Prof Hennie Botha, Leading with Humility

Professor Hennie Botha is a renowned gynaecological oncologist and the Executive Head of Obstetrics and Gynaecology at Stellenbosch University. A leading clinician, teacher, mentor and researcher, with a particular interest in cervical cancer treatment and prevention. 

In this episode of Awakening Doctor, Prof Botha joins Dr Maria Christodoulou to reflect on his leadership journey and medical career. From his early clinical years at a small rural hospital in Malawi to leading an academic department through a time of socio-political transformation, he shares thoughtful insights into the challenges and rewards of academic leadership, and the cultural shifts he has witnessed in medicine over time.

Together, we explore the non-linear path of a medical career, the emotional complexity of working with cancer patients, and the importance of healthy boundaries for navigating grief as a clinician. We also reflect on the restorative power of music and mountains, and the role of humility, openness, and curiosity in facilitating meaningful change.

From quiet introspection to systemic transformation, this episode offers a measured yet powerful perspective on what it means to lead, to serve, and to grow - both as a clinician and as a human being. Join us for a thoughtful reminder that medicine is never just medical; it’s also personal, relational, and political.

Chapters

• 0:00 Cancer is not your fault
• 2:53 Introduction
• 4:02 Journey from medical school to Malawi
• 12:21 Finding purpose in gynaecological oncology
• 21:20 Leadership challenges and transformation
• 35:32 The love of surgery and mountains
• 48:45 Navigating grief and medical complications
• 1:07:29 Career advice for young doctors
• 1:18:27 Reflections on cancer and emotional boundaries

Transcript

Prof Hennie Botha: 0:00

One of the problems often for individuals when they are diagnosed or confronted with a diagnosis of cancer is, what did I do to bring this on to myself? What is the reason for this cancer? Is it my diet? Is it the way I live my life? Is it because of my bad habits? Is it because of my genetics? So people often look for reasons for getting a specific diagnosis of cancer and in the majority of cases, there is not a clear-cut reason why somebody ends up with a diagnosis of cancer. It's mostly not your fault, and I wish we could take away the stigma that's associated often with a diagnosis of cancer. It is not a single disease. There are many different forms of disease that's called cancer. Some of these are more easily managed than others, so cancer is not necessarily a death sentence, but it is often a formidable enemy that needs to be managed within a medical team and by the individual patient and their family members and the people around them. It's not your fault.

Dr Maria Christodoulou: 1:14

One of the things that always stays with me about cancer is philosopher Ken Wilber, who wrote about his wife's journey with breast cancer. He spoke about cancer as a medical phenomenon, which is the medical diagnosis and the treatments and all the different things that have to happen from a biomedical perspective, and then cancer as a social phenomenon or as a sociological phenomenon, and that they spent about 20% of their time dealing with the medical phenomenon and 80% dealing with all the, why you got cancer and what it means to have cancer, and all the images it evokes for people of chemotherapy - emaciated people, vomiting, nausea, death and that actually, fighting that was much, much harder than dealing with the medical treatments and the medical phenomenon that is cancer.

Prof Hennie Botha: 2:17

Ja, I think, unfortunately, that's what we often see is that managing the disease is a small part of managing the entire entity that is cancer, and it's very difficult.

Dr Maria Christodoulou: 2:29

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. Joining me today is Professor Hennie Botha, a distinguished gyneacological oncologist and the Executive Head of Obstetrics and Gynaecology at Stellenbosch University and Tygerberg Hospital. Hennie is a leading academic, clinician, teacher, mentor and researcher, and the co-editor of a seminal textbook on clinical gynaecology. His research focus is on cervical cancer prevention and treatment. He has served on the Council of the International Gynecological Cancer Society and is currently the International Vice- Chair of the HPV Working Group for the AIDS Malignancy Consortium, a group that has done several important studies that are changing the way in which patients with HPV and HIV are treated. Welcome, Hennie, it's a privilege to have you with us today and I'm looking forward to our conversation.

Prof Hennie Botha: 3:45

Thanks, Maria.

Dr Maria Christodoulou: 3:46

Also with us is Amy Kaye, the producer and editor of Awakening Doctor. Hi Amy.

Amy Kaye: 3:51

Hi Maria, Hi Hennie. Nice to be here.

Dr Maria Christodoulou: 3:54

Hi, Amy, Nice to see you. So, Hennie, you tell me, where do we start to tell the story of Professor Hennie Botha?

Prof Hennie Botha: 4:02

My story starts at school. I grew up in a household where academic performance was important. Both my parents were teachers. My mum went back to university when my youngest brother went to secondary school. She finished her PhD a few years later and both my parents ended up in academia. So I grew up with this idea that I may also want to do academic medicine. So medicine was not an obvious choice. At school I enjoyed music very much. I was always thinking that that's one option is to do music for a career. And then, when I got to matric, my parents sent me for some tests to see which direction I would go at university, and medicine came out as one of the options and, without too much thinking about it, I ended up in medical school. I cannot remember that my first year was particularly exciting or interesting, but after that I got into this medical way of doing things and thinking, and I'm still here.

Dr Maria Christodoulou: 5:10

How many years later is this now?

Prof Hennie Botha: 5:12

Many years later. I think that's enough. I don't think we need to count.

Dr Maria Christodoulou: 5:16

Where did you go to medical school?

Prof Hennie Botha: 5:19

At Stellenbosch University.

Dr Maria Christodoulou: 5:20

At Stellenbosch, gosh, and you're still at Stellenbosch all these many years later.

Prof Hennie Botha: 5:24

I grew up in Port Elizabeth and coming to Stellenbosch was not the obvious choice.

Prof Hennie Botha: 5:35

I applied in a few places, but I had family nearby so ended up in Stellenbosch. After many years I'm still here.

Dr Maria Christodoulou: 5:38

And when you decided to enter medical school, I mean, it's so interesting for me that music was the other possibility, what made you lean towards medical school?

Dr Maria Christodoulou: 5:47

Why medicine?

Prof Hennie Botha: 5:47

Thinking back, it's not clear to me exactly how I made the final decision. Perhaps I was guided by my parents. I think also that it's a job-orientated career choice rather than music. I still enjoy music a lot. Unlike many young people now that know exactly that they want to do medicine from the first day that they go to school. I didn't have that strong feeling in my final year of school.

Dr Maria Christodoulou: 6:13

Right. And when you think back on your time in medical school, what are some of the things that stand out for you? What do you remember about that time?

Prof Hennie Botha: 6:22

I think a lot of the social interaction with other students from around South Africa was very enjoyable. I'm, generally speaking, a fairly social person. I enjoyed meeting people from many different places in South Africa. Perhaps a little bit too much, because I can remember in my fourth year the then Vice Dean, Prof "Vaatjie du Toit”, asked me one day so what do you want to do? Do you want to be on the Student Representative Council or do you want to study medicine? I really enjoyed my time at medical school, particularly sort of the last few years, the clinical years, I enjoyed very much.

Dr Maria Christodoulou: 7:00

I think we would have been at medical school at around the same time. Were you in res on campus or did you stay off-site?

Prof Hennie Botha: 7:07

I was in res until, I think, my fourth year and then moved into a house in Boston, which is also nearby.

Dr Maria Christodoulou: 7:15

Right, and then you started your career in a rural hospital in Malawi, is what I understand. So how did that happen?

Prof Hennie Botha: 7:24

Ja, so I got married at the end of my student years and then did my internship here at Tygerberg, because my wife was then working at the head office in Belville at Sanlam. And then, towards the end of my internship year, I was looking for some international exposure. I wanted to travel. Many people worked in the UK and England at that point in time.

