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| Dr. Rita Van Wyk |
As we sat together, Dr. Rita Van Wyk began the interview with her story of being a two-year-old during the polio epidemic in South Africa in the mid-1940s. She paused to ask how much time she had. “As much as you want,” I replied. (Knowing that the stiff new chair she was sitting on was not the most comfortable one in the room.)
Rita had the “ascending” form of the dreaded disease, she said. As it traveled up her body and the chest wall muscles were affected she couldn’t breathe. She had to be encased in an iron lung to save her life. The prognosis was poor for many such toddlers, and her working-class parents were coldly informed that she “might be a vegetable” if she survived. (Use of Jonas Salk's polio vaccine would have to wait until 1955.)
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| Children affected by paralytic polio (from polioeradication.org) |
Rita had two much older brothers. Her parents hadn’t planned on another child, and taking care of a daughter with serious neurological and orthopedic problems was a burden they couldn’t handle. You see, girls in South Africa (as elsewhere, it seems) were supposed to be pretty and lively so they could marry up. This was more important for a family from “the wrong side of the tracks.” But Rita was a burden; she was saddled with problems. So she was sent to “The Hope Home For Crippled Children.” (“Hope” was the founder’s wife’s name, not what they were offering.)
The Family
What was her family background? When Rita’s Afrikaner father left school after the tenth grade he was recruited to work for DeBeers overseeing the experienced black mine workers. Later, during the war, he learned Morse code and joined the Air Force as a radar operator. After the war, he worked in civil aviation. He eventually became the manager of the Johannesburg International Airport. After Rita’s mother finished the eighth grade, she toiled in a sewing factory. In time, Rita’s parents’ combined salaries gradually lifted them out of poverty. They were able to hire an Indian housekeeper who taught Rita how to cook. Curiously, Rita’s father “never” actually called her by her name; for him, she was always “di-da-di di-di da di-da!”
At the "Hope Home," there was grueling physical therapy, with very little reading, writing, or arithmetic for the youngster with a curious mind and (as Dr. Van Wyk later learned) attention deficit hyperactivity disorder.
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| The "Hope Home and Convalescent Center for Children" on exclusive Westcliff Ridge overlooking Johannesburg (from hopeschool.org.za) |
rBut her “Auntie Sis” (the oldest of 11 children and a teacher) stepped in and was a blessing. She taught the bright little girl how to knit, crochet, and embroider. Keeping Rita’s hands busy in a “well-rehearsed and well-controlled manner” had a “fantastic effect” on her “frustration, restlessness, and impatience.”
She picked up things quickly, and when she graduated from the "Hope Home" (and School) at 11 the standard exam placed her in the tenth grade. She wasn’t really prepared; her interpersonal social skills were poor and she was “unsophisticated.” And as she was still relying on bulky crutches to get around she would certainly get in everyone’s way, she thought. Yes, she felt awkward. This isn’t going to be good, she said to herself.
High School and Beyond
But rather than wallow in self-pity, Rita would “bust everyone’s balls” and excel. Her goal was to know (get this) more than the teacher. So she studied the published curriculum before class to try to stump the teacher with a tricky question. That was her “adaptation” to the situation, she told me; shove the despair aside and be brilliant.
As the paralytic polio left her right leg weak and shortened she had a series of orthopedic procedures to try to improve her gait. At one point, her foot became infected and she developed gangrene. The surgeons wanted to amputate it but her parents refused to give them permission. The wound slowly healed but she ended up with a “really painful scar” and a limited range of motion. So Rita still has a shorter right leg and is unable to push the foot down, she has no “plantar flexion” she said.
After high school, Rita took the national exam for college matriculation and “did really well.” By that time, she had already decided on a career in healthcare. But where would she fit in? The physical therapists who worked on her were “mean and bullying” and burned out by the heavy workload during the epidemic (no good). The nurses had to take orders from the doctors (not her style). The doctors gave the orders that others followed (perfect).
It happened to be that Rita’s family doctor’s wife was also a physician (quite unusual at the time) and it was she who became a role model for the strong-willed teen. Dr. Wagenaar had dedicated herself to helping people who could not afford medical care. These disadvantaged souls were the native black Africans, the victims of apartheid (the Afrikaans word for “apartness”).
