of medicine and Research network, a five year international collaborative Thealthcare delivery. study, funded by NIHCD and NIAAA to investigate the hy- Wright is an anatomical pathologist with a particular pothesis that perinatal alcohol exposure increases the risk interest in both paediatric pathology and the use for fine for SIDS and stillbirth. As part of this study she was ap- needle aspiration (FNA) biopsy as a diagnostic modality in pointed affiliate professor of Pathology at the Children’s resource limited countries. Hospital Boston. This natural synergy led to her research into the diag- Wright promotes the recognition of the contribution of nosis of paediatric tuberculosis using FNA, the topic of her placental pathology to the understanding and management of doctoral dissertation. She promotes the use of FNA in both adverse pregnancy outcome, convening courses on placental neo-plastic and infectious diseases in countries with limited pathology for pathologists from South and Southern Africa, financial and medical personnel resources. as well as lectures to obstetricians and neonatologists. Wright has been training medical and nursing staff at u Further to the above achievement, Prof Colleen Wright under- and postgraduate levels in the FNA technique. In was invited in October 2010 by the International Academy 2005, she also initiated the first distance-mediated Masters of Cytology to be a member of the International Board of degree in Cytopathology through Stellenbosch University, Cytopathology. This recognition is a rare and sought-after thus making specialist training in cytopathology accessible to honour that reflects the international respect and status students throughout Africa. that she enjoys as a leading cytopathologist.

Volunteers wanted for OCD study

The MRC Unit on Anxiety & Stress Disorders, University of Stellenbosch, is searching for volunteers to participate in a study on Obsessive Compulsive Disorder (OCD)

Three “types” of volunteers are needed for participation: 1) People diagnosed with Obsessive-Compulsive disorder; 2) people diagnosed with Trichotillomania (compulsive-hair pulling); and 3) first-degree relatives (aged between 18 and 65 years) of persons diagnosed with OCD.

Participant information will be kept confidential. If you think you are up to the challenge, and want to contribute to this study, please contact: Prof Christine Lochner (Tel: 021 - 938 9179, e-mail: [email protected]) or Ms Bryony Fell (Tel: 021 - 938 9762, e-mail: [email protected]) for more information.

36 Tygerland 2010 Faculty news SPORT AND HIV A new, research-based partnership

Using sport as an important measure to prevent HIV is at the heart of an extensive new tripartite partnership that was recently established between Stellenbosch University, the Technical University of Munich (TUM) in Germany and the HOPE Cape Town organisation, which conducts various HIV pro- grammes at the SU Faculty of Health Sciences and Tygerberg Hospital.

he groundwork for the initiative was laid last year “One of the main objectives of the working group is to when Prof Jürgen Beckmann, dean of the Faculty of recruit leading researchers and experts from South Africa T Sport and Health Science at TUM visited Prof Bernd and Germany into HIV research, with special focus on pre- Rosenkranz, head of the Pharmacology Division to explore vention through sport programmes, including practical public possibilities of cooperation between the two universities. health care and the attraction of big industrial investors to During the Soccer World Cup in June this year, the two problems of HIV prevention.” professors presented a workshop at the Artscape theatre in The mission of the South African-German cooperation Cape Town, focusing on aspects of sport that can play a role will be to improve access to effective measures of HIV pre- in the prevention of HIV and Aids, such as teamwork and the vention through sport programmes, appropriate patient man- building of self-confidence. Prof Mark Cotton, Mr George agement, to stop transmission of HIV, to reduce its social and Fourie, both from the Children’s Infectious Diseases Clinical economic toll, and to assist in development and implementa- Research Unit (KIDCRU) at Tygerberg Hospital, as well as tion of new preventive and therapeutic tools and strategies Rev Stefan Hippler, HOPE Cape Town, presented their ex- to stop HIV. periences. It will particularly, but not exclusively, aim at an inter- To transform this cooperation into a long-term, sustain- disciplinary approach to address the following fields in HIV able and research-based partnership, a letter of intent was prevention, both in research and clinical practice: signed shortly afterwards to create a partnership between all . Educating peer-group mentors in sports activities; 3 partners to support HIV prevention through sports pro- . Empowerment of young females; grammes. . Teaching young males about the importance of responsi- Rosenkranz says the partnership intends to establish a bility and teamwork, and long-term scientific cooperation between South Africa and . Increasing life quality through adequate sports in HIV the Federal Republic of Germany in various aspects of HIV, positives. i.e. clinical science, sports and health sciences, immunology, The South African-German partnership will endeavour epidemiology, training and public health. to contribute towards reducing the burden of HIV in both “This will be underpinned by the exchange of students, countries. It will enhance the quality of education, training teachers, doctors and scientists with the aim of training high- and scientific research by capacity building and exchange of ly qualified scientific experts and teaching personnel. skills and resources.