Prof Hennie Botha: 7:45

Some people went to Canada, but then I heard about an option to go and work in a rural hospital in Malawi and that immediately caught my attention. I thought that sounded exciting and something different. The other good thing about that option is that my wife would also be able to work as a teacher. So it is a mission hospital in a small rural town in Malawi and she had the option to teach at a mission school, which was, I think, a big plus and a big advantage for us. I think that really changed the way I look at medicine. It was a particular starting point to a medical career. It changed my outlook on medicine, I think, forever.

Dr Maria Christodoulou: 8:26

In what ways?

Prof Hennie Botha: 8:27

We had limited resources. I'm not talking about public hospital in South Africa limited resources. I talk about very limited resources. We reused gloves. We had a very basic operating theater. We were four doctors working in the hospital, providing surgical and obstetrics and gynaecology services, right through paediatrics, adult care. Realizing that you can actually do a lot to relieve suffering with little resources was quite eye-opening, and I think that's also where I first started enjoying doing obstetrics, because with very little physical resources, you can actually make a huge difference in terms of outcomes for mothers and for their babies.

Dr Maria Christodoulou: 9:12

Sjoe, and so that's kind of where the interest in oncology began, or was that later?

Prof Hennie Botha: 9:19

I enjoyed obstetrics very much. It's mostly a good news specialty. Usually obstetrics ends with a healthy mother and a healthy baby, and it's good news m edicine, and again, you can do quite a bit in terms of improving outcomes with very little resources. Just by doing proper care during pregnancy and childbirth. So I think obstetrics was definitely my first love. I spent two years in Malawi and probably would have stayed a little bit longer, but malaria was a problem, particularly for my wife at some point. So we decided we wanted to come back or move away from Malawi at that point in time and I made contact with the Department of Obs and Gynae here at Tygerberg, but I also wanted to see first-world hospital in the UK, so I had a provisional place to come back to do obstetrics and gynae at Tygerberg but was given a year to go and do medical officer work in the UK.

Prof Hennie Botha: 10:14

That was also a very good experience to see the world a little bit. I think many of us in South Africa felt the need to see the world outside of South Africa, so I spent a year in the UK and then came back and specialized in obstetrics and gynaecology.

Dr Maria Christodoulou: 10:29

Right and today, looking back, when you contrast that environment of medical school and Stellenbosch University, Tygerberg Hospital, first-world hospital in South Africa at the time, and then you go to Malawi and then you suddenly find yourself in the UK. What stands out for you about those different experiences?

Prof Hennie Botha: 10:52

I think it was important for me to move out of South Africa for various reasons. I mean, firstly, in a political sense, it was an education to live in Malawi. And, looking back to South Africa with an external view, I was suddenly now in a different cultural environment where I was the minority and I had to sort of look back on almost the abnormality of South Africa of that time and for the first time see it with slightly clearer vision.

Prof Hennie Botha: 11:20

It was very difficult to see the abnormality of South Africa at that point in time. T his was pre-1994, even though we thought... well, I thought I was well aware of what's happening in South Africa and had a political awareness. But it's very different when you look from outside back into South Africa to actually see how abnormal we lived at that point in time and how normalized many of the apartheid era separation between people, how normalized it became. That was very important to me. And then traveling in Europe a year later again showed me that even if you have a lot of resources, my need was to make a difference where it's a little bit more important, if you like, because in the NHS at that point in time, I felt like a very, very small cog in a very big machine. It was important for me to come back to South Africa.

Dr Maria Christodoulou: 12:14

So, Hennie, we've talked a little bit about how your career started and, in response to my question about where we begin to tell your story, if I say to you who is Professor Hennie Botha, what would you say?

Prof Hennie Botha: 12:27

I still think of myself as perhaps this small little boy, coming from a relatively small school in a rural part of South Africa and I haven't changed much, I think, in the way I see the world now. I think I do enjoy the fact that over a long career I was able to experience a lot. A s a very privileged academic in a well-functioning university environment, I'm thankful for all the opportunities that I had over the years, but I still somehow feel that same feeling of sometimes being inadequate and not being good enough and expected to be something and play a role that I can't really achieve. So that component is still there.

Prof Hennie Botha: 13:13

But it is a privilege to also work with very talented people. I'm thinking of the undergraduate and the postgraduate students that we work with every day. I'm very thankful that I'm in an environment where there's a lot more good news, because I think the energy that you get from students are mostly positive and future focused. If you ask me who am I? I'm moulded in a way by where I am and the work that I do and the people that I work with, but I'm still that same person that I was many years ago before I started medicine.

Dr Maria Christodoulou: 13:47

Right. And the interest in gynae oncology or finding yourself as a gynae oncologist, how did that happen?

Prof Hennie Botha: 13:56

I think again, it was not a planned process, it was not something that I knew all along this is the way I wanted to spend my career almost. But when I was doing my registrar training there was a potential gap in gynae oncology because the consultant was leaving and I also realized that I actually enjoy doing surgery quite a lot. So the first love was obstetrics and eventually, when I did start doing more gynaecological surgery, I realized that this is really what I want to do. This is something that I enjoy.

Prof Hennie Botha: 14:28

And then there was an opportunity towards the end of my registrar time to go back to the UK to go and work in an oncology unit, because I already knew then that probably that's where I would like to go. So I spent another 18 months in the UK in a cancer centre where I learned a lot about multidisciplinary management of patients, about surgical techniques, about how to communicate with patients, about oncology, and that really cemented my future career. It was not a formal fellowship, but at that point in time formal subspecialty fellowships have not been established, but that was my fellowship time.

Dr Maria Christodoulou: 15:09

Right.

Prof Hennie Botha: 15:16

I still enjoy what I do every day immensely. It's a huge privilege to work with gynae oncology because there's a lot of things that happened over the last two decades that is very positive.

Prof Hennie Botha: 15:27

When I started out as a gynaecologist, I was overwhelmed by this almost impossible problem of cervical cancer in South Africa, both in terms of the suffering that it caused. But also, at that point, we didn't understand the disease very well. But in the last 20 years there's been huge developments in terms of understanding the aetiology of the disease, how it can be prevented effectively, and being involved in that process on a meaningful level was extremely rewarding. I've done some work recently with the World Health Organization on guideline groups and we've worked with the Provincial Department of Health and with the National Department of Health to introduce HPV vaccines and effective screening methods, and all of that is really positive and exciting. And working on an individual patient level, I do like sometimes the continuity of oncology as compared now to obstetrics, which is often a fairly short-term relationship. T he longer-term relationship with somebody, sometimes over years is very rewarding, but it's not all easy.

Prof Hennie Botha: 16:34

Maria, you know this. And oncology is sometimes difficult and specifically when you're up against an enemy, cancer is the enemy here, he's not always playing fair. Then it has its difficult moments.

Dr Maria Christodoulou: 16:48

Are there any particularly difficult ones that stand out for you?

Prof Hennie Botha: 16:52

I think many clinicians will say that sometimes individual patients get close to you for whatever reason. There's something in that interaction with that particular individual that makes it a little bit more difficult when there's a complication during surgery or it makes it a little bit more difficult when that person has a recurrence or has a long, protracted suffering. So I think those individual patients sometimes is hard.

Dr Maria Christodoulou: 17:18

So how do you manage it?

Prof Hennie Botha: 17:20

I think it's important to have a cognitive approach sometimes to these interactions, to sort of say that this is something that needs to be put in a box in my brain.

Prof Hennie Botha: 17:34

I must identify where that belongs, because it can be completely disabling if you take that suffering on board, because then you cannot help, and if you are disabled by somebody else's suffering, then that is not helping anybody really. It is something that needs a bit of exercise over time. I think one needs to work on it constantly. There is a balance between being empathetic and on the other side perhaps a little bit cold sometimes, but I do think it's a balance between humanity and showing empathy, but also to keep your distance and realize what is your role in supporting a patient. And often my role is to do a good diagnosis, to make a suitable plan, and to do the best that I can in the operating theatre and to provide the best post-operative care and that is perhaps all I can offer and then rely on people around that patient. Other professionals, but also sometimes family members and other support networks to do the rest and to know where your responsibility ends and where somebody else's responsibility starts.

