Dr Nondumiso Makhunga-Stevenson, Redefining the Narrative of a Medical Career

Dr. Nondumiso Makhunga-Stevenson is a medical doctor, clinical epidemiologist and physician coach whose story weaves together threads of traditional wisdom, social justice, and cutting-edge medical practice. 

In this episode of Awakening Doctor, we explore the many contrasts that have defined her professional career, the legacy that shapes her holistic approach to patient care, and her deep conviction that equitable healthcare is a right, not a privilege, no matter the setting or the context. 

From her experiences in aesthetic medicine to her work with marginalised communities in the Johannesburg CBD, and from her involvement with grassroots public health initiatives to global health programs, Dr. Nondumiso's story showcases the transformative potential of redefining conventional notions of a medical career, and the myriad of ways in which a medical degree can be leveraged to effect change. 

Her insights serve as a reminder that medicine is not just a science. It's an art, a spiritual practice and, above all, a voyage of continuous learning and discovery. Join us as we discover the multi-faceted dimensions of a career shaped by a spiritual calling and unwavering dedication to positive change.

Chapters

• 0:00 Navigating Medical Privilege and Tradition
• 11:01 Career Path and Social Perspectives
• 15:24 Medical School Reflections and Social Justice
• 28:29 Empathy in Medical Practice
• 43:52 Diverse Career Paths in Medicine
• 55:53 Spiritual Growth in Medical Career
• 1:04:37 Spirituality and Coaching in Medicine
• 1:21:12 Learning From Experience

Transcript

Dr Maria Christodoulou: 0:00

How do you reconcile within yourself this paradox of - Y ou live in the townships. You witness the kind of things that you were witnessing there. T he poverty, the inequity. Even in residence you are made aware of the differences in terms of socioeconomic status. B ut then your father is a doctor. You have access to private boarding schools. You get to go to university to study medicine. How do you reconcile that within yourself?

Dr Nondumiso Makhunga-Stevenson: 0:27

I try to correct it. Most of my career has been characterized by me working in public health and working with communities that don't have access to the same level of care that I have access to. For example, in the past five years I worked in a clinic in the Johannesburg CBD. I worked for a program for people who inject drugs and I was doing that part-time and I would go to the clinic three days a week and the rest of the time I was spending in my GP practice, which was beautifully air-conditioned, electronic systems.

Dr Nondumiso Makhunga-Stevenson: 1:16

Patients were coming for aesthetic treatments. A very, very different type of patient, but my mission was, they both deserve the same care. I would make sure that when I work with patients from all walks of life, whether they are patients from low economic backgrounds or well-to-do patients, I approach them exactly the same way, understanding that they all deserve the best of me at least a s a doctor. But I've also had quite an extensive career in global health and most of the global health programs have really given me an opportunity to be part of normalizing health equity in medicine, so I worked on many HIV prevention programs and even working in the pharmaceutical sector, t he lens that I always use is how does this help the person who otherwise would not have access to this care?

Dr Maria Christodoulou: 2:29

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 Nandumiso Makunga-Stevenson, a medical doctor and clinical epidemiologist with more than 20 years of experience across a vast range of sectors in the health system. A colleague who is passionate about the profession. A n advocate for equitable health care, and a woman for whom medicine is a generational and spiritual calling. Welcome, Nondumiso. Thank you. Also in the room with us is Amy Kaye, the producer and editor of the Awakening Doctor podcast. Welcome, Amy. Thank you, Maria. So, Nondumiso, you tell me, where do we start to tell the story of Nondumiso Makhunga-Stevenson?

Dr Nondumiso Makhunga-Stevenson: 3:35

I always like to start at the beginning, the very, very beginning. Umlazi, where I was born. If you go to my social media profile on Instagram, you'll see that I put the number plate and use that to my DNA. That's really a home that shaped me, the people that I grew up with, the mentors, the village that raised me, that influenced me. That's really shaped my thinking and who I am over the past four, almost five decades now. B orn to a single mother, so I grew up with my maternal side of the family, although I have very, very strong connections with my paternal side, who have also been very, very influential. I grew up with one sister and I have a number of half-brothers and half-sisters and we're all very close. V ery, very tight. How I became a doctor actually is also from my upbringing and my roots.

Dr Maria Christodoulou: 4:34

Right. You mentioned to me that your father was a doctor, r ight?

Dr Nondumiso Makhunga-Stevenson: 4:39

That's right. My father grew up in ingwavuma, which is a rural area in northern KZN, and he was the oldest and very intelligent. T o this day, one of the most well-read people that I know. So it wasn't surprising that he managed to do well academically. He got some scholarships for high school and eventually made it to medical school in the 70s, so he was one of the first batch of Black doctors. G raduated the year that I was born and worked in Johannesburg since then. Somebody that is close to my heart because he gave me his name, his first name. We actually have the initials for our first name and our second names are identical, so I've often had results from patients being sent to me that were intended for him and vice versa. Then I have to call the lab and say I didn't see the patient, and so forth. So he's somebody that I think our lives are very much aligned in terms of our passion for patients and for the medical profession.

Dr Nondumiso Makhunga-Stevenson: 5:53

I've learned so much from him, and especially his views about health in general and his respect for all forms of medical thinking and paradigms. So he's somebody that has a huge respect for traditional medicine. He's the one that the first time I heard about yoga was from my father. The first time I heard about allied health professionals was from my father. He believes in Reiki and Ayurvedic medicine also. Those are all the different ways that people find healing that he instilled in me to be very respectful of and to be open-minded about. He's very much a big part of how I have practiced medicine and how I interact with patients who have a much more holistic way of understanding their health or who are looking for more in healthcare besides the traditional Western medicine way that I have been trained.

Dr Maria Christodoulou: 7:02

You told me that traditional medicine is a calling in the lineage and that you have an interesting perspective on the difference between a sangoma and a traditional healer. Do you want to talk about that?

Dr Nondumiso Makhunga-Stevenson: 7:14

Yes. So you know there are different ways that these gifts because that is how it is really considered. It's a gift and a skill at the same time. That is how I was raised to understand it. But you will have a sangoma whose skills extend beyond the use of herbs. But they have some other ways of communicating with ancestors in order to guide you in terms of diagnosing medical problems, social problems or any other issues that you might be bringing to them.

Dr Nondumiso Makhunga-Stevenson: 7:50

But in my family, on my mother's side, my maternal grandmother was a healer, or a herbalist. T hat is what some people would call her. So she had a very profound knowledge of different types of herbs, how they're used, for which ailments and so forth. So I really grew up with a grandmother who used to understand this as well. Although my mother was a nurse, we were not really the type of kids that immediately would be given cough syrup. There was a very specific plant that seemed to cure all these ailments and she would use the leaves and we would drink it. A very bitter- tasting, horrible plant, but it did the trick. And one thing I appreciated about my grandmother's knowledge was that understanding that healing is a gift. It is something that can be passed on from one generation to the other, and so that was the explanation of why my mother gravitated towards nursing and I gravitated towards medicine.

