South African Psychiatry - May 2021

MEMORIAL LECTURE

THE STREAMS

THAT MAKE

A RIVER

BERNARD JANSE VAN RENSBURG
12.04.1960 – 23.04.2020

Presented as the inaugural BJvR memorial lecture of the Faculty of Health Sciences
of the University of the Witwatersrand, 28 April 2021, as a personal perspective by Prof
Ariane Janse van Rensburg, [email protected]

I would like to express my appreciation to Last year as condolences poured in, I was struck
Prof Subramaney and to the University of the by how many colleagues saw him as a mentor
Witwatersrand (Wits) for initiating this BJvR and a father figure, but knew very little about
memorial lecture series, and I am deeply him as a person, and how many family members
honoured to be able to deliver this inaugural and childhood friends said they knew he was a
lecture, fittingly, on the life and work of Associate psychiatrist, but they had had no idea of all the
Professor Bernard Janse van Rensburg, who died things he did. I was privileged to be married to him
abruptly just a year ago, in mid-career as Assistant for more than thirty years, and I realise that I am one
Head of School of Clinical Medicine at Wits, and the of the very few people who has shared both sides of
Chief Psychiatrist at Helen Joseph Hospital. his life and can colour in the picture of his humanity.

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I make no excuse for my very personal voice, but it We thoroughly enjoyed our creative partnershipi,
is at the same time a researched biography based whether it was designing academic posters,
on many personal documents and conversations, branding material or the homes we have lived in. In
and published material as cited. many ways he honed me as a conceptual designer
During the course of his life, Bernard tried and in my own career.
studied a host of different things and gathered
many kinds of experience. It was all these small Bernard has a younger sister Alma, who shares
streams that flowed together to eventually many of his interests, and neither of them fitted
produce a strong and unique river, that could comfortably into a small-town, often right-wing
carve new pathways. The image in my mind is environment. Bernard loved the Highveld seasons
the very Mpumalanga Highveld where he grew and the wide skies, but he generally escaped into
up, where the Vaal and the Komati and the two his books and to boarding school in Ermelo in 1973
Olifants rivers start as little trickles in the grass, and to do music as a subject. He continued with piano
flow to different oceans. and bassoon even as a medical student at the
Bernard was born in Pretoria and named Albertus University of the Free State, where he qualified with
Bernardus Janse van Rensburg after his paternal his MBChB in 1983. There was even a time when he
grandfather, which he later changed to Albert would have left medicine for piano, if he could, and
Bernard-Repsold, bringing in his maternal line as the fact that his daughters inherited his love and
well. His grandfather farmed in the Middelburg talent for music gave him great joy.
district of Mpumalanga and although his father
Albert started his accounting career in Barclays He matriculated at the age of sixteen and went
Bank and was promoted from branch to branch all into medicine, less as a passion, than because
over the Highveld, he decided that his heart was clever students went into professions, he wanted
in farming and the family moved to Grasfontein, to fix the world, and more importantly studying
one of the family farms just outside Hendrina, when medicine gave him a more acceptable alternative
Bernard was eight years old. His mother Marthie had for his compulsory military service. Ironically it was
qualified as a teacher, but she was also a farmer his empathy that made him uncomfortably aware
and gardener at heart, and his parents remained of not generally fitting in and being understood,
on the farm until they were nearly eighty. making him particularly introverted. He easily
engaged with people on their turf, but did not
BERNARD’S ARTISTIC EXPRESSION FOUND share his own soul easily, except in his poetry. At
MANY OUTLETS. HIS KEEN EYE MADE one stage he was in correspondence with the poet
HIM AN EXCEPTIONAL PHOTOGRAPHER. Sheila Cussons who was very encouraging, but he
THE GRAPHIC MATERIAL IN THE LECTURE wrote mainly for his family and close friends.
PRESENTATION, UNLESS OTHERWISE
CREDITED, CONSISTS MAINLY OF HIS Bernard was always interested in people holistically,
PHOTOGRAPHS AND VISUAL DESIGNS and he found the dimensions of the mind, soul and
THAT HE SOMETIMES ASKED ME OR spirit far more intriguing than the mere mechanics
OTHERS TO REALISE TECHNICALLY. of the body, which is why he eventually chose
psychiatry. However national service offered him
another escape route out of physical medicine
into public health, as he worked in the SA Medical
Services Head Quarters Section – Epidemiology. In

Grasfontein Highveld

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1987 he took up a position in the Head Office of the which was his brainchild, is evidence of this – it
National Department of Health, first in the Directorate pushed him beyond even his limits, amidst personal
of Epidemiology and Strategic Planning, and later calamities, but he pulled it off. The next challenge
in the Chief Directorate of Strategic Planning. he was getting ready to take on was addressing
Bernard has always been an excellent strategic the anomalies created by the “joint appointment”
thinker and manager, in whichever field he applied system between universities and provincial health
these skills. He felt that investing his energy in departments. If anyone feels inspired to take up his
effective health planning and implementation mantle, that is what was on the menu!
could make a greater difference to the lives of We met in our late twenties when we were both
more people, than a career spent seeing individual working in Pretoria and were married in 1989. By
patients. This stream that culminated in his pivotal the end of the national health plan chapter, we
role in the completion of the Gauteng Province were taking our son in his carry cot to Civitas at
MENTAL HEALTH STRATEGY AND ACTION PLAN 2019- night where Bernard was introducing me to the
2023, started during his years in Civitas, where he wonders of spreadsheets on floppy disks on a very
was deeply involved in developing the 1991 new immovable work computer, and we were rethinking
national health plan. During this time he completed our future, as his clinical training was reaching
diplomas in Community Medicine and Tropical its sell-by date for specialisation. He applied for
Medicine and Hygiene, while also progressing far a registrar’s post in Psychiatry at the University of
enough with an MBA at the University of Pretoria Stellenbosch, was accepted, and we moved to
to extract and use this knowledge without time to Cape Town from Pretoria at the beginning of 1992.
complete the qualification. As an avid reader and We were grateful for a cheap hospital house on the
gatherer of information, he could see how solutions grounds of the old Westlake Tuberculosis hospital,
from other fields could be applied to the challenges where we stayed until the police told us to rather
in which he was engaged, and he never limited his move: They had discovered a corpse in the bushes
thinking to the ways that things are usually done. At after some convicts had escaped from Pollsmoor.
the same time he used all the management tools We hastily moved to Belville when our daughter
at his disposal, especially that of statistical analysis. LeOui was two weeks old. Bernard worked mainly at
Lentegeur Psychiatric Hospital, which was a model
He was also not scared of big ideas. I think this was facility that shaped his thinking, and at Tygerberg
partly because he was such an intense person: It Hospital.
was as if he had double the capacity for things that After Bernard had completed three years as a
normal people had- he thought twice as fast, was registrar, his parents were faced with the challenge
twice as loving and generous, felt twice as deeply, of economically reinventing the family farm,
got twice as frustrated and worked twice as hard precipitated by circumstances outside their control.
as most people I know. He had the courage to It offered Bernard an opportunity to get strategically
face the whole problem. He was a visionary who involved in the family business and relationships
saw solutions in terms of his own capacity to realise he had tried to escape earlier in his life, but at his
them and did not always understand why others own level of skill and interest. It also gave us an
shied away from the tremendous effort it would opportunity to start various creative enterprises as
take. From my side, once I pulled my head out of a sideline to our careers, which he longed to do.
the sand, I usually realised that he was right; his
idea would address the problem; and it was not HE SUGGESTED, IF I WERE HAPPY TO DO
so impossible after all, especially if he was involved THAT, THAT HE SHOULD INTERRUPT HIS
in implementing it. He was charismatic, unafraid STUDIES AND WE SHOULD TEMPORARILY
of investing enormous energy in an idea, and he MOVE TO MPUMALANGA TO SEE WHAT
could ignite a spark of excitement that made the WE COULD ESTABLISH. HE LACONICALLY
impossible possible. The 2016 international World EXPLAINED THAT THIS WAS CHEAPER
Psychiatric Association conference in Cape Town, THAN YEARS OF PSYCHOTHERAPY.

He did courses in cheese making and weaving to
see whether these could be viable concerns, came
with ideas to cultivate aromatic crops for essential
oils, and for an income he did the rounds of primary
health care clinics throughout the province and
truly developed a feeling for the challenges faced
by mental health care in remote areas. As our
personal lives were in a state of flux, Bernard could
not commit to returning to Stellenbosch in 1995
when things had settled, but took up a registrar’s
position at Wits, working at Tara and Baragwanath
hospitals and graduated from the College of
Medicine in October 1996. He also completed the
requirements to graduate with his M.Med. from the

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University of Stellenbosch in 1997. He worked as a rather be working in a state hospital than a private
specialist at the Johannesburg Hospital until June practice.
1997 when the University of Pretoria offered him the Academia was his natural home. He loved learning,
opportunity to establish and run a new psychiatric he loved research and writing, and he was always
unit at Witbank Hospital, as part of their project to encouraging others in this realm. One of the first
establish an academic hospital in Mpumalanga. things he proudly showed me shortly after we met
This was an offer he could not refuse: It gave him the was an article he had written for the SA Medical
opportunity to realise a career dream while moving Journalii. He ended up as an NRF-rated researcher
fully back to the farm, and his experience of the and his work has been very influential. At one stage
primary health care infrastructure in the province our school’s librarian excitedly came to tell me that
was an excellent grounding. he had the record citation score for Wits that year.
After getting the Witbank ward well established, He was the one who finally persuaded me into
he decided to start a private practice in Hendrina doing a PhD because he made it look easy – but
in October 2000, in order to address a new set of he also made it easy. He mentored me into using
challenges. research strategically, to make every work project
double as a publication, to publish to push social
ON A PERSONAL LEVEL, HE WAS justice agendas. Bernard used academic research
RETRACING HIS STEPS TO OWN HIS to establish evidence that could be used to
ORIGINS, TO RE-ENGAGE WITH THE TOWN validate campaigns. It was his particular brand of
HE HAD LEFT TO CREATE OPPORTUNITIES activism. Amongst many other topics he produced
FOR IT TO REALISE ITS POTENTIAL. a congress presentation on the circumstances
and rights of Lifecare chronic care patients as far
At that stage there were no private psychiatrists back as 2003, and many papers illustrating how
in the Highveld region and he served the whole better statistical records in hospitals could be
region from his Hendrina base, despite many used to track the effectiveness of mental health
stigma issues. His first consulting room was next to care interventions and count the real cost of the
the home industry and patients parked two blocks revolving door phenomenoniii.
away, in case their cars were recognised, and
entered through the home industry. He next bought HE ALWAYS MANAGED HIS OWN WARD
and restored an historic house to accommodate AS A CASE STUDY TO INFORM THE
both our practices, a tourist information centre and GREATER SERVICE DELIVERY CONTEXT,
small gallery. He was the one who saw the potential WHILE AT THE SAME TIME SUPPORTING HIS
and sparked the ideas, but we both became STAFF AT A REAL, PERSONAL LEVEL WITH
deeply involved in developing and marketing a THE STRESSES OF A VERY DEMANDING
tourist route in the area with the potential of offering ENVIRONMENT.
employment opportunities and bringing the long-
segregated communities of Kwazamokuhle and One example of his way of tackling problems was
Hendrina together. His vision for our own home on the question of mental health care facilities. His
the farm was to build with the traditional materials return to State employment at Helen Joseph Hospital
shared by Ndebele and Voortrekker building was in 2003 shortly after the new mental health
traditions on the Highveld – raw stone and cow- care act had been introduced, but by 2007, despite
dung and mud. It was also what we could afford repeated requests, no physical changes had been
at the time. made to the facility to make it possible to implement
His modus operandi was always to invest all he the human rights granted by the act. What made
could to build in a personal example of the ideal he the ward at Helen Joseph particularly problematic
envisioned. If others saw that it could be done and was the fact that it had never been designed as
bought in, it developed a life of its own and grew a psychiatric facility in the first place and was
from there. If they liked the idea but were not ready entirely unsuited to the needs of mental health care
to start investing their own energy, he did not push it users. The operational budget could not be used
– he cut his losses, but also did not count it as loss. He to make even the smallest structural changes to
did not begrudge investing energy and resources locks and doors which would make the separation
in things he wanted to try or to learn. By the end of voluntary and involuntary users possible, so he
of 2002 he had worked through his own issues and decided to approach the problem from a different
invested what he could in the Highveld, without any angle. The Khanyisa awards competition offered
financial gain. The medical aid conditions that had the opportunity to submit a proposal to improve a
previously supported his unlikely private practice health facility for a specified amount. If the proposal
had changed, our son needed a high school won, this could be implemented. Bernard involved
environment that offered more opportunities and me in this venture and he basically redesigned
after testing some scenarios, Bernard was very the flow of the ward and the allocation of certain
happy to return to Wits and start afresh with the spaces to create better surveillance and a visitors’
Gauteng Department of Health at Helen Joseph area. We spent a couple of long nights designing
Hospital in August 2003. He never looked back. He a new look and addressing the main challenges
often said that despite all the challenges, he would with very few resources, costing it, and presenting

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it. It paid off! The psychiatric ward proposal got the being advertised. Was it his job as a clinician to do
third prize of R50 000 , and for that one could do the all of this? No. Did it work? Yes. My greatest pleasure
small structural changes and buy some furniture has been to have been commissioned to recently
without doing the painting. Then one of the sisters add a BJvR memorial mural to the ward’s visitors’
managed to get Plascon sponsorship for the paint lobby. I must add that when I left there the other
to implement the whole proposal. The effect that night spattered in paint, shortly before the midnight
a more congenial environment had on all the curfew, the bottom security guards were rather
ward users, but most especially on the staff, was concerned that I might be an involuntary patient
dramatic. Bernard then took it to the next level. leaving the psychiatry ward.

