Dr. Johnny Mahlangu graciously sat down with NHF's CEO Dr. Len Valentino for an informative dialogue to honor Black History Month and World Hemophilia Day. Read these Q&As and watch the video to learn more!
Black History Month and World Hemophilia Day Discussion with Dr. Johnny Mahlangu
I'm here today with my friend and colleague, Dr. Johnny Mahlangu. Johnny, welcome to the National Hemophilia Foundation's Black History Month, a special presentation. Can you tell me a little bit about your personal and professional background?
I'm Johnny Mahlangu, I am in the hematology space in Johannesburg, South Africa. I am a South African by birth, have lived and worked in South Africa. In fact, all of my life. After high school, I started a science degree. This was followed by medical training at the University of the Witwatersrand. And then I became board certified in hematology through the Colleges of Medicine of South Africa and took a sub-speciality training in clinical hematology.
What was your inspiration to go into medicine and, in particular, into hemophilia?
A very inspirational teacher in the undergraduate years when I was doing my Bachelor of Science, Professor Mendel, who was the, at that stage, the chair, the chief of hematology is in the division of hematology at our university.
He basically supervised my fourth-year project that he said, "look, Johnny, I think you should go into medicine" and that actually has not crossed my mind. And in fact, I applied, and I got into medicine through his mentorship and his help. And when I finished medicine in 1996, he basically insisted that I come back and specialize in hematology.
I suspect that that was why you began your career and focused on, on bleeding disorders and hemophilia was because of that mentor. Can you tell us a little bit about your early experience in hemophilia and bleeding disorders?
Yes, it's been a very enlightening and certainly very fulfilling journey up to now, Len, perhaps just to give you a little bit of background. When I completed my medicine, I went on to specialize in hematology and got trained and got licensed in hematology malignancies., But I wanted an area where could have some kind of expertise. So, as I spend a bit of time in critical care and I started to have an interest in bone marrow transplant, in fact term did a fair number of transplants of a plastic anemia.
It is at that stage when I realized that there was a void in the care of patients with all bleeding disorders. But in particular with inherited bleeding disorders. And literally I decided to switch because I thought that need in fact, I could find myself actually driving it. And of course, you know, the rest is history. I stayed in that area, and I enjoyed it up to now.
Can you tell me, were there any other African or black mentors that you had along the way that you thought were particularly impactful on your career choice?
In the context of our, at least our medical school, there weren't. And I wasn't familiar that there are at least seven medical schools in South Africa. So, at that stage, most South Africa was going through a very difficult history of segregation. So, I wasn't familiar with the lack of academics in other institutions that traditionally were exclusively for Blacks because I was at this institution, which was traditionally for whites. So, there wasn't really anyone in particular that I could look at as, as a mentor and in fact it turned out to be a fair amount of trial and error learning my way through. And I must admit, in fact, currently I've taken that role extremely seriously.
I've got just over a dozen medical and science individuals that both students and qualified individuals that I am mentoring, you know, coming from that background. And perhaps more importantly, I've got just over 25 fellows throughout Africa about have trained with me that we have continued to keep in touch in the context of their career progression.
So yeah, it’s been a very fulfilling journey. Having started with no mentor, I see myself as being available to mentor many more people.
What advice would you give here in the United States, and in particular at the National Hemophilia Foundation, about engaging more young students, scientists, physicians of Color, and encouraging them to pursue a career in blood disorders?
I'm not sure I'm the best person to give you advice. But I can give you what I've given to, perhaps my colleagues in the rest of Africa. My career largely was through a single individual identifying potential quite early in my career. And he started to give me support. And that's what I would do. I mean, I wouldn't try and obviously overnight transform your community massively. I would identify one or two individuals. And in fact, if you're asking the question, how do you identify those individuals? The way I do it nowadays is you basically keep them small projects and you say, look, you know if this person can actually latch onto this project, do it so well. I think in fact, I could then challenge them a little bit better and allow them to grow.
And that's, that's the way I do it in our center. And certainly, I think in fact it's available way of doing.
