Prof Tasleem Ras, Leading with Community at Heart

What would the world be like if we understood that each time a patient shares their story, they are inviting us into the sacred ground of their life? What wisdom might we gain from truly listening to those we aim to help? How might we transform our institutions to better serve our communities?

For Professor Tasleem Ras, family physician, educator, researcher, and Head of UCT's Department of Family, Community and Emergency Care, these questions lie at the heart of the academic endeavour.

In this episode of Awakening Doctor, Prof Ras shares his personal story and reflects on the pivotal moments that have shaped his career: the epiphany that surgery would not fulfil a deeper calling; building a family practice in his childhood community; the difficult decision to leave clinical practice for academia; and managing the CTICC Hospital of Hope during the COVID-19 pandemic – a time when shared vulnerability created unprecedented unity and humanised care.

Together, we explore the lessons he learned from working in under-resourced communities, the existential and ideological tensions facing healthcare today, and the vital role of faith, trust, and humility in medicine.

Through each transition and reflection, Prof. Ras’s philosophy becomes clear: medical education must balance technical competence with empathy and wisdom, must recognise the knowledge that resides in communities, and honour the sacred dimensions of healing.

Join us for a thought-provoking reminder that education, at its best, is an act of hope - shaping not only better doctors, but a better world for us all.

Chapters

• 0:00 Introduction
• 11:04 Journey to Medicine and Education
• 26:47 From Surgery to Family Medicine
• 40:05 Building and Leaving a Community Practice
• 54:51 Faith, Ethics and Medical Practice
• 1:07:28 The Existential Crisis in Modern Medicine
• 1:17:02 COVID Response and Community Engagement
• 1:26:29 Vision for the Future of Medicine

Transcript

Dr Maria Christodoulou: 0:00

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. Today on Awakening Doctor, I'm delighted to welcome Professor Tasleem Ras, family physician, educator, researcher, and the head of UCT's Department of Family, Community and Emergency Care. Professor Ras has spent his career not only treating patients, but also reimagining how we teach and practice medicine, especially in the places where it's hardest to do so. Awarded the UCT Distinguished Teacher Award in 2022, he is passionate about primary care, deeply rooted in social justice, and isn't afraid to talk about the tough stuff. He also comes from a large, busy family with three generations living together under the same roof, alongside the cats who have adopted them. Welcome Tasleem. It's lovely to have you with me today.

Prof Tasleem Ras: 1:14

Thanks, Maria. I really appreciate the invitation. Thank you.

Dr Maria Christodoulou: 1:17

So as I said to you, when we met briefly to talk about doing this, I usually like to begin with a question of, where should we begin to tell your story?

Prof Tasleem Ras: 1:26

Oh gosh. That's probably a question I've never been asked before. I don't know. I mean, I suppose one could start at where we are right now and then start unpacking how we got here. I would imagine that if you start at the beginning, you could very easily go off on a tangent as you follow whatever little stories are hidden behind different corners. So maybe let's start where we are right now and then move backwards. Maybe we can move forward also at some stage.

Dr Maria Christodoulou: 1:55

I would like that. Absolutely. I think you have some interesting perspectives. So where are we right now?

Prof Tasleem Ras: 2:01

So, where we are right now in my life as a doctor, because obviously we wear many cloaks. And so in my cloak as a health professional, I've just emerged in the last two or three years into a leadership position, both within our community of family physicians and within my institution, UCT. It's a result of authentic work, I'd like to think, that spans the last more than 25 years. And so, been recently appointed as head of family, community, and emergency care, which incorporates all of those three disciplines, including palliative care and sports and exercise medicine. Very exciting department to be in because, in many regards, these disciplines are at the cutting edge of how medical practice is expanding. And I don't see myself as being the sharp point of the spear in this regard, because all of the people I work with who are heading up these respective disciplines are leaders within their own right. It's quite exciting to be working with a bunch of really passionate, really empowered, visionary people who are making real differences in their respective spheres. So that's pretty cool. And then the other big part of my professional life is as the president of the Academy of Family Physicians in South Africa. What this means is that I essentially hold a responsibility in a nonprofit organization. So it's a voluntary appointment, which has been working for the last about 40 years, looking after the interests of the discipline and expanding the discipline of family medicine in South Africa. Very excitingly, just heading off this year, making good connections with our colleagues across the African continent and with family physicians globally. So also an exciting space to be in. Really good opportunities to advocate very strongly with national and provincial departments of health for enhanced primary care services, which you mentioned at the very beginning. That's where my heart lies.

Dr Maria Christodoulou: 4:04

Yeah. You've also spoken about the reality that we all wear many different cloaks. So what are some of the other cloaks that you're wearing at this stage of your life?

Prof Tasleem Ras: 4:13

Oh gosh. I mean, so there's the family cloak. That's probably been there forever. I come from a large family and I have a large family.

Dr Maria Christodoulou: 4:23

Right. I think you said you had four children, right?

Prof Tasleem Ras: 4:25

Uh I got five kids.

Dr Maria Christodoulou: 4:27

Five.

Prof Tasleem Ras: 4:28

Five of them, ja. I don't think they want me to refer to them as kids. They are my offspring. All right. And they range in ages from 23 to 10. The last 23 years have been quite busy. Married an amazing woman in 2000. So it's 25-year anniversary this year.

Dr Maria Christodoulou: 4:53

Congratulations.

Prof Tasleem Ras: 4:54

In October. Ja. And then I have... My parents are still alive, thank God. They're around 80. And I have my siblings who are all kind of my sounding board. You know, they're the ones that really tell us the truth, isn't it?

Dr Maria Christodoulou: 5:10

.

Prof Tasleem Ras: 5:11

More than anyone else, our siblings. So full life. And I'm really, really grateful for that.

Dr Maria Christodoulou: 5:17

I'm trying to imagine three generations all living together under the same roof. How does that work?

Prof Tasleem Ras: 5:23

It works. It works out of... It works. I think initially out of necessity, and now because we don't see any other way to do it. My wife's father was quite severely disabled, and as they were getting older, they were living on their own. We had space in our home, and then we said, you know, because um anticipate their medical needs down the line, took them into our home. So that's been a blessing having them with us. Our kids love it. I mean, we really appreciate the added adult presence. It allows my wife and I to take weekends away on a regular basis and not really have the anxiety about who's looking after the home. It's been quite good.

Dr Maria Christodoulou: 6:03

Right. So let's go back a little bit. Tell me about the journey that took you to medical school to begin with.

Prof Tasleem Ras: 6:09

Oh gosh, yeah. So I've always been a reader. I mean, to get into medical school, there needs to be a fair amount of academic achievement. We can't lie about that. Even today. I mean, probably harder to get into med school today than when I got into med school in the early 90s.

Dr Maria Christodoulou: 6:25

Definitely than when I got into med school in the mid-80s, for sure. I wouldn't have got in now.

Prof Tasleem Ras: 6:30

No, it's become so, so very competitive. And it just shows you why apartheid was so wrong, because the potential that we see coming out of young people today, which a generation back was being suppressed quite severely. So I was very fortunate in that I had parents who valued education very, very highly and placed education as one of the main things in our lives for all my siblings. We come from a working class background. There wasn't surplus money, there was enough to feed us and clothe us and put a roof over our head. And for that, I'm thankful and grateful. Hardworking parents, mother and father worked. So I do see the value in hard work that was instilled from a very young age. And so I can tell you stories about being a member at the city library in the center of Cape Town from the age of three. That's my mother's doing. Our Saturday morning routine was do the shopping, get some lunch, go to the library - every week. By the time I was about 13 or 14, I can probably with confidence say that I'd read pretty much every book that I could in English. The Afrikaans ones I just kind of passed by. So avid, avid, avid reader all through until I came to med school. My mother thought I was going to become a teacher. Yeah, she was surprised when I chose medicine. In my head...

Dr Maria Christodoulou: 7:57

She wasn't wrong indirectly.

Prof Tasleem Ras: 7:59

Yeah, I think she probably knew the truth behind it all.

Dr Maria Christodoulou: 8:02

Because today you are a teacher, right?

Prof Tasleem Ras: 8:04

Absolutely, absolutely. So she saw beyond the medical degree. I suppose I have to credit her for that. And yeah, for me, there wasn't really another choice. I was going to become a doctor or I was going to become a doctor.

Dr Maria Christodoulou: 8:17

When did you know that?

Prof Tasleem Ras: 8:18

I don't know, eh? High school sometime. I don't think I even thought about it much. This was what I was going to do. I don't know where that thought came from. I mean, at the time in the 80s and 90s, when people thought about studying something, it was engineering, law, medicine, nursing, teaching. There were a few set. And you didn't go to university to get an education. You went to university to get a degree so that you could have a job.