Apartheid
Starting in 1948, (and until 1994 when it was peacefully and democratically ended) there was a legally mandated separation of people. Where you could live, where you were actually forced to live, was determined, in essence, by the color of your skin; whether you were pure black (of African heritage), white (mostly European), or colored (mixed). The blacks were compelled to return to their ancient tribal lands while the whites alone would populate the modern prospering cities. (Another category, Indian, was added later.) The effect (if not the stated goal) of this creul system was to continue to exploit the majority indigenous black population for the economic benefit of the very small minority white ruling class. And there was fear.
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| Cautionary sign during apartheid in South Africa (from history.com) |
Thus inspired, learning by example, Rita came to feel that those who have much must give to those who have nothing. But when she enthusiastically shared this idealistic insight about social justice with her family they branded her as a “bloody communist,” she said. She soon decided to get away from her “nasty bush family.” She would henceforth be “self-reliant.” And she would “never get married,” fearing that a husband would try to control her (fat chance, I think).
(It wasn’t until quite late in the interview that Dr. Van Wyk disclosed that she had been witness to repeated domestic violence, including extreme physical violence, in the chaotic household of her childhood. And that her mother suffered from a severe undiagnosed mental illness.)
Medical School and A Year of Obstetrics
Anyway, Rita received acceptance from all of the medical schools she applied to and chose to attend Pretoria University (on a full scholarship). The program, like the others in South Africa and parts of Europe, ran over six years. She did not say much about those years (actually, nothing) so they will remain a mystery. She did let on, however, that she was one of only three women in her class of 117 (and she suspects that one was a feminized male with an extra X chromosome, a Klinefelter’s).
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| University of Pretoria (from up.ac.za) |
She passed the exam easily, so she was, she thought, “good enough for America.” However, she had no real interest in going to the States but rather liked the idea of possible training in England. She decided on a year of internship in obstetrics (the miracle of fetal growth and birth being, she thought, “the most exciting thing in medicine”. (Though Rita, at 21, decided never to have children of her own.)
Going against her earlier vow to remain single, she got engaged to be married, but this fell apart early during her training.
Politics Intervened
She had put away her dream of foreign travel for practice when she stumbled into some political trouble. It was July 4, 1970 (exactly two months after the shock of Kent State). “all eyes were on America,” said Dr. VanWyk as 350,000 of President Nixon’s staunch pro-war supporters rallied in D.C. at the Lincoln Memorial for the so-called “Honor America Day.” But thousands of idealistic young people waded into the iconic Reflecting Pool in protest. (The previous day, counter-demonstrators had drowned out a Nazi rally speaker who blamed America’s troubles on blacks and Jews.)
So Rita and a group of her liberal Jewish friends, interns, decided to do a peaceful sit-in. They would argue for fair and equal salaries for their black and Indian counterparts, for a show of South African social fairness. The expected press coverage didn’t materialize, but the chief hospital administrator did appear, and he simply handed out pink slips. Everyone was fired; Dr. VanWyk was out of a job.
By sheer luck, Rita already had a passport and a visa. Her less fortunate colleagues were denied such documents, and because they didn’t complete their internship year, they could not practice medicine in South Africa. Perhaps she could go to America where there is “equal opportunity and no racism” to “polish” her education before returning to South Africa to be “the poor people’s doctor” thought Rita. (She believes that this “escape route” was “divinely inspired.” )
Travel to the States
One of her brothers was a PanAm pilot and lived in (of all places) Lancaster, Pennsylvania. She would stay with him and his family for a while and travel around by Greyhound bus. However, her brother’s friendly neighbor was the Director of Medical Education at Lancaster General Hospital and he had an urgent problem that Rita might help solve.
It was July, the start of the year for interns and residents. Well, wouldn’t you know, one of the 12 prospective interns had finked out at the last minute? The eager South African visitor without a job was informed that she could fill that slot if she got an Immigrant visa. Rita was interested. Strings were pulled and the work visa was granted. But her gratitude was mixed with guilt as life fell into place so easily for her.
