Dr. Kgosi Letlape needs no introduction. In South Africa and the World Medical Association, he is an institution. He is an embodiment of success, an achiever who has left enduring legacies in the World Medical Association. Though he has handed over as President of the World Medical Association, Dr. Letlape is obviously still filled with great commitment to the welfare of Physicians. His interaction with the Editor of MEDINEWS on Thursday, October 12, 2006 at the Convention centre of the 57th annual General Assembly of WMA (Pilanesberg, Sun City, South Africa) was most engaging. I warmly invite you to join me in this voyage into the life, passion, convictions and achievements of this great son of Africa, and a leading light in the World Medical Association.

Below are excerpts.

MEDINEWS: Mr. President, Sir, can you kindly introduce yourself.

LETLAPE: I am Kgosi Letlape, the current President of WMA, a position I've been occupying and for which my tenure of office ends in the next 24 hours.

MEDINEWS: Mr. President, Sir, there's no doubt that a lot has happened in WMA since you became President. Sir, what has been your experience in office as President of WMA? What were your major challenges, highpoints and achievements as President of WMA?

LETLAPE: Well, I can't really talk about major achievements. Am not really sure if I've achieved anything. Nevertheless, there have been highlights, but I'm not sure those highlights can translate into achievements just yet. I think WMA is a changing and transforming organization where there has been a recognition of the importance of advocacy; the need for us to advocate for our patient's care, unlike in the past when we concentrated a lot on self interest.

There's also the realization that we need to get more involved in global affairs and not be insular; the need for us to take a broader view of issues and get more involved in society, hence the theme of the 57th General Assembly of WMA is “Health as an investment: Leadership and Advocacy”. Another highlight was the opportunity accorded me to visit the different National Medical Associations (NMAs) upon their invitation. It was a good collective learning experience, learning how the different NMAs work, especially having being exposed before now to the affluent, Western NMAs.

What was particularly rewarding was being able to visit Nigeria. That was a great experience for me, in that it met the core of an objective I had set for myself, which is to try and get Africa more involved in World Medical affairs, meaning there must be greater participation of Africa in the WMA. Initiating the African Medical Association (AFMA) was a thing that has been in the making for about 23years. Am happy that finally there is an organization that is constituted with sixteen (16) African NMAs currently participating. We now have an organization of our own.

AFMA, as we discussed in the first two days of this week, will be project oriented. It would not be an organization that is insular or one that only looks at us as a Profession, but rather an organization that looks at the challenges of the continent; an organization that can partner with Government (and its various health departments) and other related agencies to design and execute positive reforms and projects in the health sector, with WMA acting as the mother organization, hence the designation of the body as WMA African Region (AFMA). So, while striving hard to secure an enabling environment for the health workforce/resource, we will be more project oriented, implementing policies and projects that will ensure physical developments and improve the quality of care and service to patients. This is the key objective we have set for ourselves as an African region. I am hopeful that the objective of this organization will come to fruition. What we would like to see is an organization that is actively working together with a very active leadership. We look forward to an organization that will not be a bilateral organization, but an organization for all, with an effective communication network.

One of the great challenges confronting African NMAs is the challenge of setting up impeccable communication structures; the challenge of developing capacity to utilize recent developments in information technology to communicate with each other, transmit information and collate data. These are the challenges we see in our organizations, which hopefully will be seriously addressed by the African Regional Body of WMA.

MEDINEWS: To be President of WMA is obviously not an enviable one, considering the enormous responsibilities of the office. Sir, as the number one doctor in the world, how were you able to cope with the responsibilities of your office in the last one year?

LETLAPE: Well, I guess having been in WMA for about 4 or 5 years now I had a sense of what it entailed; I had a sense of what was involved and I was prepared. I wasn't deployed, I wasn't appointed, I availed myself, I put my hand up. But before I put my hand up, I had to do an internal assessment: Do I think I can make a difference? Is there something I think I can contribute? Would I have an objective? Would I set targets for myself? Though one sometimes became exasperated by the agenda items of the WMA, but very quickly I learnt that there was essentially nothing wrong with what was happening in WMA. So, essentially, coming into the WMA and being a lone voice for Africa, and knowing the environment one was working back home, the state of the nation, the state of the continent, I had to grapple with the reality that befell us (as Africans) in not being on the agenda of the WMA, simply because we were not there to put our interests on the agenda. It is not correct to expect people to put on the agenda issues they are not exposed to.