HE WROTE A SERIES OF THREE ACADEMIC Bernard’s memorial mural had to be a tree, in the
ARTICLES ON THE IMPLICATIONS ON colours he chose for his PhD tree model for the
HEALTH FACILITY DESIGN DEMANDED introduction of spirituality into Psychiatryvi. He was
BY THE HEALTH CARE ACTiv, ONE OF always fascinated by trees, from the physics involved
WHICH I CO-AUTHORED ON THE DESIGN in getting water to the top of a giant redwood to
PRINCIPLES THAT SHOULD BE USED IN the symbolism of the tree of life, with healing for the
MENTAL HEALTH FACILITY DESIGN, AND nations in its leaves. He took a series of beautiful
HE CONTINUED TO PERSUADE SPONSORS tree photographs when he was completing his
TO DONATE TOWARDS THE WARD. thesis and had an anthology of tree poems ready
to publish.
Helen Joseph Hospital was originally planned as Bernard was fascinated by the relationship between
an academic hospital for the then Rand Afrikaans the physical body and the psyche, and by what
University and there were structures that had been makes us human. To him it made no sense to only
built, but never fitted as wards, that were only used apply a bio-psycho-social model to Psychiatry
for storage. We used the Helen Joseph psychiatric when the spiritual dimension is such a significant
ward as an example of how the existing ward could factor in people’s interpretation of mental wellness
be redesigned to house double the number of or illness and healing. In his PhD he started to
patients, use the available unused space to fully explore what the place of spirituality in Psychiatry
meet the requirements of the mental health care act might be and had to tease out the differences
and optimally support the types of therapy required, between spiritual awareness as a human capacity
proving that the cost of this type of refurbishment and specific religious beliefs. In the process of
was well below the cost of building new facilities. doing this PhD he also had to pave a way for the
We presented this as a congress posterv, we showed acceptance of qualitative research methods
the difference that the Khanyisa refurbishments
had made, and this slowly rippled out to invitations
to present this research to the Federation of
Hospital engineers and at other seminars. When
the Provincial Government instruction came to
double the ward capacity, Bernard was ready with
an academic proposal that could address all the
other issues as well.
Eventually the trickles of awareness that Bernard
had started, delivered full results, and his ideas were
realised, despite many delays. The last furniture that
Bernard selected shortly before his death has since
arrived and the clinical posts needed to open beds
in the completed additional ward are currently

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in clinical medicine, which became one of his In the process he networked between groupings
research specialities. He subsequently developed a with the same concerns and interests, creating
spirituality scale which delivered results beyond his collaborative working groups to focus and
expectationsvii and was well received in December strengthen these efforts, such as the Mental Health
2019 at the congress of the WPA Section on Religion, Care Alliance. As he developed a voice through
Spirituality and Psychiatry ,viii of which he was the his leadership roles at SASOP, other opportunities
secretary. I remember his excitement years earlier opened up which he would take on, despite his
when someone delivered a paper at a congress impossible workload, if they would add to the
in Paris on the measurable clinical improvement of impetus of a movement. In this way he became a
mental wellness when patients engaged with truth valuable agent for change.
in psychotherapy.
He started to introduce the spiritual aspect of BERNARD HAD NO ILLUSIONS ABOUT
Psychiatry within the profession in exactly the way he THE HUMAN CONDITION AND COULD
had proposed in his model, by building awareness. SOMETIMES SOUND QUITE CYNICAL,
He was always a very active member of SASOP, the BUT HE ALWAYS CLEARLY SAW THE
South African Society of Psychiatrists, which was his POTENTIAL IN EVERY PERSON AND
vehicle for making his profession meaningful. He SITUATION AND WOULD CONTINUE
introduced the theme of spirituality as the fourth TO REFLECT THAT BACK AND CREATE
congress theme at the 2012 SASOP national congress OPPORTUNITIES FOR ITS REALIZATION.
hosted by his Southern Gauteng branch, also TRUTH AND JUSTICE WERE NOT ONLY
through his own presentationsix, but he expanded SPIRITUAL AND ETHICAL VALUES TO HIM,
this awareness of the relationships between brain BUT THE ONLY FOUNDATION FOR MENTAL
development, cognisance, symbolic thought, WELLNESS, AND HE STRONGLY FELT THE
spirituality and humanity into the bio-psycho-social RESPONSIBILITY OF THE PSYCHIATRIC
themes as well. The entire congress was his vision. PROFESSION TO UPHOLD THESE.
He found a venue in the cradle of Mankind, got
fascinating guest speakers from archaeology and He was deeply cognisant of the complicity of the
anthropology on human development and held profession in social injustice throughout its history,
the speakers’ dinner in the Wits Origins Centre. He either through commission or by not speaking up
invited high profile international psychiatrists as against known injustice and felt that the profession
speakers and showcased SASOP’s ability to host a had neglected an opportunity to come forward
conference at an international standard. After this during the Truth and Reconciliation Commission
succeeded, he shifted his goal to championing a after 1994. Bernard adopted WPA president Denish
SASOP bid to host the World Psychiatric Association’s Bughra’s term “the social contract of Psychiatry with
international conference in South Africa. There was societyx” as the theme for the WPA international
never anything random or short term in Bernard’s congress which heralded his term of office as
thinking. SASOP president (see figure 1). Again the congress
Bernard’s other great strategic tool was to use was almost entirely his vision, and he used the
synergies to create enough energy to turn the preceding two years as president-elect of SASOP to
tide. He was involved in many different bodies, not build momentum around this theme through a series
because he had any great love for meetings, but of workshops that actually established SASOP’s
because then the motivation for the same change stand on social justice issues. This culminated in
could be pushed from different angles, involving a series of talks and exhibitions, in collaboration
enough role players for it to become a common
goal.

Figure 1 The social contract of Psychiatry with Societyxi

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with the various ethics and human rights bodies, an established system without support concerned
during his term of office. He felt strongly that lavish him. Very soon after returning to Wits he became
sponsorship in the medical field was unethical if it a member of the transformation committee,
did not contribute to professional learning, so he promoting the equity of different spiritual views in
channeled pharmaceutical sponsorship into these clinical training. He was academically concerned
workshops. that there was too little discussion between the
College and the Universities on the specifics of
IN THE MIDST OF THIS BUILD-UP, THE what registrars learned, or how new perspectives
PROFESSION WAS CONFRONTED WITH like the role of spirituality should be brought into the
THE VERY REAL EXAMPLE OF THE LIFE syllabus across different institutions. He was deeply
ESIDIMENI TRAGEDY IN THE MAKING, AND involved in both qualifying systems as a Senate
THE SASOP LEADERSHIP, VERY MUCH AT member of the College of Medicine and a senior
BERNARD’S INSTIGATION, TOOK UP THEIR academic at Wits. In addition, he completed a
ROLE AS THE VOICE OF THOSE WHO PGDip in Health Sciences Education in 2018 in order
COULD NOT SPEAK. WHEN THIS WAS to understand syllabus design well and was ready
DISCOUNTED, THEY TOOK IT FURTHER IN to start the process of streamlining psychiatric
THE FORM OF A COURT APPEAL TO STAY training nationally at the time of his death.
THE TRANSFER OF PATIENTS, WHICH WAS
OVERTURNED. AS A TEACHER, HE WAS AN EXCELLENT
MENTOR, ENCOURAGER AND
Once again Bernard made this the focus of a series EDUCATIONAL EXAMPLE, WITH A GREAT
of academic papersxii, and eventually exhibitions at DEAL OF EXPERIENCE TO IMPART.
the Holocaust museum, around the haunting cry: MANY TRIBUTES FLOWED IN FROM HIS
“What have you done to prevent it?” I believe that STUDENTS, ALWAYS WITH THE EMPHASIS
one of the fruits of Bernard’s vision for SASOP was NOT JUST ON WHAT HE HAD TAUGHT
the quickening of the conscience of the profession. THEM, BUT THE EMPATHY AND RESPECT
Bernard was constantly penning statements WITH WHICH HE HAD TREATED THEM
on behalf of the profession, such as a stand AS PEOPLE, THE CONFIDENCE HE HAD
condemning the homophobic violence in Uganda, GIVEN THEM, AND APPRECIATION FOR
and he was very instrumental in equipping the HIS OPEN-DOOR POLICY TO TALK ABOUT
profession to understand the ethics and practice THINGS THAT MATTERED ON A ONE-TO-
of activism. He occasionally sat me down and ONE LEVEL.
we carefully considered the potential costs and
risks of a course of professional action in which he He far preferred individual discussions to delivering
believed, whether it was signing financial surety for lectures, papers and press conferences. He actually
a world congress or taking on a system. hated public speaking, although he became less
stressed about it over decades of acute exposure
ANOTHER KEY ASPECT OF THE to it. This was never his favourite part of the job,
WPA CONGRESS THAT WAS CLOSE but he well realised the value of media coverage
TO BERNARD’S HEART, WAS AN and always accepted invitations to use these
INVOLVEMENT OF THE ARTS IN CREATING opportunities to voice what he felt should be heard.
PUBLIC AWARENESS OF MENTAL HEALTH
AND THE ROLE OF PSYCHIATRY. He described himself as socio-phobic, and he
was happiest surrounded by his family, whether at
He also saw this as an opportunity to empower artists home or on holiday. He wanted us to be there. His
from disenfranchised communities and possibly special relaxing spot at home was on the couch,
create a fund for further support of young artists. watching movies or stand-up comedians, and even
This produced some moving original narratives and if he fell asleep, he still had an uncanny ability to be
productions as part of the congress programme, aware of what happened at the end of the story.
which afterwards continued with a life of their own. The crowning joy of his life was our three children,
Once Bernard became an educator, he typically Briard, LeOui and Renate, and his main concern in
took on the whole big picture challenge of life was our welfare. He would never leave a deep
quality psychiatric training, and medical training conversation unfinished, even if we were all late
in general. As he encountered challenges in his for school. At one stage in Briard’s primary school
personal sphere of work, he would immediately career, (before mobile phones ruled the day), our
start to analyse how this could be improved for the son in desperation set all the clocks and watches in
whole system and use his individual experience to our home forward by ten minutes and that actually
motivate for change. The personal and professional worked until Bernard discovered it. He was impressed
challenges faced by Wits medical students with his son’s strategic thinking. In Bernard’s book
returning from training in Cuba to integrate into the speed limit was always a goal, in order to not
waste a second. I found a quote on his phone that
said “if you aren’t in conversation with the traffic,
it means you’re not paying attention”. Our children