Dr Maria Christodoulou: 18:46

Ja, absolutely. I shared a newsletter today and one of the things I wrote about was grief, and I referenced the work of Francis Weller, who talks about the five gates of grief and how personal losses of people that we love or things that we love is just one gateway into grieving and that another is the grief that we feel for the collective suffering and the suffering that we witness on a daily basis and I think in your profession there's probably an overload of that and he talks about how even that grief needs to be felt, we need to mourn, we need to allow ourselves to experience those losses, and that actually we're not designed to do that alone. And I wonder sometimes about what it means in our profession that we witness so much suffering and that we often don't talk about it other than to analyse how it happened, why it happened and what we can do better.

Prof Hennie Botha: 19:42

But I also think it helps a little bit sometimes, and I think the palliative care people do this fairly well.

Prof Hennie Botha: 19:49

It's to acknowledge the normality of change and the grief that is built into change and when I'm saying change I mean from a healthy state to somebody with a new diagnosis of cancer.

Prof Hennie Botha: 20:01

There's a grieving process for the previous you that had a different life and a different prospect of life, almost into a new normal and actually see that as a normal process. And it helps a little bit to say that it happens to all of us. I know it's still necessary to engage with that and to work with it while it's there, and often as doctors we're not very good at that because we are expected to cope and to continue. I mean, if you have a room full of people waiting for their consultations and they're all anxious about whether cancer has come back or maybe a new diagnosis, you expect your doctor to immediately to be on your page when you enter the room. While I'm still perhaps busy dealing with what I've just with a previous patient experienced and my own collective grief. As a care provider, you're sometimes not finished with that process while you have to engage with somebody new. I think we know that, but we need to acknowledge that as part of almost our normal daily life, but I think, Maria, in that sense, when you invited me to do this podcast, you asked a little bit about who am I and so on, and I thought I've already mentioned music and I've already mentioned medicine.

But the other thing that is important to me is mountains, and that's maybe a little bit more of a philosophical mountain than just a physical mountain. It's that thing we need in our profession, where you can get away from your work for a little bit. So I enjoy hiking in the mountains or, over weekends, just going for a run or a hike in the mountains, and to me that is equally important. Plan for those times that you will not be engaging with all of these other thoughts.

Dr Maria Christodoulou: 21:46

Right. When last were you on a mountain?

Prof Hennie Botha: 21:50

Last weekend. Any hill to me can be a mountain, so it doesn't need to be a high mountain. You don't need to have a tent and a backpack.

Dr Maria Christodoulou: 21:58

Have you done any interesting hikes or climbed any interesting mountains?

Prof Hennie Botha: 22:02

My last exciting mountain trip was… I don't know if you're familiar with the Rim of Africa. It's a multi-week hike that starts in the northern Cederburg and then goes all the way to Mossel Bay. So you can hike for nine weeks if you want, but you can also do week sections completely off-grid. You carry everything with you, typically fairly small groups, maximum about 12 people once a year, and over the last four years I've completed all nine sections of that hike. A lovely way of just getting away from everything.

Dr Maria Christodoulou: 22:34

So what have mountains taught you about how to navigate life?

Prof Hennie Botha: 22:38

I think one is often stronger than you think, because if you have to go up a hill you sometimes think I cannot do this. But then you rest a little bit and take a break and maybe rest for five minutes and then you hike a little bit more and then you sit down again and then you hike a bit more and eventually you get to the top of the mountain and then you get a beautiful view. So I think mountains teaches us that the weather can change quickly, sometimes get unexpected things happening. Mountains is just a fantastic place to be without having to think too much.

Dr Maria Christodoulou: 23:15

And since we're talking about your interests outside of medicine, I know you've mentioned music, but if I remember correctly, you were also in a choir.

Prof Hennie Botha: 23:22

Yes, I sing in the cape town chamber choir. It's my bit of therapy every week to just engage a bit with classical music. It's absolutely wonderful to be also with people that are from all walks of life and that have a completely different interest, which is, at that point in time, just music.

Dr Maria Christodoulou: 23:44

I was listening to a talk on grief the other day, coming back to that. Clearly it's on my mind a lot, but where this teacher, Martin Prechtel, who is a Mayan shaman, spoke about the fact that the word for shaman in the Mayan tradition means the weeper or the singer, and that it's through the grieving and the singing that the souls of the dead are able to cross over to the other side. And so I'm finding it interesting that we talked about grief and we're talking about you as a singer and your love for music. There may be something of the shaman in you.

Prof Hennie Botha: 24:24

At the moment we are practicing Brahms Requiem for a performance next weekend, and I mean that is deep grief there, but that is also a legitimate way of engaging with grief and with suffering, and I think many people find music to be one of those things that is beneficial or can help at least with some of the suffering that's associated with grief.

Dr Maria Christodoulou: 24:46

Yeah, do you play a musical instrument?

Prof Hennie Botha: 24:48

I have to say not anymore. I used to play the trombone. I did music as a subject at school until matric and then played for a while in a symphony orchestra and then a short while when I lived in Malawi, in a jazz band. Many of the expats living around us played in this band. I couldn't keep it up.

Dr Maria Christodoulou: 25:06

Right. So, coming back to this medical career, you and I met in the middle of 2016. I actually went back and found the notes. It was July 2016. And at the time, you had been in your position as the head of department of obstetrics and gynaecology for about six months, and one of the things you said to me that day was that you didn't see yourself staying in the position longer than five or six years. And here we are, nine years down the line. I'm wondering what's changed for you in the time since we met and spoke about leadership.

Prof Hennie Botha: 25:43

Taking on a new role, for many people... Perhaps not for everybody, but it's quite daunting. You need to see yourself in a new light. You need to almost grieve for the previous comfortable position that you're leaving behind, moving into a new role and seeing yourself in a different light. So I found that first few months as head of department quite challenging and thank you for supporting me during that time.

Prof Hennie Botha: 26:08

I think that entire coaching process was extremely important to show me also that taking time to reflect and to be structured in how you sometimes think about not only problems but in almost those vague emotions that you can't necessarily put into words. Spending a bit of time around the difficulties is important. Otherwise it will not go away. It will not get any better. So I think your question is what has changed? I still find it challenging to be head of a fairly large team and there are difficult things to navigate from time to time. But I think one becomes a little bit more comfortable to make mistakes and to move on, and it is not the end of the world if a particular meeting doesn't go 100%. It is okay to not necessarily have the strategic vision for the next year e very year on the 1st of January. I've learned to live with that a little bit, that sometimes I don't have a vision for the next few months. What are we going to do differently? Because it is a dynamic process with bursts of energy and creative new things that you do. But there's also times where it is just important to keep the boat afloat. Because I think change management is very time-consuming, sometimes for yourself, but also with a team.

Prof Hennie Botha: 27:30

I don't want to belabour the point of grieving, but change management, there's always that phase where people don't want to go off how we do things and that needs to be managed. It's only then where you can see the new normal almost. I'm talking a lot now, but it has become a little bit less scary over the years and it is a huge privilege to be in this position for a longer period of time, because you can actually see what is happening to an environment because of a change of culture, and you'll remember that when we worked... it's almost 10 years ago now it was a lot around culture and about how we engage with culture in a group, and I think that is not something that you can see changes overnight. It needs a bit of time.

Dr Maria Christodoulou: 28:15

Right.

Dr Maria Christodoulou: 28:16

That was the time of #Fees Must Fall and the #Me Too movement, and you were fairly new in your leadership role at that time, so very much culture change was the topic of the day, as was diversity and the management of diversity.