Dr Maria Christodoulou: 8:43

Right. And the implication being that you would have a better job and you would earn better money than someone who didn't have that, yes.

Prof Tasleem Ras: 8:50

Absolutely. And so I don't think I thought critically about those categories. So I fell into the medicine category. I don't have any regrets whatsoever at all. I enjoyed med school tremendously.

Dr Maria Christodoulou: 9:01

Were there any doctors in your family?

Prof Tasleem Ras: 9:04

No. So we're first generation university graduates currently. My mother worked for doctors, so maybe there was some liminal messaging coming from that side. She did administration for the Department of Health for the last 30 years of her working life. So she had a connection with medicine. That was the only connection. I suppose deep inside I admired our family doctor, Dr. Ibrahim Abrahams at the time, one of the legends of the Woodstock District 6 area. Yeah, so no specific aha moment. I remember in high school, people would be asking what you're gonna do, and I'd be saying, Oh, I'm gonna study medicine.

Dr Maria Christodoulou: 9:44

And how did your family feel about you choosing medicine?

Prof Tasleem Ras: 9:47

I think as long as I studied something.

Dr Maria Christodoulou: 9:49

Okay, right.

Prof Tasleem Ras: 9:51

You know, there was no pressure at all, ever. My brother before me had gone to, at the time, Cape Technicon to study civil engineering. So it wasn't as if I needed to walk in his footsteps. So this was not some type of family tradition, anything of the sort. I think there was just support at the time to go and study anything. It turned out to be medicine. And it was an interesting time in the country's history. It was 1993, we were transitioning. Yeah. The biggest issue, I suppose, was finding the funding to pay for the university fees. And that happened. I remember my dad and I, and maybe this is kind of the support for the studying in whatever I needed to do. There was an economic slump. My dad was in the building industry, there was no work. Right. And we literally, he and I made appointments with different business people and we went knocking on doors and saying, this is who I am, here's my results. Will you sponsor me? And a kind-hearted businessman in 1993 said, How much do you owe? Here's a cheque, pay your fees.

Dr Maria Christodoulou: 10:56

Wow, that's amazing. And when I visited him six years later to tell him, Listen, I can pay you back now. I've just graduated as a doctor. He told me, actually, you know what? Just pay it forward. That's amazing. We need more people like that in the world.

Prof Tasleem Ras: 11:11

100%. I agree. For a young man trying to find his way in the world, I think sometimes you feel as if you're on your own. But uh I learned something from my father, you know, put your pride in your pocket. There's a much bigger picture happening at the moment. And uh if you have a vision for where you want to be, then pride oftentimes is an obstacle to achieving that vision.

Dr Maria Christodoulou: 11:35

You also said in various public forums that education is fundamentally a hopeful endeavor.

Prof Tasleem Ras: 11:43

Absolutely. Why do we educate? We never educate for the moment. So someone finishing grade 12 isn't finishing grade 12 for the sake of grade 12, or doing a degree, isn't doing it for the sake of a degree. It's aspirational because the fruits of that is going to be harvested sometime in the future. So it's always aspirational. And it's always transformational. It's never about doing a quick deal on the side and getting quick profit. Education is a long game. And so those who embark on education either as a profession or for their own improvement understand that there's a process and there's a certain level of discipline that comes with that. And it's always about aspiring to something which is not there. Basically, whoever's being educated at any point in time is in the process of creating something in their lives which had not existed before. And in that sense, for me, it is always aspirational, always, regardless of the intent. I want to make money, I want to do this, I want to do that. It doesn't matter. There's an aspiration to create something which doesn't exist now.

Dr Maria Christodoulou: 12:50

So, what was it like to start medical school in 1993 with everything that was going on in the world?

Prof Tasleem Ras: 12:57

It was great. We were on upper campus at UCT, liberal institution. There was a lot of healthy political debate going on. We were kind of Madiba kids. UCT was at the time reformulating its student politics. The National Party was rebranding itself. There were lots of student organizations active. We formed the first student parliament at UCT. So I'm a member of parliament, by the way, somewhere in the records, in the archives. But it was great. I was reflecting with a colleague the other day after I chaired a bit of a difficult meeting, that the skill to handle debate, conflict, time management within meetings, it was never taught to us. As students, we learned that from our political activism. It was a space in which there was lots of debate. I don't recall a calm meeting ever as a student. Neither I do recall a meeting that ever ended on time. I remember I was sitting with a colleague, and we had this debate. We had different political perspectives on what the new South Africa should look like. We debated from the coffee shop, right through the parking area, into the lift, up the lift to the second floor, into the anatomy lab where the corpses were lying that we were supposed to go dissect. And we were debating while we were dissecting. And eventually one of the tutors came over and he said, I think you should concentrate on the anatomy. But what it meant is that those first two, three years at university meant that I read a lot of philosophy and politics. More than I probably should have. I should have probably concentrated on the microbiology and the chemical pathology a little bit more, a little bit less on politics.

Dr Maria Christodoulou: 14:44

What makes you say that?

Prof Tasleem Ras: 14:45

I think. No, I probably should not have done that. I did exactly the right thing. I think I responded to the time. I could have gotten better marks if I had studied, like if I had been reading just medical books. But actually, you know what? One of the regrets I do have of med school is that it is so academically intense. From third year onwards, I don't think I read a single novel. From second year onwards. You just don't have the capacity to. It's so intense. And that was my great regret. In my internship, I plundered the library in Ladysmith. I did my internship in Phutalichaba, the closest library was Ladysmith. And I just went there every Saturday because I just had this thirst for. I mean, Terry Pratchett was my favorite novelist at the time. The escapism, the surrealism, I just enjoyed that. So yeah, but I don't regret reading the politics of the time. It was a great time to be at university. We were pulling in different directions, but there was this vision that we needed for ourselves to develop. Yeah. Interesting times. The 90s were really, really interesting times. I suppose every decade is.

Dr Maria Christodoulou: 15:55

Yeah, and I'm sure every generation has their own version of that kind of experience.

Prof Tasleem Ras: 16:00

Absolutely. Absolutely. Are there any stories that stand out for you about that time as a student, the politics that was happening, but also the patient encounters you were having? Yeah. I'd have to go look at my journals. I remember quite an interesting thing. So I was involved with the Muslim Students' Association on campus. And during orientation, there was this... So this is kind of early to mid-90s. We were kind of exposing each other to each other's cultures. And someone gave the Adhan, which is the Islamic call to prayer on the plaza. And immediately there was a backlash from some of the senior academics. This is Cape Town, not Tehran. That's a line I remember from the letter that was written. So remember, this was probably in the very early days of email. We didn't have access to email, so everything we received was written or typed. And this led to multiple engagements with university and really unearthed for me some of the hidden biases that existed within. Because you know, at the time, UCT being this liberal space gave lip service to accepting multiple cultures and being open to different practices. And then when we enacted that, it was a completely different story. It was the first time also for me as a young Muslim South African getting into a space where we needed to assert our identity. Where before, you know, growing up in apartheid designed communities, you know, in a coloured community in Cape Town, Islam and Christianity coexisted for generations. And it's not just about tolerance, it was really we celebrated each other's faiths. We have interrelated families. And so it was a very strange, but almost like to go out and to assert who you are was not something that we had needed to do in the past. And so it does start this process of who am I really? Why do I do this? Why is this so important to me that I need to go and engage with university leadership about it? So the kind of process of affirming your own identity for me was probably one of the biggest take-home developmental tasks that I needed to do for myself those years at university. So that's one story. Patient-related stories a bound, I mean, multiple stories. I remember one of them was in our fourth year. We visited a family in Bridgetown, Silvertown, in Athlone. Their child had a long-term chronic medical condition. And it was the first time that I saw how an illness impacts on the entire quality of life of the family. One person's illness. That for me was a really... It was a real eye-opener, because you have limited resources in this family. They didn't have a car. You know, they were a typical working class family living in a council flat. My colleague and I visited them at home, sat down, chatted with them , and that for me was such a transformative moment because it's kind of a threshold concept. When you understand the impact that a chronic illness like that has on the entire family, it's not just the patient sitting in front of you. Cannot be. Because this child needs to be cared for. They need to be... Not just from a medical perspective. Generally. They need clothes, food, etc. etc. All of these things. And then added to that burden there's this thing about this chronic medical condition which is incurable. And there was no known treatment for it at the time. So that for me was something which really, really moved me as a medical student. I suppose, you know, kind of stayed with me all the years, which eventually led me into family medicine.

Dr Maria Christodoulou: 19:55

I guess my next question would have been so why family medicine? But I guess your sensitivity even to that broader context when you were sitting across the way from that family and that patient perhaps points in that direction quite naturally.

