Becoming a Doctor: Learnings and unlearnings about life and the politics of medicine

By Hloni Bookholane

Join Hloni Bookholane on his journey of becoming a doctor: from student to intern at the world-famous Groote Schuur Hospital in Cape Town to the best school of public health in the world across the Atlantic, and back home amid the COVID-19 pandemic. There are highs and lows – learnings and unlearnings – about the personal versus political as he discovers how government policy, socioeconomics and more influence disease and medicine.
 

• Language: English
• Publisher: Tafelberg
• Release date: Jul 9, 2021
• ISBN: 9780624089254

Hloni Bookholane

Hloni Bookholane completed his medical degree at the University of Cape Town. He was awarded a Fulbright Scholarship to pursue a Master of Public Health at the Johns Hopkins Bloomberg School of Public Health in the US. He is passionate about medicine with a specific focus on organ-donation and transplantation policy.

Book preview

9780624089810_FC

Becoming a

DOCTOR

Learnings and unlearnings

about life and the politics

of medicine

Hloni Bookholane

Tafelberg

For my family, my friends, my mentors and those whose stories have intersected with mine

Foreword

The day Hloni left South Africa to start his masters at Johns Hopkins University was both a beginning and an ending. I remember standing in his apartment as he underwent the pre-international travel ritual of checking, double-checking and triple-checking that he had his passport and flight itinerary at the ready. I also recall observing a mixture of excitement and nervousness on his face; he was ready to arrive in Baltimore but seemed unsure how to leave Cape Town.

After hugs and final inside jokes were exchanged, we walked to my car in a comfortable silence, punctuated only by footsteps and our mutual exhales that underscored the heft of the moment. He was departing for a new space and new experiences which would challenge him in ways he could not yet conceive.

I remember my parting words to Hloni were: ‘be influenced so that you can influence.’

Sixteen months later, when we finally reunited, he would return to South Africa with a Masters in Public Health and a manuscript that would eventually become the book you are reading.

This book is a testament to Hloni’s experiences which have merged to form his identity. From his origins in Mthatha – that enclave from which so many of our country’s greatest thinkers emerge – to the esteemed halls of Johns Hopkins University, Hloni traces significant moments over the entire arc of his life, reflecting how he has been influenced and how he aspires to influence as he starts the long ascent that will be his medical career.

It must be noted that a plethora of books has been written about the healthcare experience. These range from detailed accounts of innovative procedures to memoirs highlighting how practicing medicine can have profound spiritual implications for healthcare practitioners. In short, the medical monograph is a commonplace offering.

However, in South Africa, what is lacking in this field are accounts that chronicle what it means and how it feels to enter medicine. There is great value in the years-long reflection and wisdom that comes at the tail end of one’s career. Backward-looking autobiographies can act as cautionary tales of pitfalls to avoid and can be a North Star for those persevering through adversity in their given fields.

But there is also value in a personal account that unpacks perspectives of what is instead of what was. In the canon of South African literature, we need more books which illuminate the mentality, challenges, hopes and aspirations of young Black professionals as they plot their career trajectories. These accounts are imperative because to be a Black millennial in post-apartheid South Africa is to be buoyed by ambitions previous generations never had the opportunity to entertain. Conversely, to be a Black millennial also requires you to shoulder the weighty inequities that still haunt the present. It is from this vantage point that Hloni takes this complexity of being and chronicles the inner conversations of an ambitious young man in the process of becoming.

Becoming a Doctor wades headfirst into an assortment of difficult topics which previous generations have dealt with and are still trenchant to young people today. The book is a brave combination of the honest, frank and vulnerable, exploring topics ranging from macro-political issues, the micro-dynamics of healthcare, as well as intimate personal struggles. By intertwining the book with a mixture of personal failings and achievements, Hloni’s words act as a salve to the disheartened med-school student whilst also catalysing inspiration for those currently practising medicine to re-examine their field.

The book traverses two countries, South Africa and the United States of America. Despite the stark contrasts between one of the world’s most unequal countries and the world’s most influential nation, Hloni draws impressive parallels between these two seemingly disparate worlds. Hloni creates interconnections, highlighting the universality of healthcare and people.

Becoming a Doctor is honest about the implications of social status for healthcare. Hloni’s reflections touch on the cost of health and the injustices associated with it – the glaring reality that people often have to buy life and that many simply cannot afford to. This tragic reality is told through the eyes of a social and economically privileged doctor who recognises that the patients he often has to care for do not share his fortunes. As he analyses both affluent and underserved communities, Hloni reminds us that peoples’ basic needs should not be constrained by national borders or the lottery of socioeconomic status.

