Feature: FHS

“It landed in my heart”

Dr Craig Parker (MBBCh 2015) left a career in engineering to work in a public hospital and serves in one of the country’s poorest regions in South Africa. Named the Best Rural Doctor of the Year in 2022, he tells us why he finds his job so rewarding.

BY JACQUELINE STEENEVELDT

Much has been written about midlife and its perils – research suggests even primates undergo a phase of unhappiness in middle age. Dante said, aged 35: “Midway on our life’s journey, I found myself / In a dark wood, the right road lost.”

In 2011, at the age of 39, Dr Craig Parker walked away from two decades of a lucrative career as a mechanical mining engineer.

“I didn’t see the purpose in what I was doing. I was frustrated by the long lag between what you do and the feedback. I just felt I was helping to make rich people richer and there wasn’t much satisfaction in that. It wore me down,” he says in a Zoom interview from his study in Gonubie, a small seaside village about a 15-minute drive from East London, on the sunshine coast of the Eastern Cape.

“On the [mining] projects I always tried to build a school or a clinic or something and there was always lots of talk in the beginning, but never seemed to be enough time or money at the end,” he says. “It was a bit heartless.”

The shelves beside him are lined with lever arch files and three degrees are proudly displayed on the wall behind him. He’s wearing a grey WildSeries running shirt – from the high-octane trail running group that takes runners through some of the country’s challenging and wild places.

Craig is at pains to emphasise that the midlife career change was a “team” decision. “My family were all on board and willing to make the sacrifices. I think they could feel where I was at and knew that I needed to change.”

At the time, the team consisted of his wife Catherine, née Godwin, (BNurs 1994), son Adon (11) and daughter Stephanie (9). Catherine, who had been volunteering at the kids’ school, became the family’s breadwinner as a researcher at Chris Hani Baragwanath Hospital and Craig embarked on the Graduate Entry Medical Programme (GEMP) at Wits.

“It seemed so impossible,” he says, outlining all the initial hurdles. He had to complete biology, physiology and anatomy courses through Unisa the previous year; he was overlooked for the entrance exam and initially rejected, then subjected to an interview with the Dean to motivate his case. “I turned 40 in my first year back there. It seemed quite difficult, but it just felt right when it landed in my heart.”

At the end of Craig’s final year, the family’s finances were threadbare: “We spent everything we had.

Everything was maxed out, all the credit cards. I borrowed from everyone we could borrow from. We had sold our house and the money hadn’t come through yet…I don’t think I was ever as poor as that,” he laughs. And yet: “I don’t think I was ever as happy either.”

The Parker family next to the Gonubie River: Adon is a second-year psychology student at Stellenbosch University, Craig, Stephanie is a grade-12 pupil at Clarendon High School for Girls and Catherine is a midwife at Life Hospital.

“I NEVER WORKED SO HARD”

After a two-year internship at the tertiary government hospital in East London, Frere Hospital, Craig was placed at Victoria Hospital in Alice for community service, before moving back to Frere to work initially as a paediatric surgeon and later as an anaesthetist. Frere is not a rural hospital, but Craig has maintained contact with smaller district hospitals throughout the Eastern Cape and has been involved in the rural districts in training and outreach. Few doctors choose to serve in rural communities. A recent report by the Bhekisisa Centre for Health Journalism highlighted that less than 3% of medical graduates end up working in rural areas 10 to 20 years after graduating.

The Parker family’s sacrifices have paid off – and to the huge benefit of many others. Early in October this year Craig was awarded the 2022 Rural Doctor of the Year Award by the Rural Doctors Association of Southern Africa (RuDASA) for his work and his design of an oxygen device that saved lives during the COVID-19 pandemic. The device, known as OxERA has received recognition from the World Health Organisation and has been included in the 2022 Compendium under “innovative health technologies for low resource settings”.

It’s the kind of medicine Craig’s always dreamed about: “There was more of a tangible benefit and it’s so rewarding.” With his unique skills set of engineering and medicine, colleagues from RuDASA’s Facebook page vouch that “his Leatherman is used just as much as his stethoscope.”