Prof Tasleem Ras: 20:10

Yeah, I think I hadn't thought about it up until that moment. They were teaching it to us, but you know, you've got to experience something sometimes before you really get it. And then family medicine wasn't really on my list of priorities. I wanted to be a paediatrician. I really enjoyed surgery, and I really didn't like obstetrics.

Dr Maria Christodoulou: 20:32

What was it about obstetrics that you didn't like?

Prof Tasleem Ras: 20:37

It's just the never-ending screaming. You think you've just finished the job and the baby's delivered and the mothers calm, and then right next door, someone's going through the process again. My surgical brain said, no, when you finish an operation, you move on.

Dr Maria Christodoulou: 20:55

Right.

Prof Tasleem Ras: 20:55

Yeah, the obstetric experience didn't appeal to me at all. I was burnt out when I finished my comm service. I did my comm service at Gugulethu Day Hospital for 12 months. This is the other big thing I think that my generation faced. We had no mentors. The odd mentor here and there. And so from a career development perspective, I wasn't talking to anyone. So I was making career decisions based on what was convenient to me. And at the time, I was engaged to be married. The day hospitals were a nice place to be because you do calls, obviously, but the work was not intellectually demanding. I mean, we're seeing 60 to 80 patients a day. You were there, you worked hard, you did your calls, but you went home. And I had a good team of people around me. The seniors were really great, they were supportive. Instead of crafting my career to say, okay, you know, you need skills here, you need skills there, you need skills in different areas, I kind of just stuck to where it was socially convenient for me. Which a mentor might have disrupted my thinking, which I certainly do with people who come to me now with similar types of questions. And at the time, jobs were not difficult to find as a doctor, unlike today, where you have unemployed doctors, which is something which boggles my mind. I can see the rationale for it, but it still blows my mind when I think about it. Yeah, and so I was burnt out at the end of comm service, as so many of us were. And I got into doing locums for a general practitioner who is very well known in the Cape Town area. He owned a number of practices across Cape Town. Enjoyed that tremendously. You know, the community engagement, doing house calls, sitting down with two, three generations of a family in the consulting room. That for me was just almost exactly what I was built for. But I needed to get the surgeon out of my system. It was there, you know. I ended up doing minor surgical stuff in the GP's rooms, and I really enjoyed that. And it took me 18 months of surgical training to get it out of my system.

Dr Maria Christodoulou: 22:58

Say more about that.

Prof Tasleem Ras: 23:00

So I remember one day I phoned up Prof. Kahn, Del Kahn, who was head of surgery, and I said, uh, Prof, I didn't know him. Just made an appointment and I went to see him. Prof, I'd like to be a registrar in your department. And he said, Okay, fine, spoke with me a while, and a short while later I got a phone call. Can you start? Okay, that's nice and easy. So I did a long time doing trauma surgery. It was great. I mean, you learn a lot. You get to meet people who, for example, the current dean at Stellenbosch University, Faculty of Health Sciences, I worked with Elmi way back. So it was quite a good space to be in. I remember quite clearly one day, I think it was a Saturday morning, I was post-call, working at Jooste Hospital. I was walking down the passageway with my two consultants. I'd spent literally from the five o'clock the afternoon before till about three or four o'clock in the morning, I'd been in theater all the time, operating on a stream of emergency patients that came in. As I was handing over to them, I looked at the two of them and I thought, am I gonna turn into the two of you? Like, am I gonna be like in my 40s or 50s and still be doing the same thing? And I thought, no, no, no, no, no. That's when I decided. That was the first really conscious decision I made. And I can clearly remember on the ward round thinking, I can't do this for the rest of my life. No ways.

Dr Maria Christodoulou: 24:39

What did you see in them that made you go, I don't want this for myself?

Prof Tasleem Ras: 24:44

No, it wasn't them. It wasn't anything in them, it was about the work. So within me, there was this need to be a community-based activist. That's how I see medicine in the community. You have a real opportunity to change people's lives. You connect with them. So you speak to NHP and they'll tell you, you know, you connect with people in some of the most vulnerable times of their lives. And that helps you because you feel really useful, and it helps them because maybe you were able to give them a different perspective on their suffering. That, I wasn't getting from surgical practice, particularly surgical practice in the state sector. Maybe in the private sector, it's completely different. And I was impatient to have that level of patient contact. I wasn't getting it from surgery. And so the technical gratification of doing an operation and having good outcomes, and the patient saying, then, oh, thank you, doctor. You know, that was brilliant. I enjoyed that. But for me, it couldn't sustain my... because it takes sacrifice to be a trainee. You have to study after hours, you sacrifice weekends, and I couldn't see that sacrifice for something which I wasn't passionate about. I enjoyed it, but it wasn't a deep abiding passion for me.

Dr Maria Christodoulou: 26:02

So you left your registrar training and then?

Prof Tasleem Ras: 26:05

I left my registrar training, I think, in 2003, and I spent the next few months planning. I went overseas, actually. My wife had gotten a job in Al Ain Hospital. She's a radiotherapist. She works in oncology. And then we had one child by that time, and he and I followed her over there. We checked out the vibes, and we, after one or two months, decided, nah, we miss Cape Town. And then we came back. So we spent about a few months in 2003 just checking out what life might be like overseas. And we haven't looked back. Cape Town's been home since then. And then I made some moves. I opened up a practice in 2004, and that started my proper journey into family medicine.

Dr Maria Christodoulou: 26:52

And you did that for a couple of years, if I read correctly on your profile?

Prof Tasleem Ras: 26:57

Ja, ja. So I was very fortunate in the sense that I started my postgraduate family medicine education in 2004, and I started my practice at the same time. And my practice also included a contract with a local rehabilitation and palliative care hospital in Tamboerskloof. And I was teaching undergrad students via UCT. So for about seven years, that kept me really, really engaged and fulfilled. That was really great. I worked in a community that I had grown up in. And so my patients were people that I had known for much longer than I had had a practice. I was intent on establishing a practice along the old community GP models. I did lots of house calls. I did a lot of palliative care as part of my practice. So it was a really, really fulfilling place to be. Kind of the combination of home-based care, hospital-based care, and office-based care kept me really, really stimulated. And I was finishing off my master's and I wrote the college exam in that time. It allowed me to do quite a lot of really stimulating things in those seven years. And I literally lived like a one-minute walk from my office.

Dr Maria Christodoulou: 28:09

Convenient.

Prof Tasleem Ras: 28:10

Ja. So I'd finish my ward rounds, I'd go home, have a cup of tea, and then at the go start seeing my appointments for the rest of the day. And late afternoon, I did my actual ward rounds in the community for whoever needed me to go and visit them. I was very blessed in being able to create that type of practice. The thing that took me out of it though was I got the masters and the fellowship, and then you kind of grow out of the work that you do. And you grow into a new type of work. And so that took me into academia full-time.

Dr Maria Christodoulou: 28:42

You say that, and it sounds quite simple and it makes sense, but I imagine that it was not an easy decision to decide to move away from your practice. So what did that take?

Prof Tasleem Ras: 28:52

Yeah, if I look back now, I think I could have done it in a better way. When I moved away from the practice, it was in response to the then deputy- dean at UCT, Gonda Perez, offering a job. Obviously, I'd interviewed for it, in Vredenburg. And that was setting up UCT's first formal rural training platform for medical students, physio students, speech and language, and OTs. So it was final year students that would come, needed some rural community practice. And my task was to go build connections, find places where they could learn, and then bring the first cohort of students through. And I did that for two years. In my imagination, I was going to do that during the week, and on weekends I'd come back and see my patients. So I violated the first rule of general practice. There was an old GP that I met in my internship when I was in the Free State who told me if you ever want to become a good GP, there are three A's of general practice that you must always obey. He says, the first A is availability. If you are not available to your community, they're not going to support you. He said, the second A is affability. Because you need to be a likable person when you are available to them. And the third A comes last, like a distant third, is ability.

Dr Maria Christodoulou: 30:17

Interesting.

Prof Tasleem Ras: 30:20

And I think when I tried to be this part-time GP to my patients, I violated that first rule of availability.

Dr Maria Christodoulou: 30:27

Availability. Yeah.

Prof Tasleem Ras: 30:28

You know, and people don't get sick when you're available. They get sick when they get sick. And I found that after a very short time, I wasn't able to ethically sustain that type of practice. We tried for a short while to have someone lease the practice from me. But you know, after a few years, you build up strong relationships personally with patients. And so they go and look for that again. And the business model, I was never a businessman. I was never an entrepreneur. I was just... I

Dr Maria Christodoulou: 30:56

Medical school doesn't teach one to be a business person.