The NMAs that were sitting around the WMA table were rightfully dealing with issues that interested them, and it is our responsibility (as Africans) to inform them about our situation, so that our issues can also form part of the agenda. Instead of blaming them, I saw my Presidency as an opportunity for me to make a difference by ensuring that the issues that were important to our NMAs and our people were made part of the agenda of the WMA. I hope that with the opportunity of hosting the 57th General Assembly of the WMA in South Africa, African NMAs will be able to enrich their quality. I hope African NMAs will not only come into the WMA, but more importantly, come into the WMA able to learn and contribute, and show that they have something to teach the rest of the world just as much as they have a lot to learn from the rest of the world.

Really, a lot of the lessons I've learnt in being WMA President have enabled me to be a better person. I've learnt to be more tolerant. I've learnt to accept greater responsibilities for my own conditions. I've learnt to be sensitive o the situations back home and have an attitude of saying in my life what can I do to make it better for the citizens that reside in my country of residence and birth. As I make that contribution back home, I make that contribution globally, because it's all about contributing to humanity. There are other lessons I've learnt. For example, there is this notion of being the first person of a particular group in society to be the President. Am not the first President of WMA from Africa. A past chairman of the South African Medical Association was President of WMA in 1996/97. So am about the 2nd President of WMA from Africa. However, in a globe that is socialized on differences, am seen as being from a different side, and I actually saw myself as coming from a different side and hence the notion of being the first Black President of WMA.

But some interesting things came into play a little more than 10 years ago. My daughter questioned the issue of why we call ourselves black because she thought that she had a perception of colours (having studied colours). She came up with an interesting concept that people were referred to as black because they have black hair (and black is a colour). When she looked at us, she said we are not black. Years later, what my daughter said came into me for many reasons, especially because of the space I was in as an individual, a space where I had to deal with my humanity; who am I? where do I belong? where do I define myself as coming from? So, because of the situation I found myself in the South African Medical Association and the changes we were going through, I found myself in an unfortunate position where as we formed the new Association (post 1997) called South African Medical Association (SAMA; formed on the basis of what we call old MASA and partner organizations coming together, usually brought down simply to blacks and whites coming together), even though there were blacks in a minority in old MASA and whites in a minority in the other partner organizations, for peculiar dynamics in the medical politics of South Africa, I was in a situation where I didn't belong to the blacks.

When I came in, I went to the blacks for a mandate. However, it became very clear few months into my chairmanship of SAMA that I was on my own, and there was nothing that would have made me go to the white side to say what is the mandate because am from you? or what are your expectations? what is the plan? Because of the dynamics in the Association I found myself, I was too honest and forthright to be black, and I could never be white. So, I was on my own and in a very lonely position. However, as I faced the challenges inside the Association, the only way I could go forward was by being honest and truthful, because I could not afford a home that was based on divisions. I guess one could say that I was too forthright to be black and I could never be white. However, I realized years later that I am neither black nor white. My complexion is a shade of brown and 100% human, so I had to find a space where I saw myself as a human being because that was all I could. I had to get to that space, because at a certain time I didn't belong.

In embracing truthfulness and being principled I became liberated and I was able to understand what it means to be free. To be free is to be free of prejudices in a fundamental way, at least in my life, because we were raised on prejudices, we were raised on indoctrination. What makes you think I am black when am a shade of brown? What is it that I don't understand about colours? What my daughter tried to teach me many years ago came to pass. This is one thing I remain eternally grateful for. So, I brought all these learning experiences into the WMA. I got into the WMA Presidency and found myself the only person from Africa. Externally, I may have looked different from all the others around the WMA table, but internally and otherwise I was not different. I had to come to terms with my thought that Black consciousness under which we were raised by Steve Biko (and others) was basically human consciousness. Even then, I had to bring to the table the plight of the people living in Africa and not the races because people living in Africa and people living in America belong to one race. I had to grow up from being what I am not, to being what I am. I had to grow up to being a better person. As WMA President, I represent the whole of humanity. I accepted the responsibility on a global basis to represent the Physicians of the world, irrespective of where I come from.

MEDINEWS: Mr. President, Sir, what is your assessment of the foreign ethical recruitment policy of the South African Government?

LETLAPE: Well, I wouldn't know about the challenges of the impact at a personal level, but I am aware of the rationale and spirit of the agreement entered into by the South African Government. Health care professionals, especially doctors and nurses, elect to work in other environments, especially in first world countries with richer economies. Also, health care professionals from elsewhere in Africa see South Africa as a better destination. As South Africa advocated to the Commonwealth Ministers an Ethical Recruitment Policy (seeking a political agreement) to restrict the emigration of healthcare professionals from South Africa to the richer economies, the question that arose is whether South Africa will still be receiving health care professionals from elsewhere. The full circle answer to this question meant that if South Africa was pushing that doctors should not leave the country they should also put in place a policy preventing other countries from losing their health care professionals to South Africa.