At the colourful function, held to sign the letter of intent, were, from the left: Members of the Bavarian Choir who accompanied the German delegation to South Africa, Rev Stefan Hippler of HOPE, Prof Jürgen Beckmann of TUM, SU FHS dean, Prof Wynand van der Merwe, Dr Rupert Pritzl of the Bavarian State Chancellery and other interested parties.

Tygerland 2010 37 Fakulteitsnuus In Memoriam Prof Barney de Villiers, hoof mediese spesialis van die Prof Glynn Wessels is op 27 September oorlede. Prof Afdeling Gemeenskapsgesondheid, is op 9 Junie oorlede. Wessels was sedert 1984 reeds verbonde aan die Depar- Hy was sedert 1994 aan die Fakulteit Gesondheidsweten- tement Pediatrie en Kindergesondheid. Hy sal altyd onthou skappe verbonde en het vanaf 2001 tot 2004 ook as mede- word vir sy wonderlike bydrae tot kinderkanker-behande- dekaan op die bestuur van die Fakulteit gedien. Ons dink ling in Suid-Afrika. Ons dink met deernis aan sy vrou Elana, met deernis aan Anntesia, sy kinders en kleinkinders, asook kinders en kleinkinders. al sy vriende hier by die fakulteit. Dr Con Meyer is op 13 Junie 2010 oorlede. Hy was voor- Dr Mickey Gerber is op Woensdag 28 Julie oorlede. Dr heen werksaam by die Departement Chemie en Polimeer- Gerber was ’n gewaardeerde kollega wie ’n lang en produk- wetenskap en het Chemie vir ons studente aangebied. Ons tiewe loopbaan oor bykans vier dekades by die Fakulteit dink met deernis aan sy familie en vriende. en Stikland-hospitaal gehad het. Dr Gerber se dood is vir baie van sy kollegas en vriende in die Fakulteit en elders Ons het ook met leedwese verneem van die skielike af- ’n groot verlies. Ons sal sy professionaliteit, kollegialiteit, sterwe van een van ons oud-studente, Dr Werner Wagner vriendskap en unieke humorsin baie mis, maar vir nog lank op 2 Augustus. Hy was Tygerberg se sportman van die jaar onthou. in 2005. Dr Wagner het in Swakopmund gepraktiseer en was ’n baie gewilde student op Tygerbergkampus.

The Cape Universities Brain Imaging Centre Catalyzing neuroimaging research in South Africa