Prof Tasleem Ras: 31:00

Not at all. To be honest, I didn't enjoy that side of practice. I had a practice manager who did it all for me. Then I had an accounts manager who did everything. And I didn't have the discipline to do that part of it. And that's partially why I left, because my practice manager went and opened up a completely different business and said, told me, I've set everything up for you. And there's software and everything. So all you need to do is this, this, and this, and this and this. Every day you must do this, every week you do this, every month you do this. This didn't happen.

Dr Maria Christodoulou: 31:33

And what was it like for the community? I mean, you've spoken about you went back to the community where you grew up. So you had long-term relationships with these people. How did they feel when you decided you were done with this practice?

Prof Tasleem Ras: 31:45

I don't think they were happy. I think there are still some people I meet who would tell me you abandoned us. Just kind of a shadowy part of my. I didn't, you know, I still live in the same area. I own property and I still see them at the mosque, at the shops, in the barber. So I'm still part of the community. I suppose it took them some time. For a few years, when I used to meet people, they'd say, Ja, Dr. Ras, what happened to you? You just disappeared. Because at the time, not everyone was an email. This was in 2011. So I sent an email to everyone that I could find. And I made some agreements with colleagues who were still active in the area to take over some of the more chronic patients. So it's not as if I just dropped it. Right.

Dr Maria Christodoulou: 32:27

Yeah.

Prof Tasleem Ras: 32:27

But I suppose, you know, one can always, in retrospect, do things better.

Dr Maria Christodoulou: 32:31

I think it's really tricky. I'm remembering my own experience of closing my practice, and I made the decision, and then I took another six months and I let patients know, and I gave them the opportunity to come and see me, and we talked about where they would go next, and I gave them their records, and I really felt that I was doing it mindfully and respectfully. And people were still very angry with me. There were some that were supportive, but many of them felt I was abandoning them. I had a lot of like, how could you do this? How can you abandon your cancer patients? Because I had a lot of cancer patients at the time, and sjoe, it was really hard. I carried a lot of guilt about that, and the guilt of juggling what I knew was best for me and what I needed to do next against the needs of these people that I had got to know and love and developed relationships with over time. It was complicated.

Prof Tasleem Ras: 33:22

It is, and I agree with you entirely. People did feel abandoned. I tried to compensate for that by still giving free advice. It was my weak attempt at some type of reproachment for having abandoned them. And to this day, you know, when people call me and I'm available, I'll pop into their homes. You know, particularly when it's patients that I've known, I've known the family for many years. And I know that we have a cohort of GPs now who are not providing home-based services. But then we also have a cohort of people who are exclusively providing home-based services. So it's not as if there's a service gap. I mean, there's a growing number of young doctors who are saying, actually, you know what, why do I need an office? I'll just see you in your home. So navigating that social space, I don't think I realized at the time, in 2010, when I closed the practice, I don't think I realised the significance of the medical practice in people's lives. I'm saying I don't think, but I just didn't. For me, it was, I was working, I was connecting with people, but in my mind there were lots of other doctors around who could just... This is an urban setting. And I underestimated the power that that relationship had in people's lives.

Dr Maria Christodoulou: 34:39

So let's be more specific, the impact that you had in those people's lives.

Prof Tasleem Ras: 34:44

Ja. I mean, I think I completely underestimated that. If I had had a sense of what value they were assigning to it, I probably would have been intentionally more gentle with making that transition. But I didn't. And I suppose it's one of the lessons that we learn from the mistakes we've made.

Dr Maria Christodoulou: 35:06

I wonder if there is a gentle way to do that. You know, I think that when something comes to an end, there's always grief and there's always a loss of some sort, even if you know that you're moving on to something bigger, better, something that will make a bigger difference, impact more people. There's still an ending of a chapter, and as you say, meaningful relationships that you built over time.

Prof Tasleem Ras: 35:29

Ja, for sure. I think that's a good way of putting it. So I've tried not to make that same mistake going forward.

Dr Maria Christodoulou: 35:38

Right. So what was the pull to academia? What was for you the draw back to academic spaces and contribution?

Prof Tasleem Ras: 35:48

So I'd always been drawn to teaching, always. And I think there was always the teacher that my mother saw that I wasn't maybe aware of, but I knew that my final place in work would be somewhere in academia. Probably unconsciously, I knew that being in clinical practice was just a phase, a season in my life. At the time, there was no reason for me to go and do a master's when I was in private practice. I did that purely because I wanted to do it. There wasn't an opportunity for us to register as specialists anyway. It was just for my own development. And I knew somehow that this thing is going to come help me in the future, so I did it. And it really did help me in my day-to-day work. So there was this, once again, not a very well thought-out pathway. I knew that I at some point I want to get into academia, but I wasn't quite sure how I was going to do it. And when the opportunity came up, I kind of put my name in the hat. It was something which was maybe not within my skill set. I'd never set up a training platform before. I had taught, but teaching and managing a teaching program are two different things. But I kind of understood the fundamental human side of things. That's maybe the kind of gifts my parents gave me, this ability to negotiate with people and use the correct words, all those hours spent in the library. And so the move was, from a professional perspective, the best move at the time. Because it did offer me completely new challenges. And here maybe a word of advice that I would normally give to young general practitioners. I used to teach on the diploma in family medicine, so a lot of the GPs would come and do that diploma. You have to find ways of being constantly stimulated if you want to stay in practice for many years. Right. And I had been in practice for seven years, and by the seventh year, I was looking for more opportunities. But the time constraints of being in full-time clinical practice, being available to your patients, means that you actually cannot explore anything except if you're going to take time from your family, which is another impossibility. So if you're really wanting to grow, if you cannot find the space within your working time, then you probably need to find a different place to grow. And that's where I was. I only know this in retrospect. At the time, I was just frustrated. And I blame the medical aids because they were bringing managed care in, and I said, I can't work with this anymore. But there was a bigger picture that I wasn't seeing at the time. You feel constrained. And the other thing about general practice is that it's lonely.

Dr Maria Christodoulou: 38:33

Yeah.

Prof Tasleem Ras: 38:33

It's a solo place. You know, you can't feed off the creativity of others that much because your income that you're generating requires that you see patients back to back. And if you don't do that, you can consciously not do that, but then, you know, financially, your practice is going to be non-viable. Right. And then you sit with that reality, you've got to pay a bond, you've got to put your kids through school, et cetera, et cetera. So I think that was the pull of academia. I mean, to be honest, I took a salary drop when I moved from the practice into academia. And my wife stopped working because we moved out to Langebaan. So we moved 'sak en pak'. We had three kids at the time. Everyone just jumped in the car. We piled all our furniture in the big truck, and we moved into a new place in Langebaan. And I worked for two years, close to two years, setting up that platform. What was good about that is that we were directly entering into communities where UCT had never had a presence before. And it was fulfilling this twin task, the desires of being like, I wanted to teach, I wanted to practice medicine, and I wanted to be a community activist. So all of those things just got rolled up into this job that really fulfilled me on all of those levels.

Dr Maria Christodoulou: 39:52

Wonderful.

Prof Tasleem Ras: 39:53

As I said, I told you at the beginning, I really do feel really blessed with the opportunities that have come my way. There were difficulties, but you know, what comes with no difficulties?

Dr Maria Christodoulou: 40:04

You've spoken about the pivotal moments where you changed things. You've also said more than once that it wasn't a well-thought-out strategy. What advice would you give a young colleague who found themselves a bit stuck? How do you make the decision about what's next or where to go next? What's been your experience?

Prof Tasleem Ras: 40:23

That's such a good question, Maria. I didn't have a master plan. There was no blueprint.

Dr Maria Christodoulou: 40:29

Right. And I hear that over and over again.

Prof Tasleem Ras: 40:31

I think it's because every moment in life as a health professional is a potentially meaningful moment. So oftentimes we're not looking for an out. We're not looking to escape this meaning that we're generating with our patients or our students. Unless people are, unfortunately, we seeing more and more people suffering from burnout and mental health issues. And that's a push factor out of doing clinical work. But if you don't have that, and you have the positives, and obviously the positives then would outweigh some of the challenges that you're facing. So I had never crafted this for myself. It was number one, out of necessity, and I at the time didn't realise there was this unconscious drive that I had within me to need, every few years... My wife, after a while, said, It seems like every time you get to the point of knowing how to do something properly, as soon as it becomes a little bit easy, then you're getting impatient to move on to the next thing. Right. I feel once again so grateful to have had a partner who had the insight because she would tell me after a few years in the job, I see you're getting bored again. Can we expect there to be some type of change?

Dr Maria Christodoulou: 41:42

Which by implication means change for the whole family, not just for you.