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all have his quick wit and family conversations All his life he was healthy, with no heart history, and
around the table can be highly entertaining, but regular health checks. At the end of January 2020
the dining room table had to be specially cleared he travelled internationally and two weeks after
for such occasions, because his study became a his return he was uncharacteristically very ill with a
completely overflowing but meticulously ordered viral infection that did not quite tick all the Covid-19
archive of past and current projects, without space boxes published at the time. He recovered, and
even for a laptop. “Hy het homself daar uitgeboer”, within a week he was working again, planning
as one would say in Afrikaans, but he also preferred responses to the Pandemic. As more information
to work in the heart of his home where he could on Covid-19 became available, Bernard did think
be part of whatever else was happening. Only he he had probably had it, but at that stage it was
could clear that table, because there was complex regarded as a respiratory rather than a vascular
order in the seeming chaos. disease, and the after-effects were still unknown.
He was not addicted to work as an escape from other He had a lingering fatigue that he could not shake
things - he was just deeply interested in everything off, and when he decided to claim back his life
and could see the potential in any project, so he and launched into an intensive exercise session
always had too many ideas to implement, and too a week after his sixtieth birthday, he had a major
many balls in the air. He was correct that he could cardiac infarction from pervasive blood clotting.
do each one of them, but not all at the same time. The cardiologist mentioned signs of previous heart
He was fully aware of the irony of how he spent damage, which probably occurred between
midnight hours writing a paper on burn-out, and he February and April.
seriously warned us that it is actually possible to die
from overwork, but he was incapable of living life at HE IRONICALLY DIED IN THE MIDDLE OF
a normal intensity. SETTING UP THE SUPPORT PROGRAMME
By the end of 2019 he was desperately in need of FOR HEALTH WORKERS IN THE COVID-19
a rest. The fact that the Health system includes PANDEMIC, WHICH WENT LIVE SOME
academic leave in the maximum permitted 30 days’ WEEKS LATER, AND HE WAS LISTED ON
leave per annum always crowded out real recovery THE HEROES’ ROLL OF HEALTH WORKERS
time and was a major factor in his exhaustion, but WHO HAD DIED DURING THE PANDEMIC.
I do not believe his death was simply caused by
stress. So what were his projects and his achievements?
His curriculum vitae runs into forty pages of

Figure 2 Diagrammatic representation of strategic synergies, projects and influences in Bernard’s careerxiii

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such listings, and his main achievements were hearts, despite their limitations, also had value.
summarized in obituaries last year. More telling is There was a time when Bernard asked me who I
this diagram of his involvements which explains the was, and I did not understand the question, but he
strategic interrelationships between activities, and helped me to eventually find an unfolding answer.
the currents that he set up (See figure 2). Needless to say, there was plenty of emotional
Over the years he often felt that he had not seen fallout in this process which we all had to deal with,
anything through, that he had not really achieved so our children have grown up prepared for the
what he had hoped, but in the last two years of his messiness of real life, despite our good intentions.
life the many small streams he had started began to
flow strongly together. His SASOP presidency earned THERE WAS A PARABLE THAT BERNARD
him a voice that was heeded. Decision-makers FOUND VERY MEANINGFUL IN HIS LIFE,
started to seek his advice and involved him in nitty- THAT THE EMPEROR MOTH HAS TO
gritty planning. His ideas were always too large for STRUGGLE TO SQUEEZE ITSELF OUT OF ITS
him to execute alone, and the process of recruiting COCOON - IF ONE HELPS TO SET IT FREE,
buy-in is a slow one. He often felt that initiatives had IT NEVER DEVELOPS THE STRENGTH IN ITS
failed, while slowly in the background an idea was WINGS TO FLY.
gathering force and at some stage it overcame the
resistance to change and started to move. In many For many years Bernard had a butterfly to remind
projects and even relationships his great personal him of this when the cocoon was tough, and his
investment possibly inhibited others from taking full choice of a symbol for his presidential term at SASOP
responsibility, much as he wanted them to. was their heraldic butterflies, symbol of the psyche
and the soul, flying free. I am deeply grateful that
I THINK HIS GREATEST LEGACY HAS BEEN he could fly away when he had developed his full
NOT WHAT HE COMPLETED, BUT THE strength.
RIVERS THAT HE STARTED - THE PROJECTS
ABOUT WHICH PEOPLE ARE NOW SAYING REFERENCES
“ I WANT TO COMPLETE THIS – I CANNOT i Grasfontein Ontwerp CC Design Partnership
LET THIS DRAIN INTO THE SAND”. TO ME ii 1.Janse van Rensburg AB. Notifiable malignant
IT IS A MOVING TESTIMONY THAT PEOPLE
ARE STILL EXPRESSING THAT A YEAR lesions in the RSA, 1979-1983 – trends and
LATER. mortality. Part I. Malignant lesions of the
bronchus and lung. SAMJ. Aug 1987; 72:178-181
What made his influence so exceptional? 2.Janse van Rensburg AB. Notifiable malignant
He was a Mensch. Bernard honestly showed how lesions in the RSA, 1979-1983 – trends and
entirely human he was. He never pretended to be mortality. Part II. Primary malignant neoplasms
something he was not, he was candid about his of the pleura. SAMJ. Aug 1987; 72:182-184
mistakes and tried to improve on them. The only iii 1. Janse van Rensburg ABR. Introduction of
person with the cheek and the charm to reprimand specialist psychiatric services to Mpumalanga
him was our youngest daughter, Renate, but he Province and referral patterns to Weskoppies
admitted it when she was right. If he promised Hospital. (Poster) 10th Biennial Congress of
support, it was unconditionally there, even if he was the Society of Psychiatrists of SA. Sep 1998,
critical; being critical was part of his support. The Johannesburg.
inspiration of his example was that when this shy, 2. Bosch G, Janse van Rensburg ABR Reasons
sometimes awkward, idiosyncratic person did what for and cost of specialist psychiatric referrals to
he could, from his heart, despite all the limitations, Weskoppies Hospital from Mpumalanga districts.
it touched other people’s lives in a genuine way. (Poster) 11th Biennial Congress of the Society of
It made others feel that maybe what was in their Psychiatrists of SA. Sep 2000, Durban.

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 56

MEMORIAL LECTURE

3.Cost of acute inpatient mental health care in African clinical environment (Paper) World
a 72-hour assessment unit. Janse van Rensburg Psychiatric Association (WPA) International
ABR, Jassat W (Paper) 15th National Psychiatry Congress in Spirituality and psychiatry; 4th
Congress SASOP. 10-14 Aug 2008; George. Global Meeting in Spirituality and Mental Health,
Jerusalem, Israel 1-4 December 2019.
iv 1. Janse van Rensburg ABR. Acute mental ix Janse van Rensburg B, Szabo CP, Poggenpoel M,
health care and South African mental health Myburgh C. Spirituality and psychiatry: guidelines
legislation. Part I - Morbidity, treatment and for South African practice and training. (Paper)
outcome. African Journal of Psychiatry. Nov 17th National Psychiatry Congress SASOP. 7-11
2010; 13(5):382-389 Sep 2012; Misty Hills, Johannesburg.
x Bhugra D, Malik A, Ikkos G (eds) Psychiatry’s
2.Janse van Rensburg ABR, Jassat W. Acute Contract with Society: Concepts, controversies
mental health care according to recent mental and consequences. Oxford: Oxford University
health legislation. Part II. Activity -based costing. Press, 2011.
African Journal of Psychiatry. March 2011; xi Motivation of AssProf Bernard Janse van Rensburg
14(2):23-29 for the Vice Chancellor’s Award for Academic
Citizenship, University of the Witwatersrand, 2018.
3.Janse van Rensburg A, Janse van Rensburg xii 1.Robertson LJ, Janse van Rensburg B & Talatala
ABR, Acute mental health care according M (SASOP), Chambers C (SADAG), Sunkel S &
to recent mental health legislation. Part III. Patel, B (SAFMH), Stevenson, S (SECTION27).
Structuring space for acute in-patient care. Editorial. Unpacking Recommendation 16 of
African Journal of Psychiatry. May 2011; 14(3):112- the Health Ombud’s report on the Life Esidimeni
119 tragedy. SAMJ. 2018: 108(5): 262-263. DOI:10.7196/
SAMJ.2018.v108i5.13223
v Janse Van Rensburg A, Janse Van Rensburg 2.Janse van Rensburg B. "Life Esidimeni"
ABR. Structuring of space for acute mental Psychiatric Patients in Gauteng: Clinicians' voice
health care. (Poster) 15th National Psychiatry and activism - an ongoing, but submerged
Congress SASOP. 10-14 Aug 2008; George. narrative. SA J Bioethics & Law. 2017;10(2):44-47.
DOI:10.7196/SAJBL.2017.v10i2.614
vi Janse van Rensburg, ABR. The role of spirituality 3.Janse van Rensburg B. Following on the
in South African specialist psychiatric practice "Life Esidimeni" Incident - Access to care for
and training, thesis submitted in fulfilment of the people living with severe mental disability
requirements for Doctor of Philosophy, University according to national policy. SA J Bioethics &
of the Witwatersrand, Johannesburg. 2010. http:// Law, 2017;10(2):48-51. DOI:10.7196/SAJBL.2017.
wiredspace.wits.ac.za/handle/10539/11211; v10i2.615
xiii Motivation of AssProf Bernard Janse van Rensburg
vii Janse van Rensburg B. Introducing the South for the Vice Chancellor’s Award for Academic
African Spirituality Scale (SASS): Measuring Citizenship, University of the Witwatersrand, 2018
spirituality among medical students in a
heterogeneous clinical environment. Mental
Health Religion and Culture. In press (Ref CMHR-
2019-0152.R1) Dec 201

viii Janse van Rensburg AB. Developing a scale of
spirituality for the use in a heterogeneous South

57 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

Depression can
make keeping
on top of daily
tasks a struggle

Brintellix can help with her mood,
concentration and fatigue, so she is able
to organise her day again

10 mg once daily

(ZA-BRIN-0081) May 2020

UPDATE

ABILIFY MAINTENA

AVA I L A B L E

IN SOUTH AFRICA!

Lisa Selwood

Lundbeck invited Prof Christoph
Correll to give a virtual
presentation entitled ‘A Stitch in
Time – Managing Schizophrenia
Effectively Long Term’ to
healthcare professionals. Prof
Correll is the Medical Director of
the Recognition and Prevention
program at the Zucker Hillside
Hospital in New York. His areas of
expertise include the prodrome, Lisa Selwood

first and multiple episode schizophrenia, as well
as the refractory illness phase in severe psychotic
L undbeck South Africa is proud to introduce and mood disorders
Abilify Maintena (aripiprazole prolonged-
release suspension for injection) to the South PROF CORRELL SET THE SCENE WITH
African market. Abilify Maintena is indicated SOME SOBERING STATISTICS. OF PATIENTS
for the maintenance treatment of schizophrenia in EXPERIENCING AN ACUTE PSYCHOTIC
adult patients stabilized with oral aripiprazole. EPISODE, ONLY 8 – 20% WILL RECOVER.
It is well known in patients with schizophrenia THE REMAINDER CYCLE THROUGH
that non-adherence to medication is the major VARIOUS STAGES OF RESPONSE,
driver for relapse and rehospitalization, which REMISSION, RELAPSE AND RESISTANCE,
results in severe economic, societal and personal WHICH BEGS THE QUESTION ‘PEOPLE
consequences. Long acting injectables can play MAY BE BETTER, BUT ARE THEY WELL?’
a role in improving adherence and keeping the
patient relapse free, out of hospital and living life.

One must also consider adverse effects when
treating these patients, as adverse events are
known to impact patient functioning and may also
lead to treatment nonadherence.

Relapse prevention is crucial. Multiple relapses
and exacerbations result in long term symptoms
and disability, increased risk of suicide attempts,
decrease in treatment response, progressive
decline in brain structure, greater use of healthcare
resources, and an increased burden on family
and caregivers. Avoid relapses and avoid the
associated suffering.

