Anne Digby and Howard Phillips, with Harriet Deacon and Kirsten Thomson, At the Heart of Healing: Groote Schuur Hospital, 1938–2008 (Auckland Park, South Africa: Jacana Media, 2008), pp. xxxii + 398, R250.00, hardback, ISBN: 978-1-77009-642-4.

Abstract

This seventieth anniversary volume on Groote Schuur Hospital (GSH) in Cape Town, South Africa, is a significant contribution to the country’s medical historiography. It is an analytical account of the world’s first heart transplant institution framed within wider social, financial and political perspectives, and is a contrast to the usual ‘histoire evenementielle’ of health institutions in Southern Africa. Part One gives an overview of the institution, from its protracted birth between the 1910s and the 1930s, to the challenges and changes of the late 1980s to 2000s. Those involved in the hospital experienced many stages of enthusiasm and doubt, as well as changes of vision, structures and practices. This detailed work traces the empirical development of services and the GSH’s management; the second part deals with racial segregation, often seen as South Africa’s main disease, which affected the daily life and work of people involved in the hospital. The authors recall that racial segregation was planned and applied long before the apartheid policy that followed the Afrikaner National Party’s victory in 1948, was made official. From the start, the hospital’s architecture was that of a typical South African public institution, with whites entering through one entrance, and Indians and Africans through another. By becoming a racially integrated institution in 1987, the new GSH took an early step towards curing the racial disease a few years before October 1990, when racial segregation in public hospitals in South Africa was officially brought to an end. The third part, entitled ‘People’, studies the GSH’s well-established teams of doctors, matrons and sisters, as well as those who were still finding their way professionally: dieticians, physiotherapists and occupational therapists. The role that all these people played in the growth of GSH was extremely important, and is examined through the experiences both of the general workers and of the patients. Thus, this book stresses the ‘history from below’ perspective favoured by Roy Porter and Barry Smith. In indicating that the nurses perceived the matron as close to ‘God himself’, and the sisters as close to the Angel Gabriel, the book successfully raises a complex anthropology of relationships between staff within GSH. The relationships between patients were equally complicated. Nostalgic for the privileges afforded by segregation, white patients disliked being squeezed ‘tightly among all colours and odours’ (pp. 115–16), when they had to wait together with non-white patients, and their complaints confirm the complexity of perceptions and consideration of the ‘Other’. The fourth part of the book examines the development of two significant tools used at GSH: clinical medicine and research, which between 1955 and 1985 became the hospital’s strengths. While very analytical, the work is at times too detailed and repetitive, and there is a certain imbalance between the parts, with Part One running to a hundred pages, and Part Two to only thirty-one. An additional annoyance is the awkwardness of having the references at the end of the book, rather than at the end of chapters. But these are small quibbles, and this new history of Groote Schuur Hospital is a timely and fascinating work. It features the medical progress and challenges in a particular context in Africa, and proves that, as a social and biomedical institution, the hospital is a microcosm of society. The book’s main significance, however, is that it challenges a particular way of writing the history of hospitals and medicine in Africa.