Prof Tasleem Ras: 41:47

For everyone, ja. So the West Coast experience was quite an adventure. You learn things. And my wife was also able in that time to further her studies because she wasn't working at the time. So she had the space. We also had another baby while we were there, but that's a story for another day. We've had babies at different phases in our lives. Every baby marks an epoch.

Dr Maria Christodoulou: 42:09

Interesting. And were they part of some master plan, or did that also just happen?

Prof Tasleem Ras: 42:16

No, master plan. At the very beginning, there was a plan. I won't call it the master plan. When we just got married, we were two young health professionals. We were going to travel the world. We enjoy traveling. So we were going to pack our bags, we were going to not commit to any assets. We were just going to go from one place to the next and just see the world. And then maybe we'd settle back in South Africa. And then three months into our honeymoon, she says, I've missed a period. Uh-oh. I'm like, no, man, that's nonsense. And I remember walking out of the bathroom before the little line appeared. And I said, Can you see it's negative? And she says, No, no, you must watch it for a little bit longer. And ja.

Dr Maria Christodoulou: 43:01

What did becoming a father mean to you? What was that, especially that first experience of becoming a father?

Prof Tasleem Ras: 43:07

Oh gosh. I haven't thought about that. It was a natural progression for me. I've always gotten along very, very well with kids. I'm still a kid myself. I enjoy playing. So I think the transition into parenthood was a natural progression. It wasn't a shock to either Shafiekah, my wife, or I. I think we just grew into it. There's some tough moments, as any parent would tell you, but I think it's not something that we were wholly unprepared for. Maybe at that phase in our lives we hadn't planned for it. Right. But I think we just adapted, and that's been maybe the story of our lives. We've just adapted to whatever life introduced us to along the way. Suppose that's the advantage of not having a master plan, huh?

Dr Maria Christodoulou: 44:01

Yes. Being open to surprise.

Prof Tasleem Ras: 44:04

Yeah, yeah. Else you get irritated by the fact that your plan is being derailed, as opposed to saying, okay, let's just construct the road as we move. Like next year might look very different to this year. Kind of just be open to that reality.

Dr Maria Christodoulou: 44:16

And if I could gather your five children into the room and ask them about their father, what do you think they would say about you?

Prof Tasleem Ras: 44:25

They'd probably say I'm pretty laid back, but I'm also a bit of a taskmaster in terms of setting standards which are not mediocre and wanting them to have balance in their lives. Leading by example, and allowing them to make mistakes. I've learned that, I mean, with from my educational work, that the reflection after mistakes is more meaningful learning than obedience before mistakes. We just hope that the mistakes aren't very big, life-changing ones. But they're also something we don't have control over, is it?

Dr Maria Christodoulou: 45:00

Yeah.

Prof Tasleem Ras: 45:01

We try not to create an environment that gives them a false sense of security in the world because I think we're actually then doing them a disservice. They need to know what the world's reality is. So I've always believed that there's a certain time in your life when we transition to adulthood. And that's not 21 or 18. It happens much earlier. And it happens at the point where you are ready emotionally and intellectually to take responsibility for your actions. That's the point of transitioning to adulthood. And that kind of informed our parenting philosophy, or mine at least, from day one. Before I became a father, I read this chapter in a book written by an American anthropologist who spoke about rites of passage and about how rites of passage in indigenous communities typically happened in the early adolescent phase. Because that's really the age when children transition into adulthood. Might be early adulthood, but it's adulthood. And how, in many, many indigenous communities that have not been colonised, they don't have troublesome adolescent phases in their communities. Because there's a process of socialising adolescents into adulthood rather than an artificially constructed postponement of adulthood until a certain age, 18 or 21.

Dr Maria Christodoulou: 46:31

Or a certain level of education, or you know...

Prof Tasleem Ras: 46:33

Absolutely. So we infantilize our adolescents and young adults at our own peril. And so that's been my kind of parenting philosophy. I kind of prepare them for that, and we've done that now with our children. They still make mistakes, but that's okay.

Dr Maria Christodoulou: 46:50

Well, I think that's human. Do you not make mistakes?

Prof Tasleem Ras: 46:53

No, I make no mistakes.

Dr Maria Christodoulou: 46:56

Okay. Right.

Prof Tasleem Ras: 46:59

No, for sure. We all do. We all do. So I teach them the reason we're holding them to account for their own actions is because we're preparing them for the world.

Dr Maria Christodoulou: 47:11

How would you describe the world that you're preparing them for?

Prof Tasleem Ras: 47:14

Oh, it's probably no different, to be honest, from a social relational perspective than the world that we inhabited when I was that age or that our parents inhabited. People say times change, but I think our basic needs don't change. And so I try and model the foregrounding of strong relationships and whatever feeds into that. So there's this technological advances, that's fine. That's kind of like cream on the cake. But it doesn't matter how the cake looks. If your dough's messed up, then your cake's messed up. And so there's a core socio- spiritual dimension to who we are that we try to give over to our kids. And then we understand that society changes. So they also need to be able to be aware of that and adapt to that. Certainly, we don't expect them to live in our world. Well, I certainly don't. We'd like them to visit us from time to time.

Dr Maria Christodoulou: 48:21

Right.

Prof Tasleem Ras: 48:22

But they need to live their lives, eh? There is no future world. We create that today. We create our networks and we choose who we want to have inhabiting our circles and who not. We are all intimately involved in that process of generating what the future is going to be like. And insofar as that, we, our kids, our neighbors, everyone else are part of that process.

Dr Maria Christodoulou: 48:51

Yeah. You shared a LinkedIn post at the beginning of the year with a prayer for 2025. And you said that your prayer was that you hoped that we find new ways to keep hope alive. And you called for more compassion, you called for justice, and you called for trust that would traverse power differentials and injustice. Say more about that vision.

Prof Tasleem Ras: 49:17

Yeah, I think I wrote that against the backdrop of what's happening in Gaza, ongoing genocide. I'll call it a genocide. About how decisions are made and actions taken which are not based on a set of objective, universal principles that we could all aspire to, which helps us shape what the future could look like. So we all understand that if we want to all live in a meaningful, productive way together, there needs to be a set of shared values that we need to kind of agree on. And what we're seeing unfolding since 2023 is a worsening of the divide between those who have particularly access to financial and military power. A worsening of the divide between them and the ones that they rule over. I find that deeply problematic. I think, as so many other people do around the world, we don't have access to other forums where we can voice our objections to this. So I raised my voice or kind of wrote and I've written a few other pieces also on social media. Because what else are we going to do besides being activists within our circles and activating for change? And it's not just this current genocide happening, it's also other issues that affect our world. We can't be silent observers. Somehow we have to put our thoughts out into the world, which are inspired by other people and which then by themselves may inspire others. I mean, there's this thing to be said about the collective voice. And so I don't post often on social media. But when I do, it's because I recognize that I occupy a position of relative prominence in my profession.

Dr Maria Christodoulou: 51:14

Yeah.

Prof Tasleem Ras: 51:14

And so if I do add my voice to the collective, it's got to be in a way that is also aspirational to a better way that the world could be than what it is, the reality that we're faced with right now.

Dr Maria Christodoulou: 51:27

You've also spoken about faith as quite fundamental to who you are in the world. And I've heard you also say that medical professionals who operate from within an Islamic ethical perspective have something quite important to offer the broader discourse of healthcare and the world. Tell us more about that.

Prof Tasleem Ras: 51:47

So I think let's talk about faith for a moment. When I think about faith, it is intimately related to trust. The two words, to my mind, are very difficult to separate. I've thought about trying to separate them and what does faith mean on its own? And so we say we have faith in God or we have faith in our fellow people. What does it really mean? And the way that I operationalise it is through the word of trust. The deeper my faith is in someone or something, the deeper my trust is. There's lots of other aspects to it, I suppose, that philosophers can unpack, but that's how I, my amateur philosopher, does it for myself. So it's really for me about asking then how can we be in the world with others, with God, in a way that we are constantly finding new ways or stronger ways or better ways to enhance a world which is imbued with trust. Before you can ask that of others, it starts with from within yourself. You can't ask for other people's trust if you are not trustworthy.

Dr Maria Christodoulou: 52:57

Absolutely.