59 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

UPDATE

Long acting injectables (LAIs) need to be considered RELAPSE PREVENTION IS ESPECIALLY
earlier on in the treatment course. A comprehensive IMPORTANT IN EARLY PHASE PATIENTS
meta-analysis of 137 studies by Kishimoto et al WHO HAVE THE MOST TO GAIN AND THE
(2018)1 examined the effectiveness of LAIs vs oral MOST TO LOSE.
antipsychotics in patients with schizophrenia.
LAIs improve outcomes in terms of antipsychotic
LAIS WERE CONSISTENTLY SUPERIOR discontinuation, relapse, hospitalisation and
REGARDING HOSPITALISATION AND mortality risk and should be considered earlier and
ALL CAUSE DISCONTINUATION RATES. in more patients.
ANOTHER STUDY BY TIIHONEN ET AL (2017)2
SHOWED THE REHOSPITALISATION RISK WAS A series of small steps leads to big achievable
20-30% LOWER WITH LAIS VS EQUIVALENT moments.
ORAL FORMULATIONS.
Lundbeck looks forward to celebrating the small
Prof Correll discussed the registration trials which steps and achievable moments with you!
were performed for Abilify Maintena, which showed
a relapse rate of 10% for Abilify Maintena, vs 39.6% for Abilify Maintena 400 mg. Each pre-filled syringe/
placebo. He then went on to discuss both the QUALIFY vial contains 400 mg aripiprazole (as monohydrate).
(QUality of LIfe with AbiliFY Maintena)3 and the Registration number: 48/2.6.5/0531
PRELAPSE (Prevention of Relapse)4 trials. The PRELAPSE
trial looked to determine whether encouraging the REFERENCES
use of a LAI compared with Clinicians Choice (CC)
delays the time to first hospitalization in patients 1. Kishimoto T et al ‘Effectiveness of Long-Acting
with early phase illness. Half the clinics encouraged Injectable vs Oral Antipsychotics in Patients with
treatment with Abilify Maintena, and the other half Schizophrenia: A Meta-analysis of Prospective
provided treatment as usual. The Abilify Maintena and Retrospective Cohort Studies’ Schizophr
sites provided specific training around aspects Bull (2018) 44(3):603-619
related to LAIs, as well as shared decision-making
principles and tools to facilitate the discussion of LAIs 2. Tiihonen J et al ‘Real-World Effectiveness of
with the patients and families. Antipsychotic Treatments in a Nationwide
Cohort of 29 823 Patients with Schizophrenia’
IT WAS SHOWN THAT WITH APPROPRIATE JAMA Psychiatry (2017) 74(7):686-693
STAFF TRAINING, MORE THAN 3 OUT
OF 4 PATIENTS WITH EARLY ILLNESS WILL 3. Naber D et al ‘Qualify: a randomized head-to-
ACCEPT A LAI. THE STUDY ALSO REVEALED head study of aripirazole once-monthly and
ABILIFY MAINTENA SIGNIFICANTLY paliperidone palmitate in the treatment of
DELAYED TIME TO HOSPITALIZATION, schizophrenia’ Schizophrenia Research (2015)
WITH A NUMBER NEEDED TO TREAT (NNT) 168(1-2):498 – 504
OF SEVEN.
4. Kane JM et al ‘Effect of Long-Acting Injectable
In terms of tolerability, a study showed that the Antipsychotics vs Usual Care on Time to First
adverse effects experienced with a LAI vs the same Hospitalization in Early-Phase Schizophrenia’
oral antipsychotic did not differ significantly.5 The JAMA Psychiatry (2020) 77(12):1217-1224
most frequently observed adverse drug reactions
(ADRs) reported in ≥ 5 % of patients in two double- 5. Misawa F et al ‘Safety and tolerability of long-
blind, long-term trials of Abilify Maintena were acting injectable versus oral antipsychotics:
weight increased (9.0 %), akathisia (7.9 %), insomnia A meta-analysis of randomised controlled
(5.8 %), and injection site pain (5.1 %). studies comparing the same antipsychotics’
In conclusion, it was shown that early integrated Schizophrenia Research (2016) 176(2-3):220-
care has the best outcome for patients with 230
schizophrenia.
Lisa Selwood is the Medical Affairs Manager at
Lundbeck, South Africa. Correspondence: LIEW@
lundbeck.com

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 60

NEW

A new treatment option for your patients with schizophrenia

S5 Abilify Maintena: aripiprazole once-monthly injection contains 400 mg aripiprazole - Reg 48/2.6.5/0531 Each unit contains
aripiprazole 400 mg. For full prescribing information refer to the package insert approved by the Medicines Regulatory Authority.
Lundbeck SA (Pty) Ltd Unit 9, Blueberry Office Park, Apple Street, Randpark Ridge X114, 2196, South Africa. Tel: +27 11 699 1600
Fax: +27 86 548 7887 ZA-ABIM-0046 January 2021



DULOXETINE HCI PITCH

for PERFECT

HARMONY

TOGETHER we are

STRONGER

Dual serotonin and noradrenaline
reuptake inhibitor1

HARMONY in MENTAL HEALTH2

Dr. Reddy’s HELPLINE : 0800 21 22 23 Dr. Reddy’s
www.sadag.org

References: 1. Yelate 30/60 package insert. Dr. Reddy’s Laboratories (Pty) Ltd. January 2020. 2. Galderisi S, Heinz A, Kastrup M et al.
Toward a new definition of mental health. World Psychiatry, 2015;14(2): 231-233.

S5 Yelate 30/60. Each capsule contains duloxetine hydrochloride equivalent to duloxetine 30/60 mg. Reg No’s 44/1.2/0114;0115. Dr.
Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Block B, 204 Rivonia Road, Morningside, Sandton. 2057. www.drreddys.co.za.
ZA/03/2021-23/Yel/003

For full prescribing information refer to the professional information approved by the medicines regulatory authority.

BOOK REVIEW

B R E AT H :

THE NEW SCIENCE OF A LOST ART

Koffi Kouakou

In Breath: The New Science of
a Lost Art, the emphasis is on
understanding the breath, its
process, mechanics, physiology
and the science behind it and
more importantly, how to breathe
correctly for better health.
Humans have undervalued the
breath function and lost the
ability to breathe correctly over
Koffi Kouakou

millennia. However, it is now being
rediscovered again as a new science of a healthy
life. So says James Nestor, the author of Breath. But
he also questions the conventional wisdom about
our most basic biological function, breathing.

Title: Breath: The New Science of a Lost Art Thus, his own unsatisfied search, to understand
the reality of the breath, led him to a ten-year
Publisher: Penguin Books personal investigation of the process of breathing
and to write a book about it. To do so, he travelled
around the world to meet men and women breath
science practitioners, adept at ancient breathing
practices like Pranayama, Sudarshan Kriya, and
Tummo, a Buddhist breathing method. His findings
are phenomenal. They confirm and helped him to
understanding that breathing is perhaps one of
the most important biological functions the human
species possesses.

Author: James Nestor THE FASCINATION TO UNDERSTAND THE
BREATH, ITS MECHANICS, BIOLOGY,
ISBN: ISBN: 978-0-241-289e07-5 EFFECTS ON PSYCHOLOGY AND ITS USAGE
IN SPIRITUALITY HAS HELPED NESTOR FIND
T here is something odd about reminding GREAT FAME AND REPUTATION AMONG
humans to breathe. By their own nature, they HEALTH MOVEMENTS WORLDWIDE.
should breathe naturally. But it seems that BREATHING CORRECTLY IS NOW TOUTED
breathing is a “mindless activity we do each AS AN ART AND SCIENCE.
and every day without giving any effort, thought,
or practice”. Why is breathing correctly a lost art?
Because humans have overlooked it and taken it
for granted.

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 64

BOOK REVIEW

B R E AT H

James Nestor’s fascinating journey to understand In part, the book mostly reads as a medicalised
and effectively use the breath reminds me of a story way to breath. It forces us to understand the
told by Jay Shetty, a former monk. Shetty tells about mechanics of breathing, its problems and fixing
the first thing he learned as a monk observing young them to improve our health. Poor breathing habits
monks and what they taught in monk school. To his lead to bad health, Nestor asserts. Adopting proper
surprise, he discovered that learning to breathe well breathing habits and “how we breathe leads to
was the first educational practice, not to count and better health.” He insists on breathing through the
read the alphabet. Therefore, breath education nose, rather than the mouth, as a key to better
was a cornerstone in the spiritual development of breathing practices. In short, changing the way we
monkish life. So, he asked himself why most people breathe is essential to our health.
are not taught how to use their breath. The lesson The book has received great endorsements from
has stayed with him and he uses it to help others. breathing therapists, breatharian movements, that
believe that the air we breathe is food in substance,
THIS SIMPLE STORY ILLUSTRATES THE and modern breathwork experts such as Wim Hof,
UNDENIABLE LINK BETWEEN THE BREATH the Dutch breath guru.
AND HEALTH. AND THAT EFFECTIVE
BREATH MANAGEMENT IS ALSO AN BREATH IS A POWERFUL AND
ESSENTIAL BIOLOGICAL FUNCTION TO CONVINCING MANUAL THAT SHOWS
TAKE CONTROL OF ONE’S LIFE. HOW THE SIMPLE AND INTUITIVE ACT
OF INHALING AND EXHALING OF THE
Nestor is a late comer to the breathwork inquiry HUMAN RESPIRATORY SYSTEM IS AN
business. Many more seasoned observers, authors EXTRAORDINARY ACT OF EVOLUTION.
and practitioners of conscious breathing have
trailblazed the path of breathwork for centuries, The surprising finding for me is the link between
beginning with Buddhist monks, Indian yogis and breathing correctly and healthy teeth.
many more. In Chinese, Qi Gong means breath
work. Ancient religions knew the power of the breath THIS IS A NOSTRIL-OPENING BOOK
and breathing correctly beyond its mechanical AND A GREAT PRACTICAL GUIDE
aspects. They saw breathing as medicine and TO THE POWER OF THE BREATH AND
associated it with beneficial spiritual practices and PULMONARY HEALTH. IT IS ALSO A “SELF-
that breathing properly helps healing. HELP BOOK” WITH SAMPLE BREATHING
METHODS. YOU WILL SURELY NEVER
WITH BOTH A JOURNALISTIC EYE AND BREATHE THE SAME WAY AGAIN AFTER
A MEDICAL DOCTOR’S DIAGNOSTIC READING IT.
MIND, NESTOR INVESTIGATES THE BREATH
AND THE PROCESS OF BREATHING. James Nestor, while warning us about our poor
HE DRAWS ALSO ON MILLENNIA OF breathing habits, is also confident about the future
MEDICAL REFERENCES AND RECENT of breathing. Nestor’s message is simple – effective
ADVANCES IN PULMONOLOGY, BIOLOGY, breathing practices change lives – and that
BIOCHEMISTRY, HUMAN PHYSIOLOGY changing the way you breathe will transform your
AND PSYCHOLOGY. MORE THAN body and mind. No wonder it is said that breath is
THAT, HE PROVIDES PRESCRIPTIONS life.
AND BREATHWORK PRACTICES TO THE So, take a deep breath, consciously. Your health
READERS WITH THE HOPE THAT THEY WILL and wellbeing depend on it.
APPLY THEM TO THEIR LIVES.

Koffi Kouakou is a senior lecturer at the Wits School of Governance, where he teaches strategic government communications
and scenario planning. He is the former director of the Unilever Mandela Rhodes Academy for Communications and
Marketing (UMRA), a Storyteller, Social Commentator, Business Strategist, Author and Futurist. He specialises in information
communications technologies for development and telecommunications adapted to environmental issues in Africa. He has
been a regular contributor to international, local media and business magazines on the BBC,VOA, Deutsche Welle,The People
Daily, eNCA, Africa 360 degrees, SAFM, 702 Radio, Power FM, China, Brainstorm,The Media, CIO.COM and Intelligence in South
Africa. He co-authored a book titled AfricaDotEdu: IT Opportunities and Higher Education in Africa, 2003. Correspondence:
[email protected]  

65 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

MOVIES

MOVIES

Title: The Conjuring: The Devil
Made Me Do It
Release Date: 04-Jun-21
Age Restriction: TBC
Genre: Horror
Paranormal investigators Ed
and Lorraine Warren try to
uncover the truth behind a
murderer's claim of demonic
possession.

