It wasn't ever "Isidor", just "Issy" from the start. His father came to
South Africa from Latvia, fought in the Boer campaigns and was decorated for valour in World War I. "Issy" grew up with seven siblings in a rough, mixed-race neighborhood of Johannesburg. It was still "Issy", in 1962, who collected his medical degree at the University of the Witwatersrand. And it stayed "Doctor Issy", when in 1966, married to Arlene and with the first of three kids on the way, he set up as a GP in the sprawling black slums of Soweto. He admits that was "a funny career move for a young white doctor back then." But, as he explains, "in my family we grew up with black playmates. It wasn't such a strange idea to me."

Scars of apartheid

Along with disarming informality, ebullience appears to be another lifelong trait, though at age 70 it has eased back nicely into cruising speed. Issy Segal seems happiest in a crowd, face split into a trademark grin, eyes glinting with curiosity. But the sunniness is by no means constant; the creased features can suddenly turn grave. Then you sense an unsmiling toughness, the legacy of years of clinical improvisation and a life-long refusal of the status quo. There are darker things here, too, the scars of battles with apartheid. And underneath it all, a stillness: the man listens carefully when others talk, the head watchful, stubborn. Gastro-Pro's Timothy Nater caught up with Issy Segal MD after a lecture delivered March 17, 2004, at the Royal Tropical Institute in Amsterdam.

Professor Emeritus Isidor Segal MD, impeccable in pin-stripes, still greets strangers with a simple, "I'm Issy". He has taken a long and deliberate step away from the teeming wards of Soweto's 3,200-bed Chris Hani Baragwanath Hospital where he made his career. Issy Segal has been practising since 2002 at the Prince of Wales Hospital in Sydney, Australia, partly to be closer to daughter Hadass, an editor for television, and partly to emphasize his handover of the African Institute for Digestive Diseases (AIDD), a pioneering teaching center he built, to a black South African successor.
 

'A world of its own'

The young Issy Segal's general-practice stint in Soweto lasted five years. Then, after four more years of specialization, in 1973 he set up in gastroenterology. "I've always been interested in nutrition", he explains. "Besides, I wanted to offer a specialized service to disadvantaged communities. Medicine is not about making money, but about offering help to people who normally cannot afford it." His move to the gastro unit at "Bara", as it's known, launched a remarkable career. OMGE Vice-President Eamonn Quigley MD calls Issy Segal "one of the world's grandees of gastroenterology". Says Quigley, "Unless you go to Baragwanath Hospital, you won't get the full measure of the man's accomplishment."

The hospital, by some measures the world's largest, emerged from the collapse of apartheid in the early 1990s with its reputation undimmed. As South Africa struggled towards its new, post-apartheid identity, Issy Segal and colleagues hustled to create at Bara the world's first GE center devoted exclusively to research and training Africans. With grit, bootstrap efforts and powerful friends in Europe, the AIDD was finally launched in 1999 – just as diarrhoea, viral hepatitis, malnutrition and the epidemic of AIDS was breaking over South Africa like a tidal wave.

Checking the schedule: Tough beneath the grin

Toxic legacy

Clearly, medical teaching is an Issy Segal obsession, and he says a crying need remains for it in South Africa. Issy points out that far fewer medical professionals enter training than are currently leaving the country: "The skills brain-drain is having a tremendous impact", he says. "Unless we get more blacks to participate in medical training, there's a disaster looming." He pines about missed opportunities, lost time and an erosion of standards. "It was terrible to see black colleagues come in from Makerere [Editor's note: Makere University, Kampala, Uganda] who'd barely touched a proctoscope, let alone a fibre-optic endoscope", he says, with a slow shake of his head. But Issy Segal's saddest burden - and biggest foe - remains the insidiously toxic legacy of apartheid in education and medicine.

South Africa's racial policy of apartheid, Afrikaans for 'separateness', lasted from 1948 until the country's first all-race elections in April 1994. Apartheid denied advanced schooling to blacks and taught, among other things, that they were incapable of medical learning and research. "Our experience with teaching African doctors has shown that to be nonsense!", says Issy Segal. "But this has stuck in many white and black minds, even today".
 

Hopeful change of heart  

"It's not just ignorance – you can fix that", he says. "It's also timidity, self-doubt, a lack of self-confidence in blacks that they're as good as any. This was a terrible effect of apartheid and it's not so visible, at first: the seed of doubt that was planted and nurtured by the state-controlled media in the minds of both blacks and whites that blacks are not really up to it. "

Nevertheless, the South African government is now committed to medical education, he says, a positive effect of AIDS activism and a change of heart by the government in Pretoria over AIDS therapy. In another 10 years, Issy Segal believes, apartheid's after-shocks will be substantially weaker. In the meantime, he says, more and more physician-trainers and GE networks are in place and ready to go.

Issy Segal's clean break with Soweto left the African Institute for Digestive Diseases that he founded in the hands of Reidwan Ally MD, "an excellent black gastroenterologist". The South African Gastroenterology Society has picked up the Segal GE training model and is running with it in a nationwide programme. From his distant vantage point in Australia, the South African expatriate can draw comfort from the fact that, in the drawn-out contest between apartheid's drive to close down minds and his long struggle to open them, the latter is prevailing.

Other pages in this news feature

Dysfunctional healthcare means "desperate call" for training
OMGE wins major private sector award
Low-profile largesse - The Helffer-Kootkar Prize Foundation
AIDD: an African 'first'
OMGE training centers in seven countries - and counting

Slow victory against the after-effects of apartheid

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19.04.04