Our vision is to establish ourselves as a cutting edge neuroimaging research facility with a focus on problems that are specific to South Africa The Cape Universities Brain Imaging Centre (CUBIC) is a joint initiative between Siemens, the Universities of Stellen- bosch and Cape Town, and the Medical Research Council. The core focus of the centre is collaborative neuroimaging research. Since CUBIC was commissioned in March 2007, over two doz- en research projects have been initiated in key areas including neurocognitive effects of HIV, TB, medical drugs, alcohol, crystal methamphetamine (TIK) and cannabis abuse, fetal alcohol syn- drome, trauma and schizophrenia. We have also seen an impres- sive growth in basic science research on improved imaging and analyses techniques. The centre boasts a 3 Tesla Siemens Allegra MRI scanner, the first MRI scanner of its kind in Africa and currently one of the most advanced brain imaging instruments on the market. In addition, the centre is also home to electroencephalography (EEG) and near infrared spectroscopy (NIRS) imaging equip- ment. Advanced neuroimaging of this kind provides detailed The image demonstrates our imaging capabilities for neu- structural and functional brain mapping, and promotes research rosurgical planning. The path of important nerve fibers in a variety of disciplines, including radiology, psychiatry, psychol- (green and blue) are shown relative to a tumour (pink). ogy, neuroscience, physics and biomedical engineering. Functional brain areas for speech and sight are also The imaging centre is not simply a service to researchers, shown (yellow and orange, respectively). but more a collaborative partner and a facility to promote cross-disciplinary relations. An MRI physicist, two radiographers, CUBIC is situated on the Tygerberg Campus of an administrator and several data analysts are employed to help the Stellenbosch University. transform your research ideas from principle to practice. In ad- For more information, visit www.sun.ac.za/cubic dition, we also provide unique neurosurgical planning capabilities involving mapping brain function and nerve fiber connections.

38 Tygerland 2010 Faculty news Quinette Louw:

Our first professor in Physiotherapy

With an inaugural address on musculoskeletal health as an under-recognised health priority in Africa, Prof Quinette Louw became the first full professor in Physiotherapy since this division in the SU Faculty of Health Sciences was established in 1966. She is also one of the strongest proponents of research in the division and this field of expertise.

ince she joined the Physiothe- versity of the Western Cape (UWC). ing relationship with colleagues in the rapy division in 2005, Prof Qui- Because of the lack of postgraduate Department of Physiotherapy, and with S nette Louw has made important Physiotherapy programmes in South Prof Karen Grimmer in particular. An- contributions towards postgraduate Africa at the time, she enrolled for a other bursary from the MRC, as well training and research in the FHS with Masters degree in Sports Physiotherapy as a scholarship from the University of Physiotherapy studies focusing not only at the University of Southern Australia. Southern Australia, helped her to re- on musculoskeletal health, but also on An MRC bursary enabled her to move alise this dream. an virtual reality pain relief for chil- to Adelaide in Australia where she Her doctoral research focused on dren with burn wounds (see Tygerland completed her degree in 15 months – the knee injuries often sustained by 2009). with a number of distinctions and a young netball players. “The aim of my However, her strongest interest Dean’s award for academic achieve- study was the primary prevention of lies in the field of sports physiotherapy ment. injuries and the secondary prevention and in 2005 she completed a doctoral With this degree in her arsenal, of conditions such as osteoarthritis.” degree at the University of Southern Louw returned to UWC where she Her work was widely reported in Australia with a unique study on the joined the Department of Physiother- the media in a sports mad Australia, es- prevention of knee injuries in adoles- apy and contributed to a postgraduate pecially when she received her degree cent netball players. She joined the SU programme presented at both UWC and delivered her first public lecture as Physiotherapy Division on completion and SU. She was, however, keen to con- Doctor in Physiotherapy in Adelaide. of her degree. tinue her PhD studies and research at Since she took up the post as as- Louw completed her undergradu- the University of Southern Australia, sociate professor at SU in 2005, Louw ate studies in Physiotherapy at the Uni- where she had built a strong work- has played a key role in promoting re- search in the Physiotherapy Division. Under her direction, students have completed several studies focused on physiotherapy problems relevant to the South African population. Louw is married and the mother of two young children.

Prof Louw delivered her inaugural address on 3 November 2010. In the photo are Profs Wynand van der Merwe: Dean, Qui- nette Louw, Dr Therese Fish: Deputy Dean Community Service and Interaction; Profs Jimmy Volmink: Deputy Dean Research and Julian Smit: Vice-Rector Community Interaction and Personnel.