Title: A Quiet Place 2 Title: Cruella
Release Date: 28-May-21 Release Date: 28-May-21
Age Restriction: 16 Age Restriction: 7-9 PG
Genre: Horror Genre: Animation
Following the events at home, the Abbott family A live-action prequel feature
now face the terrors of the outside world. Forced film following a young
to venture into the unknown, they realize that the Cruella de Vil.
creatures that hunt by sound are not the only
threats that lurk beyond the sand path.

Title: In the Heights Title: The Misfits
Release Date: 11-Jun-21 Release Date: 11-Jun-21
Age Restriction: TBC Age Restriction: TBC
Genre: Musical Genre: Adventure
A feature version of the Broadway musical, in which After being recruited by a group of unconventional
a bodega owner has mixed feelings about closing thieves, renowned criminal Richard Pace finds
his store and retiring to the Dominican Republic himself caught up in an elaborate gold heist that
after inheriting his grandmother's fortune. promises to have far-reaching implications on his
life and the lives of countless others

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 66

WINE FORUM

RAISING HANDCRAFTED
WINES… ALONG WITH

TWO DAUGHTERS

Y ou’d be forgiven for thinking a wine brand Indeed, John and Peter-Allan
dubbed Thorne & Daughters, cobbling started out sharing cellar space –
together the second name of the winemaker and many ideas, alongside tastes
and the fact he and his co-owner wife have – with Chris & Suzanne Alheit and
two daughters, was conceived far from consumer Marelise Niemann at the Alheit’s
focus groups or marketing consultants. Add to that Hemelrand just short of a decade
whimsical wine names out of the nursery like Rocking ago.
Horse,Tin Soldier, Paper Kite and the like, and it’s sort
of charmingly Heath Robinson. Talk turns to a new foreign buyer
But, sit across a table from the handsomely bearded who is rumoured to have bought
John Seccombe and you’ll see what an intuitive, some 100-odd hectares at the
considered, thoughtful and incisive mind is behind northern, Shaw’s Pass end of the
these wines. We’re in the boardroom at Bot River’s David Swingler
Gabrielskloof, where John makes his wine alongside
resident cellarmaster Peter-Allan Finlayson (who also Hemel-en-Aarde Valley and is planting them all
makes his own Crystallum here). simultaneously. Which means he will be bringing
rafts of a new wine to market, without a track record,
THEY’RE SHOWING ME ALL THEIR all at once. Amongst the tut-tutting, it’s clear that
NEW VINTAGES TOGETHER, WHICH slowly building a brand for organic growth is the
REFLECTS THE NEW WAVE OF YOUNG secret to survival at the epicentre of seismic South
REVOLUTIONARY WINEMAKER WHO IS African wine.
COLLABORATIVE, KEEN TO LEARN FROM
OTHERS,AND NOT SCARED OF SHARING. T&D started life as a duo of wines, Rocking Horse
and Tin Soldier, in 2013. Schooled at St Stithians and
armed with a Maths and Computer Science degree
from Stellenbosch, John did harvests in Australia and
France before gaining a BSc (Hons) in Viticulture
and Oenology from Plumpton College in Lewes,

1. Thorne & Daughters in the vineyards 2. Thorne & Daughters in the cellar

67 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

WINE FORUM

England. After winemaker experience at Thelema, Rocking Horse, Wanderer's Hart,Tin Soldier and Paper Kite
Iona and Domaine des Dieux, John and professional
photographer wife Tasha established T&D in 2012. There are two reds in the line-up. Copper Pot is
They have now built the range to include seven comfortably one of few pinots noir around R150 that
wines. I can swallow, and what a delightfully fruity mouthful
Rocking Horse is the foundation stone of the brand, it is. It’s not Red Burgundy but, mercifully, doesn’t try to
and a poster child for the Chenin Blend white wine be. Wanderer’s Heart is wrapped in a package with
revolution that has wowed foreign, especially British a handwritten poem that reminds one, as serious as
markets, and is seen as the next best South African these wines may be, there’s always place for whimsy.
thing. There’s ever less chenin in it, interestingly, with Cinsaut is retreating in the blend, with grenache,
semillon, roussanne, chardonnay and clairette mourvèdre and syrah to the fore.
blanche leading the way, but that matters not. It is
crystalline, finely chiselled with a coated acidity and CONSIDERING THE VARIETY OF GRAPES
penetrating length of flavour. AND VINEYARDS JOHN USES, IT’S CLEAR
The two Semillons are a contrast. Paper Kite comes HE OWNS NONE AND WORKS WITH
off Swartland vines planted in 1963 and has a rich GROWERS TO PROVIDE THE FRUIT HE’S
lanolin viscosity to it, while Tin Soldier beats the LOOKING FOR. TAKE AS READ TOO,
‘natural’ wine drum, being Semillon gris (a ‘grey’ HIS NATURAL WINEMAKING WITH WILD
mutation of Semillon blanc) that has seven days YEASTS, NO COERCIVE ADDITIVES LIKE
of skin contact – made like a red wine initially – to ENZYMES, AND MINIMAL INTERVENTION.
extract body, tannin and freshness. It’s at home in the
fashionable ‘orange wine’ genre, with an austerity Nine years on and the
that charms many, albeit not me. monikers have not yet worn.
Will they, as their daughters
Snakes & Ladders vineyard grow into adults? One
gets the sense that John
Cat’s Cradle is a stunning Perdeberg-sourced chenin and Tasha have carefully
blanc in its third vintage in 2019, framing the peachy planned this venture for
stone fruit core of the variety, while Snakes & Ladders the long haul, and perhaps
is an interesting new take on sauvignon blanc, 2019 one day the daughters
fruit from Citrusdal Mountain fermented with wild themselves will be at the
yeasts in seasoned oak. It’s more blackcurrant than helm.
grassy or tropical; even this hack liked it!

Thorne & Daughters is
represented locally by
Ex Animo www.exanimo.
co.za while other outlets
Copper Pot and international agents

can be found on their own website at https://
thorneanddaughters.com/

Chenin Blanc Snakes and Ladders David Swingler is a writer and taster for Platter’s South
African Wine Guide for over 21 years to date.Dave Swingler
has over the years consulted to restaurants, game
lodges and convention centres, taught wine courses
and contributed to radio, print and other media. A
psychiatrist by day, he’s intrigued by language in
general, and its application to wine in particular.
Correspondence: [email protected]

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 68

TRAVEL

MPUMALANGA

BEYOND WILDLIFE

M pumalanga is one of South Africa’s culture in the Highveld region boasts icons like
provinces endowed with natural Sarah Mahlangu who have managed to preserve,
attractions and experiences bound to package and export the colourful culture to
astound any traveller. international countries.
Expediently dubbed South Africa’s adventure
capital, Mpumalanga offers an array of activities MPUMALANGA IS AN IDEAL GOLF
ranging from, abseiling, white water river rafting, DESTINATION WITH A MYRIAD OF WORLD
fly-fishing, paragliding, mountain biking, bungee CLASS GOLF ESTATES AND COURSES
jumping, hiking and 4X4 trails to name a few. THAT PROVIDE SHEER ENJOYMENT OF
The province is undoubtedly the ultimate in terms THE GAME IN COMPLETE SERENITY.
of wildlife experience. The Kruger National Park,
the Sabi Sands private game reserve and other Get off the beaten track and explore the many
game reserves dotted throughout the province other offerings on offer. Visit www.mpumalanga.
offer an exhilarating and unequalled experience com for more information.
that brings visitors in close proximity to nature. The 1. MAKHONJWA MOUNTAINS WORLD HERITAGE SITE
Kruger Park boasts a conservancy area spanning 2
million hectors rich with flora and fauna. The Barberton Makhonjwa Mountainlans
The Lowveld escarpment (Panorama Route) offers was inscribed as the World Heritage site on
spectacular landscapes with attractions like the 2 July 2018. The site comprises 40% of the
Blyde River Canyon (3rd largest in the world), Barberton Greenstone Belt, one of the world’s
majestic waterfalls and high altitude scenic drives oldest geological structures. It represents the
leading to attractions like God’s Window, the best-preserved succession of volcanic and
Bourke’s Luck Potholes and the Three Rondavels. sedimentary rock dating back 3.6 to 3.25 billion
The province also boasts a rich heritage, which years, when the first continents were starting
is greatly unexplored. The myriad heritage sites to form on the primitive earth. It also features
include the Samora Machel monument near meteor-impact fallback breccia’s resulting from
Mbuzini, Makhonjwa Mountains in Barberton the impact of meteorites
boasting rock formations dating back to more than formed just after the Great Bombardment (4.6
3,5 billion years. Other sites not to be missed are to 3.8 billion years ago). Barberton Makhonjwa
the mining village of Pilgrim’s Rest, the Highveld Mountains is South Africa’s 10th World Heritage
Heritage Route abound with adventurous tales into site, and the first for Mpumalanga.
history, the stone circles of Mpumalanga, Goliath’s
footprint to name just a few. Barberton Makhonjwa Mountains World Heritage Site
Bird watchers can have a glimpse of more than
500 different birds endemic in the Kruger Park or
the Chrissiesmeer areas in the southern part of the
province.
The midveld, offers trout fishing opportunities in
pristine rivers and dams with Dullstroom referred to
as South Africa’s trout-fishing Mecca. The Ndebele

69 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

Three Rondawels TRAVEL

2. GEOTRAIL against racial segregation as well as the
The Geotrail allows you to step back in time and destinations that featured prominently during
explore what the surface of our planet would the liberation struggle.
have looked like 3.5 billion years ago. Before
man, before the dinosaurs, when the first life THE NKANGALA DISTRICT RESISTANCE
forms were only beginning to appear and the AND LIBERATION ROUTE HIGHLIGHTS
planet was a far more hostile place. Along the FOUR KEY TOWNS AND SITES THAT WERE
route, you will see evidence of the first life visible EXTENSIVELY INVOLVED IN THE ANTI-
to the naked eye, of superhot volcanoes, ancient APARTHEID LIBERATION STRUGGLE,
tsunami’s and what could be the first land! It is WHICH RESULTED IN A PEACEFUL
impossible to overstate the importance of the TRANSITION TO DEMOCRACY IN 1994.
Geotrail, as these rocks only occur in two places
on earth and the other is totally inaccessible. These include Delmas, Emalahleni, Botshabelo
So come and let the Geotrail reveal its secrets, and Mapoch caves. The Gert Sibande District
take in the spectacular scenery & wildlife along Liberation and Heritage Route highlights six
the route and learn about life 3.5 billion years towns like Bethal, Daggakraal, Ermelo, Saul
ago. The Geotrail starts just outside of Barberton Mkhizeville (formerly Driefontein), Secunda and
at the intersection between the R40 and R38 Volksrust. Although these are not the only sites
and continues all the way along the R40 to the within the Province that were home to various
Swaziland border. There are 11 stops along the freedom fighters involved in the grassroots
route, each with information boards. The route liberation struggle. As more research continues
takes around 5 hours to do, so pack a picnic to be conducted, other towns may be added
and make use of the picnic sites along the way. within the route.
It is free for those doing a self-drive tour, the cost A detailed content highlighting each town and
of guided tours vary. the various offerings in each place has been
developed. This provides a detailed information
about the route, accommodation, attractions,
maps and cities. The information will assist in
planning your trip when visiting the attractions
on these routes. Information is available on www.
mpumalanga.com or you can download it from
the Mpumalanga Travel Guide App available
on apple and android phones.
4. DR ESTHER MAHLANGU
Dr Esther Mahlangu was born in 1935 on a
farm outside Middleburg, in what is now the
Mpumalanga province. She was the first of
nine children: six boys and three girls. Following
traditions passed down from her mother and
grandmother, she learned traditional Ndebele
wall painting and beadwork as a child. She

Graskop Gorge Lift Botshabelo Historical Village,

3. LIBERATION HERITAGE ROUTE
The Liberation Heritage routes form part of
the Mpumalanga chapter of the National
Liberation Heritage Route, spearheaded by the
Mpumalanga Department of Culture, Sports
and Recreation, to map out, document and
preserve Mpumalanga routes to independence.
It highlights the key freedom fighters who fought

