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12 May 2020 | Story Prof Francis Petersen | Photo Sonia Small
Prof Francis Petersen.

In a rapidly changing, uncertain and complex world, the role that universities are playing as the engines of social mobility, as drivers of the economy and as generators of new ideas, is now more critical than ever.  Due to the universal nature of knowledge, universities are global in scope – a space that encourages new ideas, controversy, inquiry, and argument and challenges orthodox views, but they are also deeply entrenched in their local environment, influenced by socio-economic and political dynamics.  There is an expectation that universities should exhibit great levels of responsiveness and public accountability, with higher levels of trust in higher education, and between higher education and government, and higher education and the public.  The challenge for both higher education and government is to allow institutional autonomy without oppressive accountability.  

Over the past few years, the purpose of universities has been challenged in relation to their role in society, their advocacy for speaking truth to power, their continuous strive to be great universities without being elitist, and their ability to function in an age of populism. The Trump administration and, more recently, Brexit have demonstrated that there is a decline in the respect for evidence and advice from subject-specific experts.  It seems (as in the case of the Trump administration) as if empirical reality does not matter, nor does empirical reasoning form the basis of public policy – a political place that is becoming increasingly anti-intellectual.  Emotion and personal belief have been shown to carry more weight than objective facts and evidence in terms of influencing public opinion.  Fake news and ‘the alternative truth’ have also challenged the fundamental principles of a university – academic freedom and the generation of new knowledge in the pursuit of truth.

A digitally unequal society
The COVID-19 pandemic has shown deep fault lines in our society – stark poverty and inequality – that universities should engage with (and they do); however, they cannot eliminate it on their own, but can be part of the solution.  South Africa is the most unequal society in the world.  Before the COVID-19 pandemic, the South African economy was already in deep trouble, with sovereign downgrades by all the rating agencies and with an unemployment rate close to 30%.   The national lockdown, in an attempt to ‘flatten the infection curve’ and hence manage the response of the national health system to COVID-19 cases, has added to the pressure on the economy.  It is envisaged that a large number of people (estimated between 3 and 7 million South Africans) will lose their jobs after the national lockdown period, adding to poverty and an already high unemployment rate.  Even during the lockdown period, there are many South Africans living in crowded spaces, hence finding it difficult to practise social distancing, may not have running water and proper sanitation, and possibly do not have regular access to food.  

As schools and the post-school education and training sectors move online with their learning, it further shows how digitally unequal our society really is – access to connectivity, data, and an appropriate digital device is a challenge, and electricity is not evenly distributed or is non-existent in our society.  These institutions, within the environment of digital inequality, are ensuring that digital equity is maintained as far as possible.  Many churches, business leaders, and certain politicians have called for a different social pact between business, labour, and government to address the state of the economy – any such action, however, must be supplemented by concrete measures for social reform.

Regaining trust in universities
But perhaps this pandemic has also created an opportunity for science and evidence to regain credibility in informing government decisions and public trust, and for universities to demonstrate respect for evidence. During the initial stages (early March) of COVID-19 in South Africa, the epidemiologists and virologists have shown through confirmed data from the National Institute of Communicable Diseases (NICD) that South Africa was in the early phase of the infection curve – also interpreted to be the relatively low-risk phase of the curve; this would be the right time to apply the principle of social distancing.  It allowed certain organisations (such as universities) to pro-actively suspend part of their activities so as to minimise the number of people in their operational environment, well before the national lockdown was announced on 26 March – a decision based on science.

Through data and proper analyses, the NICD, other scientific bodies and the Ministerial Advisory Committee on COVID-19 provided evidence-based information to government and the public, from which meaningful decisions could be taken.  The South African government has made it perfectly clear that decisions around COVID-19 will be made based on the science associated with this pandemic – a stance to be applauded.  Hence, the risk-adjusted approach of ‘opening up’ the economy through easing the lockdown measures but constantly monitoring the infection curve is an excellent example of risk management while continuously assessing the risks.

Universities, science laboratories, and pharmaceutical companies around the globe are hard at work to develop an effective vaccine for COVID-19, which is another opportunity to demonstrate how science can assist in protecting people from this terrible virus. Universities are making advances in personal protective equipment (PPE), the development of new technologies for non-ICU provision of oxygen to COVID-19 patients, more advanced methods of testing (for the virus) to reduce turnaround times, and various other scientific studies.  

This platform is giving universities a renewed impetus to use science and scientific developments to advance societal agendas such as climate change, poverty and inequality, public health and social justice (ethics of care) – and more immediate – assisting in re-building a strong South African economy.  It is an opportunity for the public and politicians to regain trust in universities, but it is also an opportunity for universities to profile their public intellectuals so that the value of science and evidence-based output is part of policy debates and informed decision-making.  However, in doing so, universities must strengthen their relationship with society at large, be inquiry-driven, and at the same time be learning and co-creating.

Prof Francis Petersen is Rector and Vice-Chancellor of the University of the Free State.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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