Overview: Partners in Primary Care

Primary care in Cape Town

Before we plunge into the biographies of the medical professionals, it is important to understand the medical and social framework in which they found themselves.

In the early forties in South Africa, the initiative of Emily and Sidney Kark, recently qualified from Witwatersrand Medical School (Wits), was in its infancy. This dynamic couple initiated the establishment of health centres to spearhead a Community Oriented Primary Care approach (COPC).

The couple were committed to social justice and equality. They believed in developing a new form of primary care practice in which family practice and community health care are combined. The first such centre at Pholela, in Natal, was the hallmark of its kind.

Between 1942 and 1944, Dr Henry Gluckman, a lecturer at Wits and future Minister of Health (1946-1948), directed a commission in order to assess the health needs of the South African population.

The commission reported that it was wrong to put all governmental effort into creating more hospital beds. Instead, it proposed that health centres be established to deal with health and social needs.

Health centres were indeed set up throughout the country. In the Cape, the first centres were at Grassy Park and Walmer, as well as in towns further out from the city centre. The centres received governmental support until 1948 after which the entire program was halted by the recently formed National Party government. The apartheid government regarded community health as a luxury, and instead focused on disease management. Existing centres were gradually dismantled.

Education in the medical schools at the time did not focus on social medicine, but rather disease management and hospital care. The primary care doctors were themselves hesitant to embrace a social system of medical practice for fear of losing their income. Political policy, the attitude of the Medical Association, as well as the problem of how to pay for the clinics all led to the failure of an integrated system of primary health in the country.

As such, general practice in the northern suburbs was performed without the assistance of other health workers or the support of additional community services.

Medical care in the community was left entirely in the doctors' hands. It was they who had the ultimate responsibility of managing preventive, primary and secondary care as it is known today.

The northern suburbs

The northern suburbs of Cape Town in the first half of the twentieth century were not a common or popular choice for recently married young Jewish couples seeking to start a home. Further from the sea and mountain, few cultural attractions, and far from the centre of Cape Town’s Jewish community.

The population of the area was mixed, including Afrikaans speakers – White and Coloured - who had migrated in large numbers from the countryside, and smaller Black and English-speaking white populations.

The Jewish community was mostly attracted to the northern suburbs for practical reasons: family connections, potential commercial ventures, availability of work in the case of the young professionals, as well as more reasonable property prices. All these factors promoted the relative ease of establishing themselves.

By the 1940s, the Jewish community had already founded synagogues, nursery schools and cheders for children. This included a rich fabric of communal activities from sport, to celebrating the Jewish holidays together.

The doctors and pharmacists

For these and other reasons, recently qualified doctors and pharmacists were drawn to the northern suburbs. Many of the doctors were graduates of the medical school at the University of Cape Town. There were also those who had studied further afield, including those who had trained in Britain in the 1920s. After WWII, some doctors who returned from service and who were newly married, set up practices adjacent to their new homes. Many of them had worked as locums in the area, before setting out independently or in group practice.

In the case of the pharmacists, most obtained their degrees at the Cape Technicon in Cape Town.

From the biographies of these medical professionals, in most cases told by their children or spouse, it is clear that even as they came to fill a key niche in a divided society, they were obliged to come to terms with the reality of treating segregated groups in the work environment. They treated families of all races in the area, many of whom could not afford the fee.

General practitioners were required to be proficient in a wide range of medical skills from diagnosing and setting fractures, delivering babies, to performing minor surgical procedures and dispensing medicines. They dealt with psychiatric and emotional issues and the crises of their patients. Their daily routines involved a fair share of home visits, including night calls which were requested by directly calling the doctors' home phone number. This in itself was taxing but featured in the busy schedule of every general practitioner.

Solidarity and mutual support is evident in the accounts that follow. They assisted one another in partnerships as well as in the routine course of daily life. Their families, especially their spouses, played a key role too. The involvement of the family was an integral part of their lives by the mere fact that the clinics ('surgeries' in those days) were mostly extensions of their homes. In the case of the pharmacists, most homes were very near the pharmacy itself and often they were opened after hours to provide urgent prescriptions.

This arrangement, while comfortable on the one hand, was often the reason that work- hours were long. Children and spouses often found themselves engaged in the routine work of the doctor. This had its implications for family life and parenthood.

Despite the pressures of work, most of the professionals were conscious of the importance of having other interests, hobbies and creative outlets in their world, be it sport, art or nature.

This project explores the work of general practitioners and their pharmacist colleagues under apartheid. They worked in an environment that was not always encouraging, and where the Jewish population was a distinct minority. These medical professionals were held in high esteem by their patients and their families.

Acknowledgements

I would like to thank all those who contributed to the project and have been partners from day one. A special thanks to Richard Mendelsohn for his advice and guidance as well as Glenda Sacks Jaffe for her skillful editing and support in putting the project together. Thanks also to Stephanie Berelowitz whose enthusiasm and help has been invaluable since the outset of the project several years ago! Professor Adam Mendelsohn, director of the University of Cape Town's Isaac and Jessie Kaplan Centre for Jewish studies, together with his competent staff, Janine Blumberg and Libby Young deserve our special thanks for both believing in the project and then tailoring it so expertly to fit the Web Exhibition format.

Gail Loon Lustig is the author and organiser of this web exhibition.