Dr Nondumiso Makhunga-Stevenson: 8:58

In her mind, it was all healing you know and the different ways of healing, and so this is how it manifested. What I really loved and learned from her was the generosity of this. So the plant that we had, in isiZulu, is called Iboza. It was actually outside the home, even though we had a fence in our home. It was our plant and people would walk past and they would just ask for some of the herbs and she would absolutely say, yes, of course, just have some. So that taught me that healing is something that should be shared. Knowledge of medicines and plants should be shared. It should be beneficial to the community. It should be beneficial to our patients. If you know how to help people, it shouldn't be something that you keep for yourself. It was not uncommon for people to visit each other to get specific herbs that were growing in each other's homes. My family is very much involved in healing and helping people.

Dr Maria Christodoulou: 10:03

So was medicine always on the agenda for you, or did you question it at any stage? What took you to medical school?

Dr Nondumiso Makhunga-Stevenson: 10:11

I don't remember a time that I did not want to be a doctor. I don't know why. The big part of why I call it a calling for me is because there was no logic in terms of why I wanted to be a doctor. One might argue well, of course, yes, your parents are both in the field. Maybe that might have influenced you, but my parents were actually very open to whatever it is that I wanted to do. They were not the type of parents that insisted on me going to medical school, and you would know, in medical school there are many, many children that end up in medical school because of parental pressure and studying medicine without really wanting to do it and because they're wanting to please parents. In fact, there was a time that my father tried to discourage me from being a doctor because he at that time it was quite challenging for women. There were not many women doctors in his generation. So he saw the disruption that it brought to the young female doctors that he was studying with, in terms of family life. They still had all the responsibilities of being a doctor, but also being mothers and being wives. He once said to me if you go ahead, it's fine, I won't stop you, but just be mindful that you might not get married, because you might have to choose at some point, because of how it was in those days. I t was really very, very difficult.

Dr Nondumiso Makhunga-Stevenson: 11:56

At some point in high school the career guidance counselors come and they give you different options and you investigate and you do some research. I was very intrigued by law and I was also intrigued by education. I was very curious about it. At some point I considered engineering. But by the end of that phase in high school of career guidance I reverted to my default state of being a doctor and that's basically what also drove me. I don't think I was necessarily the brightest student or had the aptitude, especially for subjects like maths. I didn't really enjoy maths at all. I don't think I was particularly good at it, but I knew that in order to get to medical school I had to do exceptionally well in maths and science, because it is competitive and it gets more and more competitive by the year. I worked very, very hard to be able to get into medical school. Driven by that, I really wanted to be a doctor and thankfully the doors were open for me and I managed to get into medical school.

Dr Maria Christodoulou: 13:14

From what you told me, you went into medical school before Nelson Mandela was released, so at that time it was often quite difficult for young Black women to get a place in a medical school. Did that affect your career trajectory in any way at that time?

Dr Nondumiso Makhunga-Stevenson: 13:30

In 1990, when Nelson Mandela was released, I was actually in high school, and it's a very good question that you're asking me, because I have really reflected on my exposure in life and realized that I've always had one foot with the haves and the other foot with the have-nots. Starting with the fact that from Grade 2 to matric, to Grade 12, I was in a private school because my father was a GP and he could afford, really, to take us to schools that a majority of Africans could not afford. So at the time it was, of course, under apartheid. As you know, one lived in the township and witnessed everything that was happening in the township, and then the following morning you are going to school in the suburbs and you are with children of other races and being in the minority, children who seemed quite oblivious to what was happening in the country or how the rest of the country lived or the majority of the country lived. So that's always given me a different perspective and I see that pattern in my life in many, many ways. E ven where I am now, where you see a country with so many resources, but the lower your socio- economic status, the likelihood of you being a statistic in terms of maternal mortality and the type of healthcare that you have and the health outcomes that you have, are affected by that. So in 1990, yes, I was in boarding school in Pietermaritzburg and that's when Nelson Mandela was released and at that time I really only had two options.

Dr Nondumiso Makhunga-Stevenson: 15:35

So, even though I had other classmates who had many options for medical school, I had three options. The first option was University of KwaZulu- Natal, which is where my father had graduated and studied, and that was my first choice. My second option was Medunsa. My third option was UNITRA (University of Transkei). Of course, one could have applied for other medical schools. It was not as if you couldn't submit your application. My expectations of being selected were quite low. There was sort of an unwritten understanding that, yes, you can apply, but chances are low that you'll be accepted. But I was happy that I got accepted to, at the time it was called University of Natal, mainly because my father had attended that school. So I just felt very proud to be part of that legacy of the university, and I still am to this day.

Dr Nondumiso Makhunga-Stevenson: 16:38

The type of training that I received in future served me very, very well in terms of the quality of the degree that I had. It allowed me to travel and work in other countries and just have a very different perspective about healthcare. If I think about the type of doctors and consultants that I had. For example, the late Prof Jerry Coovadia was one of our consultants, and I learned so much from him in terms of a holistic approach to a patient, not just treating the patient and then putting them back into the same situation. The lesson I learned from him was that you have to be a patient advocate. You have to be the change that you want to see for the patients too. It's not enough to just manage them and then leave them to the health system. You have to move and shape the people that can make the environment for that patient healthy for them as well.

Dr Maria Christodoulou: 17:54

You also mentioned to me the other day that medical school really traumatizes people. How did it traumatize you?

Dr Nondumiso Makhunga-Stevenson: 17:57

It absolutely does. And sometimes you don't realize how challenging medical school is until you have left, because as doctors we tend not to talk too much about our vulnerabilities or our feelings of inadequacy. Medical school is a very, very competitive environment and, as I mentioned, I was not necessarily the top student in all the subjects. I failed a few semesters along the way. But it's not a very kind environment if you don't have the determination to finish. I've found that even here in the United States there is the same type of culture of training. It's a very competitive culture. It's a culture where you often feel that you are questioning your decision and your competence and your adequacy. Am I really supposed to be here?

Dr Nondumiso Makhunga-Stevenson: 19:09

At some point I thought it was just myself, but it was only when I started doing coaching and started to look and read from other coaches about how they do coaching for doctors that I understood how imposter syndrome is so prevalent amongst doctors, which I thought was just me at times, but realizing that it's really an issue for us and a lot of them attribute that to the culture of how we are trained.

Dr Maria Christodoulou: 19:48

You made the decision to go. It's in the lineage. Y our mother's a nurse, your father's a doctor, your grandmother's a herbalist. You go in, and certainly my own experience and many of the younger students I've spoken to there's this wide-eyed innocence and excitement about learning how to be a doctor. And when you think back to that time when you started medical school, what did you imagine medical school was going to be like and how did that contrast with what you encountered?

Dr Nondumiso Makhunga-Stevenson: 20:15

I suppose in my head it was just going to be like high school and my father did not really let on much about the academic side of medical school. My conversations with him were about two things in terms of what I expected. The first was the political activism. So my father was during the times of Steve Biko in the same medical school. The university was quite a hotbed of political activity. So I sort of understood that that's part of university life and I think it continues to be to this day.

Dr Nondumiso Makhunga-Stevenson: 20:58

And then the second thing, of course, was he insisted that I stay in the residence and not be a day student, even though it was possible for me to commute. The reason he said that was you need to interact with other people, although he was alluding to it as if it was going to be a very big party and the usual sort of college experience as they call it here, which it was. Of course, there was definitely that element of having fun, but it was more about socializing. That is what he impressed on me, because at medical school and at university in general, you meet people from all walks of life, and that was very different for me because I had been in a boarding school with people mostly similar to me in terms of their background.

