Surgeons Scope Magazine - July 2022

A Surgeon in…Dublin

MS TAFADZWA MANDIWANZA, CONSULTANT PAEDIATRIC NEUROSURGEON, TEMPLE STREET HOSPITAL, ON LIVING AND WORKING IN THE CAPITAL

Ms Tafadzwa Mandiwanza – known to everyone as Taffy – was born and raised in Harare, the capital of Zimbabwe. The eldest of three children, she says the idea of wanting to work in healthcare came from watching her mother, Francisca, a nurse, at work.

Ms Tafadzwa Mandiwanza, MB BCH BAO, FRCSI

“My dad, Antony, is in dairy processing,” she says, “in fact he’s retiring soon. He is very businessminded but I don’t have the head for business so I wasn’t tempted to go down that track.”

As a child Taffy says she was obsessed with the books of Enid Blyton, particularly the Malory Towers series. “I really wanted to go to boarding school,” she remembers. “My two younger brothers were allowed but I wasn’t. And so I said that when it came to my time for university, I was definitely going to go away and not live at home.”

Taffy applied to universities in South Africa, but at the time places in Medicine were not open to students coming from another Southern African state that had its own medical school.

“My dad had Irish friends in UCC who used to send postgraduate students over to him in Zimbabwe and he had been back and forth a few times and he thought it was a great place,” she says. “Because he had friends there who could act in loco parentis he felt safe sending his young daughter there to study. I of course had never heard of Cork and the sum total of my knowledge about Ireland was that Mary Robinson had been President and I thought having a female president was amazing. I visited initially for a few weeks in the summer of 1997 and returned in 2000 after my A Levels at home in Zimbabwe to enrol in the School of Medicine at UCC.”

Back in 1997, Taffy says she often felt as if she was the only black person walking down the street.

“It was obviously very different from a diversity point of view to the way it was at home,” she says. “That summer I became obsessed with The Corrs – I absolutely loved their music, and someone took me to see the Michael Collins movie and I learned about some of the history and the pride in Cork as the ‘real’ capital. Everyone was lovely to me and I had a great time.”

By the time Taffy returned for college, the city was already home to more immigrants and felt more diverse. She enjoyed her studies and got along well with her classmates. She hardly left the city during that time, aside from a couple of short visits to Dublin and trips home.

“Cork was everything,” she says. After graduating, Taffy did her first six months as an intern in Limerick, before returning to Cork.

“I loved Limerick and the hospital there,” she says, “and was very inspired by the surgeons. When I applied for the BST, my first choice was the job with six months in neurosurgery in Cork and the rest in Limerick. At that point I was convinced I wanted to be a vascular surgeon.

“I remember finishing up on a Friday as a dermatology intern in Cork South Infirmary and on the Saturday at 8 o’clock in the morning I was the SHO in neurosurgery in CUH on call for the weekend! My goodness, I don’t know how I did it. I was lucky enough to have a fantastic registrar, Martin Murphy FRCSI (now working in Dublin) that weekend and I was terrified. What did I know about neurosurgery? I thought neurosurgeons were scary people who shouted all the time.

“I think that weekend Martin had me in theatre for a chronic subdural haematoma and I got to drill a hole in a skull (burr hole) for the first time and it was amazing. At CUH I worked with Charlie Marks, George Kaar FRCSI and Michael O’Sullivan FRCSI. It was an amazing job. As a SHO you don’t always get the chance to go into surgery but they had me in theatre learning how to suture, open the abdomen for shunts and so on. I thought it was brilliant. At the time, the other specialty I thought I might be interested in was cardiothoracic – I had romanticised it from a young age. There was a Sydney Sheldon novel with a female cardiothoracic surgeon as the main character and I wanted to be like that. But in Cork I was hanging out with the cardiothoracic SHO and he was overworked and exhausted and didn’t get to do much else, and I thought: No, Neurosurgery is way cooler!

“Back in Limerick for the next 18 months, I worked mainly in A&E, Urology and Colorectal, which gave me a good grounding, but I was drawn back to Neurosurgery.”

After completing the BST, Taffy had her first child, Zoe, in 2008 and, on returning from maternity leave, took standalone SHO jobs in Limerick (Colorectal) and Cork (Neurosurgery).

“That cemented what I wanted to do,” she says, “but getting on the higher training programme was slow and hard for me. I had my second daughter, Bella, in 2010, and then I interviewed for an SHO job at Beaumont. They asked me to come on as a reg, which was a huge jump for me. During 2011, I worked in Beaumont and Temple Street, and had my son Matthew in 2012. When I came back from maternity leave it was to a research job in Temple Street. I had a few publications, which helped with applying for Higher Surgical Training. I finally got on in 2014; it took a lot of patience!”

Taffy acknowledges the challenges of balancing the needs of three young children with her career goals and those of her husband, Rebabonye Pharithi, a cardiology fellow, who she met when he was attending medical school in UCG at the same time she was studying in Cork.

