Dr Lisa Joy Africa, An Artist in Medicine

Dr Lisa Africa’s journey into medicine was guided by her artistic sensibilities and her fascination with the intricate wonders of the human body. Today, she is a healer and a visual artist who seamlessly integrates her artistic ability and her medical expertise to empower and educate her patients. In this episode of Awakening Doctor we sat down to talk about her experiences as a young doctor working in South Africa’s public healthcare sector.

Lisa shares openly about what it’s like to be an ‘outlier’ in the profession and offers her unique perspective on the intersection between art, science and healing. She also speaks with unflinching candour about her personal encounters with racism, sexism, sexual harassment and abuse of power in the workplace, and the myriad of social, relational and academic pressures she has faced. The personal and emotional toll of bearing witness to the darker side of the human experience on a daily basis is evident throughout.

It’s a conversation filled with raw truths, deep insights and sobering reflections on the limitations of humanity. It’s also a challenging confrontation with the harsh realities faced by many of our young doctors during their community service years and beyond.

Come prepared for an encounter with the unembellished truths that shape not only the lives of our aspiring doctors but also the reality of the world we live in.

Please note:

If you or someone you know needs counselling or support to deal with trauma, violence, sexual assault, substance abuse or mental health concerns, please contact one of the following resources in South Africa for assistance: https://www.gov.za/faq/justice-and-crime-prevention/where-can-i-find-organisation-offers-assistance-victims-violence

Chapters

• 0:00 Introductions
• 8:18 Reflections on Medicine, Art, and Healing
• 22:22 Challenges and Stereotypes in Medicine
• 26:13 Gender Dynamics in Medicine
• 30:46 Healers and Relationships
• 40:58 Privilege and Racism
• 48:54 Changing Perspectives Through Conversations
• 57:10 The Power of Art in Medicine
• 1:03:26 The Complexities of Being a Doctor
• 1:08:55 Medical School and Graduate Attributes Reflections
• 1:15:33 Closure and acknowledgements

Transcript

Lisa Africa Guest 00:00

I love the human body. Just trying to draw it. And also, just, people are so interesting. There's so many dimensions. 

00:07

I thought medicine would be the connect between the art of having to see it {the body} and study it all the way down to the cells and also get to experience it. I have to deal with patients. I have to deal with people. It's a lot more complicated than that. Now, actually, being a doctor, having to see sick people and dying people every single day of my life, it's actually a very difficult space. It's quite beautiful as well to see, this is what the body does. This is what it does when it's sick. This is what it looks like when it's healthy. This is what humans have created to try and help this. They've actually studied different things and they've come up with this chemical that can somehow work with the human biology and kind of help restore it. I kind of find that it's all art. You have the Louvre. You get these artists that come and they touch up the paintings. They've studied the colours and the textures. Art fades over time, so they come and they touch it up. I guess it's kind of like that, being a doctor. 

Maria Christodoulou Host 01:12

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real life challenges of those who carry the title, responsibility and privilege of being a doctor. 

My guest today is Dr Lisa Africa. Lisa is currently working as a Medical Officer at Groote Schuur Hospital in Cape Town in the Western Cape, in South Africa. Lisa and I met many years ago when she was a first-year medical student.

Also in the room with us is Amy Kaye, writer and narrative coach, and the producer and editor of the Awakening Doctor podcast.

I'm very excited to get Lisa to share some of her story with us today. Thank you, Lisa, for being here. 

Lisa Africa Guest 02:06

Hi Maria, it's really nice to see you after so long. 

Maria Christodoulou Host 02:09

Yes, it has been a long time. I was trying to remember, it was probably when you were in your sixth year. I still remember us sitting outside in the quad there at Tygerberg, at the cafeteria, and talking about what you were going to do next with your internship. Some financial person had come and told you all about car loans and you were thinking of buying a car. 

Lisa Africa Guest 02:29

I wish that someone explained to me properly about adulting at that time, because I just jumped into it and I have no idea what I'm doing, still. 

Maria Christodoulou Host 02:38

I do remember thinking then that before you'd even earned your first paycheck, people were trying to convince you to hand it over because they were like, you just have to give us your first salary slip and then you can get a car.

Lisa Africa Guest 02:50

Internship was so much fun. I was finally working and learning new things and earning a salary. 

Maria Christodoulou Host 02:58

You did it at Mitchell's Plain District Hospital?

Lisa Africa Guest 03:01

Yes, it was incredible and I couldn't actually decide which specialty I liked. It was so much fun in every department. Completely different personalities as well. So I think when deciding I had to kind of decide, what personalities can I work with? Like, surgeons are completely different, but very strong personalities, and they generally do think that surgeons are God's gift to mankind. 

Maria Christodoulou Host 03:22

I remember there was a time when I think you had just done your first surgery block and you were really excited about surgery. In fact, you were thinking that maybe you'd want to become a surgeon one day. 

Lisa Africa Guest 03:33

I enjoyed surgery so much because it's quite practical and you use your hands. When I was an intern, every time we opened up the abdomen, oh my gosh, like the bowels are moving and I'd just be completely involved every single time. But besides the personalities, it was when I had to assist at like 3 o'clock in the morning and I'm half asleep. Like, this is not safe for anyone. How are you cutting and going into someone's body at this time? No, this is not okay. 

Maria Christodoulou Host 04:02

The crazy thing is that it's often the young doctors that are the ones cutting, the less experienced doctors that are the ones in theatre at 3 in the morning. 

Lisa Africa Guest 04:11

Exactly! It's very interesting. Maybe if I could stay awake at that time. Maybe there are people that are able to think and have their hands work and everything. I did internal medicine at Mitchell's Plain and I absolutely loved it. I completely fell in love with just touching and listening and like, figuring out stuff. A lot of people didn't expect me to do internal medicine because it's quite academic and I'm quite the artsy kid, but I found it very beautiful. My consultants at Mitchell's Plain were very supportive and they kept on telling me, you think like a physician did you want to do internal medicine? 

04:47

I didn't think of internal medicine because in final year of med school it was the only thing I failed. It was the only thing you failed? Interesting. Last exam on the last day and I just didn't sleep the entire week. I was just taking Ritalin every day. Terrible. This is literally the story of being a med student in hell week. Everyone's just popping Ritalin, not sleeping, studying throughout the night. And the morning of my exam I just had a panic attack and I couldn't think. With internal medicine they used to do this thing where you had a certain amount of exams according to your marks. If you were average, you'd get one exam and then, if you were almost 75% or you were already cumming, you'd get two exams, and then if you were failing, they'd give you a C. So I had two exams at the time because I think I had 70 for internal medicine. The first exam, I went into the room and I just couldn't think. I remember it was a neuro case, some spinal thing, and I just couldn't think. 

05:50

I was in the room with the patient and I said nothing to the patient the entire time. The time was done, the examiner came in and I just couldn't say anything and I cried. And then, now I had another two exams and then I told them I can't do the exams. So that was my first rewrite in my entire duration of med school. Actually, the first time I failed anything besides my driver's in my life. 

Maria Christodoulou Host 06:16

So how was that for you? 

Lisa Africa Guest 06:17

Horrible. It was the last exam and people were getting their results in the next week and saying they're doctor's now. I wasn't getting it. 

06:24

I still had another two weeks before I wrote the rewrite. It was just quite a very bad experience. But if I think about it, it wasn't actually my fault. It was just a really bad decision. How do you expect people to have all of their exams in one week and still be functional? The Ritalin also didn't help with the anxiety and all of that, but I know that now. But it was kind of like a quick fix. 

Maria Christodoulou Host 06:47

Where were you getting the Ritalin? 

Lisa Africa Guest 06:49

Oh gosh, there was this one girl that was in res. She had ADHD but she did not want to take her meds and she wanted to sell them. So she supplied the whole of the res with her actual prescription medications. Like if I speak to a lot of other doctors, this is how most people got through their final exams - with Ritalin. I completely hate that stuff now. 

Maria Christodoulou Host 07:14

So if we step back a little bit and I say to you, who is Lisa Africa, what would you say? 