For all your Emergency medicine workshop needs the ECI is hosting the following workshops in 2011: MIMMS, HMIMMS, Wound Managment course, BLS, Aviation Medicine, EMSB, ACLS, ANLS, Advanced Airway Course, Ventila- tion workshop, FEC,PHPLS,ECG workshop, EM Radiology, Emer- gency Point of Care ultrasound, EM CME, Advanced Management course. Further enquiries and online bookings: Website: www.eci-sa.org

Tygerland 2010 39 Infection Prevention and Control New milestones on the road to he proliferation of nosoco- mial infections places a sub- Infection prevention and control can save money and count- stantial burden on patients less lives, says Prof Shaheen Mehtar, head of the SU and and health care systems Tygerberg Hospital Unit for Infection Prevention and Control. Tworldwide – so much so that infection prevention and control have become With new initiatives and partnerships, as well as new steriliza- a priority for hospitals and health au- tion equipment and facilities, the Unit is well set on the road thorities in all parts of the world and is now considered an independent sub- towards a safer hospital environment. speciality of health care sciences. In this regard, South Africa and the sub-continent are no exceptions support of the World Health Organisa- Hospital, but also for audits in Namibia – and the Academic Unit for Infection tion (WHO) and collaborating partners and Swaziland and it will also be used Prevention and Control (UIPC), estab- from other international organisations, for an upcoming IPC audit of health lished at Tygerberg Hospital and Stel- says Prof Shaheen Mehtar, who pio- facilities in Botswana. Recently, Mehtar lenbosch University in 2004, has been neered the SU/Tygerberg UIPC and be- and Marais provided support services playing a leading role in African efforts came the first elected chairperson of IP- for the improvement of IPC services in to tackle this problem head-on. CAN – the first organisation of its kind Swaziland, specifically in the context of Since its establishment, the Unit in Africa to receive WHO support.” HIV/Aids for health care facilities, with has achieved several infection preven- The organisation’s second confer- a focus on reducing the transmission tion and control (IPC) milestones with ence was organised by the SU Unit and and control of tuberculosis. measures specifically designed for low comprised a joint conference with the “For many years, hospitals and resource settings where IPC can save International Federation of Infection health institutions have thought of IPC lives and millions of rands every year. Control, which was held in 2010 at as a nursing procedure. Today it is glob- Spier near Stellenbosch. ally recognised as a very important New African Network discipline,” says Mehtar, who has just A major milestone that was reached Neighbouring countries completed a comprehensive textbook in 2008, was the establishment of the Locally, the UIPC has developed an IPC on infection prevention and control African Network for Infection Preven- model that seems to work well in Af- (see p 42). tion and Control (IPCAN), followed by rican settings, Mehtar says. “With Dr the Network’s first conference, held in Frederick Marais as project manager, Sterilization service Uganda in September this year, with the we have used the model at Tygerberg Another major IPC highlight at Tyger- berg Hospital has been the official opening of a new, multimillion-rand central sterile supply department (CSSD) in November last year. This R20 million upgrade of the sterilization unit is set to contribute to a dramatic improvement of infection control in the hospital. The new, state of the art infrastructure includes three imported washer disinfectors, 10 new sterilizers, new shelving, lockers and an air conditioning system that puts the unit on par with world class SSD’s. Pre- viously, the hospital’s outdated cleaning equipment was the subject of news- paper reports which highlighted the dangers of hospital infections and cross contamination. According to Mehtar, infection rates will be closely monitored to ensure that the unit is making a perceptible impact Prof Shaheen Mehtar and Mr Wayne Moses with new sterilization equipment in the on infection control in the hospital. CSSD. Since the establishment of the

40 Tygerland 2010 Infection Prevention and Control infection prevention and control

UIPC at Tygerberg Hospital, crude in- fection rates have dropped dramati- cally from 17% in 2006 to a sustained level of approximately five percent in 2008, Mehtar says. “Bringing hospital in- fections under control is an extremely costly exercise and the 12% drop rep- resents a savings equivalent of R15 to R30 million per annum”. Apart from continuously emphasis- ing simple infection prevention mea- sures such as the washing of hands and the appropriate wearing of protective clothing, Mehtar and her UIPC team have provided in-service training to about 800 hospital staff. Over the past few years, needle-stick injuries – which are of particular importance in the light of the HIV pandemic – have dropped from 35/40 per month to about 12 per month – the majority of which now occur in labour wards where sharps Prof Shaheen Mehtar (right) with Mr Wayne Moses, principal operator, at the autoclaves containers are not within easy reach as in the new CSSD in Tygerberg Hospital. they are in other wards in the hospital.

