Behind the kind smile of this warm paediatrician is an astute mind that's constantly searching for inventive ways to better serve the young patients that present at the children's ward at Tygerberg Hospital.
“Are we using our available resources optimally? How can we work innovatively? Are we leveraging partnerships to best serve our paediatric patients and their families?" These are the questions Professor Regan Solomons grapples with every day. He is the newly appointed Executive Head for the Department of Paediatrics and Child Health at Stellenbosch University's (SU) Faculty of Medicine and Health Sciences (FMHS).
He believes that good relationships are at key to achieving these objectives. “I place value on building and strengthening relationships within the paediatrics and child health team in order to ensure buy-in to this common vision and good clinical and corporate governance," says Solomons.
“We see children from the eastern half of the Cape Town Metro area and further afield in the province. It is therefore important to have good communication with staff and gain first-hand experience of our referring hospitals and health centres in order to strengthen referral pathways and management of children with the best available evidence."
Transformative environment
Solomons' vision for the unit is not limited to just clinical excellence – he also strives to create an environment where teaching and learning can thrive. “In the next few years we will explore novel methods of teaching to contribute to a transformative experience for both undergraduate and postgraduate students," says Solomons, who holds a joint PhD from SU and Vrije University Amsterdam.
“We strive to create a transformative environment in the Department of Paediatrics and Child Health as we seek to develop excellent doctors, educators and researchers, whose work will be relevant in South Africa, Africa and globally, while having a deep understanding of the nuances, pleasures and frustrations of working in South Africa."
TB meningitis
As a paediatric neurologist, an issue close to Solomons' heart – which was also the topic of his PhD – is TB meningitis (TBM). This condition, whereby the TB bacterium affects the brain and spine, mostly affect children under the age of four, and can cause severe neurological impairment and even death. “Early diagnosis and treatment of TBM is imperative to prevent poor outcomes, but this is made difficult as early symptoms are non-specific and microbiological diagnosis to confirm the disease is often lacking," he says.
The exact prevalence of TBM is currently unknown and it is estimated to make out between 1 and 4% of all TB cases. An average of 50 children with TBM are admitted to the Paediatric Neurology Ward at Tygerberg Hospital each year.
“Colleagues at the Desmond Tutu TB Centre (DTTC) [situated within the Department of Paediatrics and Child Health] are at the forefront of including surveillance of TBM as part of monitoring and evaluation of paediatric TB care. This can help to measure and report both on the burden and outcomes of TBM in children and identify health system challenges. Given the poor neurological outcomes in children who survive, including severe motor and cognitive impairment and epilepsy, data on the burden of post-TBM health in children is critical to ensure adequate healthcare support is available to these children and their families," he says.
High-tech hope for children with neurogenetic conditions
An exciting development in Paediatric Neurology was the acquisition of next-generation sequencing in 2018. This technology makes it possible to sequence an entire exome or genome, which assist in the diagnosis of genetic disorders, such as muscular dystrophy, genetic forms of epilepsy and dystonia, amongst many others. “In South Africa and Africa, next-generation sequencing is far from being a routine neurogenetic investigative service, however, at Tygerberg Hospital it has been evaluated as essential to the standard investigation and care offered by Paediatric Neurology, together with the Medical Genetics service, under the leadership of Prof Shahida Moosa. If history, clinical examination and/or neuroimaging suggests that there is a likely genetic cause, next-generation sequencing is offered for a wide variety of paediatric neurology conditions. The bulk of which were previously unconfirmed," says Solomons.
Adaptiveness
“If Covid has taught us anything it is to adapt, or suffer the consequences," he says. “In the paediatric and child health space, things can change in the blink of an eye with regard to outbreaks, surges in common conditions, staff fluctuations and unexpected resource cuts.
“To be successful in this environment, one has to constantly pre-empt scenarios and react early to change. The ethos in Paediatrics and Child Health is to continually build towards a departmental adaptive mindset which responds well to change, so that challenges are embraced as opportunities to innovate and improve in the clinical service delivery, teaching and learning, and research spaces," Solomons concludes.