Lisa Africa Guest 07:20

I've been thinking a lot about who I am over the past two years since I've come back from Comm Serv. Trying to figure out who I am as a doctor, who I am as an artist. It also took me quite a while to acknowledge that I am an artist because it was something that growing up, okay, you're good at painting, you're good at drawing, but you can't do that. And you can't do that because it's not a career, you're not going to get anywhere with it. And I think also in coloured communities or even black communities, going into the arts is not encouraged at all. If you were smart in high school, or if you got A's, there were certain careers that you were - I wouldn't say, forced into. I don't think I was forced into medicine. I really loved biology at school. Biology and art was my two absolute favourite subjects. 

Maria Christodoulou Host 08:08

So let's talk about the art, because in a way, the journey began there. I remember you telling me that it was Frank Netter's anatomy books that took you to medical school. 

Lisa Africa Guest 08:18

I love the human body. Just trying to draw it. And also, just, people are so interesting. There's so many dimensions. I thought medicine would be the connect between the art of me having to see it and study it all the way down to the cells and also get to experience that I have to deal with patients. I have to deal with people. It's a lot more complicated than that. Now, actually being a doctor, having to see sick people and dying people every single day of my life, it's actually a very difficult space. I know it's quite beautiful as well to see, this is what the body does. This is what it does when it's sick. This is what it looks like when it's healthy. This is what humans have created to try and help this. They've actually studied different things and they've come up with this chemical that can somehow work with the human biology and kind of help restore it. And I kind of find that it's all art. You have the Louvre. You get these artists that come and they touch up the paintings. They've studied the colours and the textures. The art fades over time, so they come and they touch it up. 

09:29

I guess it's kind of like that, being a doctor. The one thing that I've realised is that I'm a healer. I do feel like that's my calling. I've also realised that Western medicine, it's interesting and it's got its beauty to it. There's so many facets, there's so many dimensions. People are not 2D at all. So that's why I've decided to continue with my art, continue painting. I've actually started doing live painting shows with a jazz band in my spare time, which I also think is a form of healing. I love watching the colours appear on the canvas. So when people, they've told me, they find it so therapeutic to watch me. 

10:15

Being an MO at Groote Schuur has been hectic. Not only am I trying to figure out what's going on, there's students and interns that I have to teach now. I'm currently working in C15 and I absolutely hate that place. Firstly, it's emergency medicine and that's not what I want to do, but we have to rotate there. So UCT kind of has this nice programme. It's like a pre-registrar programme for the MOs, so you rotate with the registrars until there's a post, which is quite nice. 

10:41

It's just quite an intense environment. It's literally within every two hours or so there's a resus. There's people screaming and it's chaotic. And everyone that works in C15, they're all either med reg's or they're medical MOs, then there are EM reg's as well. So the medicine people are miserable because no one wants to do emergency medicine. So it's always a weird environment. No one really speaks to each other. No one's happy. Then it becomes a strange kind of competition about how many patients you see in a shift. People gossip about how long someone else took a break. It's a very, very toxic working environment. When I had to come back, because I did Mitchell's Plain - which was lovely - for the first few months of the year, because it was going back home. Now I was coming back as a senior, and the registrar that was my reg on internal medicine was now a consultant at Mitchell's Plain. It was really nice. 

Maria Christodoulou Host 11:38

And then you went for two years to Natal to do your community service? 

Lisa Africa Guest 11:43

CommServe was a whole other traumatic experience. Oh my gosh. So I did CommServe at Madadeni in KZN. After internship, I was quite excited to leave. I haven't seen the rest of South Africa. So Madadeni is this small rural township in northern KZN. KZN is beautiful, it's green. One thing about CommServe, I'm grateful that I got to see it because everything else is kind of close, besides Cape Town. So when I was in KZN, I would drive on a weekend to Mpumalanga. I would just drive up and it was maybe about a five-hour drive every time. 

12:21

In Madadeni I worked in the District Hospital. There I spent, I think, six months in the TB and HIV unit. That was a very interesting experience because everyone came in stage four HIV because the surrounding places were all about four or five hours away so no one could ever really get to the hospital. I'm not sure how big the population was that we served, but it was big. The patients would kind of stay with me for a really, really long time. I was the only doctor in the ward. There was another senior medical officer that kind of ran the TB and HIV unit. A sweet old man. He was also a pastor, so he would always give me lessons in the morning. 

13:04

The patients that I had in the ward, I'd get quite attached to them. A lot of them were young women. So, it would be a young girl. Now she's got HIV, aged 16, 17. Her boyfriend would be 40, but he would also have a whole bunch of other girlfriends. When it was visiting hours I'd have to leave the ward because I'd get so mad. How on earth is this even..? And the most interesting thing is, sometimes the girls would ask me, can we please get discharged? They're so worried that their boyfriends would cheat. That was horrible. And most of them didn't leave my ward because they died. All of the complications. 

Maria Christodoulou Host 13:46

Sjoe, Lisa. So here you are, all of what, 24 years old, when most of your peers who are not in medicine are just maybe starting careers or still partying or still studying, and you're working in an HIV/ TB ward where young women are dying. How do you make sense of that? 

Lisa Africa Guest 14:06

I have no idea. This is why I'm saying, CommServe felt like it was my coming of age story. I really saw what was going on in South Africa. In the world, I guess, and I was by myself. I was now in a completely different place. I couldn't understand isiZulu. I actually got a tutor. I had this tutor in Joburg and she was teaching me. The nurses as well were trying to help. I didn't have my family. 

Lisa Africa Guest 14:33

So it was a completely new space. My male patients were very interesting. A lot of them were prisoners, so they'd come with the guards. They were very proud of telling me what they were going to prison for. I had this one patient, I actually liked him a lot. 

14:50

He had a very interesting personality, but the guards were incredibly scared of him so they would go and buy him whatever he wanted. I was quite in contact with the court all the time because they had to ask me, is he okay? I remember I managed to get a drain for him because he had an empyema, so I asked him the one day, why is everyone so scared of you? What's going on? No, he killed 83 people. 

15:13

I was like, oh! What he told me was, you're really good at your job, I'm also very good at my job. I felt quite surprised that I really liked his personality because it was quite, I wouldn't say, arrogant, but confident. 

Amy Kaye Other 15:30

You have to be if you're killing that many people. You've got to know what you're doing. You've got to believe in yourself that you can kill that many people. If you were a killer, wouldn't you be confident? 

Lisa Africa Guest 15:40

He was some sort of hitman. People were hiring him. No one ever told me properly. So that was the TB and HIV ward. While I was still there I would sometimes do kumbiku (?). It's a psych ward, but it was, oh my gosh, the most inhumane ward that I've ever seen in my entire life. The psych patients, they would come in and they'd get sedated in casualty and they'd be in that ward for a week. Not seen, just given sedation for the entire duration. 

16:10

But I don't think that this person ever went to the ward ever, because I found a TB meningitis. I found epilepsy postictal patients there. They weren't actual psych patients, they were just getting sedated. So this ward was the 72-hour ward. So before they actually go to the psych area, which was in another part of the hospital, the patients would be there for months and they would have no forms done. The nurses didn't even know who the patients were. There was complete chaos. They called it the detox ward. People just laying in faeces and urine and just sedated and no one actually noticed that they were sick and not psychotic. 

Maria Christodoulou Host 16:50

Sounds like something out of a horror story. 

Lisa Africa Guest 16:52

I discharged so many people. Please go home. I spoke to the families. He's probably got schizophrenia, but I'm not even going to send him to that side because that's even worse. And then I did two months of Thutuzela. So Thutuzela is the rape crisis center. They've got Thutuzela's all over South Africa and that was also just, what on earth is happening in this world? I think I saw mostly children. I was doing at least three rape kits on babies. How is this even.. now I'm going to start crying. I remember there was this one family that came in and it was.. I remember this story because it was just so fucked up. It was a mom, a grandma and two children. A five-year-old, and a three-year-old, and an eleven-month-old. And they all came in. So the woman's ex-boyfriend, the current guy that she was with was not the father of the children. Neither was this other guy. So this guy killed her boyfriend and he raped everyone. Sorry, this is actually the first time I've ever spoken about CommServe. Proper horrific stories. 

Maria Christodoulou Host 18:03

What's it like to talk about it now? 

Lisa Africa Guest 18:05

I'm feeling like a bit emotional. I've been meaning to go to a therapist. I just haven't had the time. Just started, you know, just coming back from CommServe. Had the rush of trying to find a permanent job. Had a bond to pay, a car to pay and life stuff. 

