Women’s Month: ‘Medicine chose me’

When Professor Mashiko Setshedi chose medicine over law many moons ago, she knew exactly what she was in for – or so she thought. She was prepared to serve her patients with distinction – quietly behind closed doors – making diagnoses, treating various conditions and getting them back onto their path to health and wellness. It was going to be the perfect, private doctor–patient relationship.

But fate had other plans. Serendipitously, like with a few other things in her career, which included her decision to pursue gastroenterology – the branch of medicine that studies the functionality and disease of the oesophagus, stomach, small intestine, colon and rectum – as her area of speciality, academic medicine found her instead. And since joining the University of Cape Town’s (UCT) Faculty of Health Sciences almost two decades ago, it’s been a lot more than just that doctor–patient relationship and diagnosing and treating conditions. It’s also been about teaching and learning (from her students, her peers and her patients); research; and publications in leading medical journals.

And she’s been on top of her game, while blazing a trail in the process. Deservingly, as of 1 July, Professor Setshedi stepped into the driver’s seat as the chair and head of UCT’s Department of Medicine. It’s safe to say that it’s been an accidental but worthwhile ride of a lifetime.

“I always say that if I knew that medicine, academic medicine more specifically, involved so much teaching and talking, in other words, putting yourself out there, I probably wouldn’t have done it. I always thought that it [medicine] would just be me, the patient and four walls,” she said with a chuckle.

Choosing medicine

As a successful, award-winning clinician, it’s hard to believe that at the time of her mock matric exam, Setshedi was still unsure about what she planned to study. But after a bit of deliberation, she decided that medicine seemed like a good idea. So, she made her way to the then University of Natal (currently the University of KwaZulu-Natal) in Durban, to start a bachelor’s in medicine and bachelor’s in surgery.

“Looking back, I say medicine chose me, that’s how I see it.”

“I don’t remember ever saying: I want to be a doctor. It kind of just happened, even though my mother says when my siblings and I used to play, I always assumed the role of a doctor. I don’t remember that,” she said. “But because medicine was one of those traditional professions kids went into, I chose it. Looking back, I say medicine chose me, that’s how I see it.”

Likewise, the field of gastroenterology also simply found her. Once she qualified as a specialist, Setshedi had big plans to specialise in endocrinology – the branch of medicine that treats diseases related to the endocrine system. She was so serious that she even accepted a post as a registrar at King Edward Hospital in Durban. But things changed when she agreed to cover for one of her colleagues – a fellow registrar in gastroenterology, who was about to go on maternity leave. Suddenly, Setshedi found a new love.

“I didn’t know what to expect in gastroenterology. But I fell completely in love. I kept asking: Where has gastroenterology been my whole life? It is so cool! And because I’m a frustrated surgeon, performing endoscopic procedures gave me the opportunity to work with my hands and that’s what I found cool. I absolutely loved that. I didn’t plan it, but I loved it,” she said.

A trailblazer

In 2005, Setshedi arrived in Cape Town to train as a supernumerary in gastroenterology at UCT’s teaching hospital Groote Schuur Hospital (GSH). And she has not looked back. She described her colleagues in the Division of Medical Gastroenterology as some of the best human beings on the planet – mellow, collaborative, friendly, smart, and who have each contributed to the division’s success and its ever-growing and thriving teaching and learning environment.   

“I came in as an outsider. I didn’t do my undergrad here and neither did I do my FCP [Fellowship of the College of Physicians] here. Yet, I felt immediately integrated, immediately accepted into the division. And that’s always been very special for me,” she said.

The environment also influenced and contributed to her success and it’s no secret that Setshedi has soared since joining UCT. She became South Africa’s first black woman gastroenterologist, and later, in 2018, she made history when she became the first woman to head the Division of Medical Gastroenterology at UCT and GSH.

Building stronger, improved systems  

During an interview with UCT News, in her office in the Old Main Building on the GSH precinct, Setshedi said she is thrilled to have been awarded the opportunity to lead the department and is excited to make a meaningful contribution to its growth and development. And how can she not be? With her appointment, she again becomes the first woman to lead the department since its inception more than 100 years ago.   

As she pulls up a chair at a table away from her desk, it is evident that Setshedi’s only been in the driver’s seat for two weeks. Her office walls and shelves were empty, except for just one picture, propped up on a shelf of the late Professor Bongani Mayosi – the dean of the FHS, who died in 2018. Professor Mayosi headed the Department of Medicine from 2006 until 2016, and was Setshedi’s mentor, colleague and friend.

But she has more than enough time to make the office her own. Right now, she is immersing herself in her new role and what it means and has already started an “investigative mission” to get to know all her colleagues. While things are still fuzzy (excitement does that), she is clear on one thing: she has inherited a department in good standing, with a team of highly competent clinicians who are “here not because they have to be, but because they want to be”.

“We need to train doctors who are not only clinically competent, but who are kind, more personable and more humane.”

And she plans to use that to her advantage. Setshedi will leverage colleagues’ work ethic and positive energy to build stronger and more improved systems. Her goal is to use technology to lead in key spaces, especially teaching and training. Further, challenging old teaching models and finding new, out-of-the-box ways of assessing students are high on her priority list. Cornerstone to this process, she added, is understanding how students learn, to ultimately produce teaching and training models that are relevant to the African context to “better serve our people”.

“I’m committed to finding newer ways of training our students. We should change things up and develop more than just the cookie cutter, typical doctor. Instead, we need to train doctors who are not only clinically competent, but who are kinder, more personable and more humane,” she said.  

“The medicine we practice should benefit the community we serve in a real way.”

Developing a culture of peace

What’s as important, Setshedi said, is promoting and nurturing a culture of cohesion among colleagues in the department.

“Building an environment where everyone, all constituents, feel like they belong and feel like this is home, is very important to me,” she said. “Everyone should be recognised for their contribution, in all shapes and sizes. And if there are conflicts and misunderstandings, we need to address those and work through them. I think if we get that right, everything else will fall into place.”

As a consultative, collaborative leader, she is well placed to get this right. But she’s also under no illusion that at times she will need to be courageous – to address not just the run-of the-mill challenges that crop up in most workspaces, but difficult, uncomfortable truths like identity politics, which she admitted, exists. Learning to navigate those challenges successfully will be key.  As an “eternal optimist”, she believes the department has what it takes.

“In this role I would like to say what I mean, and mean what I say, no matter how difficult.”

What’s the one thing she’d like staff to know about her? “I try to be honest, always honest, and aim to be trustworthy and transparent. In this role I would like to say what I mean, and mean what I say, no matter how difficult.”  

And the students?

“I’m accessible; my door is always open. I hope that they agree. I also hope they see me as a role model because spaces like these, in different industries, need more people who look like me,” she said.

A homebody

As with everything, Setshedi said there’s work to done, and she’s ready to jump in.

Does that mean the long days and nights are a thing of the past? Most definitely not! But little sleep and spending a few hours at home come with the territory.

So, naturally when she is home on her sofa in her pyjamas, with a steamy mug of coffee in hand, she’s happiest. There’s just something about being in her own space, without any disturbances, she said with a broad smile – there’s nothing quite like it.

“It’s my sanctuary, my peace and in this frenzied world, all of us need that,” she said.