The idea for OxERA came after a visit to his grandmother, who had turned 100 in March 2020 in the UK: “London was a ghost town and on the news we saw pictures of Italy and the UK’s health sector starting to implode and struggling to cope with the volume of COVID patients. I thought we would be in far bigger trouble in South Africa because we didn’t have ICU space, or enough ICU-trained nurses and equipment, and we didn’t know what effect HIV/Aids would have on the disease.”

On the plane home Craig started thinking about ideas for giving patients basic pressure support and non-invasive ventilation. He put out a call for volunteers in East London and very quickly he had corralled a team of engineers, doctors, designers and 3D printing specialists. “Everything suddenly stopped and everyone was keen to help. There was a real sense of ubuntu.”

One of the doctors was fellow Witsie Brendan Toy (MBBCh 2009), who had enjoyed travelling on a cruise ship for five years but settled at the adult ICU at Frere Hospital since 2018. “Craig contacted me from the departure lounge of Heathrow and proposed an idea of hope. I responded with belief and ventured forth to assist Craig in making this hope a reality,” writes Brendan.

Within three months, the volunteers had a working prototype. “I’ve never worked so hard in my life,” Craig says with a chuckle. “I worked about 18 hours a day, doing clinical work and then testing things.”

Through trial and error Craig and his team of volunteers realised that improving oxygen delivery was more important than pressure support for breathing. They watched in awe as patient after patient’s oxygen concentrations improved with every breath with one of their designs. They worked on refining the simple mask which eventually became the OxERA.

“WE NEED A DIFFERENT MODEL”

The device, which helped prevent lung collapse, was welcomed by doctors working in district areas at the height of the pandemic. “The ICUs were full and about 50 patients were waiting in casualty. Around 30 of those patients were not coping. As fast we could make them, people were taking them and using them,” says Craig.

The team joined forces with Gabler Medical to produce a standardised, regulated medical device and gave rise to a company called Umoya, which translates as “spirit” or breath in isiXhosa. The South African Health Products Regulatory Authority issued a licence in December 2020 and they were able to supply devices to those in need in difficult-to-reach places along the coast and as far away as Zimbabwe, Zambia, eSwatini, Peru and Bolivia.

Craig is excited about the company’s model, in which all profits are ploughed back into the project with the prospect of job creation through the local manufacture and distribution process. “If we’re ever going to narrow the gap between those who have and those who don’t, we need a different model, such as companies that are willing to forgo huge profit margins.”

Like a modern medical MacGyver, Craig seems unfazed by challenges: “There are days when you struggle – but I’ve always been a glass half full kind of guy. It requires far less energy,” he says.

“There is something about doing something new, doing something you know nothing about and feeling ‘stupid’ again. We tend to get quite puffed up about our own importance and our own knowledge. And to start again somewhere when you know nothing is good for our character. We should probably all do it.”

HOW THE OXERA WORKS

The team called their invention the Oxygen Efficient Respiratory Aid, better known as OxERA. The device works with a well-sealed mask and a valve that helps the lungs stay inflated. It is described as an “all-in-one device using an oxygen accumulator bag, an anaesthetic mask and an adjustable mechanical peep valve (a spring-loaded valve which the patient exhales against) that is cost-effective and oxygen efficient”. It is more efficient because it requires far less oxygen than non-invasive ventilation or high flow oxygen therapy. In this way, the patient’s oxygen levels are kept where they need to be without overusing resources. See more from their website: https://umoya.org.za/

“More universities should adopt it”

The Graduate Entry Medical Programme, or GEMP, allows applicants who meet certain minimum requirements to enter into the third year of the MBBCh degree. “I really, really enjoyed it. It was well-structured and integrated so well. I enjoyed the diversity. We had people who had done fine art and music, we had physiotherapists, dentists and chiropractors - with their families. It brought a richness to the class that benefited everyone. I think more universities should adopt it.”