Prof Tasleem Ras: 52:58

And so the discourse around the ethical dimensions of being, it really starts with: I don't want to talk about ethics until I know within my heart that I am an ethical person. And I think the faiths that we have, and I'm speaking of the world faiths, each one of them have fairly well articulated, over many, many generations... There are very well articulated positions on what it means to be an ethical, trustworthy, faithful person in the world. Right. And it's from that perspective. I mean, medical science is only 350 years old, as we know it. It's a little, it's a neonate in terms of its historical contribution to human society. I mean, 300 years is nothing compared to 5,000 years of Chinese wisdom within their healing systems, the Ayurvedic healing systems, which stretch beyond that. And then there's the ways of knowing who we are as humanity. I think, you know, medical professional education, health sciences, medical sciences could do with a very, very healthy dose of humility. And in so saying, there is a position for faith-based discourse to enter into the realm of who are we as health professionals working in this multi-fractured society that we work in? Right. If we're talking about being healers, let's not talk about health professions, medical, let's talk about being healers. From what perspective do we heal? And from what perspectives are we ourselves healed? How can we, as people that are fractured, claim to go out into the world and make other people whole when our own hearts and beings are fractured?

Dr Maria Christodoulou: 54:58

What does it even mean to make other people whole? Like what is the part that we play in that? So who or what determines that? How do we define that? Yeah, those are important questions.

Prof Tasleem Ras: 55:11

And yet we're taught, we're trained that we go and heal people. And the level of internal knowledge is not touched upon at all in all years of medical training, including in what happens in the postgraduate spaces.

Dr Maria Christodoulou: 55:27

I agree.

Prof Tasleem Ras: 55:28

So it's almost as if we're in a moment in history where we've completely secularized who we are. And so we can compartmentalize, okay, so this belongs to Caesar, so we're gonna give it to Caesar.

Dr Maria Christodoulou: 55:44

Right.

Prof Tasleem Ras: 55:45

And then in a different part of my life, but that's not how it operates, is it? You know?

Dr Maria Christodoulou: 55:51

Yeah. Not if you're willing to dig a little deeper than the surface stuff.

Prof Tasleem Ras: 55:56

Absolutely. And I suppose it's a defense mechanism when people say that, you know, I don't get involved. I just do my work and I go home.

Dr Maria Christodoulou: 56:03

Or I'm a scientist. There's no place for that in emotions, yeah. Yes. Or even faith.

Prof Tasleem Ras: 56:10

I suppose it's probably because there's a period in time where we had very limited vision of who we are and what it is that we are doing in the world. And I think I'm not the lone voice in medical education, health sciences education, where... that's saying, no, no, I mean, we really need to reconsider who we are as whole human beings and what that means for our contribution into this thing called education, health systems, etc.

Dr Maria Christodoulou: 56:43

Yeah, I also heard you talking about the situation Western medicine finds themselves in now and all the different challenges of being in this profession as an existential crisis.

Prof Tasleem Ras: 56:55

Completely. I still believe it is. I think it's gonna take us a generation, maybe longer, to get out of this. We're sitting with a situation where about 15% of our graduates in South Africa are retained in the public sector. That's through a combination of just the scarcity of resources in the public sector, but also because the private sector is a much more attractive space to be from a psychosocial well-being perspective. And the reason that is, is because the private sector is dominated by neo-liberal capitalist tendencies, which focuses on the individual as being at the centre of society. And that's how our educational system has also been set up. Yeah. So we're educating young doctors in a neo-liberal, individualistic manner and telling them that these skills that you have and the way in which we're going to examine you is for you and this individual patient. And your job as a medical professional is to benefit this patient to the utmost. And then we set up our public health system to benefit the majority. Right. And the question of individual rights becomes secondary to the utilitarian approach, which is about the greatest good for the greatest number of people.

Dr Maria Christodoulou: 58:08

Yeah.

Prof Tasleem Ras: 58:09

I'm not making an ethical call, I'm just saying there are two ethical powerhouses in play, which are clashing.

Dr Maria Christodoulou: 58:16

Contradictory ones, yeah.

Prof Tasleem Ras: 58:17

Which are completely contradictory. And the people feeling the brunt of it are young health professionals.

Dr Maria Christodoulou: 58:24

Ja.

Prof Tasleem Ras: 58:25

They've been trained in this neoliberal individualistic system, but they're being thrust into this utilitarian system, and they're right at the nexus where these two opposing philosophies are meeting. They don't know what the hell hit them. I've got nothing but compassion for them. Because you know, sometimes you know what's coming and you can prepare yourself. They don't know what hit them. Yeah. The sad thing is that many of my colleagues also don't know because they haven't seen this bigger picture. The clash of philosophies, which we're seeing every single day. So I'm not quite sure whether I will see that change. What needs to change? Do we change the way in which our system operates? Do we change the way in which our health education operates? How do we change our medical professional who is just basically reflecting what their own culture has told them is the right thing? So I am realistic in the sense that I'll raise my voice, I'll write some pieces, but change happens at this level, at the macro level, change happens in very, very slow, incremental ways.

Dr Maria Christodoulou: 59:36

Yeah. And, you know, something else you said, something that stayed with me was about how education needs to be both empathetic and wise, particularly in very harsh clinical environments. And I'm curious about what your thoughts are on how you translate that into concrete actions or even teaching strategies in those under- resourced settings. What does that mean?

Prof Tasleem Ras: 59:58

I think the combination of empathy and wisdom is something that comes with experience. I've been with junior colleagues teaching them about opening yourself emotionally to a patient's experience, practicing with empathy. And I, without fail, see them being completely overwhelmed when they truly listen, because they've heard it before, but they've never really listened. When they truly listen to the suffering of the person who's in front of them, it's overwhelming. Yeah. Because you recognize that actually you've got so little power to help this person. And what you've been trained for is to write a prescription.

Dr Maria Christodoulou: 1:00:38

Absolutely. I was gonna say, and what you've been trained for does not equip you to deal with that reality that there's so little you can do to help them.

Prof Tasleem Ras: 1:00:47

Yeah. So there's the threat of being overwhelmed by empathy. And so I caution my trainees that there needs to be a point at which you step back. So, in as far as I'm saying go to the brink, make yourself available, but there also needs to be a point where you step back, and that's where the wisdom comes in. So that comes with experience. And the wisdom then tells us, you know, you need to also understand your place in the world. And sometimes when someone's suffering, it's enough just to be alongside them. Yeah. You do not always need to be the saviour.

Dr Maria Christodoulou: 1:01:26

Yeah, perhaps it's even more important to be there alongside them than trying to be the saviour.

Prof Tasleem Ras: 1:01:32

Absolutely. And oftentimes my students would come back and say, Tasleem, I did nothing for this patient, but they're thanking me. Like I just sat there and I let them tell their story. And that would be a recurring theme. But we know, having been in general practice, that oftentimes people just need a sympathetic ear.

Dr Maria Christodoulou: 1:01:52

Yeah.

Prof Tasleem Ras: 1:01:52

An ear that they know there's no judgment, it's in a trusting environment. They don't have the expectation that we step in and save the world. They are just people who need to tell their stories. And this for me is a kind of an indictment on our society, isn't it? That people are so hungry to tell their stories. As a society, we don't have the spaces where people can tell these stories. We have it in our families and I suppose in our social circles. But, you know, being in an urban setting, I've been quite aghast. People come and say, Well, I can't tell anyone about this. I don't know who I can trust. Within the family context, within their friends. I'd rather not tell anyone, so I'm telling you. Right. And I think we need to prepare our young people for this reality that oftentimes you're just someone who sits there and listens. The thing about empathy is that the most important thing to practice empathy is to have functional ears.

Dr Maria Christodoulou: 1:02:52

Functional being the operative word.

Prof Tasleem Ras: 1:02:55

Obviously on many levels, but being able to listen is a skill in and of itself.

Dr Maria Christodoulou: 1:03:02

Yeah.

Prof Tasleem Ras: 1:03:02

I mean, the wisdom for me comes with being able to navigate through these stories. I remember one of the authors that we use in family medicine training, Ian McWhinney, the Canadian who wrote in the 1970s, speaks about when a patient decides that they're going to tell you their story, understand that they are taking you into the sacred ground of their life.

Dr Maria Christodoulou: 1:03:25

Yes.

Prof Tasleem Ras: 1:03:26

It's sacred. They don't just let anyone hear their secrets. And so if you have the appreciation that you are stepping on sacred ground, how you are, what you say, how you respond gets seen through that lens. And there's this whole thing about when you asked me about faith earlier on, when there's an absence of faith, there's an absence of us holding things sacred. Because the two go hand in hand, isn't it? Yes. And so us building faith in our relationship with our patients is really about us holding things sacred that they hold sacred. And when they see us doing that, the trust levels starts to increase over time. Like, wow, you know, I went to this doctor, I told him the story. The response I got was as if he or she was holding something precious, you know? And then can you just imagine what the world would be like if that is how practice was?