On the academic front On the academic front, the Unit’s two- ber of medical doctors on the course as hospital management, sterilization year postgraduate diploma course – has been greater than the number of and decontamination and others. At the first of its kind in Africa – has been nurses registered for the diploma. the same time, the Unit is implementing drawing a full complement of students “It is indeed a reflection of the qual- research projects in collaboration with since it was instituted in 2004. The Unit ity of training as well as the increasing PATH, the HSRC and the Copper De- will also introduce a postgraduate di- interest in IPC among doctors.” velopment Association Africa. Notable ploma in decontamination and ster- The Unit also provides extensive research projects in this regard have ilization, which will be presented by training courses in IPC for health care focused on hospital-acquired HIV/Aids experts from the United Kingdom. The workers and IPC specialist across the and tuberculosis and included success- postgraduate diploma (PIDC) is re- country and some neighbouring coun- ful investigations of copper touch sur- stricted to 16 students, some of them tries. All the short courses are accred- faces as an adjunct to IPC in order to from African countries, to ensure indi- ited by Stellenbosch University, carry reduce the transmission of bacteria in vidual attention. Since 2010 the num- CPD points and focus on subjects such health care settings. Prevention in a pouch n their endeavours to combat infection, staff at the Academic Unit for Infec- tion Prevention and Control (UIPC) designed a Survival Kit pouch, which Iwas launched at the Unit’s annual Infection Prevention Control day held on 2 November 2010. The pouch consists of a series of flash cards, containing valuable information about the core elements of Infection Prevention and Control, e.g. important telephone numbers for the management of infection, droplet precau- tions, airborne precautions, communicable disease containment and outbreak management, risk reduction, sharps injury protocol, hand hygiene, waste segrega- tion, transmission based precautions, and contact precautions. The pouch also has a handy bottle of alcohol rub and a pocket for personal belongings, e.g. a cell phone, staff cards and keys.

Tygerland 2010 41 Fakulteitsnuus

Understanding Infection Prevention and Control

"A good IPC programme is problably the single most cost effec- tive investment any government can make in health delivery", says Prof Shaheen Mehtar in the preface of her new book, Understanding Infection Prevention and Control.

PC plays a significant role in containing the spread of Key features of the book are: disease. Increased resistance to antimicrobials and the • Explains how effective risk management can reduce hos- Irapid spread of communicable diseases such as tubercu- pital stay and thereby reduce costs. losis, swine flu, SARS and avian flu have highlighted the need • Provides easy to follow information, simplifying the sub- for good IPC measures in both the healthcare setting and at ject of IPC. home. • Reflects recent evidence published on IPC especially in The text book is a comprehensive compendium of IPC hospital design and natural ventilation, giving the reader the processes that can be applied in all countries. The text em- most up-to-date, evidence-based information. braces the recent developments and recommendations in • Is comprehensive and covers everything necessary for a IPC from international authorities, such as the World Health postgraduate qualification in IPC, so that no other book is Organization. It is an ideal study and teaching tool, and will necessary. serve as a reference book for healthcare systems planners Prof Mehtar is an internationally recognized expert in the who wish to understand IPC and strengthen systems. The field of infection control. She currently heads the Unit for various sections of the book guide the reader through the Infection Prevention and Control at Tygerberg Hospital and origins of infection, transmission and the IPC risk assessment Stellenbosch University. The royalties from the book will to ensure that the principles are understood. Finally, IPC be donated to the Infection Prevention and Control Africa practices which will reduce, if not prevent, transmission are Network (IPCAN) of which she is a founder member and included. current chair. Kliniese Assistente laat US-vlag wapper in Kollege Eksamens

