As an optometry student in Joburg I loved our clinic work. Especially the outlying clinics in Alexandra and Riverlea. I have never forgotten the man who ran Riverlea clinic, a jovial man who introduced himself with a huge smile as, “Gerald Durrell! You know, like the author who wrote My Family and Other Animals?” That was ca.1975. After I qualified the army sent me to work at Addington hospital in 1980, and I loved working under ophthalmology Prof Anne Peters, who sent us to all three of her outpatient clinics: Addington on the Durban beachfront (strictly white people only), King Edward in industrial Umbilo (less strictly black people only) and RK Khan in suburban Chatsworth (less strictly Indian people only).
I enjoyed the work, so stayed on for years as a volunteer at nearby Addington even after I entered private practice.
At Natal SAOA meetings I met a wonderful man Abdul Motala, who was quietly running a clinic in Umlazi, south of Durban – as well as doing some pro deo work in his practice in town. I joined his efforts and with my propensity to nod instead of shaking my head, got involved in running it and encouraging others to join us. ‘The more of us do it, the less often we’ll have to do it,’ was my recruitment schtick. We got a number of volunteers and that helped a lot. We could see more people. The main reasons for people dropping out were 1. Some were not happy using unfamiliar (and usually inferior to their own practice’s) equipment; and 2. Some were uneasy with driving to Umlazi.
We tried a number of approaches and after a few years of running Abdul’s clinic in Umlazi, we settled on one: Centralisation. Instead of trying to establish a clinic in each township, we moved the Umlazi clinic to near the main transport hub in the city centre. That way 1. People from all the townships had a better chance of getting to us; 2. Our volunteer optoms were closer to it, greatly reducing their traveling time; 3. We solved the problem of some colleagues feeling they could not drive into the townships for security reasons, so we got more volunteers; 4. We could hire permanent staff at the clinic; 5. We could buy better equipment as we were actually making money and only needed one set of equipment; 6. Our volunteers could see more people as our trained staff did pre-screening for them on the automated equipment;
At its smoothest the Durban clinic ran like a well-oiled machine with minimal input from us. The two ladies Marian Glenn and Margaret Radebe managed it really well. We would arrive and be handed a card, introduced to our first patient and we’d get going with a record card that already had on it: 1. The patient’s main reason for visiting the clinic (translated from isiZulu where necessary by Margaret); 2. An autorefraction result; 3. Non-contact tonometry pressures; 4. Half-PDs measured. All we had to was examine, refract and suggest a course of action. All post-examination work – referral, frame selection, dispensing, paying, ordering, etc was done by Marian and Margaret.
At the end of the session our optometrists were handed the exact cash to pay for their secure parking, so that was not a hassle or an expense. Marian even arranged with volunteers how many people they were comfortable seeing. Some optoms saw painfully few, but at least we knew beforehand to book them less people so we didn’t turn people away after they had waited and expected to be seen. Our peak volunteer numbers were when we managed to get Continued Professional Development CPD points allocated for indigent clinical volunteer work. That ended when people wanting to make money out of CPD got the HPCSA to end it, even though we allocated a meagre ONE point for a morning session helping the poor, for goodness’ sake! Over the years our HPCSA has been pretty consistent in doing the wrong thing. We had a drop in volunteers then, but kept going.
Later, as President of SAOA I was keen to expand the clinic work done in Durban to the rest of the country. I thought our model could work all over. Progress was slow, but we did open a number of “clinics.” Some though, were just in-practice, which our experience showed were not at all productive. No paying patient was going to be kept waiting for an indigent person, and they were often kept waiting way too long. I felt we had to do it properly, not “as a favour when we felt like it.” I was told a few times, ‘You don’t understand, our people are not like Natal people.’ (meaning no volunteers)!
Later came a new president – of a wannabe medical bent – derisive of refraction: “I could teach my dog to refract.” He was putting drops in people’s eyes and that excited him. Putting specs on their noses didn’t, even though it paid his bills. Later, when I asked him his views in front of other colleagues who I wanted to assess his approach, he dismissively said, “I could teach my wife to refract.” Interesting little fella. I can confidently say his years in practice did way less good than Abdul Motala’s! Over time our clinics dwindled. Some were usurped in seedy for-profit takeovers. Theft, really. Volunteer efforts need a champion to keep up momentum. Allan Marais’ Pinetown clinic sure had one, and he and Lily continued running it up to COVID, when I declined to go for the first time.
We received our fair share of criticism over the years for the way we did our clinic work. Eg: My guideline was let’s do what we can do to help TODAY. ‘Let us try to NOT say, “Go away; Try somewhere else.” So sometimes we gave a person with cataracts a pair of glasses and caught flack for doing so. We did the right thing. If a person had no specs and couldn’t see well and we could improve their vision TODAY, we did it in addition to referring them for a hospital consultation. The criticism that those specs would be useless after the op assumed that the op would actually take place. We did not assume that. Getting to the hospital for the initial consultation was a challenge, having money for transport was a challenge, long waiting times was a challenge, getting back to the hospital for the actual op was a challenge. Even if the op took place within six months after our appointment those specs could be a life-changing help in the meantime. Poverty has many MANY challenges. We tried to understand them and help directly wherever we could. ‘Sorry, go away’ is an easy and convenient response, but to see the disappointment and resignation in people’s faces . . . We would sometimes see people again a year after we had referred them to a hospital, still wanting help having NOT got to the hospital. It amused me (OK, pissed me off) that the people making criticisms were sometimes people who would not do a cataract operation for under R10 000 and WE were “making money” on our cheap specs! Humans! Greed! Cognitive bias! Tell me about it! And anyway, for those who thought we unpaid volunteers were greedily after our five bucks profit (which went to the clinic anyway!), all who did have an op soon after and returned to us would get a free post-op lens change to their frame, fgdsake!
One of my memorable days at a hospital clinic (there were many!) was in 1984 after I had returned from a month-long canoeing trip to the USA. As I walked in to Addington OPDB Anne Peters took one look at me and walked me down to her car in the basement parking garage and whisked me off to ENT Mike du Toit’s rooms at St Augustine Hospital. He whisked me straight into surgery (much whisking) and drained my frontal sinuses of ‘gallons’ of brown Colorado River water. After the op I remember a nurse pulling ‘miles’ of snotty brown bandage out of my nostrils. Mike’s re-alignment of my sinus drainage was so successful I have not had a day’s sinus block or hassle since! Not many surgeons can give a forty year warranty!
While still in the army Neville Welsh was the ophthalmology professor. He insisted we do his ward rounds on Saturday mornings which was cruel and unusual punishment to inflict on hungover soldiers. But we loved the rounds and always learnt something. One fine Saturday we stared in wonder at a worm in a patient’s anterior chamber. Fascinating to watch how the worm would peep his head out from behind the iris and when you switched on the slitlamp would jerk back as if to hide behind a curtain!
At King Edward hospital staff nurse Anita Lekalakala ran ‘her patients’ and ‘her doctors’ like a sergeant major. Full of confidence, was ‘Sr Lekalakala.’ I watched her march out of her office into the crowded waiting room carrying the next record card one day. She glanced down and a small smile appeared. Looking up she announced in her usual authoritative tone, ‘Grace Kelly! Would Grace Kelly come through, please.’ An old gogo struggled to her feet off the wooden bench, picked up her kierie and shuffled to the exam room. She was Mrs Grace Cele.
gogo – granma
kierie – walking stick