Maria Christodoulou Host 18:22

So what makes you keep going? What makes it possible to get up every day and go back to work, especially in that kind of setting? 

Lisa Africa Guest 18:29

During CommServe what kept me sane was driving. You won't even believe how much petrol I used to use. During CommServe I had like a rural allowance but I spent it all on petrol. So even after work, if I was having a terrible day, I'd drive out two hours and go to another town and there was quite beautiful places to see. I remember going to Dundee. There's a lot of historical places around there. That was what kept me sane. I'd go out and see the mountains and then I'd be able to come back in the morning and deal again. During weekends I'd drive to Nelspruit or Graskop. I loved Mpumalanga. I actually fell in love with it when I was in KZN so I kept on driving there. It was a five-hour drive. It's actually what fueled me. Just seeing life's beauty and then coming back and dealing with the opposite. Life's full of that duality. So the balance in me was quite important. I really needed to do that. 

Maria Christodoulou Host 19:29

Were you painting in that time? 

Lisa Africa Guest 19:31

There was a few that I started there. Like this one I started when I was in KZN and this one that I've never been able to finish. So she actually was one of my patients and I just kept on like adding cheeks, because she just - I kept on adding meat to her face. I was thinking about what she would look like if she had to be healthy and survive. 

Maria Christodoulou Host 19:54

Do you want to talk about the tears? 

Lisa Africa Guest 19:57

No, it's just that I haven't been able to finish her. 

Maria Christodoulou Host 20:01

What happened to her? 

Lisa Africa Guest 20:02

She passed away from TB because she was like a naughty child. She kept on coming back and not taking her TB treatment. She was an alcoholic so she'd go on benders, and then she came back with MDR. She was lovely though. I used to enjoy speaking to her. Very funny and fun. 

Maria Christodoulou Host 20:21

So I'm aware that this conversation is making you relive some of those moments. What's that like? 

Lisa Africa Guest 20:27

It's quite interesting that I'd almost forgotten. There was another person that was at Madadeni that I knew from med school. Strangely enough, we couldn't be around each other when we were together. The conversations were always so dark. So although I had like someone that I knew, we were just always, I would say suicidal, that's actually probably the best way to describe it. 

Maria Christodoulou Host 20:50

That's the honest way to describe it. 

Lisa Africa Guest 20:53

So we stayed away from each other. Quite strange. We're quite close now. He went on the ships. Even he struggled quite a lot coming back. He's a musician. He makes the most beautiful music. He stayed in the town. I stayed in the township. I just thought it'd be interesting to be part of the community that I was working in. We'd have these little sessions where he'd write some music, he'd add his keyboard with, and I'd come and paint. We were just so sad. It was incredible. 

Lisa Africa Guest 21:25

Even coming back, for a while, I was like, I can't see him. He messaged me the other day and he said, remember that time in casualty where there was this netball team that had pseudo-seizures. Like, an entire netball team. I can't remember that at all. Lisa, you were there. There's so many things about that place that I just can't remember. And he was telling me he felt like there were times he was speaking to me, I was completely dissociated. I was not there. 

Maria Christodoulou Host 21:50

So the theme of depression and psychiatry and suicide was a recurring theme in our conversations over the many years of medical school. Not so much that it was you personally being depressed but, I think it was in your second year, one of your classmates tried to commit suicide and then established a suicide support group. 

Lisa Africa Guest  22:10

A friend of mine, when he committed suicide in his final year, it was Propofol. He actually put up a bag. He was on anaesthetics, so he stole some and put up a bag in his res room. Doctors are not well. After work, I do not see doctors. Like, all of my friends outside of work are all artists and creators. I can't. It becomes trauma bonding rather than actual friendships or relationships. 

Maria Christodoulou Host 22:36

What do you think it is about doctors, about the profession, that makes it harder for us to actually support each other through these things? Why aren't we talking to each other, telling these stories in a way that is healing? 

Lisa Africa Guest 22:48

Now that I'm in an academic space again, it's a lot of ego and a lot of, I'm strong, I know so much. People seem to act like they're not human. To try and impress the professor, people are always spitting academia like, this publication, this article I read, but they forget that there's a person there and they've interacted with that person. That interaction was besides just you diagnosing something and giving medication. That takes a toll on you. This is a sick person. Sick people are sick for a lot of reasons. There's the society that they come from. It's how the world is working at the moment 

23:29

It's a lot of negative energy and that comes on to the doctor. I don't care how smart you are, you're still going to feel that. Most doctors have such unhealthy coping mechanisms. A lot of my friends from med school, they are cocaine addicts. Alcohol, no one wants to admit that they're alcoholics, but they are alcoholics. Drinking two bottles of wine after work. You are an alcoholic. I think people will just develop these really weird addictions instead of actually dealing and actually speaking to each other about what they're facing. 

24:02

Sometimes I wish that I could have conversations with doctors where they speak to me about how an interaction with a patient actually impacted them. If it made them happy, like this patient told them this really funny story and it made them laugh or the story really affected them. But it just becomes about this clinical science that's not just that. I'm a lot better at detaching than I was as an intern, and I think CommServe also kind of forced me to detach. But I don't think that detaching completely would make me a good doctor. I think it would make me even worse. Make me a terrible doctor. 

24:42

I started thinking about healing being multifaceted. When I prepare for work in the morning, I actually put on all these different essential oils. Today, this is the kind of vibe that I want to give off to my patients. I'll actually really think about the colours that I'm wearing, because there's the visual aspect to it too. So when I'm going into the sick person they're having aromatherapy. Plus, they're seeing something visual. I'll have, like, dangly things on my ears and colourful scrubs. So it's not only just this ugly place, this ugly wall that they're seeing, and other people screaming and in pain. So that's another thing that I've kind of been... I love that. It's beautiful. I'm enjoying preparing to go to work. 

Maria Christodoulou Host 25:19

You once told me about a doctor who was a role model for you. I think it was in our early conversations about what had brought you to medical school, and there was a doctor, a paediatrician, I think. 

Lisa Africa Guest 25:30

Paediatricians are nice people, because most of the time their patients can't speak to them. They are a lot more patient. I have these boxes of different specialties in my head. 

Maria Christodoulou Host 25:39

Not just you. I think it's kind of a phenomenon in the profession. We all have these descriptions for the different specialties and there's an assumption that paediatricians are soft and gentle and kind and surgeons are arrogant and aloof. I mean we can stereotype all of them. 

Lisa Africa Guest 25:55

The problem is I've seen only outliers, like you will be, oh, that's a nice surgeon, you know what I mean? As though that's unusual. Yeah exactly. So like, even now in C15, then I see it even more so, being a female doctor. 

Maria Christodoulou Host 26:11

Yes, let's talk about that. 

Lisa Africa Guest 26:13

This is something that's been making me so angry, especially being in casualty. 

26:18

I'm trying to refer to the departments. Please do not flirt with me, and I'm not going to flirt back, for you to accept my patient. What on earth? This is something that really frustrates me. As it should. I feel like everyone is flirting with me all the time. We exchange numbers because I have to send patient stickers or I have to send something. Hey, what time does your shift end? Can I take you out for coffee? I was showing a friend of mine the other day. On my phone. It would be GSH with, whatever department, doctor so-and-so, and I just go through my phone. Just look at all these messages. Am I supposed to go and report to HR every single time? This is tiring. I've done that before. It doesn't even do anything. It just makes you look like you are full of shit. 

Maria Christodoulou Host 27:02

And if you confront them directly, then next time you call them up to take a patient, you're going to have a problem. 

Lisa Africa Guest 27:06

I had this problem. So there was this one guy, a surgeon actually. He kept on flirting with me. He asked me out for a drink and I kept on saying no. And then one day I saw him outside of work. He was sitting with a friend and he stopped me and I spoke to him, because I knew him from work, and then he commented on my pants. Then I lost it at him. It was in the middle of the street. I was literally walking by and I told him I'm sick and tired of you doing this. 

27:32

You're making it so uncomfortable for me at work. It's just weird, man. Please leave me alone. Then his response to me was, oh, you're feisty for an intern. So, is this what you do to the interns? I was so angry. Then, referring (patients) to him after this interaction was hell. Then he wanted a CT, then he wanted 5 million bloods. But, this is your job now, I've stabilised the patient. 

