UCT in Africa
Great universities and great religions are among the most enduring of human institutions. The first medical school established in sub-Saharan Africa was at the University of Cape Town (UCT). However, the first on the African continent was in Cairo, established in 1827, followed by Algeria in 1879. By the end of the Second World War (WW2) there were 8 medical schools in Africa, 3 of which were in South Africa. Independence of African countries from colonial domination, starting in the 1950s, saw rapid growth of new home-grown medical schools on the continent. However, economic decline, dictatorships, kleptocracy and state interference in education compromised medical education standards elsewhere in Africa. Currently there are 160 medical schools in Africa1 and there is evidence of slowly improving standards with improved economic performance in Africa. UCT remains a leading Health Sciences Faculty on the continent. What caused the UCT Medical School to be established and to flourish? Several works on the history of the University, Medical School and medical history of South Africa document this in detail.2 This note serves to contextualise the Faculty’s 100th anniversary celebration.
Themes and memes
The first requirement to enable consideration of a new medical school was the accumulation of a critical mass of medical practitioners until there were sufficient to develop formal organisational structures. The South African Medical Association was established in 1883 and the first version of the South African Medical Journal appeared in 1884. Leaders in these organisations, especially Dr E Barnard Fuller,3 , 8 were responsible for the vision and drive to establish a new medical school. Undoubtedly Scottish education and of South Africans who graduated in medicine from the University of Edinburgh before the UCT Faculty was established, had considerable influence.
Cecil Rhodes, on whose estate the Faculty is located, and the philanthropy of Alfred Beit, his brother Otto and his partner Julius Wernher,3 , 8 significantly funded the University and the fledgling Faculty. Philanthropy helped support the early teaching hospitals. Notably the building of the Red Cross War Memorial Children’s Hospital was influenced by the vision and fundraising initiative of soldiers on their return from WW2. More recently this hospital has developed one of South Africa’s most successful fundraising campaigns. Many individuals and trusts currently support Faculty education and research. The early years and continuing well into the second half of the 20th century were characterised by the enormous influence and contributions of part-time medical staff (minimally paid) who were often heads of clinical ‘firms’. Their spirit of philanthropy also continues to be fostered among students through the ‘hidden curriculum’ of the student-run SHAWCO organisation.9
The massive worldwide impact made by the great educationist Abraham Flexner10 is not fully appreciated by historians of the University and Faculty. His educational survey of medical schools in the USA (Flexner Report, 1910) emphasised the scientific basis of medical education and of the importance of high standards of teaching, learning and medical practice. The early medical teachers at UCT were doubtless much influenced by this revolution in medical education. The early curricula that separated the basic sciences from the clinical years served their purpose well at the time. Later the educational concept was to produce an ‘undifferentiated iatroblast’ – a graduate fit to move in any direction upon graduation. Present educational initiatives aim to provide a more integrated curriculum and to protect students from a common teaching failure – information overload.11
Clinical service excellence is a hallmark of Faculty graduates making their mark elsewhere in the world. Apart from inspiring role models, the collaboration with the province through joint agreements and outstanding personal relationships profoundly influenced teaching, research and clinical service.12
A measure of the quality of a faculty is its research record. Since its early days research has been a notable feature of the measurable Faculty outputs.13 In today’s tough funding environment, where state and provincial support has shrunk, the Faculty has developed a vision with clear strategies to remain a major research contributor.14
The University (and Faculty) has a mixed record concerning racial issues, despite taking credit for opposing apartheid’s formalised racial impositions, such as separate educational institutions, and having taken the lead in desegregating healthcare services.5 , 6 Students, not classified white, were subject to humiliating experiences15 and established activist groups to oppose this.16 Feelings of discrimination based on language have also been expressed by Afrikaans-speaking colleagues.
The concept of ‘memes’ is about thoughts, beliefs and ideas that behave like genes in that they can be passed to future generations and evolve with changing circumstances in order to survive or flourish. The memes planted by the Faculty founders continue to flourish and adapt 100 years later.
J P de V van Niekerk
Dean Emeritus, Faculty of Health Sciences, University of Cape Town
Managing Editor, SAMJ
1. Foundation for Advancement of International Medical Education and Research (FAIMER). International Medical Education Dictionary. Philadelphia, USA: FAIMER, 2011. http://www.faimer.org/resources/imed.html (accessed 10 April 2012).
2. Burrows EB. A History of Medicine in South Africa. Cape Town: Balkema, 1958.
3. Louw JH. In the Shadow of Table Mountain. Cape Town: Balkema, 1968.
4. Kirsch R. The Forman years. Cape Town: UCT Press, 1984.
5. Kirsch R. UCT Medical School at 75. Cape Town: UCT Press, 1987.
6. Phillips H. UCT 1918 - 1948: The Formative Years. Cape Town: UCT Press, 1993.
7. Digby A, Phillips H. At the Heart of Healing: Groote Schuur Hospital. Cape Town: Jacana, 2008.
8. Dent DM, Perez G. The place and the person: Named buildings, rooms and places on the campus of the Faculty of Health Sciences, University of Cape Town. S Afr Med J 2012;102(6):396-399.
9. Favara DM, Mendelsohn SC. The Student’s Health and Welfare Centres Organisation (SHAWCO) of the University of Cape Town: A review of the past 69 years. S Afr Med J 2012;102(6):400-402.
10. Bonner TN. Iconoclast: Abraham Flexner and a life in learning. Johns Hopkins, 2002.
11. Hartman N, Kathard H, Perez G, et al. Health Sciences undergraduate education at the University of Cape Town: A story of transformation. S Afr Med J 2012;102(6):477-480.
12. Sanders H-R, Kane-Berman J. The University of Cape Town’s Medical Faculty and Groote Schuur Hospital. S Afr Med J 2012;102(6):394-395.
13. Saunders SJ. The contributions of the University of Cape Town to medical science in the first 100 years: Personal reflections. S Afr Med J 2012;102(6):391-393.
14. Hussey GD, Hawkridge A. The state and future of research at the University of Cape Town’s Faculty of Health Sciences. S Afr Med J 2012;102(6):412-414.
15. Perez AM, Ahmed N, London L. Racial discrimination: Experiences of black medical school alumni at the University of Cape Town, 1945 - 1994. S Afr Med J 2012;102(6):574-577.
16. Pick W, Claassen J, Le Grange C, Hussey G. Health activism in Cape Town: A case sudy of the Health Workers Society. S Afr Med J 2012;102(6):403-405.
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