Dr Maria Christodoulou: 1:04:26

Yeah. It's interesting you mentioned McWhinney because I read one of his textbooks many years ago, and I remember the piece that stayed with me was about how the technical competence of medical school is emphasised, and the knowledge and the skills that we have to acquire in order to practice medicine is very important. But he also spoke about the second sidelong path of who we become in the training. How in most indigenous cultures, the path of becoming a healer or a shaman had these two very different threads. The one was the tools of the trade, and the other was the initiation, which was a ritualistic sacred thing of acknowledging that you were part of something much bigger and that you were subject to that sacredness, I guess, or that there was also a requirement that you grapple with matters of life and death and confront your own mortality.

Prof Tasleem Ras: 1:05:20

Absolutely.

Dr Maria Christodoulou: 1:05:31

And so for me, there's also something about how, in some ways, I think medical school is in denial about the rituals and the processes and the way in which the identity is constructed and the way we think about what health is and what the role of the doctor is, and that our students are taking that on. And then in that, you called it an individualistic sort of paradigm. If I'm the expert, then I am responsible. Then it is my task to find the solution or to have the intervention that's going to fix this. And there's no possibility for me to hold a space for something bigger than both of us at play here, some humility, some surrender to the shared experience of being human that includes suffering.

Prof Tasleem Ras: 1:06:18

So isn't that a very rich way to learn?

Dr Maria Christodoulou: 1:06:21

Absolutely.

Prof Tasleem Ras: 1:06:22

It would be. The problem that I see is that we start off at the point where we don't feel as if we can trust others with our vulnerability. Once again, it's kind of an offshoot of a society which values competition. Where if we see weakness or vulnerability in someone else, we then go and exploit that so that you know we can get a heads up on that person. And that's why I call it an existential challenge. Because it means that something needs to die. An old way of thinking, an old way of being needs to become extinct for a new thing to exist. And that process doesn't happen in the twinkling of an eye. It happens over time. It happens when people in decision-making powers make certain decisions in a very conscious way. But it also happens when people start valuing different things in their relationships, in their professional relationships. When they start saying, you know, hang on, doing an operation that takes three hours and that's going to earn me R 90,000 in that three hours, but then I don't really know who this person is that I've just operated on. That's a question of values. Like what do we value as a society? And those are big questions, you know, and so those things change over generations. They don't just change because someone said something clever.

Dr Maria Christodoulou: 1:07:48

We've dived a little bit more into some of the philosophical perspectives of being in this profession. What are some of the things that stand out for you as highlights in your career so far?

Prof Tasleem Ras: 1:07:58

Oh gosh. Yeah. I mean, there's been many. I must say one of the absolute highlights was the COVID response. I mean, this was really something where people pulled together, where you felt like you were really part of multiple strands coming together in just one big sea of humanity. And in that space, we could talk about our emotions. So I was a clinical manager at the CTICC Hospital of Hope, the first field hospital, and we spoke about our emotions all the time. It was such a liberating space to work in. It was hard work, people were dying. The extent to which we were able to humanise care, for me was just next level. In our hearts, we were hoping that this would continue post-COVID. If there was anything that we wanted to carry with us after COVID, it was the fact that we were able to humanise not just care, but also care for our staff and how we interacted, how we engaged. Certainly, that few months that we were able to run that service was an absolute highlight. It took a lot of the principles which I thought were maybe unattainable, and it crystallised it into an operation which I'm going to say it was just fantastic to be part of. We cared for each other, we created space for people to be debriefed on a daily basis. The private sector came in and said, What can we do? And we spent less money than what it takes to run a normal hospital. We connected with patients, we connected with patients' families. For me, it was a possibility of what our health system could be like. And anybody that comes in is a naysayer, we now have evidence to say, go back and see what we did together.

Dr Maria Christodoulou: 1:09:40

I've had more than my colleague talk about that time in the way that you're describing it. And I guess I find myself curious about why isn't that model sustainable? Why do we drift back to old ways and habits post-COVID? What was it about COVID that facilitated that? And what do we need to have happen in order to continue working together in that way? Why does it have to be under conditions of crisis?

Prof Tasleem Ras: 1:10:06

Well, that's exactly it. Now we're going to get back into philosophy, Maria.

Dr Maria Christodoulou: 1:10:10

Right. That's okay. I think we're both a little bit of a philosopher at heart. So these are big existential questions.

Prof Tasleem Ras: 1:10:19

So I think there are two opportunities for people to come together just out of the human experience. The one is through celebration, and the other one is through suffering. Right. And Wahbie Long, who's a head of psychology at UCT, writes about in his book Nation on the Couch, he writes about the collective emotions of people sitting watching a football match. And they don't have to talk to each other, they're not communicating with each other. They're watching a unitary spectacle and so the oohs and the ah's and the collective sighs and gasps and the cheering is all completely spontaneous, but it's in harmony. And similarly, if they were observing people in a cinema watching a horror movie, have the same type of emotional responses. And I think with COVID, it was the fact that we shared vulnerability, all of us. There wasn't a single person who was untouched. And the fact that it came from the rich Western countries and moved to the global south just meant that the media was on it more. If it had started in the global south, chances are the media wouldn't have latched on. It would have been just another disaster happening in poor countries. So the media captured people's imagination. But then reality kicked in when we realised, hang on, we're all in this together. Sitting at the CTICC, I would get phone calls from heads of departments that I didn't know, but they would say, listen, we've got this new research that came up. This could potentially help with how you guys are working. Things that hasn't happened since.

Dr Maria Christodoulou: 1:11:47

Interesting.

Prof Tasleem Ras: 1:11:48

So I think there's something to be said about shared vulnerability. And in COVID, that was thrust in our faces. I mean, we do still have shared vulnerability, but it's not front and centre of our public discourse. That's how I've rationalised it. And people have short memories, unfortunately. Yeah. Society has short memories. If I could change anything about the world, it's that we'd have longer memories so that we don't get rooted in instant gratification. This desire for immediate results and immediate answers that's led us down this slippery path. I do regret that we weren't able to maintain that.

Dr Maria Christodoulou: 1:12:24

What about some other highlights of your career?

Prof Tasleem Ras: 1:12:27

I spent two and a half, three years working in Delft. And people kind of raise their eyebrows when I say Delft was a highlight. Absolutely, Delft was a highlight. I mean, I really learned about community engagement. Maybe people don't know what Delft is. It's a really poor community on the outskirts of Cape Town. And it's made up of people who have been doubly or triply displaced. It's one of the youngest townships in South Africa. It was formed in the late 90s. And it's just got very little roots. And one of the things that struck me about working in Delft was that the old people would come and tell me, I live in my daughter's house. Rather than if you go to a place like Hanover Park, which was formed in the late 1960s, or in Woodstock, which is even older than that, or in Bo-Kaap, where people would say, I live in my mother's house. The owner of the house holds the authority and in Delft, the younger generation held the authority. And so the rules that govern that community is different than the rules that govern many other communities. Being a family physician who wanted to get into community-based work, that was a real highlight. The receptiveness of community members, the ingenuity, their resilience in the face of really, really hard times, the ability to understand forever changed my ways of thinking about people living in poor communities because up until that time I just used the popular words of these are disempowered, unengaged individuals. And so their health outcomes is because they're disengaged and unempowered. You move into one of these communities and you realize there's nothing which is disempowering. If I had to live there for two, three months, I wouldn't have survived. Right. I just didn't have the capacity to be as resilient and innovative as those communities. My intention was to retire from that space. But then UCT once again came knocking at the door. It taught me about the reality of a space that I had thought I knew, but which for the first time I was deeply engaging with as a professional. You know, in our political speak, people often talk about the rural poor. The rural poor as being kind of the most marginalised. I think that we're missing the urban poor. And in many regards, urban poor are experiencing poverty in an even more violent way because rural communities still have social capital. Right. Which sustains them in times of great economic need. Oftentimes, in the urban poor, social capital has been eroded. It's nonexistent. The gangsterism, substance abuse, and the mental health issues mean that the social capital over generations has been eroded. If we think about poverty in a holistic way, to me at least, having worked in poor rural areas and poor urban areas, that's why the Delft community held such a close space in my heart because I learned from them what poverty is, but how poverty doesn't define. I mean, so I came from a working class background, but I never knew poverty. You know, we had food, we had very strong relationships in our house growing up. There were times when we struggled financially, but that's okay because that was what life was like. But I really came to know the depth of human ability when you see how people grapple with real poverty.

Dr Maria Christodoulou: 1:15:59

You describe it as a highlight. So I find myself wondering about some of the challenges maybe you've experienced in your life. What have been some of the vulnerable, scary moments for you?