Maria Christodoulou Host 27:57

I'm sorry Lisa.

Amy Kaye Other 27:58

That's amazing, the mirroring, because having worked in radio I had almost the exact same experience as you in terms of, it's very male-dominated. Radio personalities, so narcissists central. So, it's almost like surgeons, I guess, in the same kind of way, think that they are God's gift, and I was getting sexually harassed by pretty much all the hosts.

I basically left the radio station because I didn't feel safe, and because I had gone to HR and management and said, I'm getting panic attacks. I don't want to be alone in the studio with these people. This is making me feel very uncomfortable. And my manager said to me, well, what did you expect? You're young and pretty. So do you want the job or don't you? That was the response by management and I just thought, I can't do this anymore. It's amazing that to be a young female in pretty much any sector... forget about it. Somebody, at one point, he put his hands on me in front of everybody else and I didn't lose it, but I got aggressive in terms of, get your hands off me. I'm not doing this. And then their response again was like, oh, you're very feisty aren't you? And you just think... They see it as a compliment. Bizarre. 

Maria Christodoulou Host 29:04

And what's interesting for me in medicine is that we can't actually say that it's male-dominated anymore. It's not male-dominated. There's more female medical students in many situations than male medical students. It's much more equal than it would have been, certainly, when I was a medical student. In some years I think we had like 75% female students, so sexism is a cultural norm. It's not just about the profession. 

Lisa Africa Guest 29:30

In the hospital, I still think it's quite male-dominated. 

Maria Christodoulou Host 29:33

I actually pulled out some of the notes I had made in our earlier conversations. When you first came to medical school, you thought you might want to be a paediatrician one day, but you weren't sure. 

29:42

And then you went through the surgical rotation and you got really excited about surgery and you said to me, I would love to go into surgery but the one thing that put me off a bit is all of the female surgeons are not married and don't have children. I still want a family and I don't know how one does that. And you said there was one surgeon, a consultant, who was pregnant and people were saying she's the only surgeon in history that's pregnant. 

Lisa Africa Guest 30:10

I remember that surgeon and she kept on being pregnant. There's also something about being a healer and attracting broken men, which is a whole other story. Raising kids in this world is scary, so I don't know if that's even a goal anymore. I was thinking about freezing my eggs. It's so expensive, though. Maybe later on. I've got like about 5 years left of good eggs. 

 Maria Christodoulou Host

 Do you feel it as a pressure?

 Lisa Africa Guest

 I don't feel the pressure of it, but it is something that I'm thinking about. 

Maria Christodoulou Host 30:46

Do you want to say more about the connection between being a healer and attracting broken men? 

Lisa Africa Guest

I don’t know if you remember my boyfriend in med school?

Maria Christodoulou Host 30:53

I do. I wasn't sure if we could go there.

Lisa Africa Guest 31:02

He was the first one. It just ended terribly. I don’t know why men also, once you break up with them, they don't understand that's what it means. People were coming to my parent’s house, or like following me around.

 Maria Christodoulou Host

 You had to get a restraining order at one stage. 

Lisa Africa Guest 31:16

Yeah, I didn’t actually go through with it. I didn't want him to have like anything terrible on his name. Also to have a chance of still changing. 

 Maria Christodoulou Host

 So you were still protecting him, despite the dramatic impact he had on your life.

 Lisa Africa Guest

 That’s why when I started saying it, I was like, I know what I’m saying now. 

 Maria Christodoulou Host 31:31

Where do you think that comes from, that need to protect the men in our lives? I've been guilty of it too. 

Lisa Africa Guest 31:37

I think just growing up that's generally what the women in the family do. The men behave terribly. Nothing would ever really be said, but we would kind of catch on things, you know, from conversations with the aunties that I wasn't supposed to be hearing, and I always felt like women were always protecting their husbands or covering up or making excuses. 

Amy Kaye Other 31:58

I think also being a female, being a healer, there's also that bordering on the line of co-dependency. There's that narcissist empath dance. Also, as an empath and as a healer, and as somebody who really cares about people very deeply, of course all the broken men are going to be, oh, my angel, and you're going to be like, well, I’m here to save you and you’re going to save me and we can save each other in our brokenness, and it’s a beautiful dance. He takes and you give and everybody does that lovely toxic dance of co-dependency. That thing that you said, Maria, about, but why are you still protecting him? Because if you're somebody who feels that deeply for other people, how could you not? 

32:37

And it's that thing of, protect myself first? That's against everything I feel, believe. That's like the complete opposite of who I am as a person. My whole thing is about healing, protecting, giving, that Earth mother energy. So the thought of going, these are my boundaries and get the hell away from me, and you've hurt me and I need to protect myself, just feels like you're doing something very, very wrong. And because the person is, I mean, I'm just assuming, they're going to completely manipulate you and make you feel like, how dare you, how dare you abuse me, abandon me? It's really, really hard. 

Maria Christodoulou Host 33:15

I do think there's a strong element of it that is conditioning about who women are supposed to be. So when you say that it’s who we are, I don't think that it's in the nature of the feminine who is caring and empathetic and nurturing to be a doormat. I think that's the conditioned perspective on women. And so, if you're a nice woman, if you're a good woman, then you are caring and empathetic and you're not feisty and you don't set boundaries and you don't say no and you accommodate. And I think it's so deeply internalized that actually the misogyny isn't coming from men anymore. We’re doing it to ourselves.

Amy Kaye Other 33:52

Well, I think also because there's a lack of support. And I think because, if you do stand up for yourself, or you're outspoken, or you are quote unquote feisty, or put in boundaries and go, you don't speak to me like that, you don't do that to me.. you’re supposed to be able to go to HR or management and say this is harassment, you’re supposed to be standing up for me and they go, please. So, if nobody is ever in your corner or backing you up in these situations, eventually, like I did in radio, you just give up and you go, I don't have the fight in me anymore. I'm going to lose. It's a very lonely battle to be empowered and to stand up for yourself knowing that nobody's going to stand in your corner and you're going to be alone again, the outlier, going, this is not cool, if everybody else goes, what did you expect? These are the rules. 

Maria Christodoulou Host 34:37

And these are the unspoken rules, and yet these are the rules we experience. I also remember conversations about bullying at university and about not just the sexism but the racism. Do you want to talk about that? 

Lisa Africa Guest 34:50

I do feel the racism in the hospital. I had a student when I was at Mitchell’s Plain and she… Initially, I just thought that she was rude. I haven't been thinking about racism as much, since university. I know it's there, but I have to stop myself from getting angry at every single microaggression that there is, because there's a lot of them. We were an MO/MO run firm and then we had fourth years and sixth years in the firm. There were two fourth years, these two white girls, both of them very interesting personalities. The one, she had ADHD issues, so she was all over the place, but her clinical partner was the rude one. So the other MO with me, he was a Dutch guy, and then I had one white male as an intern and one black female as an intern. So this student, she would talk down on me and then I watched her interact with my partner, the Dutch guy. He gets good mornings and please and thank-you’s. 

35:47

And then I watched her interact with the interns. She would go to the white male and she would completely ignore the black girl. Now I'm starting to notice it and I'm trying to convince myself almost that it's not that. Then we were on call and I went to her and I asked her why did she skip… because the patients come on this system and so you can see patients that are referred to Internal Medicine… Why are these patients skipped on the list, like they've been referred to us before these other patients? And she said. she doesn't speak isiXhosa. Okay, so there's a lot of people that do speak it. A lot of the times the patients do understand a bit of English, so you try and speak to them. And there’s nurses around, and you've got some of your colleagues that are able to speak isiXhosa, so you can ask, and she gave me such attitude about it. Okay, maybe it is the language thing. I had this patient with a peripheral neuropathy, I remember, and he had a vitamin B12 deficiency. 

36:43

She saw this patient, then she tells me, I've read up enough about that. Thanks. So she gets a needle stick (injury) and she goes to the Infectious Disease clinic to get her bloods done. The doctor there calls me and he is extremely condescending. The doctor that I work with is also a coloured guy. The nurses started complaining about it. My diagnosis was correct and I really wanted to give her the benefits of the doubt. And then I spoke to the UCT co-ordinator about it, and that was a very awkward conversation. The UCT coordinator basically told her that it doesn't matter what your background is. You're going to have to see black patients and you're going to have to receive teaching from black doctors, and I could not believe that this was the conversation that we were having. She's young. She was fourth year. She's like this tiny little cute person. 