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 70

TRAVEL Blyde River Canyon
became an expert in executing murals as a
teenager, using a widening range of paint TOP 10 THINGS YOU MIGHT NOT HAVE
colours that emerged in the 1940s. She married KNOWN ABOUT MPUMALANGA
and had three sons, but lost her husband and 1. South Africa’s first stock exchange was built in
two of her children. Between 1980 and 1991, she
lived and worked at the Botshabelo Historical Barberton in 1884 during the gold rush.
Village, an open-air museum of Ndebele culture. 2. The world-renowned artist Gerald Sekoto was

MPUMALANGA INTERESTING FACTS born at Botshabelo near Middelburg on 9
Have you ever … December 1913.
• Hiked the Blyde River Canyon trails through the 3. Makhonjwa Mountains in Barberton boast the
oldest rock formations in the world dating back
deepest green canyon in the world? 3,5 billion years.
• Visited the cultural villages at Loopspruit, 4. By far the world’s largest underground
coalmining complex is in Secunda, making
Botshabelo, Matsamo, Ebutsini and Shangana? Mpumalanga South Africa’s powerhouse.
• Visited the Samora Machel monument and 5. The Blyde River Canyon is the 3rd largest in the
world and the largest green canyon.
museum at Mbuzini? 6. The Kruger National Park is 2 million hectares in
• Birdwatched at Wakkerstroom, Chrissiesmere size.
7. Ray Phiri, Marriam Makeba, Hugh Masekela,
and the Southern Grasslands? Zakes Nkosi, Lucky Dube, Rebecca Malope all
• Rock climbed at Waterval Boven? hail from Mpumalanga.
• Explored the southern grasslands 8. The Sudwala Caves are the oldest known
dolomite caves in the world. The caves are
archaeological sites from Ermelo? approximately 2 000 million years old.
• Photographed the sculptural wonder of the 9. Pilgrim’s Rest was the second town in South
Africa after Kimberly to be electrified. The
Bourke’s Luck Potholes? electricity was generated from a hydro
• Taken a historical gold mining tour of Pilgrim’s electrical plant in the Blyde River Canyon built
in 1911.
Rest and Barberton or panned for gold? 10. The giant footprint otherwise known as the
• Played golf at Skukuza in the Kruger National Goliath’s Footprint embossed on a rock on a
farm near Ermelo is 6ft long.
Park or many other Mpumalanga golf courses?
• Explored the Sudwala Caves, the oldest CONTACT:

dolomite caves in the world? Tel: +27 13 759 5300
Email: [email protected]
Bourkes Luck potholes Reservations: [email protected]
Web: www.mpumalanga.com

71 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

QUETIAPINE FUMARATE TRUST is
EARNED

Treatment with

PROVEN EFFICACY

For the treatment of schizophrenia
and manic episodes associated
with bipolar disorder1

HARMONY in MENTAL HEALTH2

Dr. Reddy’s HELPLINE : 0800 21 22 23 Dr. Reddy’s
www.sadag.org

References: 1. Dopaquel Package Insert. Dr. Reddy’s Laboratories (Pty) Ltd. June 2017. 2. Galderisi S, Heinz A, Kastrup M et al. Toward a new
definition of mental health. World Psychiatry, 2015;14(2): 231-233.

S5 Dopaquel 25/100/200/300. Each tablet contains quetiapine fumarate equivalent to quetiapine 25 mg/100 mg/200 mg/300 mg.

Reg No’s 43/2.6.5/0429;0430;0431;0432. Dr. Reddy’s Laboratories (Pty) Ltd. Reg no. 2002/014163/07. Block B, 204 Rivonia Road,

Morningside, Sandton. 2057. www.drreddys.co.za. ZA/03/2021-23/Dop/005.

For full prescribing information refer to the professional information approved by the medicines regulatory authority.

This content is for HCPs only and the intended recipient should not share or forward it.

SASOP

• The Scientific committee invites the submission • Contact details of the first author (telephone
of abstracts to be considered for Oral or Poster numbers, e-mail address etc)
presentation
2. Abstracts must be typed in English, single line
• The deadline for the submission of abstracts is spacing.
31 April 2021
3. The body of the text must not exceed 350 words
• Registrars and postgraduate students are (this excludes the information listed in point 1)
specifically invited to present.
4. Please adhere to the following format:
• All abstracts must be submitted online via the • Introduction: should be brief and informative
website
and state the aim of the study
• E-mailed or faxed abstracts will not be accepted • Methods: include a description of subjects and
• All appropriate abstracts will be reviewed by
research methodology
the Scientific Committee. All abstracts received • Results: outline the findings of the study
will be acknowledged, and authors will be sent
acceptance or rejection letters by 30 June 2021 supported by statistics as appropriate. Do not
• Please note that the presenter of the accepted use figures, graphs or tables in the abstract. The
abstract must register and all costs, including data provided must be sufficient to permit peer
registration fees, are for the author’s own review of the abstract
expense • Conclusion: provide summary and relevance of
the main findings
INSTRUCTIONS TO AUTHORS:
All accepted abstracts will be published without
1. Each abstract must clearly state the following: further editing. Abstracts that do not adhere to the
• Abstract title (the title of the abstract must not specific format will not be published

exceed 20 words) SUBMIT ABSTRACTS HERE:
• Name of contributing author(s). The name of https://sasop2021.co.za/index.php/abstracts/
abstract-submission
the presenting author must appear first in the
list of authors.
• Affiliation of all author(s).

For further information, please contact the Congress Organisers:
Londocor Event Management : Sonja Du Plessis Tel: 082 455 7853 email: [email protected]

73 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

N O M I N AT I O N
AND ELECTION

OF SASOP BOARD OF
DIRECTORS 2021 – 2023

D ear SASOP member,, months before the Annual General Meeting by the
The term of the current SASOP Board of SASOP Secretariat.
Directors (2018-2021) will be coming to 1. NOMINATIONS AND ELECTION OF
an end in six months’ time. The Board consists of CANDIDATES FOR PRESIDENT
the following members: President; Past President; In order to comply with the specifications of the
President Elect (Vice President); Honorary Secretary; MOI, nominations for President must be signed by
Honorary Treasurer; the Convener of the SASOP 5 SASOP members with voting powers and who are
Public Sector Group; and the Convener of the in good standing and should be received by the
SASOP Private Sector Groups. According to the MOI, Honorary Secretary of the SASOP within 5 weeks of
all Directors shall be elected, after being nominated the mailing/posting on the website of this notice
in writing and accepting the nomination in writing, of the call for nominations, i.e. by 24h00 on 4 June
during the next Biennial General Meeting. 2021, as this period constitutes a deadline.
Completed nomination forms may be submitted to
THE NEXT BIENNIAL GENERAL MEETING OF the Honorary Secretary or HEALTHMAN:
SASOP, WILL BE HELD DURING THE SASOP • electronically by email as a legible scanned
CONGRESS FROM 21 – 24 OCTOBER
2021 IN CENTRAL DRAKENSBERG. document to: [email protected]; and
[email protected] or joey@healthman.
While, according to the MOI, nominations for other co.za
Board members must be received, by the Honorary • by telefax to: 011 782 0270 for attention Joey
Secretary, 4 weeks prior to this meeting, the election Swart at HealthMan;
of the President is governed by the MOI, which
determines that nominations should be called for 6

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 74

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

NOMINATION AND ELECTION OF SASOP
BOARD OF DIRECTORS 2021 – 2023

• by regular mail to: HEALTHMAN, PO Box 2127, • electronically by email as a legible scanned
Cresta, 2118; or document to: [email protected] and
[email protected] or [email protected]
• delivery to: HEALTHMAN, Unit 16 Northcliff Office
Park; 203 Beyers Naude Drive, Northcliff. • by telefax to: 011 782 0270 for attention Joey
Swart at HealthMan;
NOMINATED CANDIDATES SHALL THEN
BE ASKED TO SUBMIT A BIOGRAPHICAL • by regular mail to: HEALTHMAN, PO Box 2127,
NOTE AND A VISION FOR THE PRESIDENCY Cresta, 2118; or
NOT EXCEEDING 400 WORDS.
• delivery to: HEALTHMAN, Unit 16 Northcliff Office
The SASOP Secretariat will be responsible for Park; 203 Beyers Naude Drive, Northcliff.
circulating ballot papers and the supporting
biographical notes to all members. An allowance The nomination forms will also be available on the
for secret ballot via email will be permissible. A SASOP website (www.sasop.co.za): in the Members’
return date for the ballot papers shall be 4 weeks Section, under “SASOP Board of Directors Election”,
after mailing and posting of these documents and under the “My Community” tab.
on the SASOP website. Counting of votes shall be
performed by an independent auditor appointed 3. VOTING AND PROXIES
by the SASOP Board.
2. NOMINATIONS OF CANDIDATES FOR Voting at the Annual General Meeting in October
HONORARY SECRETARY, HONORARY TREASURER 2021 shall be done by show of hands unless the
AND CONVENORS OF SASOP PUBLIC SECTOR majority of members present at the voting requests
AND SASOP PRIVATE SECTOR GROUPS a secret ballot.
All nominations for the other members of the Board
of Directors, the Honorary Secretary, Honorary As specified by MOI, a proxy may be appointed by
Treasurer and Convenors of SASOP Public Sector a member with voting power (i.e. a fully paid–up
and SASOP Private Sector Groups, should only Full Member, Life Member, Pensioner Member or
be received 4 weeks before the Biennial General Honorary Member).
Meeting of SASOP during the SASOP Congress from
21 – 24 October 2021 in Central Drakensberg, i.e. The appointed proxy may be present at the
24h00 on 26th of August 2021. meeting, debate and vote on behalf of the proxy
grantor but must himself, or herself, be a member
A REMINDER, SPECIFIC DATE AND TIME with voting power as described above. Such
WILL BE CIRCULATED TO MEMBERS AS appointment is for a specific meeting and must be
SOME INFORMATION REGARDING THE so specified. The appointment of the proxy must
ANNUAL GENERAL MEETING STILL NEEDS be received in writing by the grantor (not someone
TO BE CONFIRMED. who acts as his/her agent) and must reach the
Honorary Secretary before 24h00 on Friday 15
Nominations should carry the signature of the October 2021.
candidate and two voting members (a proposer
and seconded) and accompanied by a manifesto WE ENCOURAGE YOU TO PARTICIPATE
and CV of the proposed candidate. It must be IN THIS PROCESS TO AGAIN ENSURE A
made by submitting the completed applicable DEMOCRATICALLY DULY ELECTED SASOP
forms to the Honorary Secretary or HealthMan: BOARD OF DIRECTORS FOR THE TERM
2021-2023.

Issued by Dr Anusha Lachman
SASOP Honorary Secretary
On behalf of the SASOP Board of Directors

75 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

HISTORY
MATTERS

A SYMPOSIUM EXPLORING THE IMPACT
OF HISTORICAL RACIAL LEGACIES ON
THE FUNCTIONING OF INSTITUTIONS

Convenors: Jon Yako (UCT), Rene Nassen(SU), Wendy Vogel

Y ou are invited to join the UCT Department dissertation 'From Volksmoeder to Igqira: Towards
of Psychiatry Transformation Committee an intellectual Biography of Dr. Vera Bührmann
Symposium. (1910 - 1998)".
Dr. Vera Bührmann was an early practitioner in the
field of child and adolescent psychiatry in South The keynote address by Prof Jonathan Jansen will
Africa and achieved prominence particularly for follow respondents' presentations, after which there
her work in cross-cultural psychiatry. She was a will be a panel discussion.
complex woman who negotiated several identities
that in some respects appear to have been SAVE THE DATE
contradictory.
The purpose of this symposium is to interrogate FRIDAY 25 June 2021
the impact of historical legacies, such as that of 09h00 - 14h00
Vera Bührmann and how these legacies impact MS TEAMS
the functioning of institutions in our current world.
Also, how to reconcile varying positions that are To register for the symposium please email:
in conflict. The symposium will have two main Sandra Swart
presentations, followed by respondents and a [email protected]
panel discussion by experts in the field.
Mr. Andre Landman will share content of his CPD points to be arranged.

