Winning women: Biko’s vision lives on in bioethics’

2015-03-16 08:00

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Professor Ames Dhai, director of the Steve Biko Centre for Bioethics, which she established in 2007 at Wits University, also serves on the World Medical Association’s working group, developing international policy on human data and biobanks. She doesn’t sleep much, writes Sue-Grant Marshall

There is little in our lives that does not involve bioethics, as it is about birth and death, health, procreation, suffering and wellbeing.

It is Professor Ames Dhai’s job to keep abreast of all the issues surrounding these topics, covering everything from mental health and euthanasia to patient care.

In the eight years since Dhai founded the Steve Biko Centre for Bioethics at the faculty of health sciences at Wits University, she has gained an international reputation for the centre’s work – hence her participation in many international bodies concerned with bioethics.

In 2013, the World Medical Association (WMA) recognised the academic contributions of the centre, awarding it the title of WMA Cooperating Centre.Furthermore, the UN Educational, Scientific and Cultural Organisation has made it the South African unit of its international network in bioethics.

The professor does not look as if she carries a load that might cripple others – she ushers me into her spacious office overlooking the treetops of Parktown, Johannesburg, with a calm, cheery demeanour.

It belies the fact that I’ve been squeezed into a diary that, quite literally, has not got a spare minute in it for the next fortnight.“Currently, our biggest issue is the lack of healthcare delivery in South Africa,” says Dhai in her soft but firm manner.

“We’re 20 years into democracy, yet this is a critically ill area and one that needs active resuscitation.”

She points out that South Africa has ratified and accepted the International Declaration of Human Rights, “and healthcare is a basic human right”.

One of the tasks of the Bioethics Centre is to look at the social determinants of health. Education is a major one, as the lack of it translates into poverty for many in South Africa.

That can mean no food, no access to clean drinking water and poor sanitation, all of which are fundamental to health.

“If these are lacking, then there is no justice. Unfortunately, in South Africa there’s a lack of delivery and a lack of understanding responsibility to our citizens.

There is corruption, inefficiency and mismanagement in most of the systems in South Africa. That’s the reason we find ourselves in the state we’re in,” she says forthrightly.

However, Dhai also lists the positives we have, including “a dedicated core group of people who work really hard and are keen to make South Africa run efficiently”.

One of the many groups she mentions is Section27, one of the catalysts for social justice. “We’re involved in advocacy from an academic perspective.

We want healthcare workers on wards, for instance, to anticipate a patient’s needs. If the medication is not there, they must actively ensure it is obtained.”

Medical students study bioethics, as “we want to ensure that what we do here at the centre has a lasting impact”.

Modern bioethics began about 15 years after World War 2 in an attempt to humanise medical education and practice in a profession considered, back then, to be overly focused on scientific and technological advancements requiring specialised skills.

Today, bioethics is about much broader issues.

“We have done empirical research at our centre into how to prevent the sexual misconduct of doctors. Guidelines are now being drawn up by the Health Professions Council of SA, which will advocate the presence of chaperones, such as a nurse or family members, during intimate examinations,” she explains.

Dhai also discusses bioethics in medical research – the rights of volunteers, their protection, the necessity of benefits outweighing harm, as well as compensation in cases of injury.

She has twice been deputy chairperson of the National Health Research Ethics Council and played a role in drawing up guidelines for the protection of volunteers.

She travels widely due to her work with international bodies and thinks South Africa, in terms of protecting medical research volunteers, “is on a par if not better, than our counterparts overseas”.

Euthanasia is a hot current topic. Dhai, who is a founder member of the Hospice Palliative Care Association of SA’s Ethics Committee, strongly believes that, with the advances in palliative care, “we don’t need euthanasia”.

“But we need palliative care to be given the same recognition as, for instance, the care that diabetics receive.“I believe the dying are given a raw deal. There are not enough resources to ensure them a dignified end. And that is what mainly concerns the proponents of euthanasia.”

Dhai knows what she’s talking about, for not only is she a medical doctor who specialised in obstetrics and gynaecology, but she also holds an LLM degree in law and ethics. She did the latter part time while a practising doctor, as well as raising her two children.

She recently obtained a PhD in bioethics and health law through Wits.Dhai chuckles at people’s amazement at her achievements, as she always intended to do law. But her salesman father worried that in the 1970s draconian apartheid era “I would not be employed by a law firm”.

It was while she was a medical student at the University of Natal that she met anti-apartheid activist Steve Biko.

He had been arrested, “but he managed to make his way back to Durban where he conscientised us – even though he was banned”.

His terrible, torture-induced death clearly contravened every medical ethic, so it’s little wonder the Wits Centre for Bioethics is named after him.

Dhai admits her average five hours’ sleep a night is sometimes reduced to two, “because this is now such a broad field”.

“There are times when I feel I’m in danger of burnout. Then I watch Bollywood movies, floating into an unreal world where I can relax and do not have to think.”

But it is her intense contemplation about how we live our lives that ensures she wakes up daily “looking forward to making an impact”.

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