Dr Maria Christodoulou: 28:31

You thanked me for supporting you in that time and I actually have a note in the summary I made of that first conversation.

Dr Maria Christodoulou: 28:38

You were the first executive head of department that I got to meet with. The Dean had asked me to meet with each of you and have a conversation about challenges and opportunities and explore what the commitment was to the transformation agenda. And I came out of our meeting so inspired and so energized and so excited because not only were you quite human and vulnerable in your conversation about leadership challenges, but you were also open to the idea of change and beginning to engage already at a very early stage in your role as head of department, with the questions of what this would mean for the department going forward and what a different kind of leadership would look like. And later I made a note, after the #Fees Must Fall thing happened, there was that one engagement with the students on the campus and I remember you came back from that meeting and you said that was the most profound meeting on this campus and that it was the birthplace of something new. Do you remember that meeting?

Prof Hennie Botha: 29:41

Yeah, I remember it very well and I can remember the faculty leaders that were involved in that particular meeting and they handled it, I think, in a very sympathetic, professional and forward-looking way. How difficult it was for the students to actually to protest in that way, because I think they could see the anxiety and almost the fear of the students in what was happening and I think it could have easily gone the other way, where the faculty leadership decided that these students are a nuisance, they are putting our business at risk, almost. But I think in engaging almost with the emotions of the students, we managed to get to a much, much better place. But it took a lot of hard work and it took a lot of time to listen and to be open for change. I thought that time was a very difficult time, I think in many places in South Africa, but specifically on Stellenbosch campus, because we had to get serious about changing our physical environment and our cultural environment to be just a little bit more accommodating for people from all walks of life, all backgrounds.

Dr Maria Christodoulou: 30:54

And for you, as a white, Afrikaans man, what did that mean?

Prof Hennie Botha: 31:02

We all have to deal with our perceived identity, of how you see yourself within a political environment, and I find it sometimes very problematic that I speak with an Afrikaans accent and that I'm white and I'm male and I studied at Stellenbosch University. So I think we all have that very racialised identity almost in South Africa, and I think that's part of where we come from in South Africa, and I suppose many other places in the world have similar issues.

Prof Hennie Botha: 31:29

But I wish that we can move forward, acknowledging those differences for what it means to allow people to develop their full potential. We cannot just say we are all equal, I don't see race, I don't see gender, because it's just not the way to get to a point of inclusion and diversity and equity. I know these are loaded words. We cannot just sort of say I don't see who you are, because that will not tell us about your struggles to get here, about the expectations of the people around you, about how you will engage with this particular environment, what messages you'll see in pictures on the wall.

Prof Hennie Botha: 32:14

In talking about transformation, I always find it very difficult because we often see it as a target. So we need to achieve something and one day we'll get there, but I don't think that is ever going to happen. It will always be a journey towards allowing people a space to be who they want to be. But in a way, I think a university must be a transformative space where students come in from one worldview and potentially go out with a very different worldview, whether that's a professional identity that they get, but also, I think, a political identity. Part of our job, I think, at a university is to develop that change and to facilitate that change, but also not to be prescriptive and say this is the answer that everybody must aspire to. We don't have a single mould that everybody should follow. I know I'm not making it easy to understand, but I think transformation is a journey. It's not a destination.

Dr Maria Christodoulou: 33:11

Right, I was speaking with one of our former guests about how he'd entered medical school thinking that medicine was apolitical and the journey of waking up to just how political it is and how all the things that are happening all over the world globally, have an impact on what's going to walk through your door as a clinician, and that there's this paradox of how medical school keeps you so busy that you often don't have time to be politically engaged or to be aware of some of the stuff that's going on and yet it's so critical to the work that we do.

Prof Hennie Botha: 33:46

Exactly, and I think we're trying to get a little of that into the curriculum specifically for the medical students, to say that we cannot only think about disease and about therapy. We need to think about health systems, about your engagement of self within a system and see the bigger political playing field, almost of where we function as professionals. I think you're not doing a proper job as a medical professional if you don't allow yourself to see the politics around your individual patient.

Dr Maria Christodoulou: 34:22

Ja. You said earlier that it was sometimes problematic for you to be a white Afrikaans male and speak with an Afrikaans accent and be a Stellenbosch University graduate. What is it that you think people don't see about you when they focus on those things?

Prof Hennie Botha: 34:43

I think I would hope that people see that there's a potential for me and for many other people that maybe look the same as me, that we can change, that I can change and that I might not be what they expect or what they might presume almost. And hopefully, if we can do that a little bit more, we can look at somebody, and I think automatically in South Africa we get a picture of somebody, but allow yourself to be surprised. Allow yourself to also not be necessarily surprised on the first meeting, but over a period of time to engage with that person and also sometimes make a bit of an effort to engage with that person and also sometimes make a bit of an effort to engage with that person to make the change that you also want to see in them.

Dr Maria Christodoulou: 35:25

Ja. What are some of the things you consider to be highlights in your career?

Prof Hennie Botha: 35:32

Ja, that's very difficult. I have to go back and perhaps make an effort to go and think about specific highlights, but I can remember a few things that was very meaningful to me. I remember I was invited to speak at a scientific conference on HIV-related malignancies in Washington DC, in Bethesda, at the NIH campus, and it was in the Library of Congress in one of their rooms there, and at that point PubMed when we grew up as medical students and as registrars, PubMed was the thing that you looked at and that was also always the Library of Congress and Health, and being there was just magnificent. To sort of think that I'm in this place, I'm giving a lecture here, but I remember other things also, very particularly.

Prof Hennie Botha: 36:23

I've been involved with the International Gynaecological Cancer Society and acted as an examiner in places in Africa in Kenya, specifically at Moi University, in Eldoret, and in Uganda and Kampala. We did some work in Rwanda, I operated in Kigali, and so many of those engagements in Africa was extremely meaningful. I'm reminded now also of once at one of these international meetings we did surgery in Santiago, in Chile, and around the table we had people speaking Spanish and English and that interaction to translate around the table. We do that in South Africa all the time, but those are exciting moments that I'll always remember.

Dr Maria Christodoulou: 37:05

Right and turning points, maybe not only in your career, but also in your life.

Prof Hennie Botha: 37:12

I think maybe I haven't had enough turning points, because sometimes I think I am maybe not brave enough to make decisions about my own life and to say that I want to make an important change.

Prof Hennie Botha: 37:24

But there's one episode where many years ago, I applied for a position in Tygerberg hospital, a promotion position and I did not get that promotion position.

Prof Hennie Botha: 37:36

And then I thought, let me apply for a job in Australia. So I did an interview and within a few days I got this message, so when can you start? And the idea was to move to a hospital about an hour south of Sydney on the coast and it all looked fantastic. And then I really had to think, what is important to me and what do I enjoy and what do I want to do for the next few decades of my life, and eventually decided that I want to stay at Tygerberg Hospital and I want to continue doing the work in this academic environment. But I also then started doing a little bit more private work. So I do one afternoon a week in private practice and to do that a little bit more formally, because I wanted to have space for not all my emotional eggs in one basket, if you like, and to show myself that I can do something more than just being a doctor at Tygerberg Hospital.

Dr Maria Christodoulou: 38:31

How is it different to working in Tygerberg?

Prof Hennie Botha: 38:33

I think you have different frustrations in private practice and in Tygerberg Hospital, but it is important, I think, in South Africa, to understand that, despite the fact that we think that we've got a private sector and a public sector healthcare service, these two worlds are definitely not separate from each other and in many ways we need each other to function properly. And, especially if you come from an academic environment, you realize that we need to help patients within the state sector and in the private sector, especially if we think about highly specialized tertiary or even quaternary services. We need to do our academic duty both in the public sector and in the private sector.