Dr Judith Kluge re- Die Douglas medalje Die Frank Doyle medal- Dr Trevor W. Parker Dr Alfonso Pecoraro ceived the Daubenton vir die hoogste punt je is toegeken aan Dr ontvang die J.M. Edel- achieved the highest Medal for outstanding in die 2010 finale eksa- Pieter Janse van Rens- stein medalje vir die marks in the May Fel- result in the College mens vir die Fellowship burg, wat die hoogste beste finale jaar stu- lowship of College of Obstetrics & Gyn- of the College of Sur- punte behaal het in die dent vir 2009 tydens Physicians (FCP) fi- aecology examination geons of South Africa is Finale Eksamen Deel A, die Kollege eksamen nal examinations and 2009 (CMSA). aan dr Stefan Hofmeyr van die Royal College of FC Orth(SA) Final. will receive a Col- toegeken. Radiologists (FRCR), Lon- lege Medal early next don, VK. year.

42 Tygerland 2010 Faculty news Clinical Nurse Practitioner’s Manual A collaborative milestone

n ew milestone in care administration. It provides the theory and the practi- transdisciplinary cal steps of routine skills as well as emergency care over a collaboration at full spectrum of primary care – from the newborn to the the SU FHS was elderly. It also looks at topical issues in the South African reached when the new SouthA African clinical nurse practi- context, including community-orientated primary care. tioner’s manual was launched at the Annual Academic Day Owing to the fact that clinical nurse practitioner train- in August. ing is becoming more formalised in all provinces, this manu- The manual, edited by Prof Bob Mash, Julia Blitz, Danine al forms an integral part of these training programmes, and Kitshoff and Susan Naudé, is a collaborative project involv- should prove invaluable to this field of nursing. ing both clinical nurse practitioners and family physicians. All royalties of the book will go the SA Academy of Family Physicians to further the education and training of family medicine/primary care practitioners. In the preface to the manual, the editors point out that South Africans, when they get sick and go to their local clinic, most often are seen by a clinical nurse practitioner. “Nurses and not doctors therefore form the vital inter- face between the general public and the health services. Clinical nurse practitioners are expected to take a history, examine and assess patients. They will treat many patients themselves and others will be referred to family physicians or district hospitals. Two of the editors of the new manual, Ms Danine Kitshoff and The South African Clinical Nurse Practitioner’s Manual Prof Bob Mash, at the launch of the new manual, with Prof Craig deals with aspects of clinical examination and common Househam, (2nd from the right) superintendent general of the procedures, as well as key proficiencies in areas of commu- Western Cape Health Department, and Prof Pierre de Villiers nication, occupational health, research, teaching and health (right), board member of the Academy of Family Physicians. New Lung Cancer treatment procedure esearchers at the Division transponder will provide radio oncolo- of Pulmonology are playing a gists with precise information about Rleading role in the first-ever the location of a lung tumor. Lung tu- clinical study to evaluate the use of mors move faster than any other tu- real-time localization technology for mors and are thus particularly difficult tracking lung cancer tumors during to treat using radiotherapy. The new radiation delivery. This international technology will improve outcomes of study is done in collaboration with Ca- radiation treatment and lower the inci- lypso Medical Technologies, Inc., based dence of side effects. titled “Diagnosis and Staging of Lung in the USA. The high standard and in- Cancer: State of the Art.” At the same ternational recognition of the research A lifetime achievement in time, the latest volume, no. 38, in his and clinical work being done within Pulmonology book series Progress in Respiratory Re- the Division of Pulmonology, and spe- Prof Bolliger’s achievements in the field search, was launched. The title of the cifically by Prof Chris Bolliger, led to of pulmonology received international volume is Paediatric bronchoscopy, pub- Stellenbosch University (SU) being se- recognition when he was awarded the lished by Karger. Prof Robert Gie and lected the preferred clinical site from Life-time Achievement Certificate for Dr Pierre Gousaard of the SU Depart- 20 international sites. his work in bronchology, broncho- ment of Paediatrics and Child Health The first implantation of the propri- esophagology and international pul- contributed an important chapter to etary anchored Beacon transponders in monology at the World Congress for the book. The book series has received a patient (first in man) was performed Bronchology, held in Budapest in June several international awards and is ar- by Prof Bolliger, Research Director of this year. Bolliger, of the SU Pulmon- guably one of the best of its kind glob- the Division of Pulmonology at the SU ology division, was invited to deliver ally. In the photo above is Bolliger with during the first week of October. The the honorary lecture at the congress, his award.