Yeah, I think to grow and develop in a particular area, they're never going to know what their capabilities are. So again, congratulations to you for really finding sort of that secret sauce: the right combination of mentoring and opportunity. So, I know you said that you haven't worked in the United States but tell me a little bit about your experiences in South Africa that are facing Black physicians and Black patients in South Africa, and then maybe we can talk a little bit about the comparing and contrasting that to the situation in the United States.
What really is exciting for anyone working in our part of the world is the diversity of pathology that we face in many levels, depending obviously on your level of interest. That may be overwhelming to the point of obviously wanting to opt out of the system at all. If you're working at another level, like I do, it could be so exciting that in fact, you can't see yourself working anywhere else.
So, some of that challenge in our part of the world is having to balance what I call high tech, very high-level medicine, talking about gene therapy for example, contrasted with what would be very basic medicine. That the pneumonias, the diarrheas, and malnutrition and having to get that balance right.
In other words, being able to progress, but also not neglecting what would otherwise be easily treatable conditions. So, some of the challenges that we face it's along those lines, that one needs to get that balance right.
But from a race perspective, medicine in general in South Africa and certainly in Africa is a very highly regarded. I've yet to come across a scenario where I regret why I decided to do medicine as a Black person. For example, I think when, wherever I go and whoever I meet, in fact they, look upon me as a professional, just like they would look upon me, as my colleagues, for example, who do the offering, the best stuff that we can offer, which is medical care.
How do you work to engage the people within the population that may not be so easy to reach, either for education or, as you brought up before, the work that you're doing in clinical trials? How do you engage those hard-to-reach diverse population?
One is to try and meet the communities on a regular basis. In the context of our country, I'm still involved in our national member organization, the South African Hemophilia foundation. And I schedule meetings with them two to three times a year. And those meetings, in fact, are both transactional, but more informative. To tell them what is exciting about what we do and what is exciting about what is to come in hemophilia. And I found those, in fact, I look forward to actually meeting the individual members. So that happens about two to three times a year. Then, I have a hand in our outreach program, in fact is mandated at various levels at our municipality government level, at our own training institution level, as well as at the national organization level.
And in fact, we've got dedicated nurse practitioners that go out and identify communities from time to time, in fact, they do bring along some of us to participate in those outreach programs. There are ones that do not do that regularly. And of course, we all do it when it comes to the World Hemophilia Day on the 17th of April every year is to go on to the media, whether it's print media or radio or television and promote the hemophilia in that way.
What do you think is advice that you might offer to us here in the United States in terms of approaching young people, particular young People of Color who want to enter medicine or have not even thought about medicine as a career, sort of like the path that you hear when somebody really stimulated you to think about this critically and then enter the field of medicine. So, what recommendations would you give for us in interacting with young people?
I would give them two pieces of advice: one is dream big and pursue your dreams. Don't let anything stand between you and what you want to achieve. And that has always been my philosophy and certainly something that I continue to do even as a profession.
The second thing is just take whatever you do and do it so well that in fact it becomes effortless, and people actually do notice when you do something. Well, they start to look that. That's actually apart from anything else, you know, that you can do a lot more things well, apart from what you are doing covered.
Those are the two advice that I would give any young staff who might be interested in pursuing, for example, a career in health or career in medicine.
Can you tell us a little bit about the barriers or challenges that you faced along your journey. And importantly, how did you overcome them?
I tend not to sort of dwell too much into barriers and challenges that I managed to overcome, but I'll share some of them with you.
I think the biggest barrier was the reality that medical education is expensive. In a middle-income, low-income countries, such as ours, I already had a Bachelor of Science degree and the community and everyone around me basically expected me to go and work and earn a living. And then my hunger for pursuing medicine would just not allow me to do that.
And that was actually quite a big barrier. To the point of at one stage I approached what I thought were prominent well to do figures in our community and ask them if they could sponsor me. And in fact, all of them simply said, no, you need to go and work. So, I went back to the banks and started to borrow money to be able to take myself through medical school. Of course, I mean, I'm coming from a background where my parents could never afford medical school. So, and that to me was what's the biggest barrier, supposedly prospectively, that's easy to talk about it, but it was very hard. So, I had to take multiple bank loans and be able to reach my goals and I did reach them out.
