Within the buzzing halls of Tygerberg Hospital's neonatal unit, Dr Gugu Kali carries forward a medical legacy nearly a century in the making. As she guides her team in caring for South Africa's most vulnerable newborns, she walks a path first carved by her grandfather through extraordinary determination and sacrifice. This path, from the segregated healthcare system of 1920s South Africa to Kali's current position as Head of Neonatology at Tygerberg Hospital and Stellenbosch University, tells a powerful story of perseverance across generations in service of healing.
Dr Rotoli Xaba, one of the first 20 Black doctors in South Africa, faced seemingly insurmountable barriers to his medical education in the 1920s. With no opportunities for Black South Africans to study medicine in their home country during apartheid, Xaba travelled first to the United States and later to Edinburgh, Scotland, working on ships and taking odd jobs to fund his education. Financial hardships forced him to abandon his studies for a decade when his father suffered a stroke, cutting off his minimal financial support. Despite these challenges, Xaba persevered, finally qualifying as a physician in 1936 and returning to serve communities in the former Transkei where access to healthcare was severely limited.
Today, his granddaughter Dr Gugu Kali, carries that legacy forward as the Clinical Unit Head for Neonatology at Stellenbosch University and Tygerberg Hospital, where she's served for the past four years. The connection between generations is unmistakable – both driven by a commitment to provide care to those who need it most.
“I'm always very grateful when I think about the people that pioneered the pathway for me, especially my maternal grandfather," Kali reflects. “He had actually qualified as a teacher but he saw how the people around him were suffering without access to good care. And he wanted to make a difference."
Kali's path to medicine seemed almost predetermined, growing up in a family where healthcare was a calling. Her father was a general practitioner who often took her along as he tended to patients in their small hometown of Butterworth in the former Transkei. Her mother, inspired by her own father Xaba, became a nurse.
“As long as I can remember, it seemed to be a natural path," Dr. Kali says of her decision to study medicine. “I can't even remember ever considering anything else."
After completing her medical training at the University of Natal in Durban during the final years of apartheid, Kali specialised in paediatrics and neonatology at UCT. Her journey included four years working in academic units in the UK and Ireland to gain experience in settings without resource limitations before returning to South Africa in 2008 to join Tygerberg Hospital's neonatal division.
As head of neonatology, Kali focuses on the care of newborns from birth to 28 days old. She has developed particular expertise in treating hypoxic ischemic encephalopathy (HIE), a condition where babies don't receive enough oxygen around the time of birth, which can lead to severe brain damage or death.
“It's one of the top three causes of death in babies," Kali explains. “Babies that survive the neonatal period can have long-term developmental problems. They can get cerebral palsy. Their vision and hearing can be affected."
Kali's work on cooling therapy for HIE formed the basis of her PhD, completed in 2021. This treatment, which she introduced to Tygerberg Hospital in 2008, involves reducing a baby's core temperature by about four degrees for three days before slowly rewarming them. It's now considered standard practice in most areas and has been proven to improve outcomes for affected infants.
Current research she is involved in explores why babies with seemingly similar oxygen deprivation respond differently to treatment, investigating potential genetic factors that might influence outcomes. Other projects in the pipeline include combining cooling with other neuroprotective therapies to achieve even better results, and looking at low cost accessible ways of diagnosing brain injury in newborns.
Despite working in a resource-limited setting, Kali strives to create an environment where patients receive dignified care and her team can thrive. Her dedication bears fruit in heartwarming ways – like when a former patient, born prematurely at 27 weeks and weighing just 900 grams, returned to the unit as a healthy 16-year-old to celebrate her birthday by visiting the place that saved her life.
“It was nice to show the mothers that they could actually look forward to a day where they have a healthy child," Kali shares.
In the halls of Tygerberg Hospital, Kali embodies the persistence and compassion that characterized her grandfather's pioneering journey. Through her clinical leadership, ongoing research, and approach to teaching, the next generation of medical professionals, she extends a family legacy of breaking barriers and healing communities – a living testament to the enduring impact of determination in the face of adversity.