Maria Christodoulou Host 37:33

So what do you tell yourself about why that happens, why that's okay, why people make that okay? What's it like to be living on the receiving end of that? 

Lisa Africa Guest 37:39

It made me extremely worried, because she's young. I would think that people are a lot more progressive now and people are not as progressive as they pretend to be. It's just her personality that makes her unable to hide stuff. I think she has some sort of personality thing going on, but how many of my white colleagues are looking at me the same way that she looks at me without saying it, or being as blind? She's just a student. The UCT environment is a lot more sneaky and people gossip. So recently they've had new registrars, but I think they must have had some sort of quota. They took in a lot of black females who were not from here or they were from other universities and there was a lot of gossiping and, oh, this person's incompetent and they just got the job because they’re black. I also feel, because I'm coloured, white people tend to gossip to me about black people as if I'm not feeling the same pain that they're feeling. 

38:43

Being coloured in South Africa is really strange. It's kind of like no place. No one really understands, because we don’t even understand it ourselves. It's like a complete history that was lost. Racism in the workplace is very subtle, but it's there. 

Maria Christodoulou Host 38:56

It sounds like it's not just very subtle. 

Lisa Africa Guest 38:58

I feel when I was a student at Stellenbosch, this is now me making very broad boxes, but I feel like Afrikaans white people, I kind of felt like I knew where I stood with them. But now it's very weird. Sneaky. Gossiping. I’ve become very observant. I don't speak much, I've just been watching. It's kind of difficult to know who sees the world the way you do and who is trying to understand it the way you’re trying to understand it. Besides just being a doctor, there's a lot of things to navigate. 

Maria Christodoulou Host 39:31

A lot of things in our society that aren't about being a doctor but that dramatically impact your experience of being a doctor. I'm very aware, as you're talking, so listeners can't see us, but we're sitting in your apartment in what is essentially both your living area and your studio, and Lisa is sitting on the floor surrounded by her paintings, and there is such aliveness in those paintings. There's vibrancy, there's a woman juxtaposed with a lion's face. I see you and then I see the portrait of your patient that you haven't finished, and then I see this dual person in this painting on the right over here and the woman with a cigarette over there, and it's almost like there's this colourful, vibrant, wild, passionate story. And then there's your lived experience as a human being. 

40:25

What's it like for you to be sitting here now sharing these things with two white women and talking about the ongoing racism, sexism? We could easily identify with the sexism. Amy brought out her examples and I could tell you lots of my own, but I'm very aware, as a white bystander, kind of sitting here, of my own prejudice that was embedded very deeply from when I was very young and then my empathy for your story. But I have no idea what it's like to be a young black woman in the world. It's an academic understanding, if anything. 

Lisa Africa Guest 40:58

My experience in KZN also made me realise how privileged I am as a coloured person. I don't like the term coloured because it was a term during apartheid that was used to divide and conquer, and coloured… just because they had white heritage they were treated a little bit better. So I don't like the term very much. That's why I prefer to say that I'm a black woman, because what you see, my skin is brown and my experiences are pretty much the same, but also not the same, and it took me going to CommServe and living in a township to completely understand that the way I grew up was much better than what I was seeing and it also made me appreciate my colleagues and my friends that I've made in university, made at work, that came from these backgrounds as well. Wow, that's incredible. I've actually come from so much privilege as well. My family's from Mitchell's Plain, but I grew up basically in Kuilsriver. So my parents didn't want me to be around my cousins that were still in the hood. I actually lost one of my cousins to gang wars. He got shot. I have that background. I'm also seeing what's happening in other places and with black people of this country, so I do acknowledge my privilege and, speaking to you guys, I went through a phase where I was very angry at white people. 

42:21

I went to a coloured primary school. Everyone was coloured, my teachers were all coloured, my family's coloured. I only saw coloured people. Then I went to a high school. I got a bursary and I went to a private girl’s school and that was also quite a weird experience for me, because now suddenly I'm feeling my skin colour. That's weird. My parents never told me that I'd go to a place and I'd be treated like I'm stupid all the time. University was even more interesting. I got some training on how to navigate the racism from high school and also how to interact with white people, I guess, because it's completely different. 

42:57

There is cultural differences. University, I think I became angry. There was all that Fees Must Fall and Open Stellenbosch. I don't know if I ever spoke to you about it in our interviews. You know I was protesting a little bit. 

Maria Christodoulou Host 43:09

I think we did talk about it the year that Fees Must Fall was happening, because you were in a leadership role. 

Lisa Africa Guest 43:15

I was in the TSR at the time. 

Maria Christodoulou Host 43:17

That's the Tygerberg Student Council. 

Lisa Africa Guest 43:19

I think since university and coming into the workspace and I told you, I tried to train myself not to get as angry at the microaggressions anymore. The patients are calling me Sister. I'm not going to correct you. I'm not going to correct 50 people in one day. It's fine. It's tiring.

Maria Christodoulou Host 43:37

What do you think would happen if you allowed yourself to get really angry? 

Lisa Africa Guest 43:44

Like lose it at someone? 

Maria Christodoulou Host 43:47

Whatever that means for you. 

Lisa Africa Guest 43:49

It's.. Completely losing yourself in anger in a public space is not good at all and I genuinely try and avoid it. I’m not confrontational at all. I was telling you that story about the surgeon at the coffee shop. That was abnormal for me. Usually, I just walk away. I'm not dealing. With regards to racism, I've never gotten as angry and I think if I had to lose it, it would be quite bad because it would have been years of playing nice and smiling and..

 Maria Christodoulou Host

Generations of playing nice and smiling.

 Lisa Africa Guest

 So it would be quite bad. 

Maria Christodoulou Host 44:25

So one of the ways that I sometimes like to think about these things that maybe feels a little bit less charged in terms of how society looks at it, is our profession. So as doctors, we have a lot of privilege, and we all have the stories and I know you do too, of the family pride that you're going to be a doctor and everybody being impressed that you're going to be a doctor, and the labels and the stories and the associations that people have about doctors. More and more not such good ones, but there is always an assumption of privilege and there is privilege. From employability to salary scales, to the perceptions that society has of who we are. And then there's the patient dynamic, and it's kind of like the white-black dynamic. The patient is in a position of deference to us. We have power over their lives, we have power over their health. They're scared to antagonize us. I see so many coaching clients who are angry at their doctors, but are too scared to give voice to that anger because it may have repercussions, or because the care that they need will be denied them. And then, as a doctor, I have spent most of my life actually feeling frustrated and disempowered rather than privileged and having all this power. As a patient, I have been so frustrated with the incompetence of my colleagues, the ineptitude in terms of their mannerism at the bedside or... 

45:47

I remember going for a thyroid ultrasound and I'd been to see a radiologist. In fact, I went for the thyroid ultrasound and you know how it is when the radiographer spends a long time on one area and kind of looks concerned but won't say anything to you. And then when I said, so are you seeing something, is there a problem with my ultrasound? I'm a doctor, you can tell me. And she said, the Doctor will be with you shortly. And then she called the radiologist and I still remember he walked into the room. He was a very big, very tall man and for those who can't see us, I'm quite small. He didn't even introduce himself. He sat down at the side of the bed and he picked up the device and he started looking at my thyroid on the screen and he said, how long have you known about this nodule? And I said about three months. And you waited this long to come, can you not see? It’s clearly malignant. Look at the microcalcifications and look how vascular it is. And I remember lying there.. One, in a state of shock. This was news to me. I didn't know all of this. Turned out it wasn't malignant, but he wanted to stick a needle in it right away. I didn't even know this man's name and I had the presence of mind, because of all the work I've done over many years with patients, to say, just stop right there, buddy. I want to see the report, I want to look at the scan, I want to take it to a doctor that I know and trust and I will decide. 

47:03

Most patients would not have the power to do that. When you talk about, if you allowed yourself to get really angry about race, it would look not pretty. I totally get from this other perspective, how dangerous it could be to get really angry when you're in the presence of somebody powerful, but also, from the other side, as a person who has privilege, how powerful it can be when I can say stop right there, dude. That's not okay. And I think that's what white people are not doing enough. We see these interactions, we get told about these interactions, but we're not calling each other out. It shouldn't be your job to call people out for that behaviour. You can set boundaries to protect yourself, for sure, but we're not doing the work of changing that. 

