Earlier this year, surgeon Prof Karin Baatjes made headlines by successfully demonstrating that portable GoPro cameras, a favourite among outdoor enthusiasts, can be used equally well to train students in surgical procedures. It provides students with a view on how things are being done, from the exact vantage point of a surgeon.
GoPros provide high-definition videos shot at a wide-angle. It allows surgeons to easily record procedures in the theatre, or even smaller procedures that they perform in their consulting rooms. Because the camera can be mounted on a surgeon's head, the video displays everything that the surgeon sees and does.
“It therefore allows students to follow procedures from a surgeon's point of view, without influencing the sterility or workflow of a theatre environment, or unnecessarily prolonging a procedure," Prof Baatjes said at the time of the publication of a research article on the subject in the journal The Clinical Teacher.
As with the GoPro research, Prof Baatjes' career has thus far been characterised by such determined yet subtle shifting of boundaries. Well before she qualified as a doctor in 1997, she already knew that she'd like to become a surgeon. She started training towards this goal in 2000, and was only 30 years old when she wrote the required College of Medicine exam. A year later, in 2005, she also graduated with a MMed in surgery.
"It is a very big responsibility at such a young age to be the consultant on call. I wouldn't recommend it to everyone," admits Prof Baatjes, who was born in De Aar and grew up in Kraaifontein.
In 2018, she became the first student in almost 30 years to obtain a doctorate in the Surgery Division of the Faculty of Medicine and Health Sciences at Stellenbosch University. This unit is traditionally more focused on the provision of clinical services and training than on research.
Regarding her own decision to become a surgeon, she says: “I have always been naturally inclined to do things with my hands, and it has always been fun to help patients in that way. I like the immediate satisfaction of seeing within a few days that a patient is feeling better, for example, after an appendix has been removed. The opposite is of course also true. If you make a mistake, you immediately see it. "
Administrative duties as associate professor in the Surgery Division of the Faculty of Medicine and Health Sciences and as head of the Division of Clinical Anatomy in the Department of Biomedical Sciences since 2018 have increasingly kept her out of the operating theatre.
"The most satisfying thing is still to sit in front of a patient and devise and talk through the treatment plan. To see that the patient understands the different aspects, and to explain why we do things. I also enjoy teaching students, and passing on what I have researched, or learned and heard from other people."
Her PhD research was on the use of aromatase inhibitors used to treat postmenopausal breast cancer patients. The treatment can adversely affect the bone density of some patients, and due to a genetic predisposition in some families, increase their chances of osteoporosis and bone fractures. Her research about it has already been published in journals.
The topic was a direct result of her clinical work as a surgeon in the breast and endocrine surgery unit of Tygerberg Hospital. It was also a result of her tendency to dig deeper and to think constantly about the practical implications of what is happening in the operating room.
"Just as it is critical for a scientist to move beyond the confines of the laboratory, it is also valuable for me as a clinician to think about more than just the patient sitting in front of me. I am a firm supporter of individualised care, because not all treatment is suitable for everyone, nor will the decisions we make about surgery or the drugs we prescribe be the same for all breast cancer patients."
She believes she is able to maintain a good balance between science and research and the training of newcomers to the medical profession.
This sentiment is confirmed by geneticist Prof Maritha Kotze, chief medical scientist in the SU Division of Chemical Pathology and co-founder of the gene testing company Gknowmix. She also supervised Prof Baatjes' PhD work.
“Karin Baatjes is not just a clinician. She's not just a scientist. She is a phenomenal clinician-scientist," Prof Kotze affirms.
Together, thanks to a grant from the Medical Research Council, they have built up a genomics-based database of breast cancer patients. This has since been kept up to date by Prof Baatjes and other PhD students working with Prof Kotze. The information it contains is of value to other researchers too. It has for instance been used by a Nigerian researcher to inform his PhD research.
The database contains records of breast cancer patients who were part of Prof. Baatjes' PhD research study at the Tygerberg Academic Hospital. Some of the patients were tested to find out if they are carriers of the two most important breast cancer genes, BRCA1 or BRCA2. These genes are usually used as a starting point to determine whether there is a predisposition in a family towards breast and ovarian cancer, and whether lifestyle and environmental influences could impact its development and treatment.
The database also includes biochemical information, the results of blood tests and the medication these patients received. That's the type of information, says Prof. Kotze, which was previously collected "only in silos".
The database makes it possible to cross-reference one patient's data with that of another. When new patients' information is entered into the database, it may indicate a relationship between their genetic, lifestyle or treatment-related risk factors. According to this, doctors may decide to contact a patient again because it triggered alarm bells, or because it means that a person's risk of developing cancer or another medical condition may have increased. Among the alarm bells might include certain comorbidities, metastasis or a second type of cancer. If this happens, a genetics consultant and medical scientists registered with the Health Professions Council of South Africa will provide the necessary support to the doctor who is treating the patient, or refer the patient for genetic tests.
They work well together, says Prof Kotze: "We look at things in a more integrated way, as it is our goal to improve patient care."
She adds: “Genetics tests have developed over the last few years to such a degree that we can already look at 20,000 human genes. However, its value lies in using it together with clinical aspects to create a context within which you can address those genetic results."
"If we as scientists and doctors do not stand together and create a better alternative that is used in the right context, many doctors and patients will be misled by the increasing supply of direct genetics testing kits," believes Prof Baatjes. "Things must work the other way around. You must first see what is wrong and then decide what is relevant. Integrated genetics is necessary, and it is necessary that the students I train also have adequate knowledge about it."
For the next few weeks, we will introduce you to some of SU`s researchers whose work is featured in the latest edition of Research at Stellenbosch University.