Dr Nondumiso Makhunga-Stevenson: 21:56

When I then lived in the residence I started to understand again the spectrum of the socioeconomic status that we have and I started to understand the different types of people that we have, and different situations that people have. So I really appreciated his advice. Although I only stayed for the first three years of medical school and then commuted in the later years, it was not really what I expected it to be. It was very, very eye- opening. I give the same advice to my children now. I encourage them to stay in residence and network and make friends with people from different backgrounds so that they have an understanding of the world. Because if you are insulated and you have your own way of seeing the world, it will be strange to you if a patient says I can't take this medication because I don't have food.

Dr Nondumiso Makhunga-Stevenson: 23:05

So when you are in the residence you meet people who share those stories.

Dr Maria Christodoulou: 23:17

How do you reconcile within yourself this paradox of - you l ive in the townships, you witness the kind of things that you were witnessing there. Th e poverty, the inequity. Even in residence you are made aware of the differences in terms of socioeconomic status, but then your father is a doctor, you have access to private boarding schools, you get to go to university to study medicine. How do you reconcile that within yourself?

Dr Nondumiso Makhunga-Stevenson: 23:45

I try to correct it. Most of my career has been characterized by me working in public health and working with communities that don't have access to the same level of care that I have access to. For example, in the past five years, I worked in a clinic in the Johannesburg CBD. I worked for a program for people who inject drugs and I was doing that part-time, and I would go to the clinic three days a week and the rest of the time I was spending in my GP practice, which was beautifully air- conditioned, electronic systems. Patients were coming for aesthetic treatments. A very, very different type of patient. B ut my mission was they both deserve the same care. I would make sure that when I work with patients from all walks of life, whether they are patients from low economic backgrounds or well-to-do patients, I approach them exactly the same way, understanding that they all deserve the best of me, at least as a doctor. But I've also had quite an extensive career in global health, and most of the global health programs have really given me an opportunity to be part of normalizing health equity in medicine. So I worked on many HIV prevention programs from about 2007, in and out of those programs, and even working in the pharmaceutical sector,

Dr Nondumiso Makhunga-Stevenson: 25:42

the lens that I always use is, how does this help the person who otherwise would not have access to this care? And so I've been very blessed to have those opportunities to do that. T o just show up in every situation, in every role that I'm in, with that lens. It's difficult to change the world. I'm in a well-resourced country. I was shocked when I found out that in the United States they have almost 1 million doctors. Of course. it's a bigger population, but if you think about the patient- to- doctor ratio it is still substantially high. But it's difficult, you know. T alking to the doctors here, I realize a lot of them are also seized with that same issue of being relatively comfortable financially as the doctor and realizing that you are not able to assist everybody the way that you would want to. I'm encouraged by the way that they approach it too, which is to have non-profit organizations that they run and they help patients in that way. They help communities in that way as an extension of their services.

Dr Maria Christodoulou: 27:06

What strikes me as we're speaking about that is. I've had hundreds of hours of conversations with colleagues and often it's people like yourself who have been exposed to this polarity of experiences, that are sensitized to the need for the social justice and the activism in the profession. I particularly recall one conversation with a young Black woman from the rural parts of the Eastern Cape who got an opportunity to come and study in Cape Town, and was becoming a subspecialist in her discipline, and feeling so torn because the assumption throughout by her professors and her colleagues was that she would go back to the rural area where she had grown up and practice her specialty in that region because there was such a need for the population to have that kind of care. And she was sitting in this place of, maybe I also want to just buy a house in Constantia and run in a fancy practice.

Dr Maria Christodoulou: 28:01

Why does nobody expect my white colleagues to make their way to the Eastern Cape and work in a rural district? Why is it assumed that because I grew up there, I want to go back there? I'll be honest, I very seldom, I won't say never, come across a white colleague who's going, I grew up in privilege, I grew up with all this luxury and I'm feeling compelled to go and work in a rural area and help the poor people. Even as I say that, I can think of a number of colleagues who will go, t hat's not true, we've all done that. But there's something I think about being sensitized to that suffering that often becomes almost like a compulsion in the career and in the career choices, and I wonder if you would have made similar career choices had you been exposed to other things. And again, even as I say that, this has been your life, these are the decisions and the choices you've made.

Dr Nondumiso Makhunga-Stevenson: 28:51

That's right. Even in Umlazi, where I grew up, you did see those polarities right, because we were all in one environment. You had families that were well-off, business people, there were professionals, educated people. They had cars. A nd then you also had your next- door neighbor. You could have low socio-economic status or less privileged. You saw that outside, of course, but also within the community, that there were these discrepancies in how society is. It's just awareness of it and choosing how to contribute.

Dr Nondumiso Makhunga-Stevenson: 29:39

I think all of us, as doctors, do have to at least be mindful. I don't think there's an excuse for ignorance, but it really does start off with your own attitude towards it, your own understanding of it, and I would be very sad if I were to have a conversation with somebody that was not aware or didn't care enough. F or me, a good doctor is also an empathetic doctor, a doctor that can put themselves in the patient's shoes. I really always share with people that one of the reasons I'm so happy that I became a doctor is my exposure in my training to this world.

Dr Nondumiso Makhunga-Stevenson: 30:26

You have these stories that stick out in your mind that you always remember, of one patient, older gentleman, and he was being discharged and his shirt was very dirty and stained. I asked him, but why are you wearing such an old and dirty shirt? In my naivety. H e said, you know, this is the best shirt that I have. It was a collared shirt. The other shirts that I have, they have holes and I didn't think they'd be suitable. I felt very embarrassed and ashamed that I had assumed that everybody has some nice clothes that you would wear going out. I have many, many stories like that of patients that just shared responses that have made me feel ignorant really. But in the moment, I took that lesson and understood that for the next patient that I see, I should be empathetic, I should hear the patient, I should listen to their situation, to their circumstances, and meet them where they are and that's the best way that I can help them, and not where I think they should be, with a clean shirt.

Dr Maria Christodoulou: 31:42

Absolutely. My experience of that was working in the diabetic clinic, and I don't know if you've ever worked in those clinics where there's the long-term chronic management of lifestyle diseases and young and naive and very ignorant, I would get really annoyed with patients who didn't come back to fetch their insulin or didn't follow the diabetic diet. And it was only much later, because of course, I think, often sitting across the way from a white doctor, they're not going to say, I can't afford to come or I don't have the food. They just keep quiet and they pretend that they've been bad. It was a long time later. I'm ashamed to admit, that I kind of went, oh my God, how do you worry about insulin or coming to fetch your medication if you don't have food to eat and/ or the means to get to the hospital. Those things become secondary when that's what you're dealing with on a day-to-day basis.

Dr Nondumiso Makhunga-Stevenson: 32:33

Absolutely. And that notion was very much cemented for me when I started working with key populations. T he understanding that if you don't understand people as they are, if you don't have respect for people, you will find yourself being in situations where you are going to be embarrassed by your ignorance. So that is something that I have also learned from patients. Y ou have to respect the patient that's in front of you for you to grow, for you to be empathetic, because empathy and wanting to listen is a choice. It's you saying, making the decision that, I'm going to be quiet, I'm not going to make assumptions, I'm not going to be judgmental. Because they are sex workers, because they are homeless and they inject drugs, and they're not clean, you automatically will have judgment and you will have that barrier.