Meeting Link will be forwarded after registration

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 76

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

SAVE THE DATE

MATERNAL

MENTAL HEALTH

SASOP WESTERN CAPE SUB-GROUP
VIRTUAL SYMPOSIUM
SAT 5 JUNE 2021 (09:00 – 11:30)

This invitation is open to all psychiatrists, registrars,
general practitioners and obstetricians with an
interest in “Maternal Mental Health”
HOW TO REGISTER:
Please RSVP to [email protected] by no later
than 3 June.
• Registration fees are complimentary
• Please include your Title, First Name, Surname,

HPCSA number and profession
• Your zoom link will be forwarded to you 2 days

prior to the symposium
• CPD certificates will be e-mailed 1 week after the

symposium
The symposium will be recorded and the link to the
recording will be available to those who would like
to view the recording after the event. Contact Sonja
du Plessis - Londocor: [email protected]
This virtual symposium has kindly
been sponsored by:

77 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

VACANCY FOR RESIDENT

P S Y C H I AT R I S T

- KIMBERLEY

C areline Clinic Private Psychiatry Hospital patient vary according to the specific needs of
is currently looking for a Resident each individual user.
Psychiatrist. Adult voluntary psychiatry patients needing
Assistance will be provided for hospital care are provided with excellent, quality
relocationband set up of a practice in Kimberley. We care and commitment by our multi disciplinary
have a big market here but lack of skills is currently team. This includes patients with mood disorders
hindering our growth and possibility of scaling. such as depression and Bipolar, anxiety disorders,
BACKGROUND schizophrenia and other psychotic disorders.
Careline Clinic is a Private Psychiatry Hospital that Our modern private mental health facility offers a
offers a continuum of psychiatric and rehabilitation therapeutic & homely setting,
services for all in a confidential, caring environment
that promotes crisis resolution, positive self WE CURRENTLY HAVE A 68 BED FACILITY
awareness, personal growth and problem solving AND ARE ADDING 20 REHABILITATION
skills. Our vision is to “Uphold Human Dignity through BEDS AT A SEPARATE FACILITY IN
a Caring Healing Service for all”. KIMBERLEY.
Our modern mental health facility is located on
the Western side of Kimberley on the R31 road. This The child and adolescent ward is fitted with a
private psychiatry hospital offers individual and occupational therapy kitchen special designed for
group therapy rooms, lounges, recreation facility, their comfort and learning process.
TV and dining rooms, and an ample sized private Substance abuse is endemic in the Northern Cape
garden. and affects children, adolescents and adults
alike. Addiction is a pathological relationship with
THE MULTIDISCIPLINARY TEAM OF MEDICAL, a mood or mind-altering substance or behaviour
THERAPY AND NURSING PROFESSIONALS which renders one powerless and produces harmful
INVOLVED IN THE TREATMENT AND consequences. The addicted person is often the
CARE OF USERS, REFLECTS THE HOLISTIC last to accept the disease concept.
APPROACH TO MENTAL HEALTHCARE AT Yours sincerely,
CARELINE CLINIC. Yvette Lucas
Careline Clinic
The team includes psychiatrists, a general R31 Provincial Road
practitioner, psychologists, occupational therapists, Kimberley, 8301
physiotherapists, social workers and mental health Tel: (+27) 053 030 0014
nurses offering 24 hour care and support. The team Cel: (+27) 68 287 0391
members involved in treatment and care of each [email protected]
carelineclinic.co.za

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 78

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

VACA N C Y

FOR A PSYCHIATRIST POSITION
AT VALKENBERG HOSPITAL

A 5/8TH SPECIALIST POST IN PSYCHIATRY IS AVAILABLE IMMEDIATELY AT VALKENBERG
HOSPITAL.

T he post is a joint appointment of the overtime. Approval to conduct Remunerative work
Department of Psychiatry & Mental Health, outside the employee's employment (RWOEE) may
University of Cape town and the Provincial be applied for.
Government of the Western Cape (see
attached). REQUIREMENTS:
1. Specialist registration with the HPCSA to practise
DUTIES INCLUDE:
• The clinical assessment, management and as a Specialist Psychiatrist
2. FC(Psych)SA, MMed(Psych) or equivalent
supervision of adult patients referred to a
general adult psychiatry unit. recognised by HPCSA
• Provide a direct clinical service and manage a 3. Clinical, teaching, research, management and
psychiatric adult inpatient unit.
• Clinical governance and administrative communication skills
organization of a general psychiatry team. 4. Ability to serve patients in at least two of three
• Provide outreach services to District Health
services and District hospitals. official languages of the Western Cape
• Teaching of under- and postgraduate students
in relevant degrees and diplomas in psychiatry. Please submit applications including the following
• To stimulate, assist with and conduct research documents by 26 March 2021 to Amanda Stephens
relevant to the Western Cape Department of at [email protected] or
Health and University of Cape Town Department by post/courier to The Chief Executive Officer,
of Psychiatry & Mental Health. Valkenberg Hospital, Private Bag X1, Observatory
• Support to the Head of the Clinical Unit with 7935 (Attention: Ms A Stephens).
respect to clinical, management, teaching and
administrative matters. REQUIRED DOCUMENTS:
1. CV
REMUNERATION PACKAGE: 2. Certified copy of ID and driver's license
Grade 1: R 691 275 per annum, Grade 2: R 790 389 3. Z83 completed - use 'as per block advert' for
per annum, Grade 3: R 917 283 per annum (A portion
of the package can be structured according to the specific post
individual’s personal needs). 4. Certified copy of matric certificate and degrees
5. HPCSA registration
The position does not come with commuted
Enquiries:
Dr Qhama Cossie
[email protected]
021 826 5829

79 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

SASOP

SOUTH AFRICAN SOCIETY OF
PSYCHIATRISTS

INVITATION FOR SUBMISSION OF DETAILS OF PRIVATE
PSYCHIATRISTS AND PSYCHOLOGISTS WHO ARE
PREPARED TO CONDUCT FORENSIC PSYCHIATRIC
EVALUATIONS FOR THE COURTS IN TERMS OF SECTION
79(9) OF THE CRIMINAL PROCEDURE ACT AND
ASSESSMENT OF CRIMINAL CAPACITY OF CHILDREN IN
TERMS OF SECTION 11(3) OF THE CHILD JUSTICE ACT

A ccording to Section 79(9) of the Criminal Interested persons are requested to submit
Procedure Act, 197(Act No. 51 of 1977), thefollowing information: Full names, contact
as amended in respect of a panel for the details, business and residential address and your
purposes of the enquiry and report under area of interest (i.e. Enquiries in terms of the Criminal
Sections 77 and 78 of the Act, the Director- Proceduire Act or criminal capacity assessments of
General: Health will compile and keep a list of children in terms of the Child Justice Act, or both),
Psychiatrists and Clinical Psychologists who are as well as proff of your current registration with the
prepared to conduct any enquiry under this Section; relevant professional body.
and Psychiatrists who are prepared to conduct any Kindly note that the contracting and remuneration
enquiry under section 286A (3), and will provide the processes for this work will be handled by the
Registrars of the High Courts and all Clerks of the Department of Justice and Constitutional
Magistrate’s Courts with a copy thereof. Development. Enquiries in this regard should be
Section 1(a) and (b) of the Regulation of the communicated to Advocate Elizabeth Picarra,
Child Justice Act, declares the Psychiatrists Chief Director: Court Services at tel. 012 315 1658,
and Psychologists (Clinical, Counselling and [email protected].
Educational) to be competent to conduct the Please submit your details for inclusion in the
assessment of criminal capacity of a child between database to the Director-General:
the age of 10-14 years referred to in section 11(3) of Department of Health, Private Bag X828, Pretoria,
the Act. 0001, for attention: Dr NE Mulutsi, Director: Forensic
The Department hereby invites private Psychiatrists Mental Health at [email protected]; 012
and Psychologists who wish to conduct criminal 395 8044 or [email protected]; 012 395
capacity assessments of children in terms of the 9055.
Section 11 of the Child Justice Act, and forensic
psychiatric enquiries in terms of Section 79(9) as well CLOSING DATE FOR SUBMISSION: 16
as Section 286A (3) of the Criminal Procedure Act, APRIL 2021
to submit their details for inclusion in the national
2020/2021 database.

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 80

SASOP

A JOB OPPORTUNITY

WESTERN CAPE GOVERMENT

Medical Specialist Grade 1 to 3 (Psychiatry) council (this includes individuals who must apply
Employment Type: Permanent for change in registration status).’
Reference No: RHS28/2021
Location: George Regional Hospital, Rural Health REGISTRATION WITH A PROFESSIONAL
Services COUNCIL:
Registration with the HPCSA as a Medical Specialist
COMPETENCIES (KNOWLEDGE/SKILLS): in Psychiatry.
Ability to (read, write and speak) in at least two
of the three official languages of the Western DUTIES (KEY RESULT AREAS/OUTPUTS):
Cape. Knowledge of a public health approach to Specialist psychiatric care to patients (all age
delivering integrated psychiatric services. Ability to groups) at George Hospital and at selected
work in integrated multi-disciplinary teams across outreach sites in the beautiful Garden Route/
platforms. Clinical, leadership, administrative, Eden - Central Karoo districts. Participate in clinical
teaching and mentoring skills. Computer literacy governance of a growing integrated district mental
in MS Office mandatory. Creativity to develop health service. Teaching and clinical supervision
new ideas which can result in positive changes to of junior and allied mental health practitioners,
existing processes. generalists and medical students within a well-
established Rural Training Complex.
MINIMUM EDUCATIONAL QUALIFICATION:
Appropriate qualification that allows registration REMUNERATION:
with the Health Professions Council of South Africa Grade 1: R 1 1060 40 – R 1 173 900 per annum, Grade
(HPCSA) as a Medical Specialist in Psychiatry. 2: R 1 264 623 – R 1 342 230 per annum, Grade 3: R
1 467 651 – R 1 834 890 per annum (A portion of
INHERENT REQUIREMENT OF THE JOB: the package can be structured according to the
Commuted overtime contract is compulsory, as individual’s personal needs) (It will be expected of
well as ability to work after-hours. Valid (Code B/EB) the successful candidates to participate in a system
driver’s license, as well as willingness and ability to of remunerated commuted overtime). A portion of
travel. the package can be structured according to the
individual's personal needs.
ENQUIRIES:
Dr BE Boon, tel. no. (044) 802-4528 STARTING DATE:
2021/05/07
EXPERIENCE:
Grade 1: None after registration with the HPCSA NOTICE TO ALL
as Medical Specialist in Psychiatry. Grade 2: A Candidates may be subjected to a competency test.
minimum of 5 years’ appropriate experience No payment of any kind is required when applying
as Medical Specialist after registration with the for this post. As directed by the Department of Public
HPCSA (or recognised foreign Health Professional Service and Administration, applicants must note
Council in respect of foreign qualified employees) that further checks will be conducted once they are
as Medical Specialist in Psychiatry. Grade 3: A shortlisted and that their appointment is subject to
minimum of 10 years’ appropriate experience as positive outcomes on these checks, which include
Medical Specialist after registration with the HPCSA security clearance, qualification verification,
(or recognised foreign Health Professional Council criminal records and previous employment.
in respect of foreign qualified employees) as
Medical Specialist in Psychiatry. • It will be expected of candidates to be conversant in at
least two of the official languages (English/Afrikaans/
NOTE: Xhosa) of the Western Cape.
No payment of any kind is required when applying
for this post. ‘Candidates, who are not in possession • It will be expected of shortlisted candidates to be:
of the stipulated registration requirements, may also • available at the venue on the time and date as
apply. Such candidates will only be considered for
appointment on condition that proof of application determined by the Department and
for registration with the relevant council and proof • bring along recently (not older than 6 months)
of payment of the prescribed registration fees to
the relevant council are submitted with their job certified copies of your Identity Document (ID), driver’s
application / on appointment. Please note that license (if applicable for the post), qualification and/
the afore-said concession is only applicable on or proof of registration at relevant statutory body.
health professionals who apply for the first time for Failure to adhere to the aforementioned may lead to
registration in a specific category with the relevant his/her application being disqualified and not further
considered.

