Helen Wainwright - Transcript Summary

Halen WainwrightDepartment of Pathology, University of Cape Town, South Africa

Interview location: UCT Medical School, Cape Town
Interview date
: 15th January 2008, and 25th March 2009

Key Themes: Autopsy, Children


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Section 1

  • Wainwright’s family are British and emigrated to Durban, South Africa where she was born.  Her father was an anatomical pathologist and she and her twin sister both went into medicine.  Her first choice was paediatrics, but she picked up everything her little patients brought in, and she turned instead to pathology, which she loves.  “As a clinician sometimes you’re feeling in the dark... But with pathology you find out actually what happened – in most cases, not in all.”
  • Her father was a professor at the only exclusively non-white medical school, and continued to socialise with his non-white colleagues, despite the restrictions of apartheid.  She and her sister studied in Cape Town, and she describes how she herself remained unpoliticised – and, as she acknowledges, largely unaware of the problems her non-white fellow students faced.  For example, she says, “I didn’t realise they weren’t allowed to see a white patient.”
  • Describes how, in her first jobs at Groote Schuur and Red Cross Children’s Hospital, there were wards for different races.  But, she says, “The one thing you really couldn’t care less about is if the baby is white or black.  If it’s a sick child it needs care... [Later] the doctors would... whizz the child across to the right [ward] ... It was absolutely daft.”
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Section 2

  • Describes how Groote Schuur was the top hospital in Cape Town, but it turned nobody away.  “The paying patients subsidised care for the very poor.”
  • Describes the changes in financial policies, post apartheid, and the implications for standards of care.
  • Briefly recalls some inspiring teachers and colleagues.
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Section 3

  • Describes her daily work routine, which includes training new pathologists. “The only sad thing is that a lot of them tend to push off overseas, so we train them for other countries.”
  • She is in charge of fetal and neonatal services. “We have so many babies born dead that we try and look at the placenta of every single one in our area.”  Explains that the high number of stillbirths has multiple causes: widespread alcohol abuse, problems with antenatal care, an exceptionally high incidence of pre-eclamptic toxaemia, and HIV and other infections.
  • Goes into detail about fetal alcohol syndrome, a legacy of apartheid-era labour practices.  The impact of this was “shocking” to her:  “The percentages [of affected children] are extremely high... This is the commonest cause of mental retardation, and it’s preventable.”
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Section 4

  • Mentions that another widespread but treatable disease is syphilis, another consequence of poor antenatal attendance and care.
  • Talks at length about the impact of HIV and the extremely high incidence of co-infection with tuberculosis.  Descibes how previously rare infections are now common. “We're also seeing cardiac disease, vascular disease, in young people who are HIV-positive, and we're assuming [this unnatural pattern of disease] is to do with the HIV.”
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Section 5

  • Turns to the subject of training and the sidelining of pathology.  “It forms something like 2% of the marks in the year... All the science has gone out of [medical training].” Makes the point that clever students will go back and learn their pathology, but with the average students, “ there are just big black holes in their knowledge.”
  • Describes how the low autopsy rate presents problems for training those who do specialise in pathology.  “Our registrars have to do 50 autopsies each... Groote Schuur [should have] an autopsy rate of about 20%.  We must be about 0.05%... We make up for it by offering our services to [the police department].”  Stresses that “you've got to be quite a tough registrar to work there, as you see very unpleasant sights”.
  • Gives some examples of unnecessary deaths and medical mistakes.  “That’s the value of an autopsy, and ...if they’re stopping them then it means you’re not picking up any of the mistakes that are being made.”
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Section 6

  • Turns to the subject of organ retention and the practices in South Africa.  Describes in detail some of the abnormalities she has encountered, citing in particular maternal diabetes as a cause.  Explains that the high rate of abnormalities she sees is because “we’re seeing babies who die, we’re not seeing the babies who live and where everything’s fine.” 

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Section 7

  • Talks about her son who was born with heart and other problems.
  • Discusses the value of ultrasound in picking up problems as early as 14 weeks gestation, and her collaboration with the scanning services.
  • More discussion about cases she encounters, including the chromosomal abnormality, trisomy 13, effects of rheumatic fever and treatment with warfarin. But points out that very often this condition is missed by clinicians.  “It’s a sneaky sort of disease, so if you’re not thinking of it you can miss it.”
  • Explains why she has never been attracted by forensic pathology: “It’s violent death and I just found it incredibly distressing. [Forensic pathologists] have a really tough time seeing the worst of human nature all the time.”  The deaths she encounters “can be very sad.  But it’s very easy to accept what’s natural.”  What she does find difficult is evidence of poor medical practice.


Section 8

  • Returns to the story of her son’s condition:  talks of a recent bout of suspected rheumatic fever, and then describes the difficult years when he was small and needed surgery.  Describes her paediatrician sister’s role in his care.
  • She stopped working for six years to look after her three children, and talks briefly of the difficulty of picking up her career again.
  • Describes in detail the “traumatic” time when her son underwent corrective heart surgery at two and a half.
  • Talks with enthusiasm of her two-month sabbatical in Western Australia and of the superb conditions and organisation of pathology services.  She appreciated too the respect accorded to the babies’ remains.



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