Hello Dr Gwyther and thank you for agreeing to be interviewed. What brought you into the field of palliative care?
Well there were two main things: one was one of the inspirational women that I knew, Christine Dare. She was a physiotherapist who worked with Dame Cicely Saunders in London, but she was South African. She wanted to provide palliative care in South Africa, but Cicely Saunders told her: “You’ll never be heard unless you have a medical degree.” So Chris applied to do medicine at UCT. She was a mature student in my class and she was quite influential for me. When I was a general practitioner (GP) out in Vyeboom, a deep rural area of the Western Cape in South Africa, I had a patient with lung cancer and I went with her to St Luke’s Hospice in Cape Town to consult with Chris. It was then that I found out that Chris was actually looking for an assistant and wanted to employ me, but at that time they had no funds to do this.
The next thing was when I was a GP in Somerset West, and another inspirational woman called Pat Pigeon, a nursing sister, was starting a hospice. When they started the inpatient facility at Helderberg Hospice, Chris came to open it and I was asked if I would be the doctor supporting them.
So I started as a GP working at Helderberg Hospice and I suddenly realised that I didn’t know anything about end of life care and pain control; I was learning from the nursing staff. And then Pat Pigeon sent me to my first international conference in Penang, Malaysia, and I met another inspirational woman, Ilora Finlay.
I had heard about Baroness Finlay’s distance learning palliative medicine diploma, and so I applied to do the course which resulted in me becoming the first doctor in South Africa to be qualified in palliative medicine.
I realised that it was so important to bring this sort of knowledge to South Africa, and I said to Illora: “We need to teach this in South Africa, can I have the course to teach it at UCT?”
Why did you think it was so important to teach palliative care in South Africa?
I had felt that, as a hospice doctor, I didn’t have the knowledge and skills to treat my patients properly. When I was at a conference that St Luke’s Hospice held in Cape Town about 1998, I met lots of doctors who were saying the same thing, that they were doing pain control from books and learning what they could from the nursing staff.
When I finished my diploma in palliative medicine I said: “Never again, I don’t want to study any more!” Then the University of Cardiff contacted me and said that they were doing a Masters programme and I said: “I want to be on that programme.”
By then another inspirational lady called Kath Defilippi had asked me to join the Hospice Association of South Africa (HPCA) and she persuaded the board of directors to pay for my Master’s degree. The dissertation was on the need for palliative medicine education in South Africa.
But before I submitted my dissertation, we already had the course in Cape Town up and running, so we started the MPhil programme in 2001 and then I got my own MSc in 2003.
Baroness Finlay and Prof van Niekerk, who was Emeritus dean of the Faculty of Health Sciences at UCT, supported me in this. Baroness Finlay sent another of my inspirational ladies, Fiona Rawlinson, to South Africa to help me set up the course and Fiona came to South Africa twice a year for three years until the course was established.
You are currently writing your PhD in palliative care as a human right. Can you tell me why this topic?
I am trying to promote palliative care in a country where it is still a young discipline. I could see the need for an evidence base to demonstrate the need, to say: “You have to teach people palliative care”. I kept coming up with different topics to write on for my PhD, and then another inspirational woman in palliative care, Mary Callaway, sent out a call for somebody to write a paper, a monologue about palliative care as a human right. So I decided, instead of competing for that commission, that I would work with Frank Brennan, who had done a lot of work on palliative care as a human right already. So the two of us, along with Richard Harding, wrote the paper on palliative care as a human right. My PhD developed from that experience and also because I was able to enlist the head of the School of Public Health and Family Medicine, Professor Leslie London, who is a world renowned expert on health and human rights as my supervisor. After that I wrote an article on how to advance palliative care as a human right, to show people how to use the human rights approach to advance palliative care development.
So that is how I got into palliative care as a human right, and the more I work with different people internationally about the gaps in palliative care, the more I recognise the truth of that statement, that palliative care and pain relief are human rights. The UN report from the Special Rapporteur on torture made the statement that denial of pain relief is tantamount to torture, and I’ve just had so many examples of that recently to just highlight how important it is to make sure that people are comfortable and pain free.
Can I ask how you balance work and studies?
If you are looking at balancing work and studies, I’m not sure I do that very well. I try and do UCT work while I’m at UCT ad HPCA work while I’m there. So I suppose it is mainly blocking off time and time management. But because they are so interlinked, it doesn’t feel terrible if I am doing one when I should be doing the other. The other thing is that I really enjoy what I do – it just becomes part of my life.
Is there anything else that you would like to add?
Yes. I just think that there are so many inspirational people doing incredible work in palliative care worldwide. Just in the UK, you have Baroness Findlay, who I’ve mentioned already, Dame Barbara Monroe, and so many more. From Africa we have Faith Mwangi-Powell, Zippy Ali in Kenya… It is a shame to interview only a few people when there is so much important work being done by so many people in palliative care all over the world.