Dr Maria Christodoulou: 39:14

Ja., If you look back on your career and your life to date, is there anything you regret, any disappointments?

Prof Hennie Botha: 39:23

Nothing jumps to mind, but I think that's part of my coping mechanism. When I get to a choice and I have to decide between one direction or a different direction, I will make that choice that I make the correct decision, and I can easily forget. When I've had a disappointing presentation at the international conference, I can move on fairly quickly.

Prof Hennie Botha: 39:48

Maybe that's not a very good way of reflecting on what went wrong, but I tend to put that out of my mind, so it's difficult for me to think about something that I regret, so I would say nothing major.

Dr Maria Christodoulou: 40:01

Right. I like what you said about making the choice that you made the right choice, which is very different to feeling like one has to make the right choice. It's almost like whichever choice you make is the right choice for that time.

Prof Hennie Botha: 40:16

One is often very anxious when you get to split in the road and you have to choose between two different options. And we often see that when registrars finish their training time they now must decide whether they want to stay in the hospital that they know, in the system that they know, or whether they must go into, let's say, private practice, or they might even go overseas to do a fellowship. And then they suddenly have choices and they put so much energy in that decision about making the correct decision. But actually all of those decisions could be correct decisions. It's what you make of it. It's actually not that important which of the good options you choose. Just make that option that you choose then the correct option for you. It's easier said than done. I know. I t's not always that easy. Sometimes you can make catastrophic decisions, unfortunately that you choose then the correct option for you.

Prof Hennie Botha: 40:58

It's easier said than done. I know it's not always that easy. Sometimes you can make a catastrophic decision. Fortunately, I can't remember any catastrophic decisions so far.

Dr Maria Christodoulou: 41:08

I'm relieved for you about that. You did say, though, that when you were in Malawi, you felt like you needed to come back to South Africa. Or, maybe more importantly, when you were working in the NHS and feeling like a small cog in a big wheel, there was a sense of I want to do something, maybe a little bit more meaningful, with my time and my energy. And then the decision not to go to Australia and stay here. If I asked you where meaning lies for you, what would you say? What gives your life meaning?

Prof Hennie Botha: 41:47

I enjoy being in a connected space where it is important that I have connection with people around me and with structures and systems around me. I don't like just being an unseen small part and in that sense, I think what makes it important and meaningful for me is when I feel I make a difference, and a positive difference, in my environment. I can't put it in any other words.

Dr Maria Christodoulou: 42:11

Right. And if I asked you what success looks like for you, what would you say?

Prof Hennie Botha: 42:18

I think that's very difficult. I can tell you what success does not look like as a starting point. I don't think it's important for me to measure success in how many degrees you have, how much money you make or how successful your private practice is. I think my measure of success is perhaps a little bit less tangible. T o say that I measure success in how you can get a team to work together, how you can get, as a leader, people to do the things that need to be done because they want to get it done, not because they have to get it done. To inspire people to think about the positive side of life more than the hard, difficult side of life. To mostly be a positive influence to people around you. I think to me that is what I would call success.

Dr Maria Christodoulou: 43:14

Ja. Nine years ago, when we were talking about leadership, you said I don't feel very senior. You said I'm a reluctant researcher and I don't feel so comfortable in the teaching role. What would you say about those things today?

Prof Hennie Botha: 43:42

Again, it is important to acknowledge that we have to grow into a particular role. I'm sure if I go back now to that point in time, I was already quite an accomplished teacher because I know that I enjoy teaching in theatre to demonstrate surgical techniques. I enjoy teaching undergraduate students in a formal class environment. I really enjoy and I think the students also enjoy small group discussions around sort of clinical scenarios. So I think I was at that point in my career more concerned about doing it now as a formal role and being evaluated in that formal role. Before it was fun and also about research.

Prof Hennie Botha: 44:16

I think research is something that is for a clinician and for somebody that grew up in our environment, is very difficult because I never got formal training in research methodologies. Even during my journey as a PhD student I still did not get adequate exposure to epidemiology and statistical methods. So I think one needs a bit more time to actually develop the skills of a researcher and I think we're doing a lot better now in the faculty because there are a lot more resources, there's a bigger cohort of established researchers in the environment. But doing research is difficult and a lot of that is about understanding clearly the science but also understanding how to work with other people. I think working in collaborative teams with people around the world is not easy. To maintain those relationships is not easy, and I'm less of a reluctant researcher now, but I'm still in awe that we get things done in terms of research. Despite all of the difficulties, it's hugely rewarding.

Dr Maria Christodoulou: 45:25

I read somewhere that you were part of a team that was awarded a R100 million grant last year and I'm wondering, with all the political upheaval and turmoil, what's happened with that grant and whether that's still available and how that research is going?

Prof Hennie Botha: 45:42

Just to put that in context, the portion of the grant that we have for Stellenbosch University is about a third of that total amount. It's a collaborative grant between the United States, a site in South Africa and a site in Zimbabwe. Up to this point, up to today, our funding has not been cut yet. Funding that's from the National Cancer Institute and the NIH in the United States. The research project is still ongoing and I hope that we can continue. It's a five-year research project.

Prof Hennie Botha: 46:09

I find it hugely rewarding to work in these larger teams with people that have the skills in all the different fields that are really necessary to do proper research. I'm very worried about the international funding, specifically from the NIH, that is now under threat. Many people in the faculty now lost their jobs and lost their research funding, but I hope that we can continue to do good quality research in South Africa and specifically at Stellenbosch. We've got unique patient populations to work with and I think we've got a unique approach to practical medicine. So all of our grants are still ongoing.

Dr Maria Christodoulou: 46:49

Great, I'm pleased to hear that, and I guess, as you've been speaking, I've been thinking about how the one thing I haven't asked you about is being a man working with women. Your patients are always women and you are immersed in women's health issues. What have been some of the challenges but also opportunities in that for you?

Prof Hennie Botha: 47:12

So, specifically talking about gender, I think we've moved quite a bit in the last decade at least, to be a little bit more flexible in how we think about gender. Maybe as a man it's a bit easier for me to say. I don't have the lived experience of a woman in South Africa and in the different spheres of social environments and academic environments in South Africa, so I'm a little bit cautious when I say this, but I find, to me, it was not a huge barrier to be a male in this increasingly female environment.

Prof Hennie Botha: 47:50

You will know that the specialty of obstetrics and gynaecology has become very much a female-dominated area. The junior doctors are... by far the majority are women, which I see as almost a natural development. I think about 70% of our undergraduates are now female. The whole discipline is moving towards being a lot more of a female environment. But talking about gender and again when we talked a little bit earlier about transformation, acknowledging that people live in different worlds, if you as a female and a male in South Africa live in different worlds, you cannot walk in the same places, you cannot do the same things and I think if you cannot acknowledge that then you're not keeping your eyes open. But in my academic career and in my work environment it is definitely not a problem for me.

Dr Maria Christodoulou: 48:43

What can you tell us about yourself that might surprise people?

Prof Hennie Botha: 48:47

I don't keep a lot of secrets to people, and I think what you see is what you get. One thing that I've experienced over the last few years now is that, perhaps because of the forced socialization that I have to do at work, it has become less enjoyable for me to necessarily socialize in my free time. It is not important for me to meet up with friends every weekend and to go to birthday parties. It is not as important as it used to be, not as enjoyable as it used to be.

Dr Maria Christodoulou: 49:24

You spoke earlier about discovering that you not only enjoyed obstetrics very much, but you also liked surgery. I'm always fascinated by people who love surgery, because I found it so scary. So tell me about what you love about surgery.

