During her childhood years Prof Heike Geduld, Head of the Division of Emergency Medicine at Stellenbosch University (SU), shied away from drama and tried to “quieten" emotionally laden situations as soon as possible. And because she aspired to be a doctor from early on, her dolls frequently developed “chickenpox", applied with her red khoki pen.
The decision to specialise in emergency medicine came during her third year at medical school when she had to accompany her very sick grandmother to GF Jooste Hospital in Manenberg. The calm professionalism of the emergency personnel amid the chaos of a weekend evening in a Cape Flats hospital hit her like a thunderbolt.
Since then, the world has just become a bit calmer whenever Geduld is in the vicinity.
In 2008 she was part of the very first class of emergency specialists in Africa who graduated with an MMed degree in specialist emergency medicine. Since then, she has been President of the College of Emergency Medicine of South Africa and of the African Federation for Emergency Medicine in Africa, allowing her to leave her mark on the continent. She advises the World Health Organisation (WHO) on issues relating to her field and has been involved in writing textbooks and many articles.
These days she doesn't see patients anymore, yet it remains a privilege to help in cases of need on an airplane, on her way to work or even at a wedding.
“Emergencies happen. Sometimes I can't do much, but I can bring stability to the situation. We know it's okay when everyone is calm. We are here, we can make a plan.
“Even if I only say I know it is bad. That I'm there for the person. When the worst possible things happen to people, they often only want someone who can take control and defuse or de-escalate the situation."
Since being appointed as Head of the Division in 2019, equal access to emergency services, also for people in rural areas, has been high on Geduld's agenda.
“Someone suffering a heart attack in a rural area must have access to the same level of care as someone residing next to Tygerberg Hospital," she said. “We need more ambulances. And more specialists in rural areas. In the culture of the medical world the expectation remains that everything should happen in central city hospitals."
The first months of the Covid-19 pandemic was a severe test for her ability to remain calm – when local healthcare and related services had to start preparing based on the events that were unfolding overseas.
“I was still finding my feet as an academic leader. I thought I was tough, but then Covid happened."
Geduld helped draft policy on the management of critically ill patients, as well as on the resultant workflow between different specialist areas such as critical care and emergency medicine. She was constantly only a phone call away to help ambulance personnel of the Western Cape's Emergency Medical Services decide which emergency cases should be prioritised. She was also closely involved in the planning, erection and functioning of the Hospital of Hope for Covid-19 patients in an enormous industrial area at Brackengate.
“We learnt a lot and we made many mistakes. It was a huge test for us as people, but also for the system, to see where our breaking point is, as well as our strengths.
“I was proud of the way in which people moved out of their comfort zones to address the situation as one that is larger than a single person. The system works through relationships. People worked together. We had a clear vision and achieved things. People didn't have boundaries. They trusted one another.
“We must remember that now that we're returning to 'normal'. I sometimes miss the camaraderie."
Geduld confesses that she didn't take proper care of herself in those 25-hour days. There was no time.
And then her own crisis struck. Shortly before Christmas 2020, between Covid waves, she was diagnosed with cancer.
Today, she can recall with a smile how she managed to fit in a breast biopsy during a meeting about ICU beds. And how nonchalant she was.
One day she was still chatting with colleagues in a lift. The next day, they barely noticed her when she was wheeled into the same lift as a patient.
During clear days in-between chemotherapy sessions, she tried to work on Covid-related guidelines for the WHO. On others she was only able to sit. She couldn't count. Her memory was poor. Due to neuropathy, her hands and feet ached for three months. Her hair frizzed.
All of these were typical chemo side-effects. The difference was that it was happening to her. The Doctor.
At the end of 2021 Geduld returned to work. Lists and notes remain part and parcel of her activities. Just in case.
She is eternally grateful towards her friends, family, colleagues, and so-called Chemo Buddies (the people with whom she shared chemotherapy treatment), for walking the road with her.
“My identity is no longer only that of doctor, but of a human in the world. I understand patients' experience of healthcare services better. I'm more in touch with how to handle the system."
Since her illness, she has often informally helped to calm several cancer patients and their families by “translating" their diagnosis and treatment – because she now understands both worlds intimately.
“People often tell you to be 'kind', but not how to achieve that. I've found a little spot in the world of chemo circles where I can be operationally kind. Where I can do something.
“Sometimes I call someone who is enduring pain. And we talk about it; that it's okay to feel that way. And what to do about it.
“Sometimes it feels as if I've achieved more in those 20 minutes than in my whole day of sorting out systems."
More about Prof Geduld
- 1998: Qualified as doctor at the University of Cape Town (UCT)
- 2003: Obtained a diploma in primary emergency care from the College of Emergency Medicine of South Africa
- 2008: Obtained an MMed in specialist emergency medicine via Emergency Medicine Cape Town (EMCT), a joint SU and UCT specialist training programme
- 2009: Head of Education and Training at EMCT
- 2016: Received the South African Medical Association's Humanitarian Award
- 2018: Inducted in the Order of the International Association of the Federation for Emergency Medicine
- 2019: Appointed as associate professor and Head of SU's Division of Emergency Medicine
Photo caption: Prof Heike Geduld
Photo credit: Damien Schumann