As Hloni’s friend, I encourage you to read this book with a generosity of spirit, contextualising the reflections by understanding that the author is still developing, still learning, still unlearning. As a cultural analyst and Diversity, Equity, and Inclusion practitioner, I invite you to engage in the broader themes and meditate on how the phenomena described in this book implicate you and your own ever-evolving identity.

Take notes, debate with loved ones and allow yourself to be influenced by this book so that hopefully you can influence others.

Litha Sokutu

Co-Founder: The Social Literacy Conversation

Author’s note

I have chosen to capitalise the term ‘Black’ in order to underline a shared history and identity. Not only is this becoming increasingly popular with young writers in South Africa, it’s becoming more common in media in the United States, most notably The New York Times. The latter announced it was changing its style on the term in July 2020 after the #BlackLivesMatter movement spurred introspection on how it referred to people of African ancestry. The reader will also notice that I have used gender-neutral pronouns some of the time. This has partly been done to protect identities.

Prologue

Going to Johns Hopkins in the US and pursuing a Master of Public Health (MPH) was a critical next step after medical school for me. I believed that it would provide me with the opportunity to gain the requisite research and analytical skills to allow me to conduct and address research that is relevant and proposes solutions for the global community at large. My ultimate goal is eventually to become an academic, or a clinician, or both, within a global community of thinkers and innovators.

At Johns Hopkins I was influenced by the university community through friendship, mentorship and a lot of banter. The people I met and learnt from and about – their ordinary, beautiful and tragic stories – contributed significantly to my own story. I met salt-of-the-earth kind of people; people who validated attitudes, beliefs and feelings I had; people who challenged previously held ideas and thoughts of mine; people who reminded me about the best of friendship, mentorship and caring that I had been exposed to and surrounded by at home.

Across the Atlantic, a comfortable distance and many time zones away from Cape Town, from the hospital and from the familiar, I knew that medicine with an element of public health would be the best career for me.

So, where did it all start? I only decided to go into medicine at the end of high school, right before applications were due, so I can’t exactly say much about a proclivity for medicine from a young age. I applied but I didn’t have the best grades. I mean, I was in the top 15 per cent of my grade, or somewhere there. But I didn’t have the grades for medicine, at least based on the admission criteria in 2010. I knew this and that I would need to work much harder in my matric finals. However, a teacher at my high school told me something that simultaneously took the wind out of my sails and put a chip on my shoulder: ‘You’re not smart enough for medicine, my boy. You need to lower your expectations.’

This hurt and pissed me off at the same time. It didn’t help that I didn’t get into medicine. (I think my NBT score was the major let-down.) I was put on the waiting list for the following year, and was eventually accepted on my third application.

Despite getting into medicine, the chip on my shoulder grew and my loathing for the school and that teacher increased every year. But he wasn’t the only one who significantly underestimated my trajectory. There were many other teachers. And many other students at my school besides me whose stories were prematurely concluded. It is for this reason that I have had nothing good to say about the place. I still loathe it and a handful of its teachers. I haven’t had any formal contact with the school in ten years but before moving to the United States, I tried to unpack my abhorrence for the place.

It was an all-boys ‘elite’ school – Selborne College in East London. A lot has been said about the role that single-sex (particularly all-boys) schools play in the discourse about these ‘top’ schools – be it about mental health, toxic masculinity, or rape culture. I don’t think this is to say that these schools are entirely bad but there’s a lot of bad that exists within them that should be a means to igniting discussion. I think it’s important to have the discussion because a lot of what is bad in these environments is subconsciously – sometimes consciously – perpetuated by the impressionable individuals who enter this system. I was no exception. This was best articulated for me in the theatrical play Sainthood¹ I saw in Cape Town a few years back. The play had at its focal point the ‘masculine culture cultivated in male dominated spaces such as [single-sex] schools’.

It took me back to a place to which I never want to return: my high school. Here, as an undifferentiated individual within the single-sex school system, I assimilated into the environment – as young, impressionable kids do, be it for a desire to fit in, or to be noticed, or for both. Maybe more. I internalised the hyper-masculine culture and I became a pawn in furthering the false narrative(s) that the school was, and probably still is, determined to preserve – the monolithic leadership characteristics and the sure formula of how and who would be successful was based on biases and prejudices. Frequently, dissent was misrepresented as impertinence, the dominant principle being that ‘if you didn’t like it, you could just leave’. In the many conversations I’ve had with friends and acquaintances who went to similar schools, the same principles dominated, even if their application differed.