Tygerland 2010 43 Fakulteitsnuus PHYSIOTHERAPY Uitblinkers van die Fakulteit Verskeie akademici van die Fakulteit het in die loop van die jaar erkenning & gekry vir die bydraes wat hulle in hul onderskeie vakgebiede gelewer het. MOTION ANALYSIS CLINIC Nasionale toekenning vir Top internasionale toekenning Die Goue Akademiemedalje vir Uitnemendheid in Dr Bonginkosi Chiliza is vereer toe Natuurwetenskaplike Prestasie word Onderrig en Leer hy ingesluit is in die top 10 Rafaelsen toegeken vir hoogstaande werk van Prof Ben van Heer- Jong Navorsers in praktiese uitvinding (of toepassing) den het spesiale 2010, wat jaarliks en vernuf, gebaseer op wetenskaplike erkenning vir sy deur die Collegium en/of proefondervindelike grondslag. besondere bydrae Internationale Neuro- Lochner word nasionaal en internasio- tot onderrig en leer Psychopharmacolog- naal erken as ’n veteraan op die gebied ontvang, toe hy on- icum aangewys van mediese navorsing. Haar volgehoue langs gekies is vir word. Chiliza is ’n navorsingsbydraes oor meer as 45 jaar, ’n Higher Education senior psigiater en toon steeds ’n stygende kurwe. Die Learning and Teaching Association (HEL- senior dosent in toenemende sofistikasie en verfyning TASA) nasionale toekenning vir Uit- die Departement van haar en haar medewerkers se me- nemendheid in Onderrig en Leer. Hy Psigiatrie. Sy belangstellingsvelde op todiek, bemagtig haar om voort te gaan is die direkteur van die Sentrum vir die gebied van navorsing sluit in eerste om steeds op die internasionale toneel Gesondheidswetenskappe Onderrig by episode skisofrenie, veral faktore wat ’n betekenisvolle bydrae te lewer. die Fakulteit. uitkoms beïnvloed, psigofarmakologie, Die Havengaprys word jaarliks HELTASA, in samewerking met die en taaltoegang in geestesgesondheids- toegeken vir oorspronklike navorsing Hoër Onderwys Gehalte-komitee, dienste. Hy het voorheen gewerk as op natuurwetenskaplike en/of tegniese gee jaarliks toekennings aan akademici navorsingsgenoot in die Skisofrenie Na- gebied en Brink het vanjaar met die van Hoër Onderwysinstellings vir uit- vorsingseenheid op die projek genaamd, louere weggestap. Die nodige vereis- nemendheid in onderrig en leer. Van “A prospective study of clinical, biological tes by die beoordeling van kandidate Heerden is een van vier uit ’n totaal and functional aspects of outcome in first- is eerstens navorsingspublikasies en van 24 kandidate wat van regoor Suid- episode psychosis”. tweedens bewys van die bevordering Afrika gekies is. Chiliza het ’n aantal toekennings van Afrikaans. Ander prestasies in be- Die doelwitte van hierdie toeken- ontvang wat insluit die Hamilton Naki lang van die wetenskap word ook in ning is om ondersteuning te bied op Clinical Research Fellowship (2007), die aanmerking geneem. Die prys word nasionale vlak vir uitnemendheid in World Congress of Biological Psychiatry slegs een maal aan ’n bepaalde persoon onderrig en leer in hoër onderwys; om Travel Grant (2009), en die Schizophre- toegeken. Brink het oor die afgelope ’n raamwerk te ontwikkel van identifi- nia International Research Society Travel paar dekades aansienlike en unieke by- seerbare akademici wat bevoeg is om Award (2010). Hy was mede-outeur draes in sy navorsingsveld gelewer wat in onderrig in hulle dissiplines, instel- van ’n aantal eweknie artikels en is tans betekenisvol bygedra het tot die bevor- lings en areas leiding te neem; en om besig om die doktorsgraad te voltooi dering van die diagnose en behandeling bespreking en publieke bewusmaking onder toesig van prof Robin Emsley. van oorerflike hartsiektes. te genereer oor dit wat onderrig uitne- mendheid konstitueer. SA Akademie vir Discovery Foundation Fellowship Van Heerden het ’n intense belang- Wetenskap en Kuns Dr Amir Zarrabi of stelling in onderrig en leer ontwikkel Urology was re- toe hy in 2001 as hoof van die destydse cently awarded an Skool vir Geneeskunde aangestel is. academic fellowship Sy betrokkenheid by onderrig en leer from the Discovery sluit in aktiwiteite op voorgraadse en Foundation. nagraadse vlak, en aktiwiteite wat ver- This is one of The team: band hou met die Foundation for the only ten fellowships advancement of Medical Education and awarded countrywide to exceptional Research (FAIMER). Proff Amanda Lochner (links) van die registrars or recently qualified special- Hy is tans die voorsitter van die Biomediese Wetenskappe en Paul Brink ists who want to follow a career in aca- MB,ChB-programkomitee en program- (regs) van Geneeskunde is vereer met demic medicine in South Africa. koördineerder vir die MB,ChB en MPhil twee besondere toekennings deur die Recipients get the opportunity to in Gesondheidswetenskappe Onderwys Suid-Afrikaanse Akademie vir Weten- take on a 12 to 18-month period of programme. Hy is ook deur die Minis- skap en Kuns. Lochner het die Goue full-time study and research towards a ter van Gesondheid genomineer om op Akademie-medalje vir Natuurweten- Masters or doctoral degree to improve die Geneeskundige en Tandheelkundige skaplike Prestasie ontvang en Brink die training in a chosen field of specialisa- Beroepsraad van Suid-Afrika te dien. Havengaprys. tion.