47:45

And to kind of stay with the theme of awakening doctor, for me, part of awakening is about awakening to our privilege, drawing on our experiences of oppression, those of us who've had oppression, and sexism is its own kind of oppression, classism, language, and so many different things... To understand how we can use our power to change things. And so, if we keep the conversation about doctors, the more we tell these kinds of stories of what it's actually like to be a doctor and the more we allow ourselves to admit that we are human beings, that we make mistakes, that we don't have all the answers, that healing is complicated, we struggle, that racism, sexism is endemic in our profession and in the world that we live in. Perhaps we can start being part of the solution. I don't know how we change this. 

Lisa Africa Guest 48:35

When I think about it, it makes me a little bit sad. There's so many things that I'm seeing now. What do I do with this information? How do you change it? The problem is so big. 

Amy Kaye Other 48:45

I think we change it and it might come across as naive, but I think we change it by having these conversations. Every conversation that we've had, with all the people that we've spoken to... Every time I'm going, I'm sure it'll be an interesting conversation, but I'm not expecting anything. I'm not expecting to have my mind blown. I'm a very cynical person. I mean, really, I work with trauma daily. I work with people's stories and stuff that they've been through. 

49:08

In these conversations, at the end of them I’m going, what doors are being opened that, just with three people in a room, and then they get listened to by 100 people, 1000 people. That's how you do it. By having these conversations the possibility of more minds and hearts and doors being opened. That's exciting and that's powerful. And just, somebody's going to hear this conversation that really needs to hear this conversation, and it's going to change them and they're going to go, I'm not the only one going through this, I can do something about this. And they're going to have a conversation and it's that beautiful ripple effect that happens. That's how you change it. Just by having the conversations that nobody's having because where is the space to do this? How do you start these conversations? Because there's so many levels and so many layers and it's so complex. 

Maria Christodoulou Host 49:55

How many people are willing to share as bravely and as honestly as Lisa has done today, and as some of our other guests have spoken about their real-life experience? I know, even for myself, that there are aspects of my story that I'm scared to tell because I wonder what people will think of me as a doctor if they know that part of my story. I'm wondering what it's been like for you, this is now our fifth conversation, to get this perspective on doctors? 

Amy Kaye Other 50:23

Like I said, it's absolutely mind blowing. I didn't know that I had preconceptions and prejudice about doctors. Oh, apparently, I really do. Apparently, and I'm somebody who really doesn't like to stereotype people. I mean, even when you mentioned the thing about like, here are two white women, and part of me was, Maria, be careful. Be careful what box you put me in because I'm all about helping people take off masks and being authentic and vulnerable and I've had, unfortunately, very bad experiences with doctors on a whole bunch of levels. 

50:55

And then you think, okay, well, I know who doctors are. And then you start having these conversations and it's just, oh no wait, they're humans too. I've been wanting to say it for like an hour already. Now I suppose is the time. What's been amazing about every conversation that we've had so far. I don't know if it's because it's you, Maria, or because you've picked people. I don't know if you had the intention going in that you were going to have these kind of conversations, because you can't really plan this. You don't know where it's going to go. You can ask very deep questions, but if people aren't prepared to go there, they're not going to go there. They have to feel safe to. 

51:23

But what's been incredible, like you were saying about this room, is besides the paintings, the plants, the life, the colour. I just see you as this incredible alchemist, because you have experienced such darkness at such a young age. Obviously, I've never been to you as a patient, but in terms of you have this ability to turn darkness into light. That's what you do, that's your gift as a healer and as an artist. It's the same thing. I think healers and artists, there's that relationship. That's why you can connect to musicians and artists and creatives - by taking the darkest parts of humanity and turning it into something beautiful. That's what it is and I'm so grateful that you're working in the hospital because, thank God there's somebody like you for the patients that have been dealing with these racist, sexist, shut down, toxic people. So, thank you. 

52:15

Your story is incredible and I know you're going to do amazing things and I can't imagine how lonely it must have been. I mean, especially when you mentioned earlier in the conversation… You said this is the first time you're ever telling these stories. My thought was, why was there nobody to talk to? Wasn't there a family member? Wasn't there a friend? Wasn't there somebody that you could have said… Not the fact that you went through one horrific thing. It was years of horrific traumas, over and over and over again. The only thing you could do was get in your car and drive for five hours. I mean, okay, a great coping mechanism, but where was that human element? Where was that one person that you could have gone, I don't know how to deal with this, I don't know how to process this? 

Lisa Africa Guest 52:57

I always feel like darkness is something that I don't want to pass on. I don't want to now leave someone else to think about all these dark things, and it's not fair. 

Maria Christodoulou Host 53:08

I also think it's hard for people who are not in the profession. Some of the stories are horrifying and I do think Lisa's right. We leave people traumatised. We sit around dining room tables and then we start with these macabre stories and people are left like reeling sometimes, and I think in a way, socially, that's how we make sense of some of the bad experiences. But many of them, back then for me, I mean, I'm not doing that kind of work anymore. It was almost like, if I opened that door to tell those stories - and Amy will smile at this because she knows I've been trying to write about some of those stories – I don't know if I'm ever going to be able to close that door again. 

53:44

There's so much grief, pain, shock, stuff I had to process as a very young person that I didn't know what to do with and I didn't have the coping mechanisms to deal with them. If they’d sat me around a table with a whole lot of my medical student friends and said, let's talk about it. I don't know if I would have been able to. I didn't know what to do with these stories. And then I think today what often happens is, if I say anything in certain situations about what it's really like to be a doctor, people dismiss it because of the narrative of who doctors are. Oh, come on you. You’ve got so much privilege. I can't argue because that is true. It’s..AND there's this other side of me that's very human and very vulnerable, and as confused as everybody else and as unsure about the diagnosis I'm making as anybody else, and terrified that I'm going to make a mistake and someone's going to die. 

Lisa Africa Guest 54:34

What I really like about Internal Medicine is that I've got a little bit more time with my patients. I remember seeing this one patient. I was examining him. This is what I like about it. I can take long, I can listen and I can feel and look for things. And when I was done he was like, Doc, what are you thinking? Okay, I can try and draw you a picture. So I drew him a picture of the heart and I was showing him what was happening and then I drew like a little picture of the lines and like how everything was going back. He was like, wow, okay, I didn't expect you to do that, to draw a whole diagram. But it helped me so much to put it onto paper and to explain to him and then explain what the medication is going to do, and it started becoming a thing that I did when I spoke to my patients. Like, I’d draw them little diagrams. 

55:20

Look here. This is what's happening, this is what the medication is doing. So when the families came, I would do exactly the same thing, so everyone could understand. Now you understand what's happening with your body. You understand what I'm thinking and what I'm trying to do. At the same time, you’re not like my textbook. Everyone's anatomy and their physiology is different, but this works for this percentage of people and it could possibly work for you. 

Maria Christodoulou Host 55:45

I love that. I feel like you're also teaching people about their bodies and teaching anatomy as you draw. 

Lisa Africa Guest 55:50

I started to have fun with medicine. Otherwise it would be really dark and ugly for me as well. Now with emergency medicine, I get very overwhelmed. I actually get like a mini panic attack every time someone comes in unresponsive. I can't think for like a second. I have to touch something and be like okay, I'm here, look at the monitors Lisa. Think. Okay, now I have to start CPR. I have to do this, I have to do that. This part I'm finding a lot harder because I feel anxiety creeps in. It gets even more difficult to think when you are anxious. Now I need to ask the nurses for things and I need to ask my colleagues for help, but I don't know what help I need. I have to think quite quickly, otherwise this person is going to die. That part about emergency medicine I really don't like. I can’t wait to get done with this rotation.

Amy Kaye Other 56:39

I think the thing that you mentioned about being nervous in the emergency ward.. As a - do I call myself a patient, somebody who's not a doctor - because we're obviously very scared too. I think the feeling is always, or the question in my mind is always, do you care? Do you care what happens to me? Do you see me as a human and do you care what happens to me? And if you can just bring across that feeling to the person, as in like, I'm here and I've got you, the minute you give that sense of assurance or safety or support, that'll help you calm down. That'll help them calm down. 

