Publications
Partners
A newly qualified doctor, Linda-Gail Bekker heads to Eshowe in rural KwaZulu Natal to repay a bursary with work at the provincial hospital there. The plan is to wrap up this obligation and then get her career going in her real interest, geriatrics – working with the elderly.
The year was 1989 and the world was only starting to learn about a disease called Aids.
What should have been a one year "bush doctor" stint turned into a four-year stay and a 180-degree turn in career path.
At Eshowe Linda-Gail saw young people dying from Aids. In what should have been the prime of their lives, their bodies were just too weak to fight even common infections. "I was frustrated that I couldn't intervene," says Linda-Gail. "I didn't have the knowledge to stop people from dying, so I decided to go back to medical school."
The typical professional route for a doctor in those days, tells Linda-Gail, was to get your medical degree (MD), perhaps specialise in a certain field, and then follow a career practising clinical medicine. "In that era, medical schools in South Africa did not encourage research – it was not something we were taught, or even made conscious about." Although she says she is starting to see a move from the clinical focus in South Africa, Linda-Gail feels that there is a need for more MDPhD programmes, and to make medical professionals more aware of the research work they could be doing.
So in 1992, Linda-Gail returned to academia to learn more about infectious disease. "It [infectious disease] really is fascinating. Usually it is a dilemma, a sort of puzzle you have to work through to find what is going on." This curiosity drove her to eventually complete her PhD in the immunology of tuberculosis (TB) with an HIV component. And in 2000 she joined the Infectious Diseases Clinical Research unit at UCT.
Also in that time she "happened to fall in love with an HIV researcher". In what she describes as a meeting of "bodies and minds" she married Professor Robin Wood, and teamed up with him at the HIV research unit.
In 2000 there was no treatment available for Africans with Aids and doctors merely managed the disease by treating the opportunistic infections. As antiretroviral treatment became available to the developed world, the team at the Desmond Tutu HIV Foundation began looking for ways to bring these life-saving drugs to the communities they served.
"So we started to use clinical drug trials as a way to get the drugs to people," tells Linda-Gail. The drugs proved to be working and the team became anxious about getting these out into the field, not only in the research lab. With that aim they went around the world to find money to bring treatment to the poor communities. Eventually they built the Hannan Crusaide Centre in 2004 in Gugulethu's Nyanga District, and it became the first dedicated HIV treatment centre in the Western Cape.
Today South Africa is one of the countries most severely affected by the HIV epidemic – it has the largest number of HIV infections in the world. In 2009 it was estimated that 5,7 million South Africans are infected with the virus that causes Aids. These figures combined with the country's high incidence of TB infection, and of late also its deadly drug-resistant strains, paint a very gloomy picture for the health outcomes of many South Africans. Aids attacks a person's immune system, leaving him or her vulnerable to opportunistic infections such as TB. Recent estimates show that 44% of new TB cases are among the HIV-positive population.
Service and research
The Desmond Tutu HIV Foundation is based in Cape Town and is run in association with the Desmond Tutu HIV Centre at the University of Cape Town's Institute of Infectious Disease and Molecular Medicine. The foundation has three health care facilities in township areas around Cape Town that offer health services to these communities (these are the Hannan Crusaid Treatment Centre in Gugulethu; the Emavundleni Centre in Nyanga District; and the Desmond and Leah Tutu Treatment Centre in Masiphumelele). In addition, the foundation also has the Tutu Tester, a mobile voluntary counselling and testing (VCT) unit that goes into township communities and offers free screening for blood pressure and blood sugar, body mass index, sexually transmitted infections (including HIV/Aids) and tuberculosis.
Linda-Gail is the Chief Operating Officer of the Desmond Tutu HIV Foundation and also Deputy Director for the Desmond Tutu HIV Centre at the University of Cape Town, where she is also an associate professor.
She believes that research should not be done on communities, but in partnership with them. "Researchers should never just parachute in, do their research, and leave." Therefore, the research arm of the foundation, the Desmond Tutu HIV Centre, collects research data from the communities serviced by the foundation’s health care centres.