Dr Maria Christodoulou: 33:44

What was it like working in the Johannesburg CBD with these marginalized populations? You said to me the other day, when we first chatted, that unspeakable things happen in this city, right under our noses, and we don't always know it. What were some of the things you encountered?

Dr Nondumiso Makhunga-Stevenson: 34:02

It was a rude awakening to say the least. Working with people who inject drugs was transformative for me because I really got to understand the impact of drugs on an individual and how much it robs potentially especially young people of their destiny. If you are a spiritual person, you will accept that everybody has a gift and free will that gets taken from people because of drugs. I witnessed that because I saw young people that I worked with had so much talent. It was overwhelming. At first I was surprised, but with time I just got to accept that it's probably the brightest of people that we were serving in that clinic and the gifts that I talk about are gifts of kindness. Some people had an incredible sense of humor. Others had leadership skills. They just rose into peer leadership role. N o training, no education, but they were just naturally and organically leaders and educators. Many of them had musical gifts and yet had found themselves in that situation.

Dr Nondumiso Makhunga-Stevenson: 35:33

The situation in the Joburg CBD, for me, really changed my views about power in the country. It made me quite angry at the situation because I feel there's a lot that can be done to help young people and to prevent young people starting drugs. Simple things like education. I think many young people are not aware of the harms of drugs, and when you are a teenager or a young person, it's natural. They're curious, they want to experiment. But many of them just shared with me that they didn't know. They just had never received that information enough or adequately to be able to stay away from it.

Dr Nondumiso Makhunga-Stevenson: 36:22

And then, of course again, the socioeconomic issues, where young people are bored. They're looking for some excitement. They are not productive. They are frustrated by unemployment. They are frustrated by the lack of educational opportunities and they become vulnerable to starting drugs. T hey end up in these situations, as I said, t hings that I've seen which are really unspeakable. That were very shocking to me that they actually exist. It was mainly young people from poorer communities who were falling prey to drugs, so it was something that really disturbed me to the core. The first time that I visited these abandoned buildings where some of them lived, I couldn't sleep at night thinking about the dangers, especially for the women, and thinking about how could such a situation really exist under our noses. It is quite disturbing, but I could only do so much, which is to serve as a doctor, encourage them, work with them, motivate them and treat them the way that they deserve to be treated, as any other patient that I was treating in my suburban practice, and show up the best way that I could show up, every single day.

Dr Maria Christodoulou: 37:50

I'm sitting here thinking about my own white privilege and how I might be quite scared to go into those areas in the Joburg CBD and have those conversations with patients. And you talk about lying in bed at night, awake, worrying about the circumstances these young people found themselves in. What enabled you to go from this aesthetic medicine upper market GP practice into those settings and stay centered in yourself?

Dr Nondumiso Makhunga-Stevenson: 38:16

Understanding the opportunity when it presents itself for personal growth.

Dr Nondumiso Makhunga-Stevenson: 38:24

It was a challenge for me because I had not worked with people who inject drugs at all and I had wanted to get that exposure. Initially, in my mind at least, it was going to be for professional reasons. But of course, as with everything else, if you dedicate yourself to being an empathetic doctor, if you dedicate yourself to saying I'm going to treat every patient the same, it becomes more of personal development and not career development. You grow, you are humbled as a person, you are taught by somebody about life who lives under a bridge, and if you come with that approach of what can I take from this and what can I give to this person. So that was my initial plan, that I would expand my skill set in terms of working with high-risk patients, but only to find that, of course, it was much more than that and learned much more about myself as well. You really learn to be very, very humble and go into a state of service. Not to say that I did not learn anything from my suburban patients. Absolutely not. There are different lessons there.

Dr Maria Christodoulou: 39:52

Did you ever feel scared or overwhelmed?

Dr Nondumiso Makhunga-Stevenson: 39:56

The first time I went to the clinic I was a bit anxious. Johannesburg CBD is known for its high crime rate, and so there was that at the back of my mind. But I can tell you I've never felt safer in the Joburg CBD. With time, the patients made me realize that they are human beings just like anybody else. I had an understanding of what drives the crime Joburg CBD. They would even tell me sometimes, don't go to that street, stay in this street. They would give me advice on what time to leave the clinic, when it's safe, and I'd really got to learn a lot about the city as a result. But I understood also that people are not born criminals.

Dr Nondumiso Makhunga-Stevenson: 40:51

Often people have an impression that when you go to work in the CBD your patients are criminals, and that's not the case. Yes, there's crime in the area, but if you see the patient in front of you, you even forget. S ome of them, o f course, they will share their criminal record. They've been in jail. Some had even murdered. For some reason, I did not feel scared.

Dr Nondumiso Makhunga-Stevenson: 41:19

Sometimes you only find that out a few months down the line. They start to open up to you, they trust you, they start to tell you the things that they have done in the course of their addiction, and because of the addiction, you have a much more balanced understanding of why people do things the way that they do, what drives them to do that. But if you start off with treating the patient in front of you as a criminal, you will be scared and that fear will never go away. But once you treat them and you see them as individuals who can be rehabilitated, for want of a better word, and who you are working with towards a goal of sobriety or a goal of not being dependent on substances, the goal of independence and a productive life, you have to believe that that person is not a criminal. Otherwise, in your mind, you are wasting time really trying to help somebody if you don't believe that they have the capacity to add value to society. So the crime did not faze me as much as I thought it would, at all.

Dr Maria Christodoulou: 42:36

You've reminded me of a definition of the difference between coaching and therapy that I was given many, many years ago when I studied coaching and I know that you also work as a coach now. A t the time, and of course, it was quite a limited perspective on therapy, but the basic understanding was that in the therapeutic space, the assumption is that the patient is wounded or broken or traumatized and needs to be healed.

Dr Maria Christodoulou: 43:00

In the coaching space, the assumption is that the patient is whole and needs to be reminded, and for me, that ability to hold the perspective of this person in their wholeness, rather than focusing on the pathology, focusing on the drug addict, I think is critical to the healing process. And it's also the thing that I learned subsequent to having those reflections about, why was I pushing this agenda about insulin and medication when people were starving or didn't have money to find their way to the hospital? And it's the assumption that our medical intervention is the primary need, when actually, if we're trying to cure symptoms, then, yes, that's the right way to go, but if we're trying to heal people, then there are many different things we need to take into account, and so I think that's often a distinction that, certainly for me, was not made in medical school.

Dr Nondumiso Makhunga-Stevenson: 43:55

Absolutely, whether I liked it or not, I had to learn that lesson and I learned it from the patients, and they taught me that life is about challenges and sometimes they relapse. Everybody has got their own journey. For you to understand, you have to be open-minded, you have to be accepting of that person as they are. Let's talk about what it is that you want to do. You need to be on methadone for so long. Treatment, how would that work? Are you going to be able to come to the clinic every day? What is your support structure? So the same principles we are using in coaching. I had a cookie- cutter approach, where I thought, once the patient is on methadone, within six months they should be back to their normal life, they should be working or go back to school. And it doesn't work like that at all, and each patient was teaching me different layers of the complexity of life. But all of the patients had the potential to achieve their goals and ours was just to support them.

Dr Maria Christodoulou: 45:11

With this idea that each of us has our own journey, I know that your journey, certainly your career path, has taken many twists and turns. What are some of the things you look back on as highlights in this career path you've taken?

