When a big brother makes all the difference

Bolstered by his brother to study medicine

Pretoria-based paediatric surgeon Dr Nyaweleni Tshifularo recalls how his older brother, then a teacher, used his social skills and knowledge of government bursaries to secure scholarships for each of his four siblings. Today, thanks to big brother Dr Johannes G Tshifularo, now a tribal chief, retired psychologist and teacher, they are all contributing hugely to South African society in fields as diverse as business, education and medicine.

“In 1986, when I went to the University of KwaZulu-Natal funded to do medicine and began studying engineering, my brother was very upset with me,” Dr Tshifularo recalls. “He said I must return to medicine, so reluctantly, I did. I loved fixing things, but I’d always loved the little ones and I slowly grew to love medicine, so the transition to surgery and paediatrics was natural.”

Successful siblings set the pace

Perhaps the best-known of their siblings is ENT surgeon Professor Mashudu Tshifularo who developed a pioneering surgical procedure using 3D-printed middle-ear bones for conductive hearing loss rehabilitation. He successfully performed the world’s first ear transplant surgery on a 40-year-old man at the Steve Biko Academic Hospital in March 2019. Of his other siblings, born to their entrepreneur parents in Germiston, Gauteng, two are mathematics teachers and one is a chartered accountant.

“I was born after Mashudu. If it wasn’t for chief Dr Johannes G Tshifularo, we wouldn’t have attained what we have. There was no way my parents could have afforded to put us all through varsity, even though they solidly backed us doing so,” Dr Tshifularo says.

He remembers his father as a strict man who kept a sjambok behind a bedroom door (but never used it). His father sent him to his tribal family village of Mbahela in Thohoyandou in the Vhembe district of Limpopo for his schooling. “He said he wasn’t having me grow up in potentially distracting environment in Katlehong,” he laughs.

His oldest brother intervened before his matric year, getting him accepted into Mbilwi Secondary School near Thohoyandou in the former Venda, which Dr Tshifularo remembers as “a science-oriented school”. “He wanted me to sharpen up my science subjects for university,” he explains.

Migrant work his norm

Living in their Mbahela mudbrick home and spending holidays in Katlehong in Germiston with their parents became the norm, something that’s stood him in good stead today as he flies from Pretoria to Cape Town most weekends to be with his nursing lecturer wife at their Pinelands home. They have two children, both in their penultimate years at the University of Cape Town: a son studying electrical engineering and a daughter studying law.

Dr Tshifularo is the principal paediatric surgeon at George Mukhari Academic Hospital in Pretoria. Since 2014, he’s been travelling at his own cost to spend two days a month at Mankweng Hospital where he supports and trains its four general surgeons for nine months of the year. In 2018, Mankweng doctors saw 2 100 patients in the Surgical Outpatient Department, 1 700 were admitted and 800 were operated on, illustrating how highly valued his training and hands-on support has been.

As the only appropriately qualified surgeon, he was appointed Acting Clinical Executive Director at Mankweng. He says about a third of the 2 100 surgical outpatients are children, admitting that it’s an “unsatisfactory situation”. “However, most of that total number will be repeats, returning later to get blood test results. In the private sector, if you send for blood counts, it takes at most an hour. At Mankweng, they get sent home and told to come back in two weeks,” he explains.

After doing his surgical registrar training through University of Cape Town-linked hospitals, Dr Tshifularo worked as a general surgeon at Mankweng Hospital in 2008. He left Limpopo in 2009 and returned to Stellenbosch to subspecialise until 2011. This was motivated by seeing the plight of Mankweng’s sick children. He returned to serve this community for two more years and moved to the University of Limpopo to train new paediatric surgeons.

“When I left Mankweng, there was a big void,” he says. He would get calls from Limpopo’s district and regional hospitals, asking him for advice and direction.

“When GPs and patients realise there’s a service, they come in increasing numbers. Later on, well after moving to Pretoria, I found myself getting more patients referred and following me to George Mukhari Hospital in Pretoria,” he says. Unfortunately, his scarce skillset was now dedicated chiefly to the Gauteng region. With Dr Tshifularo’s interest and some considerable experience in neonatal surgery, he became even more sought after.

A colleague at Mankweng Hospital, Head of General Surgery Professor Mirza Bhuiyan, decided to apply for a Distinguished Visitor Award for Dr Tshifularo. He succeeded and from April 2019 until April 2020, Dr Tshifularo’s travel and accommodation costs will be fully covered, enabling him to do teaching rounds, attend at the outpatient surgical department, do elective operations and conduct mini-symposiums.

“I usually travel up in the early hours of a Friday and work that day and the Saturday, so it doesn’t take too much from my work at Mukhari. We usually go out for a meal on the Friday evening and discuss the general situation,” he adds.

To keep trim, Dr Tshifularo runs 5 km three times a week, double that on weekends and has so far completed 12 Comrades Marathons. He’s an avid fresh-water angler, saying it helps him unwind.

Substantial, incremental progress

The situation at Mankweng Hospital, although still difficult, has improved significantly since his early supportive visits. “From the beginning of 2019, they employed a paediatric surgeon, Dr Elliot Motloung. He’s been thrown in the deep end, so they collect all the difficult cases for when I’m there. Teaching him and supervising surgeries is an important part of what I do.”

"Because of the volumes of patients, Dr Motloung will probably be able to stand on his own feet in no time and I will look for new outreach. He'll also help empower the local surgeons. They'll probably occasionally steer a patient in my direction - this is major progress," Dr Tshifularo concludes.