Palliative care: Face to face with Michelle Meiring

This is part of a four-part series on palliative care for children in South Africa.

See other articles in the series here: Children’s hospice an oasis for those in need and Face to face with Joan Marsten.

It all started at Baragwanath Hospital in Soweto in 1999; the year that saw Thabo Mbeki’s presidential inauguration and the onslaught of Aids-denialism. “I was training at Baragwanath Hospital,” says Michelle.

“I think a lot of us went into paediatrics thinking kids are resilient, they don’t die, they bounce back – it’s a fun field. And then to be swamped with all of that dying, it was just not what a lot of us expected.”

She recalls how up to 50 sick babies arrived at Baragwanath per night. “It was the days before we had antiretroviral treatment,” she says.

“We were fighting for Nevirapine, there were a lot of doctors picketing, I mean Mark Heywood (former Section27 executive director) was involved and all the rest of it. So we had a lot of paediatric deaths, sometimes up to three deaths on one shift. It was very traumatic to witness so much death and dying and having to fight our own government for proper treatment.

“I was a bit of a nerd and didn’t like to have death stats on my slate. So I used to try and keep the babies alive until the next shift, handing over to my colleagues, so they got the bad statistics.”

Michelle smiles and shrugs her shoulders.

“You know, silly little things you do in those situations,” she says.

During the interview, Michelle laughs a lot. Her face breaks into an easy grin, even while recalling perilous days on the job. This may well be her nature; perhaps it’s also partly a learned response, a means to soften the sadness at the centre of her work.

One particularly gruelling night at Baragwanath remains etched in her mind – this was the night that would shape her future. She was working around the clock to prolong the life of a little girl, four months old.

“She came in with very, very bad pneumonia,” recalls Michelle.

“She should have been ventilated, but we weren’t able to do so. She also had renal failure, with a lot of electrolytes and salts in her blood. I thought of doing things like putting twice the amount of oxygen on, nebulising her; we also had this thing where we did blood tests every hour to see what’s happening and trying to correct that. Basically, I was poking this poor baby every hour to see if I could get her through the night. And you know, occasionally we did pull babies through. But this baby, she was dying. She died at seven o’clock in the morning, and the handover was at eight. So I was like: ‘You little bugger, why couldn’t you have waited just one more hour?’”

After the baby died, teetering with exhaustion, Michelle had to tell the child’s mother.

“And we weren’t really taught much in the line of communication skills at medical school,” she says.

“So I basically mirrored what most of my senior consultants did. They usually said to the moms: ‘Terribly sorry, we did everything we could, but your baby has died.’ That morning I was met with one of those very violent grief responses. You know, she fell to the floor and wailed, and there was nothing I could do to calm her down. I was tired, and she was tired.”

Then a bolt of insight struck.

“I had one of those out-of-body kind of moments; just thinking, actually that could’ve gone better. I thought to myself, what have you done? All of those holes you made, poking the poor dying baby. Had I realised she was dying, I would not have pricked her every flipping hour. I would have managed her distress because she was really struggling to breathe. And also, if I had just sat down with the mum and said: ‘You know, it’s not looking good.’ Then she would have been better prepared.

“It hit me. There is this huge gap in our training. We are not taught how to look after people who are not going to survive: how to prevent pain, how to manage distress, how to counsel the family. Basically, it was just this missing skill set.”

After her “aha moment” Michelle discussed the matter with staff at the Houghton Hospice in Johannesburg.

“To my surprise, they told me they weren’t looking after children at the time. They said they didn’t have the paediatric expertise. So I said to them: ‘Why don’t we make a trade? I’ll teach you paediatrics and you teach me palliative care’.

In 2003 she opened a five-bed paediatric ward at the Houghton Hospice, and in 2007 a ten-bed ward at a hospice in Soweto. That same year she started hospital consultation services at Baragwanath, then at Coronation Hospital and at Charlotte Maxeke Hospital.

“I mean, we eventually made it happen. But it was tough in the Thabo Mbeki era,” she says. “Actually quite a lot of my colleagues and friends either went overseas or into private practice. They could not deal with the public sector, it was just too much.”

