Dr Benn builds a clinic without walls

dr carol benn helen joseph breast clinic Dr Carol Benn is the leader, but she praises her team for the success of the HJ Breast Clinic.

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Sulaiman Philip

Pink has never seemed as soothing as it does on the walls of the HJ Breast Cancer Clinic at Helen Joseph Hospital in Johannesburg. The colour warms up the windowless warren of consulting, counselling and treatment rooms.

Warming the sterile environment even more is clinic head Dr Carol Benn. She is a dervish of energy and conversation, stopping to check on patients waiting for treatment, leaving smiles in her wake.

Most are black, some are white. The little girl of one patient is falling asleep on a chair next to her mother. All are sitting straight-backed on plastic chairs. One has dressed up, reminding the world she is a sensual, vital woman. Another is wrapped tightly in starch-stiff traditional dress. Some are mothers, other grandmothers. One looks just old enough to have finished high school and another has the weary look of someone who has lived a long and difficult life. They are all women who look to Benn and her staff to make them and their lives better.

The team at the HJ Breast Clinic has created a welcoming, healing space for women. Their success is just another step towards creating what the doctor calls a “clinic without walls”, a health system that treats its patients as whole beings and not just a collection of diseased organs.

dr carol benn helen joseph breast clinic hallway The HJ Breast Clinic survives on the generosity of former patients and corporates. One of whom donated the pink paint to brighten up the clinic (Image credit: Shout-Africa).

Dressed in surgical scrubs, bag slung over a shoulder, a bottle of something green cradled in her arms, Benn starts talking. “I had a patient tell me she had to stop chemo because she could not be a wife to her husband. She chose death for her husband; is that what men should be demanding from the women in their lives?”

Her clinic without walls is a place where a multitude of medical and social disciplines look at the whole of the patient during treatment. She is pushing to move away from the small pond kind of medicine that has been standard, especially in the public health system, where the social challenges patients face have a bigger effect on treatment outcomes.

“Nobody dies from a cancer in the breast; it’s the damage that the disease does elsewhere. With a multidisciplinary team we can ensure that a woman, for example, one day post-op does not have to take a taxi home and she must not be discharged before a social worker or counsellor sees her.”

At the breast clinic, Benn oversees a group of passionate doctors, nurses and administrative staff who care for each patient from her first visit onwards. They work tirelessly to promote safe and healthy lifestyles for the 200 women a day who visit the clinic.

“We love what we do. If we were not passionate about helping to create better lives for South African women we would need to evaluate how we spend our days.”

The clinic is a centre built on the free access to information, awareness and treatment. Despite the challenges, Benn is recreating a system she uses in her private practice to provide the best care for her patients, many of whom lack the information or the resources that can stop their treatable disease from being a death sentence.

“This is the kitchen of the house, where we come together as family,” she begins. Her home analogy builds as she talks of the women who seek treatment as kin. “It would feel like I was kicking someone out of the nest if we could not offer this other help. Our work is not just about operating; it’s also about health awareness and taking away the stigma.

“We need to get education out to everyone. We need to get health awareness into our young girls about condoms, safe sex, about gynae and breast exams. If, by the time the girl is out of school or university, you have instilled that in her, she will encourage her mom, sister and family to go for check-ups.”

One line for penises and one for breasts is the way Benn remembers the first breast clinic she was asked to set up in Soweto’s Chris Hani Baragwanath Hospital in 1997. Her clinic was a desk in the urology department, where she treated about two patients a week. The numbers, she says, were down to a lack of information about and awareness of breast cancer.

Instead of welcoming her light work load, Benn started pushing back against the lack of awareness because, as she explains, she was tired of “looking into the sad faces of women who would line up for emergency breast cancer operations”. Her biggest success then was to re-introduce breast reconstruction into South African operating rooms, especially in the public health system.

“Doctors would tell patients it was their breasts or their lives and they would not do immediate reconstructions.” Now she counsels patients that it is their body and they need to be fully informed and take part in decisions about their treatment.

And she is off again, her voice raising as she warms to the point she is making. Benn, a patron of the newly formed Medical Women’s Association of South Africa (MWASA), hopes that people will learn to give back instead of asking what is being done for them. At the MWASA founding congress, she heard a story from an internist about a woman who would seek treatment after being abused by her partner, but could not leave him. She had nowhere to go to escape her tormentor; her escape came when he killed her.

“Where is the community hall named after her? Why is there no shelter for women in her community, a place where meals and a bed are available? With security. How much could that cost?”

Benn comes to a pause in a consulting room, overstuffed couches and framed portraits add touches of comfort and home. In rest she is just as excitable. Not a collage, but gilt framed portraits of women who have conquered breast cancer line the walls. There are celebrities – Lillian Dube, women young and old, all heroes to her. “Here, look at this woman. She beat breast cancer. Came back to the hospital and donated blankets. She felt a need to give back; we need more people like her.”

When she asks “what are you doing to make your community better” it is heavy with substance. Victims of domestic abuse who cross her path, many too scared to leave or without a place to flee too, have her phone number and are welcome in her home till they find a safe place.

Choosing to work at Helen Joseph is one way that Benn makes a difference in her world. She wonders aloud how quickly the public health system would improve if other doctors did as she does. “We make a real difference in women’s lives. Can you imagine if other doctors volunteered? We could change health care for the better.”