Why so many of SA's doctors are killing themselves
The UCT medical dean's suicide has highlighted the depression epidemic in the medical profession. We look at the causes
Professor Bongani Mayosi, the University of Cape Town medical dean and world-renowned cardiologist who committed suicide on Friday, made it is his life’s work to eliminate rheumatic heart disease in Africa.
Much of his focus was in the public sector and helping the poor, which many who paid tribute to him admired. But while doctors shared their pain at his loss, some have called for a renewed look at problems facing doctors who have a high rate suicide due to the stress of their jobs.
National Department of Health director general Precious Matsoso said of Mayosi: “He wanted rheumatic heart disease reduced in Africa in his lifetime. It was a passion to solve this problem. He was a servant of the people.”Rheumatic disease is caused by an untreated strep throat infection in early life, which is easily cured with a single dose of penicillin and is thus entirely preventable. The prolonged infection weakens children’s heart valves, but the symptoms of heart disease usually only develop about 20 years after the child has the sore throat.
About 330,000 adults worldwide die each from rheumatic heart disease every year, with numbers having barely decreased since 1990.
Mayosi campaigned for the disease to be prevented across the continent.
“Children living in informal settlements and impoverished communities with poor access to healthcare are therefore most at risk,” said Mayosi. “Yet it can be treated with penicillin.”
He was also co–heading a large international trial using a common blood-thinning medication, to see whether it helped adults with rheumatic heart disease. The trial started in 2016. For the past 20 years Mayosi had followed a family, many of whose young members had heart attacks at young ages with no risk factors such as high blood pressure or smoking.A few years ago he teamed up with Italian and UCT geneticists who sequenced these youngsters’ genome. This led to discovery of a genetic mutation that leads to heart attacks in otherwise healthy young adults.
However, Mayosi started the work long before genome sequencing was accessible and speedy.
His colleague, Medical Research Council head Glenda Gray, said: “The untimely death of Bongani is heart-wrenching. I met Bongani about a decade ago. He made a huge impression on me: his love for clinical research and capacity development, coupled with an innate intellect, quickly propelled him into being a science leader in clinical medicine and cardiology.
“He always inspired me and gave me hope for the future of clinical research in South Africa. Over our coffee meetings in Cape Town we would dream about a future for clinical research in South Africa and how we could conspire to make this realisable.”
She said the plan was for Mayosi to take over from her at the council: “He would have been spectacular as the head of the Medical Research Council.”Gray said Mayosi had not liked being medical dean, a position that became more stressful as universities navigated #FeesMustFall protests and funding challenges.
Doctor and former UCT medical student Geoff Modise said: “It’s no coincidence that cardiology is one the most popular disciplines among UCT medics. Professor Mayosi was a light and symbol of excellence. He made young black students believe that excellence was attainable.”
UCT professor and hepatalogist Mark Sonderup said of his colleague: “Words defy one with the gravity of the shock and loss we all feel deeply and painfully. I had the pleasure of having worked for Bongani in the department of medicine from his inception as head in 2006 until his resignation to take up the deanship of the faculty in 2016.
“Simply put, Bongani was one of a kind and had the quality of gravitas – not only because of his achievements in the scientific and academic world, but in his very nature. You simply respected him. He cared deeply for the public healthcare sector of our country.”
‘Don't hide it, share it’
As people in the medical world reeled from shock, some called for more doctors to be honest about depression and the conditions doctors face, including long work hours, a lack of support, and making daily decisions about life and death.
Fellow world-recognised scientist Professor Quarraisha Karim, from the University of KwaZulu-Natal, praised Moyasi’s family, including his wife, UCT dermatology professor Nonhlanhla Khumalo, for speaking openly about his suicide.
“I applaud his family for putting the spotlight on the devastating impact of depression. Hamba Kahle, Bongani!”Intensive care doctor Professor Guy Richards, who heads the critical care department at the University of the Witwatersrand, said he lost one his fellows (a qualified specialist doctor studying to qualify in a sub-specialty) in December last year to suicide. He urged doctors to be open about facing mental illness.
“I appeal to those among us, doctors, who are suffering from depression, not to hide it but to share. We lost one of our fellows last year. It was completely unexpected and also completely devastating.”
Medical doctor Jonathan Witt, who was friends with the fellow doctor who took his life, said: “I don’t quite know how to emphasise the scale of this epidemic among doctors. Personally, I know of three medical specialists who have taken their own lives in the past nine months.
“Besides the loss to their families, the death of a medical practitioner is a tragedy for entire communities.
“The medical fraternity has a major mental illness and suicide problem which is constantly ignored in lieu of working ridiculous hours, taking abuse as routine and dealing with life-and-death decisions daily. As such, too many doctors resort to self-damaging behaviour and, far too often, suicide.
“Many of my colleagues are coming to work with a fake but convincing smile on their faces, while suffering through crippling depression. Those in a position to advocate for change must do so urgently.”
He added that medicine didn’t cause mental illness, but stress exacerbated it. “I implore my colleagues to take this seriously.Witt said it affected junior doctors too. “It’s not just those at the top of their game either. Interns, medical officers and registrars are just as vulnerable. When I led the Medical Students’ Council at Wits our survey data showed that as many as 60% of medical students took one kind of psychiatric medication or another.”
The SA Depression and Anxiety Group runs a helpline for medical students, set up after a Wits medical student committed suicide last year. Call 0800 323 323, or to talk to a counsellor use the emergency helpline on 0800 567 567.