“For a lot of the time I was in Limerick he was in Galway and Sligo. When he came to Limerick we were together for six months before I went to Cork with the kids. Then he went to Dublin and I was in Cork. It was only around 2011 we were finally together in Dublin and lived in the same house for a sustained period of time and got to know each other properly!”

“You are there at a time when people are very vulnerable and you can be a positive interaction in their lives.”

Temple Street Children’s Hospital

Taffy trained in Beaumont, Cork and at Temple Street, and completed her training in July 2020. Later that year she went to Great Ormond Street Hospital (GOSH) for fellowship. “My husband pushed for the whole family to go to London for the year,” says Taffy, “and he got a cardiology fellowship in London too. I was worried we were disrupting the kids’ lives too much, but it was the best thing for us as a family, as travel would have been hard during COVID-19. The kids loved London and blossomed there.”

Taffy interviewed for her current position as Consultant Paediatric Neurosurgeon at Temple Street in October 2021 and took up her appointment last December. “This is a new post, in that I am employed purely by CHI,” explains Taffy. “Before this, consultant neurosurgeons looked after both adults and children. I’m managing brain tumours, spinal pathologies, trauma, hydrocephalus, and my sub-specialty interest is in closed dysraphic conditions, such as tethered cord, or closed spina bifida. These are kids with an incomplete spinal arch and fatty lumps (lipomas) in their spine holding their spinal cord down. I am also interested in complex tone which is mainly spasticity as a result of cerebral palsy. One of the things I’d like to do is to be able to offer Selected Dorsal Rhizotomy in Ireland. That’s an operation to cut some of the nerve roots in the lower spine to release some of the tension in the muscles. It’s not for every child, but at the moment the children who are eligible are having to travel to Leeds and some kids are going to the US. It’s very straightforward, and something we can do here and have the expertise to do, not just from my point of view but also from the neuro-rehabillitation and neuro-physiology perspectives. Hopefully that will happen at some point in the next year.”

For Taffy, it was the year she spent at Temple Street working with the paediatric neurosurgeons there on research projects that convinced her that she wanted to commit her career to paediatric neurosurgery.

“The paediatric subspecialty in neurosurgery is amazing in that it is the one specialty where you can apply all the skills you learn in training,” she explains. “I don’t have to focus on spine pathology or just tumours or just vascular issues, it’s the one area where you can almost be a general neurosurgeon. Another thing I love about paeds is the patients. There is nothing like a child who comes in with a brain tumour and you operate and within two days they are sitting up eating and itching to go home. They are so resilient compared to adults. Obviously it can be very traumatic and sad at times, and there are times I can’t fight the pathology, or whatever I can do is not enough to bring that child back to health or give them a normal life, but it’s still special. You are there at a time when people are very vulnerable and you can be a positive interaction in their lives.

“When I went to GOSH it was solely as a paediatric neurosurgery fellow, and to be honest I did not miss adult neurosurgery – that year confirmed for me that I would be happy with a career in paediatrics.”

Taffy’s working week starts with a neuro-oncology clinic in OLHSC on Mondays, followed by theatre on Tuesdays. “There are four consultant neurosurgeons at Temple Street,” she says, “and we tend to share the list and operate once or twice a week. On Tuesday afternoons, if I’m not operating, I usually work in the cranio-facial clinic and on Wednesdays I may operate with the cranio-facial team. Then on Thursdays I have my sub-specialty clinic for closed dysraphic with Darach Crimmins FRCSI, two regular spina bifida clinics and an outpatient clinic. I’m on call one in four weekends, and once or twice during the week, and while it’s busy it is more chilled than when I was in training. CHI Temple Street is the only neurosurgery centre for children in Ireland and we do over 580 cases a year with 50-60 new brain tumours being referred yearly. When compared to other centres on UK and Ireland, this is second only to Great Ormond Street Hospital.”

Marlay Park

Taffy lives in Rathfarnham and spends her free time with her family, getting to drop the children – now 14,12 and 10 – to school some mornings and being home in time to cook dinner a couple of times a week.

“I have a bit more time as a consultant than I did as a trainee, and I am still getting my head around that,” she says. “The kids are so independent now they don’t care if I am around! I love being at home, and I spend my free time cooking. I love experimenting and I have piles of cookbooks in the house. I take my time and find it very therapeutic, sometimes my family thinks I take too long – I could be cooking for hours while they are starving. My favourite thing to cook is seafood, and I’m very good at meat, especially pork. I love curries and make a good oxtail stew to a recipe from home. I’m rubbish at baking, you’d think as a surgeon I’d be meticulous enough to be a good baker, but nothing ever seems to turn out right!”

When she’s not cooking, Taffy enjoys the parks near her house and often heads to Marlay Park on a summer evening to play tennis with the children. On weekends, when the weather is good, the family drive down to Glendalough to walk and enjoy the scenery.

And Taffy’s still an avid reader, although these days it’s more likely to be something by Colson Whitehead – The Nickel Boys is a recent favourite – than Enid Blyton or Sydney Sheldon. ■

SURGEONS SCOPE / 21