Closing Date: 2021/05/28

81 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

SASOP

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NEW PROCEDURAL CODING
STRUCTURE FOR PSYCHIATRY
TO BE PUBLISHED FOR 2021

I t has been brought to our attention that some THE FUNDERS IN QUESTION, I.E., BESTMED
Funders i.e., BestMed and CAMAF have already AND CAMAF HAVE BEEN REQUESTED TO
implemented the New Procedural Coding ACCEPT BOTH CODING SYSTEMS (THE
Structure without notice or transition period. OLD AND THE NEW) FOR THE REMAINDER
This sudden implementation was due to the late OF 2021 TO ALLOW A TRANSITION
finalisation of the 2021 SAMA MDCM. PERIOD.
Psychiatry as a profession, has been a leader in
the South African coding environment and has If this is not possible, the request is that they revert
always encouraged that coding is on international to the old coding system until an implementation
standards. PsychMg has requested all Medical date and process can be agreed upon.
Schemes, Funders, Administrators and Managed
Care Organisations to engage with PsychMg Please find attached a copy of the SAMA MDCM
regarding the transition and implementation of changes for 2021. A full set of Psychiatry coding
the new Procedural Coding Structure for Psychiatry and rules only, will be circulated shortly. If you
during 2021. experience similar challenges with any other
We have asked that they accept the new coding funder please inform us via the HealthMan offices
structure and only implement the new system to ensure the matter is being addressed as a matter
fully if all problems are ironed out. The objective of urgency. The HealthMan office contact details
was to engage with each funder on the process are as follows:
and timeously communicate a roll over date to • Email: [email protected] and/or peet@
Psychiatrist.
healthman.co.za
UNFORTUNATELY, THIS HAS NOT • Telephone: 011 340 9000
HAPPENED AND SOME MEDICAL Alternative you may contact the PsychMg
SCHEMES HAVE ALREADY IMPLEMENTED Chairperson (Dr Sebolelo Seape) - seboseape@
THE NEW CODING SYSTEM WITHOUT gmail.com, to discuss the matter.
ENGAGEMENT OR NOTICE.
Should PsychMg and HealthMan become aware
We are aware that practice management and of any further developments, we will inform you
administration software, switching houses, accordingly.
accounting software, third-party billing agents,
administration & billing personnel and even Yours faithfully
yourselves, may not be ready for the new coding.
DR SEBOLELO SEAPE
CHAIRPERSON: PSYCHMG

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CHANGES MADE TO THE 2020
SAMA MEDICAL DOCTORS’
CODING MANUAL FOR 2021

2021-02-01 schedules. These new and revised codes are
The Principal Officer incorporated in the eMDCM2021 (the electronic
Medical scheme version)
Dear Sir/ Madam Please note the errata to the 2020 MDCM book is
CHANGES MADE TO THE 2020 SAMA MEDICAL reflected at the end of the changes document.
DOCTORS’ CODING MANUAL FOR 2021 These changes were made on the eMDCM.
Our sincere apologies that this letter only reaches For the electronic MDCM as well as the hard copy
you at this late date. (book), can be accessed via the following link:
In line with our mandate from our members, the https://www.samedical.org/products/
South African Medical Association (SAMA), has Please note that both the MDCM and eMDCM are
been updating the procedural codes used by the Intellectual Property of SAMA and cannot be
medical doctors contained within the Medical altered, distributed or copied without the express,
Doctors’ Coding Manual (MDCM) (previously written permission of SAMA.
known as the Doctors’ Billing Manual) in order to You are welcome to request a meeting with SAMA to
keep abreast of new developments in medical discuss some or all the proposed changes. Should
practice. The MDCM is not only a procedural coding you need such a meeting, we would appreciate
manual but also represents the scope of practice an indication of what you would like to discuss to
of the medical profession. Due to the Competition enable us to prepare for the meetings and to invite
Commission ruling of 2004, we have not included representatives of the specific disciplines to join the
any tariffs but have reflected the respective relative meeting. (If required/indicated)
value units (RVUs), as these are time related units Should you have any queries, please contact the
that are scientifically calculated to ensure inter SAMA Medical Coding Division via email.
disciplinary relativity. Procedural tariffs can be Dr Vusumuzi Nhlapho
calculated by using a rand conversion factor MSc BA MBBCh ACBOM DOccMed
(RCF) and the determination thereof is left to the Acting General Manager
discretion of each individual medical doctor. HOD: Private Practice
The SAMA Medical Coding Division is sending you Landline: + 27 (0) 12 481 2122
a PDF document consisting only of the changes Mobile: + 27 (0) 79 033 8330
made to the 2020 Medical Doctors’ Coding Manual Fax: + 27 (0) 12 481 2117
for 2021 for consideration to include in your benefit Email: [email protected]
Web: www.samedical.org
83 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

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PSYCHIATRISTS

CHESTER PIERCE

HUMAN RIGHTS AWARD
(CPHRA) ENDOWMENT INITIATIVE

T his year's APA Scientific Meeting was quite a Germany in 1994 when the Nazis were firebombing
treat, albeit virtually. It got off to a memorable the homes of Turkish "guest-workers".
start with a riveting, consciousness raising
and inspiring keynote speaker, Ms. ISABEL In November 2016, Dr. David Henderson, then
WILKERSON, challenging us to consider engaging of Harvard, Prof. Bonga Chiliza of South Africa
in transformative, relevant actions and projects and I, together with other African and American
given our current predicaments and the reckoning colleagues, reinitiated the African Diaspora
now in progress. In the spirit of our APA keynote Psychiatrists meeting, this time in Cape Town,
speaker's lecture, we cordially invite you and South Africa. During that event we proposed to APA
our APA Hispanic Caucus colleagues to join the President Dr. Altha Stewart and APA CEO Dr Saul
Chester Pierce Pierce Human Rights Award Levin, - who were in Cape Town for a WPA meeting
(CPHRA) Endowment Initiative. - that the APA Human Rights Award be named
This unprecedented initiative is honoring Professor in memory of Professor Pierce and become the
Chester M. Pierce, a psychiatric physician, a Chester Pierce Human Rights Award (CPHRA). That
Professor of Psychiatry, of Education, and of Public proposal is now a reality and has been so for a few
Health, a Harvard gentleman, a scholar, the founder years.
of Black Psychiatrists of America, and above all, a
superb human being and a good friend. I also feel We cordially invite you to join in this adventure of
blessed to have had a special bond with Chet. My endowing the Chester M. Pierce Human Rights
son and I cherish the fond memories of Professor Award. Would you, please join us?
Pierce hosting both of us for an entire day in the
summer of 1999 when he invited us to visit with him We gladly accept pledges now from our colleagues
at Harvard as my son, Marc, and I were embarking towards this endowment. Hope you will join us in the
on visiting colleges for prospective college Chester Pierce Human Rights Award Endowment
applications that autumn. initiative.
Professor Chester Pierce pioneered, as you know,
the concept of microaggessions and did innovative Eliot SOREL, MD, DLFAPA
research in stressful and deprived environments Founding Editor in Chief Global Mental Health and
inclusive of Antarctica. I was also privileged and Psychiatry Review
honored to have been invited by Professor Pierce to Clinical Professor Global Health, Health Policy &
be his advisor to the 1st African Diaspora Psychiatrists Management, Psychiatry & Behavioral Sciences
meeting that took place at the Massachusetts School of Medicine & School of Public Health The
General Hospital in Boston, Massachusetts in the George Washington University
autumn of 2002. Professor Pierce, Judge Richard Founder Conflict Management Section World
Goldstone of South Africa's Supreme Court, Psychiatric Association
Attorney Mojanku Gumbi of South Africa and I, did T +1 202 293 2112
the symposium on Microaggressions in Hamburg F +1 202 293 0440

SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021 * 84

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CONSENSUS STUDY REPORT ON:

PROVIDER CORE COMPETENCIES FOR

IMPROVED MENTAL HEALTH

CARE OF THE NATION

T he Academy of Science of South Africa URI: http://hdl.handle.net/20.500.11911/179
(ASSAf) Consensus Study Report on: Provider DOI: http://dx.doi.org/10.17159/assaf.2019/0067
Core Competencies for Improved Mental Publisher: Academy of Science of South Africa
Health Care of the Nation is now available (ASSAf)
on the following link: Sponsorship: Janssen Pharmaceutica
https://research.assaf.org.za/handle/20.500.11911/179 Subject: Mental Health; Task sharing; Neurological;
PROVIDER CORE COMPETENCIES FOR Substance use; Competencies; Sustainable
IMPROVED MENTAL HEALTH CARE OF THE Development Goals (SDGs); SDG3; SDG10; SDG16
NATION Peer review status: Peer-Reviewed
Academy of Science of South Africa (ASSAf) (2021)
Cite: Academy of Science of South Africa (ASSAf), Provider core competencies for improved
(2021). Provider core competencies for improved
Mental health care of the nation. [Available online] Mental health care of the nation
DOI http://dx.doi.org/10.17159/assaf.2019/0067.
CONSENSUS STUDY REPORT ASSAf Consensus Study
This report is a comprehensive document reviewing
current training programmes for various cadres of
service providers who provide (or could provide)
care for people with mental, neurological and
substance use (MNS) disorders in South Africa. The
review used national mental health and disability
policies to develop a vision of contextually-
appropriate services using a task-shifting disability-
inclusive approach as a framework for the review.
The report consists of the following sections: •
An introductory section including the executive
summary, background to, and methodology of the
study. • The body of the report consists of separate
chapters for each category of service provider, with a
detailed examination of current curricula measured
against the core competencies identified by the
researchers. Key findings are highlighted at the start
of each chapter, as well in the concluding section
of the report. • The concluding section of the report
summarises key findings, discusses limitations of the
study and makes recommendations regarding the
use of the report as well as for further research.

85 * SOUTH AFRICAN PSYCHIATRY ISSUE 27 2021

INSTRUCTIONSTO AUTHORS

South African Psychiatry publishes original contributions that relate to South African Psychiatry.The aim of the
publication is to inform the discipline about the discipline and in so doing, connect and promote cohesion.

The following types of content are published, noting that the list is not prescriptive or limited and potential
contributors are welcome to submit content that they think might be relevant but does not broadly conform to
the categories noted:

LETTERS TO THE EDITOR
* Novel experiences
* Response to published content
* Issues

FEATURES
* Related to a specific area of interest
* Related to service development
* Related to a specific project
* A detailed opinion piece

REPORTS
* Related to events e.g. conferences, symposia, workshops

PERSPECTIVES
* Personal opinions written by non-medical contributors
NEWS
* Departments of Psychiatry e.g. graduations, promotions, appointments,
events, publications

ANNOUNCEMENTS
* Congresses, symposia, workshops
* Publications, especially books

The format of the abovementioned contributions does not need to conform to typical scientific papers.
Contributors are encouraged to write in a style that is best suited to the content. There is no required word count
and authors are not restricted, but content will be subject to editing for publication. Referencing - if included -
should conform to the Vancouver style i.e. superscript numeral in text (outside the full stop with the following
illustration for the reference section: Other AN, Person CD. Title of article. Name of Journal, Year of publication;
Volume (Issue): page number/s. doi number (if available). Where referencing is not included, it will be noted
that references will be available from the author/authors. All content should be accompanied by a relevant
photo (preferably high resolution – to ensure quality reproduction) of the author/authors as well as the event or
with the necessary graphic content.A brief biography of the author/authors should accompany content, including
discipline, current position, notable/relevant interests and an email address. Contributions are encouraged and
welcome from the broader mental health professional community i.e. all related professionals, including industry. All
submitted content will be subject to review by the editor-in-chief, and where necessary the advisory board.

REVIEW / ORIGINAL ARTICLES
Such content will specifically comprise the literature review or data of the final version of a research report
towards the MMed - or equivalent degree - as a 5000 word article

* A 300 word abstract that succinctly summarizes the content will be required.
* Referencing should preferably conform to the Vancouver style i.e. superscript numeral in text (outside the full
stop with the following illustration for the reference section: Other AN, Person CD. Title of article. Name of

Journal, Year of publication; Volume (Issue): page number/s. doi number (if available); Harvard style or

variations of either will also be acceptable

* The submission should be accompanied by the University/Faculty letter noting successful completion of the
research report.

Acceptance of submitted material will be subject to editorial discretion

All submitted content will be subject to review by the editor-in-chief, and where necessary the advisory board.
All content should be forwarded to the editor-in-chief, Christopher P. Szabo - [email protected]

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