I grew up in a very nurturing and supportive home, reinforced by the primary school I went to – Transkei Primary School. Here, I got a good balance of praise and reprimanding whenever it was necessary. As a naughty little shit, the latter was necessary. But I still did exceptionally well, academically and on the sports field as a little squash-playing maestro. But at Selborne – with hindsight – to be nurtured the way I was in primary school required a certain hue of melanin and an ingratiating manner. I have never been a sycophant, and together with the chip on my shoulder, my disdain for toadying behaviour increased exponentially. This is probably why I clashed often with certain teachers at the school, and why I have little tolerance for any explicit or implicit requirement for obsequious behaviour. I guess I shouldn’t have been surprised then that I was thought to be arrogant, too big for my boots and aiming too high.

I decided that I would become my own cheerleader and block out the noise – until the teacher made his pronouncement on my future. All of a sudden, that was all I could hear. And even years later, whenever I achieved something I would think back to him and his devastating remark. When I was awarded a prestigious scholarship to go to Johns Hopkins University in Baltimore – the best school of public health in the world – I wondered what that teacher, together with the others I loathed, would think of me and my trajectory. It was the first time that I seriously considered the effect of being underestimated in the manner in which I had been. Ten years later, I realised the real perils of underestimation. It sucks to be reminded of such things.

I’m not motivated by hate for the school or certain of its teachers, many of whom probably aren’t even there any more. To say that would be to exalt their insignificance in my life, and be an affront to my mentors, my friends and my family – people who have been my supporters, my advocates when needed, and have always tempered their belief in me and my ideas with honest and constructive criticism. People who matter.

The school wasn’t terrible but I had interactions that were, and they still have an influence on me today. It took knowing what supportive and encouraging teachers are like – for example, at my primary school – to identify the opposite. While I’m at it, a shout-out to Trish Schmidt and Ashley Markus, who were my English and mathematics teachers. They were both anchors and voices of reason that kept me focused on what was beyond the microcosm and echo chamber that was Selborne College.

So that’s where it started – motivation that was fuelled by misplaced doubt from people who didn’t matter. It evolved, as did I. Initially I was motivated to study medicine, in part, by wanting to help people in immediate and concrete ways, with the immediate goal being treating them when they are sick. But through clinical research, my motivation morphed into wanting to develop a deeper understanding of factors influencing people’s health – be it social, economic, or psychological – and why people get sick. This was largely informed by my experiences both inside and outside medical school, and nurtured by a network of mentors who are part of a global community of academic clinicians contributing to the body of knowledge in their respective fields, but are grounded and easy to engage with. Mentors’ doors are always open.

The past decade has been a consequential one for me. It took my leaving home, literally and figuratively, and zooming out for things to come into perfect focus. Hindsight is always 20/20, and so it was in 2020. In the US, I was blessed with the space to reflect and introspect. In doing so, I have seen my personal growth and development, and I am happy with the person I have become. I really am.

My personal and educational experiences have allowed me into spaces and places that I could never have imagined. The stories I have are not all humdrum, run-of-the-mill. Some are funny, some are romantic, and some are unbelievably hurtful. I couldn’t have made them up even if I tried. I speak about some of them in this book.

The English translation of my given Sesotho name means ‘to be blessed’. My life represents the collective and cumulative experiences, lessons and stories that have converged to form what may seem a single story. My blessings are both tangible and abstract. They have come in ways that I am only able to describe retrospectively.

I graduated from the University of Cape Town with my medical degree, after which I was awarded a Fulbright Scholarship to pursue a Master of Public Health degree at the Johns Hopkins Bloomberg School of Public Health. It would be easy to tell my story in a linear form, tracing it from one milestone to the next, but to do that would be to reduce a meaningful and relatable story to an esoteric mathematical equation – y = mx + c – that lacks animation, context or nuance.

I continue to learn, unlearn, reflect and introspect on my experiences, all of which have informed this book in one way or another. Moreover, these experiences were instrumental in informing my medical-school experience. They were my medical-school experience, and more. This book is a lens among many with which to see, contextualise and understand the sometimes-blurry medical world and its over-caffeinated, high-achieving, K-Way-wearing human inhabitants.

This book is an ode