44 Tygerland 2010 Sport Injuries PHYSIOTHERAPY neurologicalMuscle/joint/ problems & do you Postural mal-alignment MOTION ANALYSIS CLINIC sufferfrom? Pain

The new PHYSIOTHERAPY AND MOTION ANALYSIS CLINIC at Stellenbosch University, Tygerberg cam- pus, focuses on human performance and move- ment rehabilitation in adults and children. Our state of the art Vicon motion analysis system is the most sophisticated, cutting edge biome- chanical technology in Africa.

Services for adults we can and children of ALL ages: conduct PHYSIOTHERAPY an analysis Sports Injuries Post-operative rehabilita- of any tion A fully equipped functional / Performance enhancement Musculoskeletal disorders rehabilitation area, sport activity Neurological disorders virtual reality to: Respiratory disorders technology and MOTION ANALYSIS AND • Diagnose biomechanical REHABILITATION consultation rooms risk factors Movement disorders are also on site. (i.e. muscle imbalances) Injury prevention • Prevent injury Ergonomics • Rehabilitate using real Postural problems time biomechanical feed- back VIRTUAL REALITY • Enhance performance Pain management Movement disorders TheThe team team: consists of a highly skilled ContactTel: details 021 938 9667 multidisciplinary E-mail: group of: [email protected]. Address: • Sports/orthopaedic/ Division of Physiotherapy neurological/pediatric Faculty of Health Sciences physiotherapists Stellenbosch University • Biomechanists P O Box 19063, Tygerberg, 7505 Room 1006, First Floor, • Biomedical Engineers Teaching Block