This is the position of the South African government which I am not in a position to defend as I am not an agent of the government. I am only trying to explain the policy to you. But I think we need to interrogate the application and impact of the policy at various levels. As a Medical Association, our view is that as human beings the human rights of Physicians must not be violated. Physicians have a right to choose the environment they want to live in and the environment they want to work in. Having said that, we must realize that having being trained with tax payers money, Physicians need to have a sense of commitment to where they obtained their training and to the people we hope to serve when we qualify as Physicians.

This does not mean that Physicians should work in conditions where they are unable to fulfill their roles as fathers and mothers, and provide for their families. Our liberties must not be undermined by the realities. There has to be engagement by the NMAs with government to improve working conditions. However, we must realize that some Physicians migrate for the sake of skill acquisition, with the hope that upon completion of training they can be in a position to render quality services on their return home. The greatest challenge is the challenge of Physicians wanting to relocate. This is a different matter. WMA does not support the principle of undemocratic and unethical agreements that violates the basic human rights of people, even though we are mindful of the challenges and realities. By not improving working conditions, we see in our country, South Africa, (even as the government implements all these blockade mechanisms) doctors just leaving the Medical Profession for other professions and vocations.

So, what is government going to do if a doctor leaves the profession and goes into business? The emphasis should be on why doctors are being lost from the Medical Profession. Where they are lost to should be secondary. Government should look into the reasons why doctors are being lost from the profession. Whatever the reasons are (whether doctors go into other businesses; whether they become politicians or administrators and not practicing Medicine; or whether they leave to other countries to continue practicing Medicine), government needs to look into the underlying causes of why they are leaving the system. Any government that does not look at the underlying causes and fails to fix them is simply doing symptomatic treatment. As physicians, we know that if you cannot understand the etiology of disease and you deal only with the symptoms you wont be able to contain the disease. The same principle must be applied to the issue of human resources in health.

MEDINEWS: Sir, as you look forward to a very graceful handover tomorrow, can you give an insight into your future plans, beyond the WMA.

LETLAPE: Well, I don't have plans beyond the WMA. I will still be a part of the WMA. I will be the Immediate Past President; I will still be an officer of the WMA and I will continue to do advocacy work for the WMA. And just having started the African Medical Association, of which I have been elected President for the next four (4) years, I will still be involved in the affairs of the Association. Hopefully, what might come out of the WMA proceedings is that the WMA Presidency should become part of the Advocacy machinery of the WMA. By this, I mean the WMA General Assembly may pass a resolution that Past Presidents and future Presidents of the WMA should be kept in the advocacy network of the WMA, to advocate for the welfare of Physicians and the health care of patients.

MEDINEWS: Mr. President, do you have any special message for Physicians around the world?

LETLAPE: The simple message I have for Physicians in the world is to get involved. They should ask themselves a question: what can I do? They should see themselves as privileged, giving the education they have and the great opportunity they have to serve mankind. They should remember that the greatest moment of a Physician is to see a patient you attended to come up to you to say the only way he/she can appreciate you is to say thank you. I feel blessed. So, we should not see ourselves as victims, but as social agents.

We should see ourselves as social leaders having a responsibility not only to ourselves but to the communities around us. We should ask ourselves a simple question: am I involved enough in the welfare of mankind? What is it that I can contribute? Our job is not simply that of being employed, ours is a life's commitment and we need to keep asking ourselves: what more can I do? We should stop complaining and judging others, but instead look at ourselves critically and say: as an individual Physician what does it mean to me to be a doctor? And what is it that I can do to make the health of all humanity on this planet better? The resource issue is a critical issue in health care. When we take a broad view of the issue as physicians, we don't just concentrate only on finite resources. We become resourceful by ensuring that we can do more with the resources at our disposal, and work hard at ensuring that negative competition for resources is minimized.

Here, am referring to expenditure on civil wars, firearms for personal possession, and wars in particular. Physicians have to understand that when we look at what governments are prepared to spend on defense and wars, health care is left behind, notwithstanding the fact that wars are health hazards. So, as we campaign against smoking and alcohol, we also have to campaign against wars. As we heighten society's awareness about the evils of war; as we preach the message that wars are prosecuted to destroy other human beings and other nations, and should be discouraged at all levels of government, we will then be able to put a lot of resources into health care and health care budgets.

MEDINEWS: Mr. President, thank you for this rare privilege to interact with you even in the middle of this extremely busy General Assembly of the World Medical Association. It's been a pleasure talking with you. You are indeed a very great leader. On behalf of MEDINEWS, I wish you the very best in all your future endeavors.

LETLAPE: Thank you for this opportunity to interact with you. I must commend your intellectually robust presentation. I look forward to meeting you in Nigeria during the AFMA congress.