Discovery Award boosts treatment of pulmonary vascular disease

In 2016, Dr Brian Allwood, a senior pulmonologist at Tygerberg Academic Hospital, was granted the R2.1 million Discovery Foundation MGH award and recently returned to South Africa to share his year-long learning in the United States.

“I can’t wait to begin filling the gaping holes in pulmonary healthcare service delivery and physician training at Tygerberg Hospital and country wide,” said Dr Allwood. Tygerberg Tertiary Hospital currently services some three million patients - with just three pulmonologists.

An undergraduate of Wits University, Dr Allwood completed his specialist training at the University of Cape Town to become a consultant pulmonologist at Groote Schuur Hospital in 2012, having garnered a Master’s degree in Public Health in Clinical Research and diplomas in Anaesthetics and Child Health.

In 2014, he secured a post at Stellenbosch University’s Division of Pulmonology – just as he completed his PhD in post-tuberculosis lung disease. The latter has since become his abiding passion and he now has locally-unparalleled expertise.

When he left for Boston’s MGH he’d set up budding pulmonary hypertension and interstitial lung disease clinics, at Tygerberg Hospital - in 2015 and 2016. Having returned from MGH, he now plans to expand these while equipping colleagues with relevant skills and expertise learnt during his MGH tenure.

Ruth Lewin, Discovery’s Head of Corporate Sustainability, says the value of a dedicated, vocation-driven public-sector specialist like Dr Brian Allwood was inestimable. “What he can now bring to the table will have a dramatic compounding effect way beyond his lifetime.”

Q & A with Dr Allwood - 2016 recipient of a Discovery Foundation Massachusetts General Hospital (MGH) Fellowship Award

No stranger to toiling in oversubscribed academic hospitals in Gauteng and in beleaguered rural district hospitals in KwaZulu Natal, Dr Allwood, aged 43, comes from a family rich in vocation-driven academic medicine. His father, Clifford, is a former missionary doctor and former Chair of Psychiatry at Wits University Medical School, now in private practice in Pietermaritzburg. His mother, Anne is a trained teacher while his older brother, Anthony is an anaesthetist and older sister, Cathryn, a psychologist. Allwood’s wife, Taytum, 32, six months pregnant at the time of writing (mid-July 2018), worked in government schools in Diep Rivier and the underprivileged Capricorn/Vrygrond community. We asked Dr Allwood about his MGH learnings and ambitions for tackling our deeply health-services-challenged society.

Q: What made you apply for the MGH Fellowship?

Answer: A key trigger was having four young patients in my pulmonary hypertension service at Tygerberg suffering from chronic thrombo-embolic pulmonary hypertension (CTEPH). Two of them died while I was trying to find surgical skills for them. Case selection is pivotal and pre-operative work-up is critical if you want patients to survive. These deaths, combined with the high number of TB patients, and not knowing how to treat the lung-heart-related problems all felt like we’d reached the limit of our knowledge base in South Africa. There were very few local people I could ask about complicated diagnoses and treatment problems. There’s just not enough knowledge in interstitial lung disease, pulmonary hypertension and post-TB lung disease in SA. That’ll probably be my focus for the next five years.

The value of critical mass

Q: What impacted you most during your year at MGH and how will you apply your expanded knowledge and expertise?

Answer: “I was exposed to a totally different way of thinking, and a new sort of clinical setting and practice. Excellence is the norm in every area. You can do more in a week at MGH than you can in a month in SA. The second thing was learning the importance of critical mass - academically and clinically. In SA you often work alone in a field. It’s often difficult to find someone to bounce things off. It’s simply not possible for one person to know everything. People who’ve been working at MGH for 30 years still ask others for guidance. I think critical mass is underappreciated here, both in the public and private sector. The third thing is that I saw what genuinely patient-focussed and individualised medicine looks like. I realised that excellence is planned for. It’s not happenstance and circumstance that caused MGH to be a world leader. It’s generational planning for excellence. You don’t plant trees for yourself, but for your children.

Q: You’re passionate about South Africa and the South African Dream?

Answer: I don’t like to make generalisations, and I’m neither an economist nor a politician, but you can’t escape the fact that South Africa is one of the most unequal places on earth. My impression is that many wealthy people are uncertain of their future here, and so they invest their time and money accordingly. I am concerned that excessive extraction from the economy to ensure personal security, is in fact doing just the opposite. Ironically, the more we try and look after merely our own future interests to the exclusion of others, the less likely we are to obtain the certainty and security we crave. It is important to realise that only if we all start investing ourselves fully in the future prosperity for all South Africans, will our own future in this country (and that of our children’s children), be truly secure. My wish is that we would be seen as the generation that planted the trees that bring the fulfilment of the South African Dream.

Q: You’ve understandably focussed on the public sector – what about the private sector?

Answer: You could easily make a case for a good interstitial and pulmonary lung disease service in the private sector. I want to work on a model of sustainability to build capacity, while not using external funding. The questions are; can we do this without using donations and hand-outs? Is there a market for this? It doesn’t have to involve government.’’

Q: If you had a magic wand, how would you use it?

Answer: I’d increase the number of pulmonologists in my institution by a factor of five (from three to 15). Knowledge is growing so fast that it would mean each pulmonologist could focus on one area - like chronic obstructive pulmonary disease, asthma, pulmonary hypertension, interstitial lung disease, bronchiectasis, lung cancer – the list is long. That way you can at least keep up with your own interest. At the moment patient pressure precludes this. We could then reach that critical mass I’m talking about and build outreach. The second thing I’d do is build an institute for training African pulmonologists – we’re so advantaged compared to the rest of Africa. We could build collaborative networks that hopefully could reverse the current physician flow to the private sector. At present we train pulmonologists in the public sector and they move to the private sector and have to almost retrain with the greater range of new medications available there. If we could get a R30 million endowment and invest it, we could probably pay a pulmonologist forever in this hospital.