She quickly found that 1970s medicine in the U.S. was different from that back home. She was accustomed to “wild rough and tumble hands-on bush or jungle medicine” where “you do what needs to be done.” For example, her first delivery as an intern had been in a South African leper colony. Where people with the ancient disfiguring disease are discriminated against, shunned, removed physically from society, and feared. It was two hundred miles from the nearest hospital. No matter what the situation, it was up to her ”to get the baby out,” she told me.
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| Batsutoland Leper Colony (from leprosyhistory.org) |
Whereas in her new position, she was “fearless and confident,” having been tested in the field, in the veldt, her fellow interns were (let’s just say)…not. They understood the more esoteric academic matters while she had hands-on experience. (Though she had to admit that she struggled with medical English, Afrikaans being her native tongue.)
After Lancaster; Obstetrics and then Planned Parenthood
After the internship in Lancaster, she later began an OB/GYN residency at the York Hospital just thirty minutes west. But, sadly, everything she had learned in South Africa, everything she had loved about obstetrics, was absent. She was trained to make eye contact with vulnerable human beings, with women carrying their unborn children. The American-educated residents made “eye” contact with the beeping flashing electronic fetal monitor.
Even the attendings whom she considered to be kind and “real mensches” typically looked at the monitors in the labor hall, not the women ready to deliver. While she appreciated that monitoring assured better outcomes, the impersonal aspects of the experience did not satisfy her deep need to help people. She couldn’t continue like this. She had lost interest in modern de-person-alized obstetrics.
So she changed direction and worked for Planned Parenthood, pretending to be Dr. Wagenaar treating the mostly non-white and poor clientele. She was quite happy there until the issue of pregnancy termination “became a big deal.” Though she believes that women have the right to choose, she could not deal emotionally with late-term suction abortions. Nevertheless, Dr. Van Wyk stayed with Planned Parenthood for eight years. The work eased her internalized “collective (white) guilt very much” she noted.
She Doesn't Like the Cold
But each year she was “dying” with the Pennsylvania cold winter, where readings below freezing are typical for months. The average winter temperatures in Johannesburg don’t dip below freezing at all, and the daily highs are usually in the pleasant 60s. You see, she said, one of the residual effects of polio may be intense cold intolerance.
Typical late effects of having polio as a child, or the post-polio syndrome, include progressive muscle weakness, fatigue, and pain. In addition, the ability to regulate one’s core temperature may be impaired as a result of damage to the body’s thermostat in the hypothalamus. The limbs originally affected by polio may feel especially cold as surface blood vessels don’t function normally in response to the ambient temperature. People like Rita may need to dress in multiple layers because it feels to them as if it’s 20 degrees colder than it really is. They need heating pads, warm blankets, and long underwear.
So her body “craved the dry desert heat” of South Africa. Arizona might come close to that, she thought. So she applied to work in the Indian Health Service (again, assuaging her guilt regarding white privilege). But they didn’t need more obstetricians, they needed general medicine or pediatric help.
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| Dry South African Veldt |
(Her therapist has told her that because she grew up in such a crazy family she feels at home in that setting, though she had to escape.)
When Rita Met Chris
Throughout her busy three-year residency, she remained free and unattached. But one fateful day she “looked into a pair of blue eyes” belonging to the “most interesting human being” she had ever met. The “really smart, quirky” and “painfully shy” intern (14 years her junior) was Dr. Christopher Due. They connected and were good friends for about a year before they “stopped being platonic and wanted to be together forever,” Rita gushed (sort of).
And so they got married. A Unitarian Universalist minister officiated at a Bed and Breakfast in Muddy Creek Forks in the southern part of the county. She wore a peasant-style wedding ensemble, a top, and a long skirt, that she fashioned herself from “Aunt Lydia’s” crochet yarn. They could now move west. But Chris wanted to stay near his “nurturing, supporting” family, so the inviting Arizona desert was out. They have been married for 35 years and were looking forward to another trip to South Africa after the interview.
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| A Muddy Creek Forks Landmark |
More Career Changes
With her family practice training finished, and a persistent urge to minister to the poor, she took a position with the (oddly-named) York Health Corporation in downtown York. Once again, many of her patients were non-white, and had little money, soothing her conscience regarding privilege. She loved working there. But (surprise!) that would not be the last phase of her varied career.