Dr Nondumiso Makhunga-Stevenson: 45:23

Hmm, it's a very interesting question. About two years ago, I was working in a pharmaceutical space for a pharmaceutical company. I was nominated to be part of an open day for young people who were still in high school and were interested in joining the pharmaceutical space, and some of them were thinking about pursuing medical school. And so one of them asked me a question about if I had a choice, would I do something else? And I said to her, absolutely not. Without hesitation. I didn't even think about it.

Dr Nondumiso Makhunga-Stevenson: 46:11

My journey in the medical profession has had its ups and downs, like most of us. The healthcare landscape is forever changing, and there have been times where I have questioned whether it's still worthwhile to be in the field, because of all the challenges that we are faced with, and I think it has gotten much more difficult after COVID. Recently, I read a statistic that during COVID, about 8,000 medical practices here in the United States shut down. Doctors had to rethink what they wanted to do, and on top of that, another stat that I read, is that almost 30% of doctors, at some point, were thinking about leaving the profession altogether. So the changes, like corporatization of medicine, is making it difficult for doctors like us who've been trained in traditional ways, where we have autonomy. When we come out of medical school, you are trained that you will decide what the patient needs. You will come to your own diagnosis, you will develop your own treatment plan, and somehow there's funding for that treatment plan, and all the drugs that you think the patient should have and all the tests that the patient should have are going to be available. But the reality is very, very different.

Dr Nondumiso Makhunga-Stevenson: 47:53

So, thinking back on my career, I have been in those situations. I worked in the UK, in the NHS, immediately after I completed community service and there I saw a somewhat better- resourced health system, but still the challenges of long lists for elective surgery, for example, although it was very encouraging for me. So I have really worked in many different parts of the sector. At one point I was a registrar in public health medicine. I was in management at an academic hospital in Johannesburg. I was in the management for an international nonprofit organization. I've been a program manager. I've been a GP in solo practice, I've been a GP in group practice and I've been in the pharmaceutical space, and most of my roles in the past 10 years have included an extensive amount of travel, also, and working in programs on the continent, which was also very eye-opening for me and really showed me that we have a lot in common.

Dr Nondumiso Makhunga-Stevenson: 49:10

And I'm learning, even here in the US, that there seems to be a certain common thread in the personality, at least, of doctors. That is my view. It's not scientific, but people who are very patient-oriented, people who will do anything for their patients, people who will put themselves in the firing line for their patients, who are dedicated no matter the system. They make a way for the system to work for their patient. They try to find a way around it.

Dr Nondumiso Makhunga-Stevenson: 49:46

Whether it's in the US, it's in Rwanda, it's in Uganda, it's in South Africa, doctors are very dedicated to the craft and to the patient and to the society. That variety in my experience, has been very helpful in shaping my view of doctors, because I've seen them working in different environments and seen whether they are working as medical directors in a pharmaceutical company or general managers in a pharmaceutical company, or they are working as doctors in the clinic in a rural facility, there is still the drive to wake up every day and make it work for the patients. That's what's very heartening for me about what I've observed about doctors.

Dr Maria Christodoulou: 50:43

Right. I'm imagining that there might be some young colleagues out there who will be listening to your story and thinking, wow, how do you go from - You were a registrar in public health, I know you didn't finish that. You went on and you did an MSc in clinical epidemiology. You've worked in the corporate sector. You've worked in all these different settings. What was it that created that path? How did you make those career moves? What enabled you to gain experience in all those different settings?

Dr Nondumiso Makhunga-Stevenson: 51:15

I think the first thing I tell young people is that we need to view our medical degree as just that. It is a degree that can be applied in any kind of setting. You have this medical knowledge that can add value, whether it is in front of a patient, or in a health tech company, or in a pharmaceutical space, or in a venture company. Your training and your experience is what adds value.

Dr Nondumiso Makhunga-Stevenson: 51:47

Non-clinical medicine is not inferior to clinical medicine. You're just applying your medical knowledge and experience in a different setting, that's all. And that's why it's been easy for me to go back and forth between clinical and non-clinical medicine, because I'm taking what I know. I'm applying it in aesthetic medicine. I'm applying it in a program for people who inject drugs. I'm applying it in a GP practice. I'm applying it in a corporate practice. I'm applying it in an HIV prevention program.

Dr Nondumiso Makhunga-Stevenson: 52:19

That's it. It's a very portable degree and I've had frustrating conversations with young people because their mindset is that you take the traditional route, which is you finish medical school, you do your community service and then you have only one of two choices, you either specialize or you become a GP.

Dr Nondumiso Makhunga-Stevenson: 52:40

That's it, and it's not like that. And it kind of disappoints me in a way, because I think now more than ever, the options for young medical doctors are much wider than they were. I see doctors here doing all sorts of very interesting things in telemedicine, for example, developing their programs in health tech. They're all part of that. Some of them are doing that part-time as a side hustle, as now is the tendency, but they're running their GP practices too, or their specialist practices. They are working in that space of inventing health-related devices because they understand what will work, because of their medical degree. D octors have so much value to add in spaces outside of clinical medicine and if people would look at non-clinical medicine at the same level as clinical medicine, then you'll see that the world is your oyster because it's such a valuable and versatile degree. So I have used that to my benefit and that's helped me also be able to relate to doctors in all different settings, because I understand those different contexts much better.

Dr Maria Christodoulou: 54:00

You spoke earlier about destiny and you spoke about people's journeys and each person having their own journey. And I'm curious about, when you look back on this career that has included so many things, because other people, as you say, they think they have to follow the conventional path. They must either be a GP or specialize, and then they get into a practice and they stay in that practice or they stay in academia. What was it about you that caused this movement, actually, from one sector to another, from one role to another?

Dr Nondumiso Makhunga-Stevenson: 54:36

It was many factors. At times it was just sheer curiosity. I wonder what it's like to work in corporate medicine? I think I might want to add that to my CV. At other times it was necessitated by personal circumstances. So, for example, when I had my children, they were still very young. That is the time that I went into part-time GP practice because that was more convenient. It didn't involve travel. Other times it was just, I need a job and this is the one that is available. Let me see what happens.

Dr Nondumiso Makhunga-Stevenson: 55:06

But in all of the roles, even those that I didn't enjoy necessarily, built my skill set. I always came in with an attitude of, let me learn as fast as I can and build my skills, and understand this sector as much as possible, and I think when you do that you benefit a lot. Even if it's a role that perhaps you may think you didn't grow in, you will realize in two or three roles down the line that, actually, I did learn something from that particular role, even if it's patience, even if it's how to manage stress. But I learned something, I developed a skill that will benefit me in future roles.

Dr Maria Christodoulou: 55:53

So what would you say to a young woman who's growing up in a rural area right now and feeling called to medicine? What advice would you give her?

Dr Nondumiso Makhunga-Stevenson: 56:03

Go for it if it is in your heart. I have a few young people that I started mentoring. They were high school students who had expressed to me that they wanted to do medicine. Unfortunately, one of them didn't get a place because it is competitive. So I met with her at the beginning of the university year and I said to her listen, don't worry about it. If it's meant for you, if it is in your heart, if you feel it was calling, you will find your way back to medicine. There's no way that you won't. And I know many, many doctors. Most of them started doing a BSc degree. They didn't complete and shifted to medicine. Some went into pharmacology. Many, many doctors. I'm sure you also know a lot of them. When it's something that is in your heart and you feel it is designed for you to help people in this way, d efinitely go for it.

