Between two continents

Dr Sophia Kisting-Cairncross has risen to one of the top health posts at the UN.

In her new office at the United Nations in Geneva, Dr Sophia Kisting-Cairncross has come a long way from her rural childhood in southern Namibia.

As UN director of HIV/AIDS in the workplace, the UCT-trained physician and researcher's roots played a significant part in her appointment, a four-year posting in the International Labour Organisation, which she describes as the organisation for occupational health.

As global coordinator for HIV/AIDS in the workplace, Kisting-Cairncross says her greatest challenge will be to find ways to ensure people living with or at risk of HIV have a "real say" in funding programmes and grassroots-level programmes for government, trade unions and workers.

Kisting-Cairncross is the second person to have been appointed to this senior position and the first South African, quite an accolade for the doctor. The Department of Labour put her name forward some months ago, a result of the high regards they have for her. Kisting-Cairncross has worked very closely with government, trade unions, particularly the National Union of Mineworkers, and industry over the past years.

The knowledge has lessened the burden of leaving her family in South Africa, but only barely. All three children have UCT ties: Lenore is a chemical engineer, Lydia a surgical registrar and Emile is studying computer science. In the end, her decision was taken against the background of the South African burden of HIV/AIDS. The country has experiences and experience to share.

"It's important for us to take on senior positions in the global context."

Kisting-Cairncross's beginnings were humble. She describes her heritage as a mixture of the indigenous Nama and colonial influence, through her paternal German and maternal Scots forbearers.

Her heritage is significant. "I am both from Europe and from Africa. This realisation is very important in my life."

The daughter of a stonemason and seamstress, Kisting-Cairncross remembers how her father was affected by his occupation, constantly exposed to fine dust, risking his lungs.

"This influenced me greatly," she said, "and I later developed an interest in the link between health and work."

Her mother, a seamstress, worked from home and was a dominant influence in the lives of the eight Kisting children.

"She taught us to read from the Bible, inspiring us to learn more."

On the surface, medicine may have seemed an ambitious career choice. In those years, South West Africa was seen as a fifth province of the Republic. Kisting-Cairncross was classified as coloured. She could choose maths or physical science at school. But not both. The options were needlework or agriculture. (Later, this meant extra classes at university to catch up). But it showed how the apartheid government tried to steer young people: farm worker or seamstress. Kisting-Cairncross knew she had more to give.

"I come from a working family rooted in care giving. My grandmother was a traditional midwife and she had a marked influence on me. Medicine was seen as a way to provide care," she reflected. "The most abiding influence of my life came from people who work with their hands."

Cape Town was a long way from home for the 18-year old. Coming to UCT as a medical student in 1969 was an education in itself, an experience that could have sent the young woman back across the Orange River. She was directed to Stellenbosch because she spoke Afrikaans. But she couldn't find accommodation. Coming to UCT was no easier. She found accommodation in Elsies River, necessitating long journeys between class and home. Nights were spent working in restaurants to supplement her fees. But she was in class early the following morning.

Like many other medical students of those years, Kisting-Cairncross remembers the indignity suffered by black students and patients alike.

She couldn't examine patients from the white side of the hospitals. "The white students had access to everyone. There was an unfair load of examinations on black patients."

Deeply influenced by the black consciousness movement at UCT, she graduated in 1975. It was a turbulent time and young interns were challenged to make very stark decisions, consciously resisting the authorities and supporting those who were disenfranchised.

When she met her husband, Eugene Cairncross, a UCT-trained chemical engineer, he prompted her to use her skills to uplift people. She chose to work in rural communities in need, influenced by her own heritage.

Kisting-Cairncross has never been interested in self advancement, somewhat ironic now that she holds one of the more influential positions in health at the UN.

Working in a "very patriarchal society", she's always had a special interest in occupational health for women, who often work in the shadows, overlooked.

"Women are the ones who wash the farm overalls by hand after the men have sprayed toxic pesticides. They are the ones who sweep the dusty workshops, inhaling asbestos and other hazardous substances. Yet they are not issued with protective gear.

"We need to look at risk assessment from a fresh perspective. We can't adopt a linear approach in dealing with men's and women's health risks."