Prof Hennie Botha: 49:39

Again, I think if you break it down into separate components, I enjoy being in a space where the environment is fairly controlled, where I'm working with one patient and one condition and one abdomen at a time and have the support of an assistant and a theatre sister and an anaesthetist to do a fairly well-circumscribed job. In a way it is less chaotic than certain other things that we are expected to do. If I compare that with many people are in labour. There are lots of decisions to make in a short space of time, lots of moving parts.

Prof Hennie Botha: 50:25

Surgery is very well controlled, even if it's very difficult surgery because you can do one step at a time. And what I enjoy very much is if I feel comfortable with the procedure that I'm doing, when it is under control, when there's no acute bleeding or injury to bowel or bladder, then surgery can actually be fun, because you can have a quick return on investment. Somebody can have a huge tumour weighing a few kilograms and within an hour that problem is solved. It is a very rewarding intervention. It doesn't take months of therapy before somebody is better, and also I think it is very rewarding to know that you've got a particular set of skills that is unique and that it's a bit like being an athlete or a good swimmer. It's something you do well and that in itself is enjoyable.

Dr Maria Christodoulou: 51:27

Right, and that's in the ideal situation, when it's all controlled and it all goes beautifully. What about times when there is a bowel perforation or a tear of a urethra or an artery?

Prof Hennie Botha: 51:40

Maria, that's sometimes the most difficult space in medicine to navigate, when you, as an individual clinician, has made things worse for a particular person.

Prof Hennie Botha: 51:51

So we intend to do good. On the balance of things, we think that if we plan an operation this person will be better off afterwards. But sometimes things go wrong or the diseases are more serious in nature and you end up with a surgical complication that is sometimes very difficult to manage. As an individual clinician, you feel personally responsible for doing harm. I find it sometimes the most difficult things for people in training to manage, but also for myself. You have somebody in ICU with a complicated post-operative course. It changes your entire life for that period of time because you can think of hardly anything else.

Prof Hennie Botha: 52:34

But again, it's important to realize that that's part of the environment that we function in. It is expected that these things will happen, and again it's important to normalize it. But then also to have support structures, and I think many surgeons will tell you that being alone is extremely difficult. But the moment you have a good partner, a colleague that is on this journey with you, that already helps a tremendous amount. Maybe just to add to that, I've had the privilege of working with such colleagues at Tygerberg but also in private practice, people that I can trust implicitly. I think their judgment is as good as or better than mine. They can look after patients extremely well, and that makes it bearable, and that makes it a lot easier if you have colleagues that support you.

Dr Maria Christodoulou: 53:24

Have you lost a patient due to a medical error that was your doing?

Prof Hennie Botha: 53:29

I think the word medical error is difficult to acknowledge because I think it implies intention. Maybe it does not imply intention, but I've certainly lost patients after complications at surgery.

Prof Hennie Botha: 53:44

That was not intentional and it is devastating. It is extremely difficult. It is important to talk about it, it's important to be honest about it, to reflect on what happened, to try and do better next time. But I don't think there's any surgeon out there that has never had a complication that was avoidable, that did not have a bad outcome or even lost a patient. And unfortunately, in the line of work where I find myself, in gynae oncology, we often work with the most difficult clinical scenarios where there's a big tumour, where nobody else is willing to actually operate that patient. It's difficult terrain, so you will sometimes trip and fall, but it's important to put it into perspective and remember that hopefully, at the end of the day, you do far more good than harm.

Dr Maria Christodoulou: 54:42

Right. So are there things that keep you awake at night?

Prof Hennie Botha: 54:46

Some nights. Fortunately, I don't have a big problem with sleeping. It's perhaps because of all the practice we had in labour ward. If you're on call for 24 hours, you take any half an hour or hour of rest that you can get. So I tend to sleep with a t-shirt over my eyes and my ear, so that's my sleep routine and then I can usually sleep almost anywhere. But I do sometimes lie awake at night thinking about work things and in my role as a surgeon, if you have that complication you worry about whether, firstly, the patient will recover, whether she'll have normal function. But also in medicine you're always worried about litigation.

Prof Hennie Botha: 55:49

And then sometimes the other thing that makes me lie awake sometimes as a leader in your team those interpersonal things that cannot be solved easily, that is ongoing, that is intense.

Dr Maria Christodoulou: 55:55

I'm struck by how much has changed for you as a leader and the way you're talking about some of the things that were huge challenges for you nine years ago. If you could fast forward time and we were sitting together maybe 20 or 30 years from now, looking back, what do you hope to be able to say about what's unfolded in the next few years?

Prof Hennie Botha: 56:14

To me it's very important that, in an environment where people are expected to grow and develop, that they have that space and the security to undergo that process without too much anxiety. To me it's important... stability, consistency, sustainability. In a way, just to keep this ship sailing over many years will be an achievement, but also to perhaps, when I look back, to think that we've created a space for people to develop professionally, but also as human beings, into a future that is accommodating for everybody in South Africa. That is looking after more than just the health, but also the fulfillment and happiness of society.

Dr Maria Christodoulou: 57:04

So what advice would you have for a young colleague who might be thinking about a career in medicine and then maybe, perhaps more specifically, a career in obs and gynae?

Prof Hennie Botha: 57:20

Firstly, I would like to encourage anybody with the inclination to do medicine to just go for it, because it is a wonderful opportunity to develop professionally but also to map your own path, because I think medicine as a discipline allows for people to develop into many different directions and there's a space for every personality in medicine. So I've heard a lot of negative things being said about medicine in the last few years and that parents tell their children I would never encourage you to do medicine. I want to say no. By all means, if you're interested, try and make that career choice to come and do medicine, because it's a fantastically exciting place to be.

Prof Hennie Botha: 57:59

And in terms of obstetrics and gynaecology, we're going through a difficult spot at the moment in obs and g ynae because of this potential litigation that is hanging all over us, both in the public sector and the private sector. So litigation has become a huge issue and despite that, I still believe that this is a specialty where people get a lot of return on investment. It is more of a good news specialty than many other places. It is hard work and many hours in the middle of the night, but it's also extremely exciting. There's never a dull moment in a labour ward or, for that matter, in a gynaecology theatre as well, and it's a privilege to work with women and babies. I think from that perspective, I would choose the same specialty again if I had the chance.

Dr Maria Christodoulou: 58:44

Right, what would you say to some of our younger colleagues whose concerns are about the lack of posts, the lack of registrar posts, especially if they do want to specialize, the limited opportunities available to them, the lack of community service placements, all the challenges that a younger generation of doctors are facing now? So there's this idealistic thing of what medicine can be, and then there's the reality of what they're confronting on the ground at the moment. What are your thoughts on some of that?

Prof Hennie Botha: 59:18

People had similar difficulties 10 years ago and we should not have this myth that there were no problems with posts and getting into registrar positions 10 years ago or even 20 years ago. I acknowledge the fact that there are difficulties for junior doctors to get where they want to be, but again, often this is a symptom almost, of, I think, this dream that you've got a pathway that is straight and there's only that one pathway. You must get into medical school immediately after school, then you must get a placement in the best hospital in South Africa for your internship and then you must get your primary exam while you are doing your community service year in order for you to get the first registrar position in the best university in South Africa. And I think that's a fallacy, that there's a single best pathway to become a specialist or to become a happy and successful doctor, because it is really those side paths that you follow. The hospital where you didn't expect to end up, where you get the most fulfilling experiences in your life. And again, those choices that you think were perhaps not the best choice, it turned out to be in retrospect, perhaps the most useful in your career.

Prof Hennie Botha: 1:00:31

And I want people to take a deep breath, to stay calm and know that there will be a job. If you have an MBChB degree in this country, there will be a job somewhere. It may not be exactly where you wanted it or how exactly you planned for it, but there's plenty of work for doctors. Perhaps not in the cities where people want to live, but I do believe there's still a fantastic career pathway for people in medicine. I hope I'm not sounding a bit idealistic and minimizing the problems in South Africa, but people are creative. They will make a plan and junior doctors will sometimes think that because this thing is not working out, I've got no future. But if they just allow themselves to be open to a few more possibilities, they might find that the sky's the limit really.