Dr Maria Christodoulou: 57:03

There were also two things you said to me the other day that I think might be quite important, and the one was that, whilst medicine is our career, it's not our entire identity, and the other was that our job title does not have to overshadow our individuality. Who is Nondumiso when she's not Dr Nondumiso? Who is the identity beyond that of the doctor?

Dr Nondumiso Makhunga-Stevenson: 57:32

First and foremost I'm a mother, I'm a wife, I'm a daughter, an introverted friend and I'm somebody who really enjoys seeing the people around me happy, especially my family. I have a very important role in my family because I am the oldest of my father's children and I take that role very seriously. So I work very closely with my siblings to support them and make sure that they're okay. P ray for them with whatever challenges that they may have and life experiences that they have. I'm an aunt and I love that role as well, and I have a favorite niece. I hope the others don't hear that. But it's difficult to de-identify yourself or to really separate yourself from the doctor. I think society does not allow you to, to a large extent, allow you to be separated. It doesn't matter where you go. The minute you say you're a doctor, automatically people start to treat you differently, they start to look at you differently and sometimes that happens even within the family. But I enjoy my role in the family very much. My family understands who I am as a doctor and they give me space for that and they encourage me in that, and my children, I'm starting to see also their perspective on the world is changing and I think it's largely because they see my passion for my profession and their values make me very happy because I can see they have that world view of service, in whatever way, to humanity, which is something that doctors do. So that is what I do.

Dr Nondumiso Makhunga-Stevenson: 59:34

I don't have a lot of hobbies other than Netflixing. I love Netflix. I am an avid viewer of documentaries. I absolutely enjoy those more than any other genre. I am a TikToker of note. I enjoy TikTok for many reasons, primarily because my algorithm on TikTok usually shows me young people having fun, showcasing their talents, whether they are telling jokes or doing sketches or singing or dancing. It always reminds me of what is possible for young people and, again, that everybody has a gift and they make me feel good watching them be in that space.

Dr Maria Christodoulou: 1:00:16

So are you an observer on TikTok? Are you also a content creator on TikTok?

Dr Nondumiso Makhunga-Stevenson: 1:00:22

Randomly, I do some content creation, but I'm primarily an observer. It's where I go to de-stress, to be honest. I t's where I go to feel good, to laugh. That's the beautiful thing about TikTok is that it allows you to gift people. So I have a small budget that I have and if I've laughed, I will gift you. If I've been entertained, I will gift you. I'll send you some roses and a few hearts because I appreciate the positive impact that you've made on me. After a long day, I can think about something else and see something beautiful, something that is a stress reliever for me or diminishes my anxiety.

Dr Nondumiso Makhunga-Stevenson: 1:01:09

What took you to the US? My husband. We've been married for some time now, actually, and I lived in South Africa, of course, but we felt now that the timing was right for me to move to the US and join him. We were going back and forth and it was getting a little bit difficult and expensive. He is American. We met here in America during one of my travels many years ago, and he always says he pursued me all the way back to the motherland, as he calls it.

Dr Nondumiso Makhunga-Stevenson: 1:01:44

I'm now in the US, but my roots are still very, very deep in South Africa. I still have my family in South Africa and I consider myself really somebody who's got the privilege of being able to work and live and love in two countries, which I think are both amazing countries. It's been a short period since I've been here, a lot of adjusting and acclimatizing to the way things are done here, but I've been overwhelmed by how supportive the doctors are here, especially on the professional side. I joined a few Facebook groups and the response was amazing. It was not what I expected. As an outsider, one sometimes has this anxiety of how you'll be received. Will you understand what is said? In society th ere are sometimes unspoken rules of engagement and, of course, being with the in-laws has been amazing as well. So I get to be with my mother-in-law and the rest of my in-laws, my sister-in-law, my brother-in-law, so that's also been great.

Dr Maria Christodoulou: 1:03:05

If you had to summarize or capture the essence or the theme of your journey this far, how would you describe it? What words would you use or what image comes to mind?

Dr Nondumiso Makhunga-Stevenson: 1:03:18

It's definitely been a spiritual journey. I've been tested many times spiritually and that has brought my spiritual side and my medical career closer and closer. With every single role that I have, I've come to understand that the medical profession and my own spiritual growth are intertwined. That's my experience. I know it's not the same for everybody and I think that's why it's easy for me to say, I don't think I will leave the profession, because every single part of the profession, every single encounter and experience, I take something away from it spiritually. I see the growth. Sometimes it's the challenge, spiritually.

Dr Nondumiso Makhunga-Stevenson: 1:04:11

I'm not the same person, spiritually, that entered medical school that I am now. Over and above just my own learning of, a s human beings we do our own self-directed learning around spirituality. I'm talking about the encounters that I had, especially encounters from patients, have built me in that way. I feel that I have worked on my intuition more, to a point where I think it comes into clinical practice with me. It comes into non-clinical practice with me how I make decisions. I've started to depend on or include my intuition, my gut feeling about certain things, and that has really been part of the experiences that I've had with medicine. It's difficult sometimes to explain to somebody who hasn't had that. But for the doctors that I know that I've worked with, many of them, some of them are priests, or who are religious, or who are traditional healers, they get it.

Dr Maria Christodoulou: 1:05:23

Right. Do you have any examples of how that ability to bring in the spirituality, to trust that intuition or that wisdom or that guidance has shown up in patient encounters? How has it changed how you practice medicine?

Dr Nondumiso Makhunga-Stevenson: 1:05:40

So I mean, the example we talked about of going into very dangerous - When I worked with a population that was in that situation, my belief was that I am there to be part of somebody else's healing and, if that is my destiny, I will be safe. There will be no harm coming to me because my intentions are good. My intentions are about healing and using this gift that I have been given of being able to be a doctor and using it to heal somebody else. So when I looked at medicine in that way, I felt safe. The other example I can give you, and I think this is for a lot of doctors too, is that during the COVID pandemic, a lot of doctors just felt the need to help. Doctors around me. I'm sure yourself and others felt that, if it is necessary for me to go and help in the hospital, even though I have not worked in the hospital for many years, I will do it. I will go and learn how to operate that ventilator.

Dr Nondumiso Makhunga-Stevenson: 1:07:00

On a lower level, I think it's not necessarily a very logical decision to make, of course, but it's a very much, for me, how I see it, it's a spiritual decision. T hat need to put yourself in the firing line to save and to help someone else and to be in service to another human being. When you wake up every day with the notion that, I go to work to be in service to another human being., T hat's it, that is enough. And that's why when a patient says, thank you, doctor, you wake up even earlier the following day, you know, because that's just a validation that, yes, you are on the right track.

Dr Nondumiso Makhunga-Stevenson: 1:07:46

Those are the ways that, for me, the spirituality has shown up, and it's more in the attitude, it's more in how it has built my resilience. And I know, certainly in my younger days, when I was an intern or doing Comm Serve, you'd be on call. You see it as part of your responsibility to serve, and unfortunately, I saw this even with my own father, who also worked throughout COVID, much to my anxiety because he was older. But his argument was, I need to serve my patients, I need to help my patients, I need to make sure that my patients are okay. And in as much as I was not very happy with his response, I understood it, I accepted it and he was fine, thank God.