Maria Christodoulou Host 57:10

And I think that, you know, the piece you mentioned, Amy, about, if the patient just knows that you care and that you’re here, and I've got you.. In an emergency situation that's often so difficult because you don't know if you've got them. You often have no clue what's going on, but you've got to appear as though you do in order to create the safety. To lessen the panic on the patient's behalf. But often internally - and that's where I think the detachment and the dissociation starts happening - you have to present in a certain way to give that feeling of safety, but internally often, I haven’t got a fucking clue what's going on here, and then you have to breathe and pace yourself and start with the ABCs and kind of do what you need to do. But it's hard to both convey that feeling of, I've got you, I know what to do, and figure out what to do at the same time. 

Amy Kaye Other 57:59

I think it's completely different, obviously in an emergency, because the stakes are so much higher. Even the timing is completely different. You don't have as much time as you want. It's happening right now. Of course you'd be having a mini panic attack because the energy of the situation is, you’re  thrown into the deep end. Figure it out. Now. 

Maria Christodoulou Host 58:17

And I think some personality types are better suited to that than others. I think one of the things about medicine is that there's so many options in terms of what you can do with the qualification. I’m loving the artistic way that you talk about Internal Medicine. Often Internal Medicine is kind of viewed as the, ugh, you’re dealing with older people. It's mainly chronic lifestyle diseases. You can't necessarily intervene. But actually, it’s this place, for you, it sounds like, where your art can really be a part of the process. 

Lisa Africa Guest 58:44

I've been enjoying doing that quite a lot. The patients and the family appreciate it as well. They've been going to the hospital for years. They never knew what these things were for, what's actually going on. If you just take a little bit of time.. It doesn't take me long to draw stuff. I can sketch quite quickly. Here’s your body, this is your heart, this is this, this is that.

Amy Kaye Other 59:01

As a patient, even just seeing a GP, if you don't have any medical background, you literally don't know what's wrong with your body, right? Biologically, you don't know what's going on with you. You go to the GP. The GP tells you, here, take this, you should feel better in the morning, or whatever it is that they say, and to be given no explanation, which happens so often. You get in there, you say these are my symptoms. They go, take this medication. Go home. You're still left completely in the dark. 

59:29

So just having just a little bit of information or a little bit of knowledge or, this might be the cause, you might want to try this or, again, that lack of care, that coldness, is what's so frustrating. You have all this knowledge. You are the teacher. Just give me something so that I can go home feeling a little bit more empowered or a little bit more, okay, I know what I'm dealing with here. Versus here, take this, it should make you feel better. And sometimes you take the medication, go home, and it has a really weird effect and then you don't know why it's doing that. I mean, I remember once I got given medication. I don't know why I got given travel sickness medication and my heart started going absolutely crazy and I had a full-on panic attack. Luckily, at that point in my life, I trusted myself enough to go, this is not good for my body. But a lot of the time... Well, the doctor told me to take it, so, even though it feels like I'm dying, surely the doctor knows, right? 

Lisa Africa Guest 01:00:18

The power is scary actually. 

Maria Christodoulou Host 01:00:21

Exactly, and I think it’s one of the problems of the profession is that in the world that we live in, you can get to adulthood and know nothing about your own anatomy and physiology. Never mind pathology and disease and the management of disease, which is the domain of the doctor. You say to somebody… or they say, I've got pain over my liver and then they put their hand on the other side of the body. Partly, medicine is to blame. We've taken that knowledge away from people. 

01:00:44

If we go back to the conversation we had with Rod Suskin about herbs and healers and naturopaths and common folklore medicine. People knew about their bodies and how to take care of their bodies. But then, slowly but surely, the powers that be took that control away and then it became only under the banner of the Royal College of Physicians could you practice any kind of medicine and the apothecaries could no longer distribute their herbs. They had to wait for the written script in Latin from the doctor. And so now we have a whole society of people who are not educated in medicine, who have no clue about anything that's going on under their skin. 

Amy Kaye Other 01:01:22

And you've got addiction, because addiction is just, how am I going to numb this pain? Just got to do something to cope. So how am I going to numb this pain? Because nobody's given you any coping mechanisms or told you that maybe the headaches that you're getting are because of your anxiety, or the tension in your body is because of the trauma you've been through. Do you even know that you have trauma? Do you know that things you've been through are not normal? All that stuff. 

Maria Christodoulou Host 01:01:43

How do you live in a human body, with its vulnerabilities and its frailties and its emotions, all these things? 

01:01:49

So, Lisa, coming back to you and your journey, art has certainly been a key theme and I'm really struck by how important art is, even in your medical practice today, because when we first started speaking and I reminded you of this last week, I think it was six or seven months into Lisa's first year at medical school and you had not drawn or painted anything and you were telling yourself that there was no time and that there was no space for that. 

01:02:15

And we had a conversation about… I remember because I looked up my notes and at the end of that conversation I said to you that I really hoped you would find a way to bring your art back into your medicine and that you should allow yourself to believe that there was a place where they would come together. And then you went on to draw your study notes and.. she was teaching through cartoons and things to other students and being commissioned to do artwork for colleagues, and now you tell me you're drawing for your patients. So when you look back at that young woman who didn't allow herself to draw for six or seven months because she didn't think it belonged in the medical world, what do you want to say to that part of you?

Lisa Africa Guest 01:02:54

She didn't know any better. I think it was just when I went to med school it was all this science, which at that point, I didn't see it as a creative space. Science is creative conclusions from what you're observing, which is not that different from creating music or an art piece. All different creations. So I thought it was two completely different things and for a long time I thought that I didn't fit in medicine. I thought, like, I was not a doctor. In med school I felt a bit weird. Like I shouldn’t be here. 

Maria Christodoulou Host 01:03:26

I can relate to that. I felt very similar for different reasons.

 Lisa Africa Guest 01:03:31

I got A's at school but I'm not really outspoken. Or, even if I did read things, I'm not going to go and speak about it the whole day and recite all of the articles that I read. And I've found my space in medicine, which is very strange. I’m quite happy with it. My patients… I've heard it quite a few times when they're looking for me and they forgot my name, then they'll be like, that hippie doctor. And I quite like that. And my colleagues all know that it's me and they come and find me. A patient actually commented on my tattoo’s the other day and I asked him what difference does it make that I've got ink on my skin? It doesn't influence what I know or how I'm treating you. It's just you seeing me and you’re seeing ink on my skin and thinking she's a druggie or something. I don't know what the... Or a criminal…I just like the art, I guess. That's why I have ink on my skin. But there are… 

01:04:23

Patients have commented on my appearance before and I've had conversations with them. So what do you think your doctor supposed to look like? Why do you think that it's supposed to be a white man in a coat? Unfortunately, that's not what your doctor looks like now, but I have gone through the same things as that white man in a coat.

 I quite enjoy talking to my patients besides just medical things. C15 has a majors and a minors. So this day I was in the minors side… So the majors is where all the crazy things happen, like the resusses, and everyone's on oxygen. So this guy came in with ascites that just needed a drain. I didn't feel like seeing more patients at that time, so I put the jelco in and I attached it to the ….. so it arrived into the bucket. I’m going to sit here and chat with this old man about his life. 

01:05:10

How he got cirrhotic liver disease. So he was a jazz musician his whole life and that came a lot with drinking. He was always performing and then afterwards it would be nights of drinking. Patients have such interesting stories. What I'm seeing now, it's a whole life that's led to this point. 

Maria Christodoulou Host 01:05:26

Well, you talked about being an outlier and we were talking at that moment about how you dress and how people perceive you, but it feels to me like you're an outlier for many different reasons in the profession. What's it like for you to feel like an outlier? 

Lisa Africa Guest 01:05:41

Groote Schuur is a new space for me. I don't know the UCT people, so I don't know any of the professors. I don't know what I'm supposed to impress there. 

Maria Christodoulou Host 01:05:49

The hierarchy is not so clear. 

Lisa Africa Guest 01:05:50

It's not at all. Most of them went to UCT or they've been there for a while, so the ones that came… got the job with me, around about the same time, were from UCT, so they know things. I'm completely new. Someone asked me two days ago, how are you so free? It's a guy in urology and he's like, can I ask you something? Yeah, sure. Like, it’s random. 

