Limpopo Leader - Spring 2005 - University of Limpopo

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Ophthalmology: CRASHING AEROPLANES AND HONG KONG RACEHORSES ‘Then British and Hungarian biochemists put it through a refining process whereupon it found a use in veterinary surgery. Racehorses in Hong Kong were found to be very prone to inflammation of the knees because of the hard tracks encountered in that part of the world. The pounding resulted in a molecular breakdown of the shock absorber lubricants in the knee. Injecting hyaluronic acid into the inflamed knees brought about miraculous recoveries,’ Stegman said. Some time later an orthopaedic surgeon in Cape Town tried it for the treatment of arthritis, but it didn’t work – perhaps because it was tried on rheumatoid rather than the degenerative type. At Harvard, meanwhile, Stegman and his colleagues were experiencing some disconcerting complications with intraocular lens implants. ‘The Perspex material was highly inert on the surface,’ he explained, ‘but underneath an electromagnetic charge damaged the delicate cells inside the cornea, causing significant damage and often severe complications.’ So Stegman began to search for something that would prevent this. ‘A substance that was thick, clear, non-inflammatory and would retain the shape of the eye. I managed to get hold of six ampoules of hyaluronic acid, and ran some animal studies. It worked wonderfully.’ The next step was to find a place to conduct the human trials. The year was 1978. He had heard of the establishment of Medunsa two years before. He got the necessary permissions. So the human trials were carried out at South Africa’s fledgling black medical school. ‘The results removed the last hurdle to unrestricted use of intraocular lenses. Today, 200-million people have them in their eyes – and Medunsa played a central role.’ Why had he not returned to Harvard? Stegman shrugged his shoulders, an unregretful gesture. ‘The status attached to being a Harvard specialist was less important to me than being in the operating theatre. That was my first love. The competition in America was fierce. The opportunities at Medunsa seemed limitless. I spoke to my Harvard P A G E 1 2 mentor, Professor David Miller. He agreed. He said: how can I help? The result of that offer was that he came once a year to Medunsa as the external ophthalmology examiner. The examinations were set to Harvard standard. The motivation in this for my students and staff was absolutely fabulous in those early years.’ There were other advantages in staying at Medunsa. During the 1980s, as Stegman described it, ‘we were ringed around by civil wars’. Soldiers and civilians were being blown up by landmines and mortars and bombs at alarming rates. ‘Modern weaponry seems to be designed on the premise that disablement costs the enemy more than outright death,’ he said. ‘Consequently, the subcontinent was full of people with frightful eye injuries; and the military flew down these patients, 30 at a time, to the ophthalmology department at Medunsa. Our expertise grew accordingly.’ With this growth, came an international reputation. Medunsa was recognised as world leaders not only in eye trauma but also in congenital defects. People from all over the world began to come to the ‘bush hospital’ attached to Medunsa to have their eyes seen to. South Africans as well: the wife of a prominent Afrikaner politician came, as did the managing director of a giant insurance company. And with this reputation came money: from the Department of Health, from the university itself, and from the private sector, most notably from First National Bank. ‘Without this funding we couldn’t have done what we did,’ Stegman declared. ‘First National was fantastic. Their annual contribution kept us in the forefront of world ophthalmology.’ The generosity of funders certainly provided Stegman with the opportunity to tackle glaucoma, the second largest cause of blindness in the world and a major scourge in Africa. Glaucoma is characterised by a gradual build up of pressure caused by an imbalance between the manufacture and excretion of the aqueous humour fluid that lubricates the eye. Stegman knew that the current surgical treatment was unacceptable, with high failure and complication rates. ‘I had been working for years with Grieshaber,
the Swiss instrument makers. They became interested in what I was trying to do. They made me the instrumentation to do it. The procedure was to go into a small canal with an inside diameter as thick as a human hair. With the Swiss equipment we led the world in this radically new direction.’ Stegman has been working on the glaucoma procedure for 16 years. The failure rate has been reduced to 10% and the complication rate to virtually zero. At first, the medical fraternity said the procedure was too complicated, but gradually it’s being accepted. Meanwhile, the work of perfecting the operation goes on – despite a dramatic fall in outside funding. ‘Many children are born with glaucoma,’ says Stegman. ‘Most end up in our blind schools. And most of these are black. We’re operating as fast as we can. We’ve also had patients from the United States, from South America and Greece. But the procedure should be more widely practised in Southern Africa where the need is so great.’ Stegman’s contribution is colossal – and it’s happened at Medunsa. At one point he was on call 24 hours a day seven days a week for seven years without a break. But, insists Stegman, he wouldn’t have wanted it any other way. Upstairs in his house is one of the biggest video libraries of eye surgery in the world. He’s given over 300 lectures at international conferences around the world. He’s operated in countries in Europe and in America, but he keeps returning to Medunsa. ‘Nowhere else in the world could I have done what I’ve done.’ When you ask why this was the case, Stegman answers without hesitation. ‘There are three reasons. First, the positioning of Medunsa in Southern Africa has provided huge opportunities. Second, some of my theatre sisters have worked for me for 20 years: they’re better than any other theatre staff I’ve encountered anywhere in the world. Third, the support both internally and externally, has been generous and regular, and it’s kept us going.’ For how long can these reasons remain valid? Stegman is not altogether optimistic. So we must add another question: what will replace his distinguished regime when he finally retires? P A G E 1 3
Page 1 and 2: LIMPOPO NUMBER 5 SPRING 2005 LIMPOP
Page 3 and 4: News flash: THE LATEST ON MEDUNSA A
Page 5 and 6: IN THIS ISSUE cover picture: Geneti
Page 7 and 8: iIN THE 1980S THERE WERE MACHINEGUN
Page 9 and 10: Sky Mkuti, Goldmarks Makamure, Tapi
Page 11 and 12: orn in Harare (then Salisbury) in 1
Page 13: Ophthalmology: CRASHING AEROPLANES
Page 17 and 18: Dr David Norris tTO WATCH DR DAVID
Page 19 and 20: Rural Community Empowerment: SMALL
Page 21 and 22: SMALL VERSUS BIG - AN IMPORTANT AGR
Page 23 and 24: Professor Ulrich Mennen a psycholog
Page 25 and 26: end of the life of OIP early in 200
Page 27 and 28: lecture room, the great advantage o
Page 29 and 30: Ecology: THE LEGACY OF ANTS fFEW TR
Page 31 and 32: Visual and dramatic arts: A PERMANE
Page 33 and 34: Visual and dramatic arts: A PERMANE
Page 35 and 36: SUPPORT THE TRANSFORMATION THE Univ

Limpopo Leader - Spring 2005 - University of Limpopo

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