Mark Slack: Moving to the UK

Chris - You go through medical school. Where does military service fit into your career? Is that done before, during, or after medical school?

Mark - So when I was at school, military service was supposed to be done at the end of school. It was one year and we could get permission to defer that to go to university, which I did in the hope that military service would have disappeared by the time I got to the end of medical school. But, by the end of medical school, military service was two years - so that was an absolutely spectacular own goal. However, you had three choices; you did your military service, or you went to jail, or you left the country but there was no return. I didn't have the moral fortitude to go to jail for seven years, so I elected to do my military service as a doctor serving in the army.

Chris - I spoke to a South African who was in the armed service and he said that military service was really quite fearsome in South Africa. He described an experience that they called the 'Garden of Pain.' Are you familiar?

Mark - I'm not familiar with that particular term, but it was quite fearsome and training was fairly fierce as well. It was an interesting one. I volunteered to serve a lot of my time in my national service in Angola because that way I wouldn't be serving against South Africa... There are lots of moral and ethical discussions about it, and one or two of my friends actually chose the other way and went to jail, for which I admire them terribly. But it's a difficult decision to make.

Chris - What was the gig in Angola, then? For people not familiar with the geography of Africa, that's a bit further up the continent. So what was the relationship there and why was there a presence in Angola?

Mark - It's a complex one. South Africa had Namibia as a protectorate. It was a legacy after the Second World War. They controlled it and they wanted to keep controlling it. Angola was under Portuguese control and the Portuguese suddenly left almost overnight. At one point there was a war of independence going on. There were three rebel armies fighting the Portuguese, and one was Marxist based, unsupported, and the other two were American based. The Portuguese suddenly said, "Oh, enough's enough. We're out of here" and they left, literally. So then there started a civil war with people supported in the North by Russia and Cuba and the armies in the South supported by America and South Africa. South Africa wanted to do it to keep the freedom fighters for Namibia further away from the border, but it was a South Africa supporting Angolan civil war with Angolans fighting Angolans.

Chris - So you did that for two years and then you came back. Was that when you travelled down south and went to UCT, University of Cape Town?

Mark - The army, ironically, was the reason I landed up in gynaecology as well. We would fly out of Northern Namibia, pick up the people, bring them back, they'd be operated on, and then we'd fly them home. I did some time working for one of the rebel armies as well, as a medical officer. But when you were on what they called 'R and R,' 'Arrest and Relief,' I was then put in the military hospital in Pretoria and I was placed in the gynaecology department. There was a really inspirational man there called Dick (?), who's the head of the gynae department. He said "Oh, what are you going to do in the future?" I said, “I'm going to be a physician. That's my academic bend." And he said, "You probably can't pass the gynae exams." Cut a long story short, he persuaded me that this could be a really inspiring career and I still had to think about it when I came out. I went back to thinking about doing internal medicine, but he'd planted that seed. Then I moved down to Cape Town to do gynaecology formally as training.

Chris - How long were you down there for?

Mark - I was in Cape Town for about six years. It was a combination of obstetrics and gynaecology. I worked at the famous Groote Schur hospital where the world's first heart transplant was. In fact, I can remember one day operating, doing a very minor procedure, and then becoming aware of a plaque on the wall that said, 'This is the theatre where the world's first heart transplant was done.' I'm pleased to say they've now converted it into a museum and it's no longer being used by low level gynaecology trainees.

Chris - I've driven past that building just recently, in fact. I was in Cape Town quite recently and it's a very impressive building, isn't it? You drive past on the motorway from the airport going into Cape Town.

Mark - Yeah, it's a beautiful building, the old Groote Schur. Of course, the main hospital's now in the modern building in the front of it and that's largely medical school and so on. But that's the hospital I trained and worked in. The style of delivering care in Cape Town was quite unique. It's something that I think the world could learn from: they didn't have enough doctors, so they promoted using what we called 'midwife units' to deliver a lot of the babies who had strict protocols. When you got problems, where there were problems, they would be transferred across to the main hospital. So they actually delivered a high level of care in delivering babies in a much more affordable way, and without the same numbers that you would've had in Europe or UK in terms of obstetricians, gynaecologists.

Chris - Many people who come to the UK from other countries, though, pregnant women who are going have a baby, are quite surprised that we have midwife led birthing units here. They're quite used to a very medicalised way of having children in their own countries, America especially.

Mark - It's a very difficult and controversial area. I don't think one size fits all. I think the two professions need to work closely together and, in fact, they have got that far more. I think the argument, "Everything's got to be a natural delivery" - multiple reasons why that's nonsense. And "Everything's got to be a medicalised delivery" is equally not a good one. I think the hybrid model that Cape Town actually had, working with respect for each other and for the constraints and the limitations was, actually, in retrospect, an amazing system.

Chris - When did you first come to the UK?

Mark - We all used to come to the UK to do a bit of extra training - I won't repeat the term that was used, but anyway. It was coming to practice, our surgery, and the NHS was seen as a fantastic place to practise; high levels of care, high volumes of work, low numbers of doctors. The waiting list is almost like an Argos catalogue: "I'll have two of those, three of those" and we all came to district hospitals. So I trained in a teaching hospital in Cape Town and, in fact, my whole career was in teaching hospitals, but I then actually came to work in a DGH in Canterbury in the United Kingdom. That was my first job and it was just an incredible experience. We saw so much and we are allowed to do a lot. It was a great early experience - I just forgot to go home.

Chris - So that was literally the first and last time you came to the UK to do medicine or surgery?

Mark - I'd been given a senior lecturer post in Cape Town and I was just coming for a year or two. And after my first year I asked for an extension, which I got from Professor Davey, and then, after my second year, when I said, "Could I have a third year as extension," he said, "You make up your mind now - you either come home and your job is here or you stay there and your job is gone." And I stayed.

Chris - When are we talking? Mid nineties?

Mark - This was in the late eighties, early nineties. And I'll be quite honest, one of my reasons for staying was I really did not believe that the South African government was going to capitulate and give up apartheid. A lot of us were looking for a way out of a system that we felt was just destroying a country, destroying people, and so a lot of my generation left.