It turned out that the head of Psychiatry at the hospital, Dr. Kirk Pandelidis, wanted input from their primary care physician when a patient was admitted to the Psychiatry Service. Dr. Van Wyk, drawn to psychiatric patients, offered to do this on weekends for those without a personal doctor.
The psychiatrists liked her work, and the part-time job became a full-time position. She would do the admission histories and physicals and follow up on any relevant blood work or imaging studies. Rita said that she “loved being the medical liaison on Psych for 21 years.” Little by little, she learned about the wounded spirit. How early painful experiences left their marks. And she felt useful and appreciated.
In fact, she enjoyed listening to the patients so much, even those with full-blown psychoses or those with a tricky personality disorder, that she even considered doing a psychiatry residency!
We Stopped After a Text
(At this point in the interview, my husband Scott received a text. Former family court judge, The Honorable Penny Blackwell, who had been lingering with progressive parkinsonism with dementia, had passed away. We stopped talking and sat in silence for a few moments; the energy in the room was drained. We thought of her husband, Dr. John Sanstead. Jack, now retired, was my internist for years. He would gently hold my feet in his hands during a routine exam. He cannot be replaced. Dr. Van Wyk noted that in their periodic discussions on general medicine during her residency, Dr. Sanstead taught her some of the most important things she needed to learn to take care of patients skillfully.)
Family, Mental Health, Climate Change, Spirituality, and Racism
After this sadness, we talked a bit more about Rita’s dysfunctional family and how living through that helped her understand troubled psychiatric patients from impoverished and deprived backgrounds. And how, as a young child who couldn’t walk she would sometimes be placed in her seamstress-mother’s wicker basket of fabric scraps. And how her Auntie Sis showed how to sew the scraps together in a quilt to turn “trash to treasure.” (She still collects the discarded material from others when she attends retreats for serious quilters.)
We talked about how mental health services are woefully underfunded. We talked about how primary care physicians, including her internist-husband, are not allotted enough time to adequately take care of their complicated patients. We talked about the fact that the “main thing” in the clinic now is the ever-present computer. And how the system can wear you down and change you if you give in.
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| Rita's attempt to understand mental illnesses graphically (scribbled in her copy of Psychiatry for the House Officer) |
We talked about Rita’s despair regarding critical climate change spelling the possible end of humanity. And that while things may appear hopeless “there is always hope,” she said, but she “could be totally wrong.”
And we talked about spirituality. She believes that photosynthesis, whereby plants (she loves plants) receive light energy from the sun and store this as chemical energy for growth as they release oxygen proves, beyond any doubt, that there is a God. And she told me that she’s been a member of the Unitarian Universalist Church/Congregation of York since 1978, spreading “love and kindness, and understanding.” And that racism exists and hurts.
You see, there is increasing recognition of the importance of so-called social determinants of health and well-being. These are (according to the WHO) “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping daily life.”
Racism, that is, bias against, and discrimination of, people on the basis of perceived but non-existent differences, is one of these determinants. It profoundly impacts physical and mental health. It must be addressed openly and honestly. It is present in South Africa and it is present and pervasive here. We need people to fix this. We need the Lamed Vavnicks.
References and Suggested Readings
1. Paton, Alan. Cry, the Beloved Country. Charles Scribner's Sons. New York. 1948. (The famous sad South African novel.)
2. Rubin, Rabbi Lisa, "One of the 36." (Rosh Hashanah sermon on the Legend of the Lamed Vavnicks who "exemplify kindness, selflessness, and humility, 2023. (Click to watch the wonderful video.)
3. Tomb, David A. Psychiatry for the House Officer: Second Edition. Williams and Wilkens, Baltimore, 1984. (My husband had this small book--Rita's discarded copy!-- in his collection.)
4. Sima, Richard. "Racism takes a toll on the brain, research shows: The chronic stress of structural racism and discrimination damages brain circuits and mental health." Washington Post 2/16/23. (Link to the story)
5. Wilkerson, Isabel. Caste: The Origins of Our Discontent. Random House, New York, 2020. (A broad exploration of the dangerous worldwide problem.)
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| One of my 15 thriving African Violets |