Dr Maria Christodoulou: 1:08:37

Have you ever carried that responsibility as a burden? Has it ever felt heavy?

Dr Nondumiso Makhunga-Stevenson: 1:08:43

What has felt heavy for me is outside of the patient. The heaviness comes from underfunding of the health system, corporatization of the health system, overwork and underappreciation of healthcare providers. That is the burden. I think in an ideal world where all of those things were addressed to some extent, medicine would be much lighter. But for people who maybe don't have the internal, I'll say battery, which can drive them, like for myself I can look at it as the calling, i t becomes difficult. Medicine becomes a burden. So your whole perspective about how you practice, I think, is very much influenced by factors that are outside of our control. B y people who are not necessarily medical people who have the same views about health and who deserves what in the healthcare system.

Dr Maria Christodoulou: 1:09:53

Where are you hoping the journey will take you next?

Dr Nondumiso Makhunga-Stevenson: 1:09:58

I try to keep an open mind. Interestingly, I did some professional photos. I had them made with a photographer in Joburg CBD, at Arts on Main, and I discovered that there was an artist incubator called the Centre for the Less Good Idea, and I was just drawn to this sign. It was on a Sunday morning, so the center was closed, but I was just drawn to this idea that there is a whole center for the less good idea. And I started reading up about this center and I found out it's for all these projects that artists propose and they don't get funded and what they do is they just focus on let's see what happens.

Dr Nondumiso Makhunga-Stevenson: 1:10:53

So there's no script. T here's an idea of just trial and error, no judgment. It's impulsive artistry, just showcase your talent. And I thought, wow, this is very interesting. How can I apply this to my life right now? Because when I came to the US, in my mind I was probably going to continue on a particular trajectory, and I might still.

Dr Nondumiso Makhunga-Stevenson: 1:11:26

I don't know, but the break has forced me to sit back and say maybe the less good idea can take center stage. It can be developed and it can turn out to be a brilliant idea. I even did a LinkedIn post about this and talked about how so many medical findings, these are all incidental discoveries, and all it took was for somebody to be curious about it and say, well, these patients are reporting this instead of what we expected them to report about. Let's pursue this idea, even though it's not our main perfect idea in this trial. So that takes a lot of humility as well. You have to be curious, you have to celebrate serendipity. So that's where I am right now. I'm saying to myself let me open up to any idea that develops.

Dr Maria Christodoulou: 1:12:30

Is there a less good idea that's in the background?

Dr Nondumiso Makhunga-Stevenson: 1:12:35

I think what is taking a lot of prominence now in my career is the coaching. Not that it was not a good idea. I always knew that this was something that I would do and I've been spurred on by the doctors. I think for me it's become a source of great fulfillment professionally to do with doctors and to interact with them, but I'm very open to it actually being my full-time role. The growth that I'm seeing in terms of my inter actions with the doctors here, because they are very, very much ahead of where I come from in terms of coaching. Like here, coaching is budgeted for in your salaries. a benefit in some practices. You get CPD points for individual coaching. So I'd love to see a situation where I can move the needle just a little bit in South Africa, because I still have most of my connections there, for the doctors there, that it becomes a part of what we do and to help them to benefit from that.

Dr Nondumiso Makhunga-Stevenson: 1:13:52

And I didn't have that understanding until I got here and that's why I'm saying, possibly the less good idea, because it was never top of mind, but seeing how much it's helping doctors here. T here are business coaches who are doctors helping other doctors to turn around their practices and teach them entrepreneurial skills.

Dr Nondumiso Makhunga-Stevenson: 1:14:14

There are coaches who help women doctors to negotiate their salaries. There are doctors here who are helping other doctors on leadership, because our medical degree doesn't really equip us for that, and I can tell you from my own experience. I was placed as a senior clinical executive at Bara (Baragwanath Hospital) armed with an MBCHB only and about five years of post-community service experience, and I was put in a leadership position. So I learned a lot. I grew from that, for sure, but how much better could I have been had I had another doctor not just mentor me, which is what I got and I really appreciated, but coach me. T angible skills for leadership. So those are all the issues that I'm seeing my colleagues could definitely benefit from, as I'm trying to learn and pull down all this knowledge and methods and tools that they are using so that I can help my colleagues back home. It's doable and it should be something that we integrate into our health system. Just life coaching, career coaching, business coaching, we need all of that.

Dr Maria Christodoulou: 1:15:39

I have such a sense as you're speaking, and when you first started telling your story, I wrote down one sentence and it was when you said this was in my DNA. And now, as I'm listening to you and I think about your career path, I see the influence of the herbalist grandmother in your time and you finding yourself in the pharmaceutical space, and then I see the father who was a GP and the work in the clinical sector that you've done, and then the mother who was a nurse, who brings a different dimension to the care of the patient than a doctor is trained to do, and it feels like you've kind of explored these different aspects of what's in your heritage and perhaps now something new will emerge, something new will unfold that will be unique to who you are and all this experience that comes not only through the lineage but through the journey that you've walked.

Dr Nondumiso Makhunga-Stevenson: 1:16:26

Absolutely. And having said that, though, one of the lessons, as you did your own training and coaching, is self-awareness, and I've also learned to develop that self-awareness in terms of understanding what I don't enjoy when it comes to day-to-day work, and know that I'm not a very commercially driven person. I find it sometimes difficult to switch my mindset, especially commercial in the health sector. I'm not somebody that wants to only do paperwork. I need to interact with other human beings. The human interaction for me is very, very important, and that interconnectedness. So I always advise people that it's very important to be self-aware. Even though there are many spaces and many roles that you can be in as a doctor, you will be frustrated if you are in the wrong space, if you don't understand your strengths, your skills, your passions, your worldview, your values, and I think that's what I've tried to bring into every role, and some didn't sit so comfortably because I didn't have that self-awareness. The mission, the passion, the service all of it is coming together in this role. That's been the most enjoyable for me.

Dr Maria Christodoulou: 1:17:53

Beautiful. Is there anything we haven't talked about that might be important to include in a conversation about your story?

Dr Nondumiso Makhunga-Stevenson: 1:18:03

Yeah, I've talked a lot. For me, it's really my love that has grown so much in the last few years for the profession. As I said, I cannot reiterate enough how much I've grown to respect the profession and how much difference doctors are making in people's lives. The last year that I worked in the pharmaceutical sector really drove that home to me, because I was working with doctors in resource-limited settings and they were making it happen. They were pushing doors, they were moving barriers, they were doing everything that they could do to shift all these areas for their patients. They were totally dedicated to their patients.

Dr Nondumiso Makhunga-Stevenson: 1:19:04

First and foremost was, how can I change this? How can I show up for my patients? Who do I need to fight? How can I improve it? Nondumiso, what can you teach me? What can you give me to help my patients? That is the attitude that they have. N o self-interest at all, and working in conditions that, coming from South Africa, we probably would have been very unhappy about. In circumstances that were very, very challenging. Their clinical skills were something to be envious of and I realized that, wow, it's possible to be in this medical field and really, really make a difference if you want to, as an individual. If you want to do it, it is possible, and they really inspired me a lot. That's really, I think, th e last thing I would want to emphasize, is just my profound respect and love and passion for the medical profession. That's what I've learned about being a doctor.