She explains that in the medical research field there has been a tendency to focus on the disease - how to treat it and cure it. Her approach to disease is a little broader and she seeks to understand the dynamics of a disease in a community - how and where people get infected. Hence she calls their work, "action research" and "implementation science".
A lot of her current research is focused on TB/HIV co-infection. "TB is not TB as usual in the HIV epidemic. HIV-driven tuberculosis is almost a different dispensation and we need to approach it in quite a different way." High numbers of new TB cases are among the HIV-positive population and to provide effective treatment, she believes it is important to understand how the mycobacterium tuberculosis, the organism that causes TB, goes to work in a population with high HIV-prevalence, such as that found in the townships.
One of the Centre's projects has involved taking sputum samples from a particular community where researchers are working and fingerprinting the cultures. Then by looking at these genetic readouts they can translate how TB is transmitted in these communities – how adults transmit to children, and how HIV-infected people transmit to each other or to those non-HIV infected. This enables them to understand how this disease moves around in communities.
In another project in Nyanga they are doing research into combining HIV and TB treatment. "Very often we have two diseases, but one patient, and we are trying to figure out how to facilitate that," says Linda-Gail. One of the challenges of combined TB/HIV is the risk of nosocomial transmission – people getting infected with TB at the healthcare centre where they receive their HIV treatment.
For this research Linda-Gail was awarded the prestigious Royal Society Pfizer Award in 2009.
"It is an incredibly exciting time in South African medical history to be a researcher," admits Linda-Gail. "But it is also troubling, worrying and sad in many ways." South Africa's high burden of HIV and also HIV and TB co-infection makes it one of a few places in the world where these epidemics can be properly studied. The work she does make her feel that she is doing something useful on a daily basis. "And I think that is a terrific gift to actually feel like what I am doing makes a difference, that it does have an impact on policy, however small."
Linda-Gail considers herself an African through-and-through and has high hopes for the continent. "I would love to see the Afro-pessimism turned into Afro-optimism – a sense that this continent can get it right. I would love to be a part of that."
Of motherhood and medicine
This Zimbabwean-born considers herself lucky to have been focused on her medical career from the earliest age. "My first recollection at the age of three was that I wanted to be a doctor."
She ascribes her success to her highly competitive nature – not only is she competitive with others, but also with herself, often setting the bar very high. But this advice comes with a warning: "I was very goal-directed – I needed a medical degree, then a PhD, and then I had to get my research career going. So I was 38 when I realised I hadn't actually thought about marriage and family – things I would actually like to do.
"As a woman it is tricky, because you often are called to make that kind of decision. Am I not going to worry about marriage and children? Am I going to focus 24/7 on what I need to do? That is a big decision."
At the age of 38 she married Professor Robin Wood, the head of the HIV research unit at UCT which later became the Desmond Tutu HIV Centre. Although she admits that it is not always easy working with a spouse, she says it has been wonderful to share this career goal with a life partner. "We have different talents – he is the data analyst and strategist, while I am the implementer… so we are a good foil for each other."
Two years later, at the age of 40, she had Oliver, or as she endearingly calls him "Olly". Just when it seemed she had all she wanted – a career, a husband and a son – Oliver was diagnosed with the child cancer, neuroblastoma, at seven months of age. "He basically spent two years at the Red Cross Children's hospital receiving chemo and having surgery." At the same time both the foundation and the centre were growing internationally and the tension between family and career became acute.
Today Olly is 8 years old and had been declared disease free for at least a year. "With Oliver now cured," Linda-Gail admitted to the The Lancet, "she looks to the resilience of humanity in the face of adversity, as the thing 'that keeps me going'."
- (Wilma Stassen/Health24, July 2010)
Sources:
Desmond Tutu HIV Foundation webpage: http://www.desmondtutuhivcentre.org.za
Global Tuberculosis Control, WHO Report 2008. Country profile: South Africa.
Republic of South Africa Country Progress Report on the Declaration of Commitment to HIV/AIDS: 2010 Report.
The Lancet, Volume 375, Issue 9714m Page 545, 13 February 2010 Linda-Gail Bekker: confronting the TB/HIV co-infection epidemic