Dr Maria Christodoulou: 1:01:23

Right, and I hear you, there's a part of me that goes okay, so, challenging that idea of the linear path, I think is an important one. You know I've always been an advocate for that. It's like that, actually trusting what's unfolding and what's emerging and being led by that rather than I must, I must climb this ladder, and I remember us even having a conversation about how you had no interest in going further up this academic ladder in terms of a deanship or a more senior position than being a head of department and making a decision about where you want to place yourself in the hierarchy. I think is really important.

Dr Maria Christodoulou: 1:01:58

And then there is also the reality that they are being challenged by all these circumstantial things that are going on politically and otherwise at the moment. And I guess we're challenging the assumption that it's someone else's responsibility to make sure you have a job and it's someone else's responsibility to make available those opportunities, if you choose a particular career path. And medicine has certainly been in a very privileged position for a very long time. Maybe we're having to face the reality that that's not going to be the case always.

Prof Hennie Botha: 1:02:28

And that's true for many places in the world. Speak to anybody working in the NHS at the moment in the UK. If we're honest, I think we've been in a very protected environment in South Africa for a long time and perhaps what we're going into now is a slightly less secure working environment, especially for junior doctors, and we need to, as universities, think about is it realistic to train a large group of undergraduates if they don't have internship posts?

Dr Maria Christodoulou: 1:02:57

Right.

Prof Hennie Botha: 1:02:58

We need to do that planning as well.

Dr Maria Christodoulou: 1:03:00

Yeah, absolutely, because it's one thing to get creative once you've qualified, but it's quite another if you need to complete an internship and community service to graduate or to be qualified and register and you don't have opportunity to do that.

Prof Hennie Botha: 1:03:13

I acknowledge that.

Dr Maria Christodoulou: 1:03:15

I find myself wanting to ask you if you remember the first baby you delivered.

Prof Hennie Botha: 1:03:20

I can't remember the exact details of a baby that I delivered, but I've got this picture in my mind of being a third-year medical student in one of the midwife obstetric clinics, probably in Bishop Lavis or Elsiesrivier, in the middle of the night with dogs barking outside and the most incredible excitement in what is happening here. I remember my first exposure to delivering a baby in my third year as an extremely positive time in my life. But I think that first year of clinical exposure in hospitals, whether it's your third or your fourth year as a medical student, is very life-changing and some of the most profound experiences actually happen in that time in your medical career. But that's what I remember when I think about my first baby.

Dr Maria Christodoulou: 1:04:05

Interesting. My story is a completely different one and I remember those nights at Bishop Lavis and Elsiesrivier clinic and the dogs barking, for sure. But my first witnessing of a birth was at Tygerberg and it was a high risk pregnancy in that it was a young girl of 16 and she was really not ready for this whole process and she screamed and shouted and performed throughout the procedure and the sisters were shouting at her and they were making really crude comments and then it ended up being a vacuum extraction and I remember like going back into the changing rooms and sitting on the bench and going, what did I just like... W here? What was this about? And the line I wrote in my journal that night was where is this miracle that I was told I was going to witness? Because it was just traumatic and horrifying.

Prof Hennie Botha: 1:04:54

I think that speaks a little bit to where we also train our medical students. Maybe it is not appropriate to train medical students mostly in academic hospitals, in tertiary level facilities, because we don't see normality. It definitely took away from the experience for you.

Dr Maria Christodoulou: 1:05:13

Absolutely. It did. And I went on to do six months in obstetrics and gynaecology in my internship and I remember when I finally left the hospital practice a few years later and I started working in private practice and kind of like going oh, millions of women have healthy babies every day, pregnancies are healthy. This also happens. Because you get such a skewed perspective in a tertiary hospital of the situation.

Dr Maria Christodoulou: 1:05:40

Hennie, is there anything I haven't asked you that you want to share?

Prof Hennie Botha: 1:05:44

I want to reflect on the fact that I feel very privileged to be where I am in my career, but also in my life. I've had the chance to experience wonderful things around the world practicing medicine and being able to get to know people within a society in a very special way through my job and through doing what I do for a living. I recently spent two weeks on St Helena Island in the middle of the Atlantic working with a team at the hospital there, and managed to engage with the local community in a way that is impossible when you're just a tourist and when you just walk past a place or a space. And I think that's one of the things that medicine gives us is that you can connect with people on a very deep level, perhaps around sometimes difficult disease or difficult conditions that they need to manage. But it is a privilege to be let into that space and getting to know people.

Prof Hennie Botha: 1:06:45

Getting to know society is a little bit better through medicine and through the work that we do, and I think we're very privileged to see a variety of people walking into the office and into the hospital that we get and I think we're very privileged to see a variety of people walking into the office and into the hospital that we get to engage on a meaningful level with people from all walks of life, and I feel that is a privilege that's unique almost to our working environment. I want to encourage junior doctors to enjoy what they do, acknowledge the pleasure of engaging in a bit of banter with somebody in the waiting room, the small moments with the clerks and with the people working with the files every day, because that's really what makes medicine special is the fact that you engage with a lot of different people every single day. It is a wonderful career.

Dr Maria Christodoulou: 1:07:32

What do you wish people knew about cancer?

Prof Hennie Botha: 1:07:36

One of the problems often for individuals when they are diagnosed or confronted with a diagnosis of cancer is what did I do to bring this onto myself? What is the reason for this cancer? Is it my diet? Is it the way I live my life? Is it because of my bad habits? Is it because of my genetics? So people often look for reasons for getting a specific diagnosis of cancer and in the majority of cases there is not a clear-cut reason why somebody ends up with a diagnosis of cancer. It's mostly not your fault, and I wish we could take away the stigma that's associated often with a diagnosis of cancer. It is not a single disease. There are many different forms of disease that's called cancer. Some of these are more easily managed than others, so cancer is not necessarily a death sentence, but it is often a formidable enemy that needs to be managed within a medical team and by the individual patient and their family members and the people around them. It's not your fault.

Dr Maria Christodoulou: 1:08:50

I think I may have spoken about this in a previous interview, but one of the things that always stays with me about cancer is philosopher Ken Wilber, who wrote about his wife's journey with breast cancer. He spoke about cancer as a medical phenomenon, which the medical diagnosis and the treatments and all the different things that have to happen from a biomedical perspective, and then cancer as a social phenomenon or as a sociological phenomenon, and that they spent about 20% of their time dealing with the medical phenomenon and 80% dealing with all the why you got cancer and what it means to have cancer and all the images it evokes for people of chemotherapy, emaciated people, vomiting, nausea, death and that actually fighting that was much, much harder than dealing with the medical treatments and the medical phenomenon that is cancer.

Prof Hennie Botha: 1:09:55

Ja, I think, unfortunately, that's what we often see, is that managing the disease is a small part of managing the entire entity that is cancer and it's very difficult. But we do that in other walks of life as well. If I think about your attachment often to a particular news app, and every morning you open this app and see what is happening in the US and in Ukraine and in all the places around the world, and it does not affect your life at all on a daily basis. It influences your space and it influences the way you think about the world, and I think very often in a cancer diagnosis or a serious medical diagnosis, the inputs that you get from media and from your own research makes it far more difficult to navigate a path through this disease process.

Dr Maria Christodoulou: 1:10:48

Absolutely. As you were talking, I was reminded of my conversation with Professor Lyn Denny, who was a peer of yours and I know you worked together quite closely and you knew Lyn. And she, in the interview we had, spoke quite openly about some of the really challenging aspects of living with cancer and managing cancer and also dealing with the medical team and the medical people that were on board. Is there anything you want to say about that? Any thoughts that you have?