Dr Maria Christodoulou: 1:20:12

Lovely, and in a way, you're speaking to what motivated me to start this podcast, because I too had that sense that there were so many doctors working from that heart space, against incredible odds, to make a difference, who were committed to making a difference. But it seems like there's such a mismatch between that and the public perception of doctors, and so I'm hoping that these conversations will begin challenging some of that, and I love that you can unequivocally say you love the profession, because you're challenging me to think about how often I've said I hate medicine, I hate being a doctor, but I feel called to be a doctor and I feel a compulsion to work with my colleagues who are struggling for us to create a space where we can be human as doctors. I'm touched by your sharing about that. I think it's quite profound. Thank you. How about you, Amy? You've been listening quietly for nearly two hours. Is there anything you want to ask or say?

Amy Kaye: 1:21:12

You mentioned that you really like documentaries. I used to be a documentary filmmaker and then something came to mind. Y ou were speaking earlier about young people and I think one of my favorite documentaries is Searching for Sugar man, and in the documentary his daughter talks about how they came from nothing and how he used to always tell his daughters that even if you don't have wealth, that doesn't mean that your dreams aren't incredibly rich, and I thought that was really beautiful, and I thought that reminded me of the kind of young people that you're seeing on TikTok and them having these rich dreams, and that just because you don't have wealth doesn't mean that you don't have a rich imagination, that you don't have desires for a rich life, and wealth can come in completely different forms. That's the one thing that I thought of when you were telling that story, and then the other thing was when you were talking about being in the inner city in Johannesburg and working with drug users. It reminded me of when I was working with sex workers and I did a writing course with them and I also entered with preconceptions of who I thought sex workers were, having not really spoken to sex workers before, and I thought all the writing prompts that I was going to give them to help them tell their story just came across as incredibly -

Amy Kaye: 1:22:26

In my mind I was going, this is going to come across as so condescending. Tell me about what your dreams are. How do you ask somebody that's literally living on a piece of cardboard under a bridge, that is trying to survive, tell me about your dreams. It just comes across as incredibly condescending. And yet they had the most beautiful dreams and they were so grateful for such little things and it completely changed my perspective. The one thing that really surprised me about working with sex workers was also, I again, in my prejudice, I thought that them being able to speak and write about sex would be the one thing they would be able to speak and write about and it's the one subject they would not touch. They would not talk about sex to me and I thought, interesting. Only right up until the last sessions that I was working with them did they kind of start really talking about what their work was about and masks started coming off.

Dr Nondumiso Makhunga-Stevenson: 1:23:20

I have experience working with sex workers and my experience is very similar to yours. So you kind of go in with some preconceptions about their morality, and I spent a lot of time with one of the advocacy groups with sex workers when I was still working in the NGOs on HIV prevention programs. They opened my eyes as well. And one thing I realized, again to the point that I made earlier, you realize that everybody has a gift and the gift will always show up in some way.

Dr Nondumiso Makhunga-Stevenson: 1:24:00

There's nothing as humbling as sitting in a room with a sex worker and they are educating you about the language that you should be using for your program in order to have people utilize those services. You have to sit and you have to be a student and accept what they are saying, because you realize you don't have the language, you don't have the information, you don't have the knowledge. You must sit and you must listen and you must be nonjudgmental and you must hear what they say, for your program to be successful. When I think about our training, there isn't a lot of emphasis on that, on how do you learn as a doctor from your patient. It's usually, the patient has diabetes so you educate them on one, two, three, four Not, w hat can the patient teach me that I can share with somebody else or that will help me to do my job better? And I had the very, very similar learning from sex workers around that. I could not do my job if I did not listen to them, it was just that simple.

Dr Maria Christodoulou: 1:25:08

When you look at the foundations of so-called evidence-based medicine. The foundations of evidence-based medicine are that the decisions were made based on a triad of information. The one was the data, the facts that are out there. The other was the patient's experience and the third was the clinician's experience, and all three together were what comprised evidence-based medicine. And unfortunately, now it's become more and more that evidence is about the data and we make the patient's experience, w e neglect the doctor's experience in making the decisions that need to be made, and often the data needs to be applied in a very different way when you understand the patient setting.

Dr Nondumiso Makhunga-Stevenson: 1:25:47

Absolutely, and my training in clinical epidemiology has helped me tremendously in public health as well, and I was very fortunate to have a professor who emphasized that. Don't underestimate the case study, don't underestimate qualitative research, because you are going to validate your data with that. You have to triangulate all of these, as you've mentioned, the doctor's perspective and observations, the patient's perspective and observations, and the data. So the less good idea sometimes becomes very important. W here somebody listens and says well, our clinical trial is for diabetes, our clinical trial is for hypertension, we're looking for this and that, but we are finding penicillin, we're finding this drug, that other drug, all of these because somebody was observing.

Dr Nondumiso Makhunga-Stevenson: 1:26:50

You didn't just focus on one data element or one data source. You're quite right, we are trained in a certain way and sometimes we do develop the tunnel vision. The human stories, the human experiences, are what should help us when we look at data. Data is important, but your experience should help you to contextualize the data and you're able to adapt and develop those programs so that it's more meaningful, it's better received, because you've considered the recipient of the services in the design of the program. You can learn a lot from sex workers.

Dr Maria Christodoulou: 1:27:33

Thank you so much for making the time, thank you for sharing your story and thank you for the gifts that you bring to the world and to the profession.

Dr Nondumiso Makhunga-Stevenson: 1:27:43

Thank you so much and I want to tell you, Maria, before we go, the gift you brought me. Two weeks ago I was on a workshop. It's a coaching workshop with all different coaches, and one of the outputs of that coaching workshop is how do you become visible? And after speaking to you, in my mind I was going to do a coaching podcast or YouTube channel and I was going to just focus only on this coaching and coaching processes.

Dr Nondumiso Makhunga-Stevenson: 1:28:15

After speaking to you earlier, I said you know, I love your approach of the reflective journey of a doctor and how those lessons can help somebody else who may not have access to a coach. But just from the questions and the way you were asking me the question, I was like, okay, I'm being coached here, even though I didn't know it. We were just discussing what we were going to talk about. It really inspired me. So one of my projects now is to do a podcast and I think that is the approach that I will utilize, so thank you so much for that and, of course, thank you so much for having me on your podcast as well.

Dr Maria Christodoulou: 1:29:01

Thank you. It's such a pleasure and I'm excited for you that that's the way you're going to approach your podcast, because I think, as I said to you when we chatted the other day, for me, what often happens with our profession is that if we are visible in the public eye, it's about our expertise, it's about our knowledge, and we're talking about our theories and our data and our facts and our ideas, but the person behind that experience remains invisible, and it's because of that that I think this mismatch in the dialogue or the public narrative about doctors and the experience or lived experience of doctors is happening, and so I think it takes courage. Certainly, for me, it was not always easy to make myself visible. I still grapple with it sometimes, but I'm always so inspired when I meet a colleague who's willing to share their story.

Dr Nondumiso Makhunga-Stevenson: 1:29:49

Only we can change the narrative about ourselves, exactly Putting ourselves out there, controlling that narrative. That's the only way that people will start to see doctors for who they are. And, as I've said, for the most part doctors are people who just want to do right by their patients, and that's it.

Dr Maria Christodoulou: 1:30:09

Absolutely. Thank you. It's been a pleasure and I'm hoping that this conversation will help with your endeavor to be more visible in the world. 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.