01:06:13

So I'm like, just ask the question. Don’t give a whole like… How are you so free? What? That’s such a strange question. That's not the question I expected at all. What do you mean? Why do you think that I'm free? You just don't seem like you're trying to impress anyone. You're just working , you're seeing patients and you just seem like you're free. I didn't know how to answer him. I told him maybe we should have some coffee. Why’s he not feeling free? This could be an interesting conversation. 

 Maria Christodoulou Host

Are you free?

 Lisa Africa Guest

 I think I'm more settled within myself. I don't know if anyone can really be free in this society. I'm feeling a lot more balanced. I don't know about freedom. Or if that's even a possibility at all. 

Maria Christodoulou Host 01:07:02

So what does freedom mean to you? 

Lisa Africa Guest 01:07:03

After that question I realized I don't know what it is at all. He made me think, like I was thinking the whole week last week. What is freedom? 

Amy Kaye Other 01:07:12

I just had this image of you in your car driving. That's what I think freedom is for you. Just getting in your car and driving for hours and hours and hours. 

Lisa Africa Guest 01:07:20

Gosh, and like stopping in little towns and seeing random people. I just love to do that. 

Amy Kaye Other 01:07:25

No one to answer to. You just get to ask people what their stories are. Who are they? Where do they come from? What are they about? I think that’s… I see you as just passing through. 

Lisa Africa Guest 01:07:35

I’d just be like saying, could I paint you, would you be able to sit for like two hours? That would be lovely, but if I had to do a career in art… How I would absolutely hate it. I have a lot of creative friends now and the thing that's depressing most of them is that they are creating for money and it doesn't feel authentic. It's not coming from that place it used to come anymore. Now they have to think about, can they sell this, do they have an audience? 

01:08:02

And that just sounds horrible. So, I wish there was no capitalism. I actually wish that we were still living in huts and going to the forest and going to get fruit and someone's going hunting, maybe getting some meat. I feel like that sounds like a much healthier way of living than what we are doing now. 

Maria Christodoulou Host 01:08:23

So we've talked a lot about the challenges and the hard stuff of being a doctor. What do you love the most about being a doctor? 

Lisa Africa Guest 01:08:30

Hmm, I don't know why to answer this is so hard. 

Maria Christodoulou Host 01:08:34

It's so funny, because as I asked you the question and waited to hear your answer, I thought there's nothing I love about being a doctor. In fact, it was even stronger than that. There was a part of me that said, I hate being a doctor. I mean, it's still very early in your career. If you were back in high school and you were choosing, knowing what you know now, would you do medicine again?

 Lisa AfricaGuest

 No.

 Maria Christodoulou Host

Do you have any idea what you would do instead? 

Lisa Africa Guest 01:09:08

I would definitely do something in biology. Maybe plants or animals, but humans… Humans are hard. This is like a weird thing to say being a doctor and I’m saving lives and all that. I think humans are horrible, actually. They're causing the downfall of the rest of the universe. I think I would want to do something else. Maybe try and save some sort of other life form. It's very honestly speaking. 

Maria Christodoulou Host 01:09:38

I'm grateful for your honesty. From a personal perspective I'm also curious about.. in your time as a medical student, you had that opportunity once a year to chat to me about what it was like to be a medical student. It didn't necessarily lead to any change, but I know the conversations were often quite interesting and maybe different to the conversations you would have had elsewhere in the faculty. So looking back now, was it helpful to have, what in essence now, would be called a mentoring conversation or a coaching conversation to reflect on your experiences as a student? Did that make any difference? 

Lisa Africa Guest 01:10:13

I actually absolutely loved them. And also, just you as a person made me feel hopeful that I could do medicine and not feel like a complete outsider. You're also quite artsy and you were telling me about astrology and all these other avenues of health and healing. The conversations were lovely and also made me feel like I could do everything. I felt like you were genuinely a healer. Coming out of the sessions I felt so much better just speaking. You have like such a lovely energy. 

Maria Christodoulou Host 01:10:45

Thank you, Lisa. The conversations were interesting for me for a couple of reasons. One, I was having a lot of those conversations and I was expected to write a report about what I was discovering - not about individuals, but about themes that were running across the student experience  - and the one thing that stood out for me was how this random selection of students, like they do for qualitative research, and then sent out invitations to, I think, 60 or 70 students, and a very small percentage of those students responded. Every single one of them, yourself included, was an outlier in some way or another. So, in a sense, you were like a self-selected group of students talking about a different perspective on medicine, and it was interesting for me because I was the one having the conversations. I wasn't a routine academic, if I can say it that way. And then the themes of the conversation were around what people thought being a doctor was going to be about. We were looking at graduate attributes, what were the qualities we wanted to cultivate in our student population as doctors? And so I, flippantly, in a meeting said, well, let's ask the students who they think they need to become. And what was really fascinating was that medical educators all over the world had begun outlining the attributes of the ideal graduate and the assumption was that students don't know how to be caring and kind and compassionate and we’ve got to teach them these things. 

01:12:04

And actually what my research showed was that when students come in at first year level, they intuitively know all of those things. Certainly these outlier students that I was speaking to, and they all said all the right things. When I said, so who do you want to be one day when you graduate? What makes a good doctor? They said all the right things. In fact I could tick off all the criteria. One year later, the second-year students were saying, when I said, what are the qualities of a good doctor? Knowledge. You've got to know your stuff, because if you don't know your stuff someone's life is on the line. And when I would say but, you know, a year ago you spoke about a whole lot of other things and you mentioned… They couldn't remember. They'd already begun absorbing this idea that expertise was the most important aspect of their medical training. And so for me, and it was quite a controversial perspective at the time, I was saying the culture of medical school erases those attributes out of human beings. And so, when you're looking at the specialists and the six years and the interns and saying these people need to learn mindfulness, these people need to learn compassion and you're putting in programs to teach them compassion, you are totally ignoring the fact that the culture of medical school and of medicine erases those things. 

01:13:19

I left the medical school and I didn't want to have any more of those conversations where I was seeing how that was happening to people, and even agreeing or deciding to start this podcast has been sort of double edged for me. So when you started talking about some of those difficult things you'd witnessed as a community service doctor, my tears want to well up. My anger and frustration at the system that we have not yet found a way to make it possible for people like yourself to have a space to debrief. We can't change the fact that people are dying of HIV and TB, but we can change how that impacts on you and me when we do this work, so that we will want to do this work. So that we won't, like me, end up stepping away from that work. Then I think, like, I don't know if I have it in me to keep holding space for people to talk about that. I went back into the academic environment thinking I was going to change it so that when new students came in they wouldn't experience what I had experienced. 

01:14:15

I was a first year in 1985. Here all these years later, a young woman is going through that kind of trauma and has no space to debrief. I get enraged. It's a little bit about my story too today, so thank you, Lisa. Anything else you want to say, Amy, before we close? 

Amy Kaye Other 01:14:34

I don't think there are any more doors or windows that can be opened. I've got so much to process it’s like wild, and the fact that I'm going to have to re-listen to the conversation multiple times is just… It's a long road. I think I'm also going to get in my car and drive. It's just… 

01:14:53

Today was fantastic and again I was so pleasantly surprised. I have no idea who you are. I just get a name. I don't know what kind of a doctor you are. I don't know what you do. I don't know anything. I come into these conversations completely blind and it's so wonderful to keep being left with a sense of hope that there are good people still in the world and there are good people trying to make change and trying to do the right thing, and we need more of these stories. There's not enough of it. There really isn't, and this should be the norm. Having these kind of conversations on a weekly, if not a daily, basis. This is what we should be spending our time doing. Talking about who we are, where we come from, why we do what we do. 

Maria Christodoulou Host 01:15:31

And how being human affects us all.

 Lisa Africa Guest

Thank you for the space.

 Maria Christodoulou Host

And thank you for sharing so courageously. I'm sorry it's been such a tough journey, but I can see such depth and complexity and beauty in you and in your art and I have no doubt that your patients feel and experience that. Thank you for being you.

 I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends. Follow Awakening Doctor on Instagram, Facebook and Spotify and go to Apple podcasts to subscribe, rate and give us a good review. Thank you so much for listening.