Prof Hennie Botha: 1:11:20

I think it's sometimes very difficult to have a medical professional who's working in the field of cancer being diagnosed and going through a journey with cancer.

Prof Hennie Botha: 1:11:29

Because you somehow expect a more profound outcome or journey. Something different. But in the end, we are all human and I think our suffering is very similar. Whether you are the professor in gynae oncology or whether you are somebody who's a clerk for the municipality, you struggle in the same way with the nausea and vomiting, with the doctor that didn't call you back with the results as promised. The journey is not that different. What you do with it, I suppose, in your professional life, depends on how open you want to be about your own suffering. Lyn, I think, was very careful not to necessarily show to her professional colleagues the depth of her own suffering, because she went through hell many times, and often. Not only with her cancer but with all the other health issues, and she was not very open. She came across as somebody that wanted to be in charge and wanted to be seen as continuing, despite all of this, to function.

Dr Maria Christodoulou: 1:12:33

Amy, anything you'd like to ask?

Amy Kaye: 1:12:35

I was thinking about how there's this. It might sound a bit strange, but to me it feels like there's this overlap. So I have this other life, as a teacher and a coach, and there's this overlap between that and medicine in that you also, as a teacher and a coach, have very intense relationships with people, but for a very short amount of time. And there is this, as Maria, you were mentioning, this continuous grief that just keeps happening because you keep connecting with people and then having to let them go and it gets really, really exhausting. And I remember at one point, especially during COVID, there were so many people grappling with compassion fatigue because you hit a wall at some point. Where you go, I can't care about another person, I can't invest in another person emotionally, because it's just too painful to have to continuously keep letting them go.

Amy Kaye: 1:13:21

And then I thought about how, in terms of you having to work with patients and you forming that connection, and then really having to let them go when they pass on and not being able to save them. But then also the juxtaposition of being there with a patient, where you get to witness their birth, which is amazing, just those extreme moments of life and death. What a remarkable career to have, where you're at the beginning of somebody's life and at the end of somebody's life, and the emotional rollercoaster it must be. But what I found was really profound was when you mentioned how. But if you get overwhelmed by that grief or you get overwhelmed by anything that you experienced with a patient, you can't be of service to them, you can't really help them if you are stuck in the emotion. So that's why you have to compartmentalize, to still be of service and I just wanted to say that that makes complete sense to me and I really, really appreciate that.

Amy Kaye: 1:14:15

And that's what I'm going to take away from this conversation for my own life and to help me be more of service to people is to recognize that, yes, it might be emotional, but it's okay to not get that emotionally involved, because I think I often have a lot of guilt with that, because sometimes I feel like, oh, but maybe I should be caring more. Why am I not caring? Why am I not having a deeper relationship with this person? Should I, and it's actually that boundary is really important to be able to deal with the next person because ultimately, there will be, however many more people waiting in the wings that will need your help and need your service. So I just wanted to acknowledge you saying that, because that's really affected me and I'm sure will help a lot of other people hearing this conversation too. So, thank you.

Prof Hennie Botha: 1:14:57

Thank you. I think it's difficult. As you say, as a coach you have similar relationships with people for a short period of time and then you quickly have to move on to maybe your next client or maybe just to your own life and there's not enough time to really work through that grief. But sometimes we don't have the luxury. But if we don't manage that properly, we can't be of service. I remember, Maria, very often after our conversations that I felt relieved. I did not necessarily give my monkey to you and make my problem your problem, but just in the sharing and in the talking about it, it made it more possible for me to carry that burden, almost.

Dr Maria Christodoulou: 1:15:37

Right, I remember you being a bit suspicious about what the coaching was going to be about and what we might do together, and I think I shared with you at the time that I'd had a conversation with a colleague in family medicine who, when he was first told that he should meet with me, was worried that... The sentence he used was, " I was become a team and make cop smuggle.

Prof Hennie Botha: 1:15:57

As surgeons we're always worried about that, and you did ‘smokkel’ with my kop. Very successfully, I might add, so thank you for that.

Dr Maria Christodoulou: 1:16:06

So what would you say to somebody who was cautious or hesitant about reaching out for a coach? Because I think often in our field we're supposed to be the experts, we're supposed to have all the answers, and it's often difficult to admit to vulnerability. And yet many of us struggle with our own vulnerability, and you mentioned indirectly the imposter syndrome earlier. So what would you say to somebody who is thinking about coaching but a bit anxious or concerned about what it might mean for them?

Prof Hennie Botha: 1:16:32

I think firstly to say that speaking to a coach is not admitting defeat or that there's something wrong with you. It's not necessarily even a cry for help. It is more of a let's exercise together type of scenario, where we work through challenging thoughts and situations together with a training partner that will help you to manage, mostly by your own insights at the end of the day, to manage your own daily challenges. I found coaching to be extremely supportive, but in a collaborative way. It's not a therapeutic relationship. It's not admitting defeat. It's admitting the fact that I can do better by involving a coach, and I think if you frame it in that way, many hardcore professionals will come and knock on your door, because I do think it helps people to perform better in very challenging environments, coping with difficult decisions, coping with complex environments. I think coaching is certainly of huge benefit there.

Dr Maria Christodoulou: 1:17:45

And I think there's something in that of acknowledging that we grow in and through relationships.

Dr Maria Christodoulou: 1:17:49

We grow by having people around us that hold up a mirror so we can see ourselves more clearly, sometimes for the good, but sometimes also for the areas where we need to grow or develop.

Dr Maria Christodoulou: 1:18:00

And if we isolate ourselves from feedback which I think often as leaders one finds oneself in a situation where you are isolated from honest, robust feedback, then we don't grow and we don't see ourselves quite in the same way. So it can be really valuable in that regard. And what I appreciated also about our coaching journey together, Hennie, was that it was very much a peer space and I remember at times stepping away from the space and wondering if I'd shared too much, because there was something about the way you also showed up in the space that allowed me to sometimes be vulnerable, and I think you were one of the first people I told that I was thinking of leaving the faculty and I remember you saying no, you can't leave. But I think our conversations also made me aware of the difference between leaders who were really engaging in the work and leaders who weren't. Thank you.

Prof Hennie Botha: 1:18:47

Again, thank you perhaps not personally to you, but to the whole coaching community for the very important role you play keeping many of us functioning.

Dr Maria Christodoulou: 1:18:57

I don't know if we're keeping you functioning.

Prof Hennie Botha: 1:18:59

No, no, no.

Prof Hennie Botha: 1:18:59

Maybe that's putting it a little too strongly.

Dr Maria Christodoulou: 1:19:02

So what are you left with at the end of this conversation that you were feeling a bit anxious about?

Prof Hennie Botha: 1:19:10

I don't like being recorded, in general. I've appeared on TV a few times. Radio is different because it's out there and you can't really go back and listen again. Because I am sometimes a little bit worried about my own thoughts in a particular moment and how it might change four or five months down the line, or even four or five years down the line and again, perhaps that performance anxiety of not sounding profound enough.

Dr Maria Christodoulou: 1:19:43

Well then, I'm even more grateful that you were willing to participate and allow us to record this conversation. Thank you for being willing to share your story with us. Thank you for speaking honestly and openly about your career and the things that you imagine for the future. And, as Amy said, I think it takes a very special kind of person to hold that place of birth and death with the same passion and compassion, and I'm really grateful for the work that you do in the world and the contribution you have made to women's health in the world.

Prof Hennie Botha: 1:20:18

Thank you, Maria, thanks Amy.

Dr Maria Christodoulou: 1:20:20

Thank you so much. Thank you, Amy. I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends, follow Awakening Doctor on Instagram, Facebook or Spotify and go to Apple Podcasts to subscribe, rate and leave us a good review. Thank you for listening.