Prof Tasleem Ras: 1:16:12

Probably not so much in the working life. I've been very philosophical about the ups and downs in work life because I recognize that work is just part of life and it's just one fraction of what life is. Suppose, as all of us, there's been really difficult health scares. My wife and the youngest son in 2015, after four healthy pregnancies, she suddenly had a birth complication which threatened both her life and the baby's. And that was probably one of the most scary times that I've ever experienced. Yeah. What pulled us through was faith. You alluded to it earlier. And in this instance, it was faith in God and understanding that we are mortals. So death is an inevitability. And if it's going to visit you at a time when you think it's inconvenient. So, I mean, to confront death, I think was one of the most scary, hardest things to do. Confront the death of my partner and the child. And it took a few months for us to go through all the medical issues, and then it took years to find some type of stability, just finding yourself back in life. Right. That happened about 10 years ago. It's an experience that many, many people will have. The thing is, you know, what really struck me also, and I'm let me put my professional hat on here, is that the willingness of my colleagues, I call them my colleagues because I mean we were on medical aid, we were in the private hospital, but people were coming in and they were just helping. Yeah, we were paying them. But at the time I wasn't even thinking about the payments. Coming in and having conversations with us and helping us through the next medical. Anybody that's experienced a medical complication from the patient's perspective would know that it's never just the one thing. Because then there's another consequence and another one and another one and another one. And we went through a series of these things over a period of about a month and then the recovery phase afterwards. And it really gave me renewed respect. You know, maybe up until the time I was a little bit jaundiced about people working in the private sector because of my ideological approach to the practice of medicine. But when I had that experience, I kind of rethought that approach. Because certainly the great colleagues that we worked with, nursing and everyone else, really kind of opened my eyes to what it means to be a patient on the receiving end of honest, authentic, empathic practice. Completely grateful for that. And it just shows the possibility of a new world where relationships and humanising healthcare is a desired value.

Dr Maria Christodoulou: 1:18:57

So perhaps that brings us to what you said at the beginning about maybe having a chance to look into the future. And you've alluded to a lot of different things that could form part of a future medical model.

Prof Tasleem Ras: 1:19:08

Yeah. What's your hope? What's your vision for medicine, but also for yourself? So let's break that into two questions. Yeah. Those are also hard questions. So just for myself, I'm in a space now where I'm able to facilitate the work of others. That's primarily what I see myself doing. And also I have some influence in where they and how they're directing the efforts and resources. And I'm very intentional about that because I think it's not just at UCT, I think at other universities also. If you look at the new university in Gqeberha, I see one of the previous people that you interviewed is Prof. Elma De Vries. Yes. Elma's doing great stuff in Gqeberha at Nelson Mandela University with her young graduates. So it's not just me, but it's me being part of this group of people who are saying, you know, our elite universities have for many years not been focused on the well-being of communities who exist next door to them. And so a lot of my efforts currently are focused at engaging within conversations within the faculty, but then also engaging with communities. The key question being: how can we reimagine what my institution, UCT, can be like in becoming a completely community-focused institution without losing sight of the global impact.

Dr Maria Christodoulou: 1:20:39

Of course.

Prof Tasleem Ras: 1:20:40

So you don't necessarily lose your focus on global impact, you expand your gaze to include communities.

Dr Maria Christodoulou: 1:20:48

And you expand the vision of or scope of the academic endeavour beyond the pursuit of more knowledge and expertise.

Prof Tasleem Ras: 1:20:56

Yes. What I've learned in my engagement with communities is that they have knowledge which we can benefit from. How do they survive in these crime-ridden areas? Our young doctors are not wanting to work there. They have something to learn from these communities. Because the reality is that at some stage they will have to work there. So for me, my department, the Department of Family, Community and Emergency Care, intentionally is being placed in a position where we are community-facing. And our voices in terms of how we transform our training is going to be raised. And so, from an operational perspective, that's the future. That work will probably animate my life for the next 10 to 15 years until I'm more gray than what I am and sitting on the stoep in the sun somewhere. So that's kind of operationally. And then obviously, I mean, I think we've spoken about the world in which we want this to happen. And that's a process that we need to also be part of. I think we just need to trust that what we put out into the world is going to land and grow. And we're not always going to be witness to kind of the fruits that it's going to bear or the shade it's going to give. You kind of just need to accept that my role is to plant the seed. Yeah. Someone else will water and nurture, and then this thing will grow. And then I might not see where it lands, but I know that I've planted.

Dr Maria Christodoulou: 1:22:27

Yeah.

Prof Tasleem Ras: 1:22:27

If we can have a world where people are just planting or nurturing or harvesting, mindful of the fact that they didn't do all of it. Because oftentimes when we harvest, we want to take all the credit for harvesting.

Dr Maria Christodoulou: 1:22:41

Right. Yeah.

Prof Tasleem Ras: 1:22:42

You know, and there's generations before us that have planted and nurtured, which allows us to harvest. And so that would be a nice world to live in, huh?

Dr Maria Christodoulou: 1:22:50

Absolutely. And for our children and grandchildren to live in.

Prof Tasleem Ras: 1:22:54

Absolutely.

Dr Maria Christodoulou: 1:22:55

Is there anything I haven't asked you that you would like to share?

Prof Tasleem Ras: 1:22:59

This has been the most thorough examination of my life that I've ever had, Maria. I don't think I've ever been asked these probing questions. I just I just, at least if I get arrested for a crime and they start interrogating me, I'll have... I'll have some type of prior experience.

Dr Maria Christodoulou: 1:23:17

So it felt like an interrogation?

Prof Tasleem Ras: 1:23:20

No, it wasn't. I mean, I was I was quite amazed at your ability to go between questions and remember something I said at the beginning. It was extremely well... As someone who teaches communication skills to students, and I try to teach in an organic way of kind of weaving a story rather than being hyperstructured in in your consultation. Super impressed. And I didn't see you taking notes, so very well done. At least your ears are fully functional.

Dr Maria Christodoulou: 1:23:49

I work at it. So is there anything I haven't asked that you would like to share?

Prof Tasleem Ras: 1:23:55

I can't think of anything at the moment. Just to thank you. We really don't have reflective spaces. The world moves so fast. And we lament it all the time, don't we? We kind of say that, you know, yeah, I must sit down and I must do this. We must, we must reflect. And then we just move at 120 kilometers per hour into the next project. So I just want to thank you because this has really been it's been kind of, in an odd way, almost cathartic. I mean, to be able to sit down and talk about my life. It's not part of who we are. It's like not my culture to talk about like the stuff that I did. You know, we focus on what others are doing, focus on the future. So I really do want to thank you for that, for building this platform where we can do this type of reflection.

Dr Maria Christodoulou: 1:24:40

My absolute pleasure. And I will say this: I've had more than one young doctor reach out to me after listening to one of the episodes and going, you've given me hope again. If this is what it means to be a doctor, if I can be a doctor like this person, then there's hope. Then I can find my place in medicine.

Prof Tasleem Ras: 1:24:57

Yeah, I think that's a seed being planted, isn't it?

Dr Maria Christodoulou: 1:25:00

Absolutely.

Prof Tasleem Ras: 1:25:01

Thank you, Maria.

Dr Maria Christodoulou: 1:25:02

Thank you too, Tasleem. Thank you for making the time. Thank you for the heart and the wisdom and the care that you bring to the profession and I'm sure to your students. Otherwise, you wouldn't have been awarded the Distinguished Teacher Award. But also for the vision you hold for humanity and for the profession. Because I think, as you said in one of your posts, we're going to have to dig quite deep into the recesses of our heart to find the courage to create this world. I think that when there are people like yourself advocating for that, that gives me hope.

Prof Tasleem Ras: 1:25:38

Yeah. And it's hope that that sustains our actions in the world. If we were devoid of hope, then we'd be in a very sad place. My last comment I want to make, I'm watching the series called The Sandman on Netflix at the moment.

Dr Maria Christodoulou: 1:25:53

I don't know it. Okay.

Prof Tasleem Ras: 1:25:54

Kind of a surrealism. It's very interesting. I enjoy these odd things. And in one scene, the sandman has to battle the devil. So Lucifer. So battles Lucifer. But it's not a physical battle, it's a battle of ideas. And eventually it's the sandman who's the master of dreams, obviously.

Dr Maria Christodoulou: 1:26:16

Right. I was just thinking that. The master of dreams puts people to sleep.

Prof Tasleem Ras: 1:26:19

Yes. So the master, but he makes people dream. And so what defeats Lucifer is hope. Because Lucifer can't find an idea which defeats hope.

Dr Maria Christodoulou: 1:26:32

I love that. Thank you.

Prof Tasleem Ras: 1:26:34

So I'll leave it there. Thank you very much. Thank you, Maria.

Dr Maria Christodoulou: 1:26:39

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, and Spotify, and go to Apple Podcasts to subscribe, rate, and give us a good review. Thank you so much for listening.