Caring for his terminally-ill godmother in an underserved retirement home on the Cape Flats as an intern and helping his late Anglican lay-minister father give communion there as a child were seminal influences for internal medicine physician Dr Denzil Schietekat.
Dr Denzil Schietekat in 2019 received a Discovery Foundation Sub-Specialist Award for training in Geriatrics. He says that since primary school, in the neighbourhood of Hanover Park, he was drawn to elderly people’s wisdom, intelligence and sense of humour. “In my high-school years, there was also an old guy who lived a few streets away who drank heavily but was extremely witty. I loved cooking and these old people gave me the best recipes, delivering more wisdom and insight than I got from my peers,” he says.
The youngest of four children, Dr Schietekat’s upbringing in the 3 km square, low-income suburb of about 50 000 people, known for its gang warfare and strong community ties, was strict but fair. His father packaged and delivered dental clinic supplies while his mother was retrenched from a chandelier-making factory when Denzil was in Grade 7.
“We all had domestic home duties, but at least my mom was home and encouraged my reading and home work,” he says.
A warm-hearted, selfless community
He remembers working on maths and science formulae while watching the short-running TV hospital drama Gideon’s Crossing and walking to the library with his books hidden in a plastic supermarket bag to avoid gang members accosting him and tearing out pages.
“I guess I was what you’d call a cool nerd. I soon learned to do my reading and research in the library,” he laughs. Yet, instead of nudging the Schietekat family’s sole university graduate out of his harsh environment, the dominant experience of the warm-hearted, selfless community pulled him back.
Dr Schietekat is married to a final-year teaching student and they have two daughters ages five and 11. Living just two kilometres from Hanover Park, they have dreams of starting a properly equipped and well-staffed retirement home in their community.
“My dream is to give our old people what they’ve never really had – proper care and facilities. Already we distribute adult nappies and food parcels in the area, but the need is so much greater,” he observes.
His drive and passion were tinged with a poignant sadness. Denzil had just lost his father to smoking-induced chronic obstructive pulmonary disease (COPD). “Like many older people, he didn’t complain. He had a roaring chest infection and he never told anyone about it. I realised this when listening to his chest during a visit. It just shows how vigilant you need to be with older people. You have to constantly probe and listen,” he says.
Strong academic influence
Coming from an Afrikaans-speaking community, a few dedicated Stellenbosch clinicians influenced his studies in internal medicine and his intention to research and study geriatric neurology.
“Actually, even at school, two Afrikaans-speaking teachers gave me a hard time and pushed me. When I questioned them, they said they could see my potential,” he recalls.
Dr Schietekat says he worked briefly with “the amazingly dedicated and energetic” former Head of Geriatrics at Tygerberg Hospital, Dr Christiana Bouwens. “She helped the penny drop for me that geriatrics was what I wanted to do.”
Adversity was, once again, what got him into internal medicine after obtaining his MBChB at Stellenbosch University. “I failed my FCP Part I [Fellowship of the College of Physicians of South Africa] twice. Repeatedly studying all that physiology and neuroscience helped me fall in love with it. I wanted to understand it all better,” he says.
He became fascinated with the different presentations of dementia and neurodegenerative disease in older patients. Dr Schietekat’s teacher and mentor, Professor Marc Combrinck, a neurologist and Head of the Division of Geriatric Medicine at the University of Cape Town, finally swayed him.
In his opinion, the lack of focus on geriatrics at undergraduate level means many primary healthcare physicians could be mismanaging elderly patients. Where he comes from and further afield, regular doctor visits to the retirement home are a luxury few enjoy. “I was speaking to my wife the other day. We need to make geriatric care popular. I want to become an advocate, perhaps starting by writing a handbook for healthcare staff on how to examine an elderly person,” he says.
Looking ahead to neuroscience
“I want to get involved in geriatric neuroscience as a post-graduate research project. Basically, I want to pursue an academic career with clinical, teaching and research work.”
With people worldwide living longer, geriatric medicine has become a highly regarded discipline in first world countries. South Africa, however, lags some distance behind. Dr Schietekat says the specialty is neglected and marginalised locally, in spite of an ageing HIV population and the potential collision of HIV-associated neurodegenerative disease, age-associated vascular dementia and Alzheimer’s disease. He cites statistics showing life expectancy at age 55 to be increasing in South Africa, with a population of some two million men and 3.5 million women over the age of 60, predicted by the year 2025.
“That’s going to put further strain on social security and pension systems and push up demand for healthcare, especially by older patients with chronic diseases – and the need for long-term care facilities,” he concludes passionately.
About the Discovery Foundation
Each year, the Discovery Foundation gives five different awards to outstanding individual and institutional awardees in the public healthcare sector.
The Discovery Foundation is an independent trust with a clear focus to strengthen the healthcare system by making sure that more people have access to specialised healthcare services.
Since 2006, the Discovery Foundation has invested more than R230 million in training and support for more than 400 medical specialists and institutions. The grants support academic research and clinical science, sub-specialist training, rural medicine as well as programmes to develop public healthcare resources. For 2019, Discovery Foundation awarded 42 grants to medical specialists working in South Africa’s healthcare sector to the value of R27 million.
Helping students from rural KwaZulu-Natal qualify as healthcare professionals is about more than providing scholarships. At Umthombo, dedicated mentors empower students to overcome challenges, build resilience and take care of their mental health.
In 2018, Discovery volunteers taught 60 learners from Aha Thuto Secondary School in Orange Farm how to solve problems using design thinking. This year, Discovery visited 10 learners who had come up with innovative solutions to address food security.
Dr Vishesh Sood, a final-year radiology registrar working at the Red Cross Children’s War Memorial Hospital in Cape Town, received a Discovery Foundation Award to investigate the value of using an abdominal ultrasound to diagnose TB in children.