Over the years, Michelle has driven paediatric palliative care non-government organisations across the country. She co-founded CHOMP (the Children’s Homes Outreach Medical Programme) in 2002 and Big Shoes in 2006.

There were ups and downs, which culminated into Paedspal in 2015. Michelle is the founding director of Paedspal, an outpatient children’s facility based near the Red Cross Children’s Hospital in Cape Town. It forms part of PatchSA (Palliative Treatment for Children South Africa), also founded by Michelle.

Her premise is that when children are dying, honest communication is the best medicine. Often parents believe that the truth will be too much for their child to bear. However, children pick up that something is very wrong, says Michelle. She adds that each child’s journey is unique and there’s no “one-size-fits-all approach”.

The Paedspal rooms are in a tall brick building – the Rondebosch Medical Centre – the interior walls covered in children’s drawings. We are seated at a table in Michelle’s office. Titles on her bookshelf include Death, the Great Mystery of Life by Herbie Brennan, and Walking with God through Pain & Suffering, by Timothy Keller.

Although Michelle is not from a medical family, she knew from an early age that being a doctor was her calling. Born in Paris, France – hence her French name Michelle – she grew up in Pretoria. Her father worked for the apartheid government’s Department of Information; her mother was a legal secretary.

“My father was based in Paris and would scour French newspapers for negative news on apartheid South Africa,” she recalls. “Then he would write to the editors to dispute the facts.”

She describes her upbringing as sheltered, yet she chose to defy convention. “Interestingly, I was part of Youth for Christ which had a pen pal club, where we used to write to black children. And I was writing to these three kids in (Pretoria township) Soshanguve for many years. It was 1983, I was 14 and interested in knowing what life is like on the other side of the divide. After writing to each other for about two years, we decided we had to meet, and I invited them to our house. My father never knew about this little act of defiance. So they actually took a risk and came into our area. We all sat around and had tea and coffee. My other act of defiance was not to use the enamel cups. No, they got the proper ceramic cups.”

Michelle matriculated at Pretoria High School for Girls in 1988. Then she attended medical school at the University of Pretoria, before doing relief work in post-war Mozambique.

“There were still uncleared land mines. That stuff is life-changing, I mean it really gives you perspective.”

She met her husband, Owen, during an internship at McCord Hospital in Durban. Together they went to the United Kingdom, working at Exeter Hospital, to pay off student debts. When they returned to Johannesburg, Michelle fell in love with paediatrics, specialising at Wits University.

They moved to Cape Town in 2009. Here Michelle also lectures in paediatric palliative care at the University of Cape Town; while Owen is an anaesthesiologist at Groote Schuur Hospital. The couple has two children, a daughter (16) and son (11).

Michelle says being a mother changed how she works with children. “When I went back into the wards after my maternity leave, it was almost like I was tuned into this new frequency,” she says.

“You know how dogs have a frequency of noise which they can hear that humans can’t? Something like that. I was able to pick up what the children’s cries meant: a hungry cry. An ‘I am in pain’ cry. An ‘I am missing my mother’ cry.”

Outside of her job, Michelle enjoys being creative. She likes painting and baking. She recently baked her Paedspal colleague Di Burger a birthday cake shaped like a sneaker shoe.

“I just made Di a shoe cake for her 70th birthday,” says Michelle. “Di loves shoes and always wears the best sneakers.”

In the Paedspal playroom, Di, a family councillor, nods enthusiastically, scrolling on her phone to show us photographs of the cake. Michelle adds that she loves walking their Africanis dogs, Luigi and Jesse. In addition, she is guided by her faith and prayer.

After 20 years in her field, Michelle’s accomplishments speak for themselves, yet there remains a lot to be done. Like fighting for the Department of Health to implement a national paediatric palliative care policy.

“I think the really difficult thing when I was training was this feeling of I can’t do anything because this baby has a non-curable illness,” says Michelle.

“And suddenly through palliative care, finding that actually there is something to be done. It’s very satisfying being able to pick up at a point where everybody else said ‘this is a hopeless situation, there’s nothing we can do’. There’s a lot of satisfaction that comes from being able to help people at what was previously considered an impasse or a dead end.” DM

Spotlight is an online and print publication produced by SECTION27 and the Treatment Action Campaign.