The second barrier then when I actually finish my basic medical degree. The expectation was now that you've got two degrees, why do you want to study more? And I wasn't satisfied with the fact that I was, I was a general practice, I wanted to be a specialist. And, in fact, at, that stage I took it that whole job. I was working as a fellow but that night I took some work and actually manned phones for emergencies while studying. And that, that actually proved to be a good training for me, by the way, because it allowed me to be able to focus and also reminded me that in fact, it was important for me to be a specialist.
So those are just two of the sorts of barriers that I faced and certainly retrospectively I think that I overcame them with some strategy.
The real important question is how might we be able to partner together to help resolve, you know, issues of health equity, not only in the US or South Africa, but more in the global community?
Addressing the question of diversity, equity and inclusion is very current in our communities. And it really doesn't matter which part of the world you live in. In South Africa, they are particularly pertinent because historically and politically our country had a dual healthcare delivery system.
You know, the healthcare system was so unequal that most of Black Africans living in South Africa where we're basically not getting the same care as everyone else in the country. My personal philosophy is very simple, it starts with an interview. Whenever I practice medicine and it really doesn't matter where I find myself, I see the patient in front of me as deserving of all that I can be in other ways.
If they need a state-of-the-art treatment, I will do whatever I can to be able to deliver it to them. Irrespective of whether they have the means or they don't have the means to be able to obviously afford the kind of treatment that they get. It is that it is that approach that has allowed some of us, for example, to be able to bring some of the best care for patients with bleeding disorders in the country, because we always believe that the patients deserve the best.
The second part of perhaps addressing equity in our setting is a systemic one. And South Africa, I'm pleased to say that, is now beginning to go along that journey, we have embraced the concept of universal health care. We can't afford it at the moment, but at least in principle, we accept that that is the only way one, at systems level would be able to deliver critical care there to all of the patients.
Earlier, you talked about sort of the segregated healthcare systems in South Africa. As a Black physician, a physician of Color, what is your experience been in South Africa, when you talk to patients that don't look like you, colleagues who don't look like you, either in South Africa or abroad? Are you experiencing any issues because of the color of your skin and the way you might be treated or viewed by patients or colleagues?
Not really, and it might just be me. I suppose if you ask that question to some of my colleagues, you might get a different answer. But as far as I'm concerned, I have not been in any way discriminated, at least not professional level. Just to give you an indication, I work in a very large tertiary care facility, which is a teaching hospital of the University of Witwatersrand, called the Charlotte Maxeke Johannesburg Academic Hospital, where I look after probably about 70% patients Black, and then about 30% are white. But I also work in a university hospital that is funded by the universities called the Wits Donald Gordon Medical Center. I'm the only hematologists there. Where probably about 80% of the people who come there are white and about 20% are Black. And the reasons for the difference in race are it's just affordability. And practicing in both of those environments, I have not seen a difference in approach by patients, by my colleagues in the allied medical fields and certainly not by the hospital administrators. I haven't actually looked, and certainly haven't seen that they treat me differently from my white colleagues.
It's a tribute to the societal change that's occurred in South Africa where it's such now an open and in embracing and engaging a community. I think we in the United States could still learn a bit about how to deal with People of Color, and basically anybody who doesn't look like me, and having that open sense. A question that I'd like to ask people that I think is a little bit fun, maybe a little bit more off topic. So, if you had to think about anybody in history, anybody alive or dead, that you would love to have a conversation with? Who might that be and why?
I recently visited Egypt and I was amazed at the mightiness of the pyramids of Giza. And in fact, if I had the opportunity to talk to the architect who designed them. And we're talking many thousands of years, these structures seem to have been planned with science of the future in mind. So, if I were to dream about meeting some great people, those are the people that I want to talk to because it would allow me to be able to try and replicate what they did some years back and trying to prepare the future the same way they did. I mean, the alignment of the pyramids, the accuracy with which they actually cost them. It's amazing!
What are some of the global challenges that you see facing the hemophilia community and maybe broadening that a little bit, to others who have inheritable blood disorders? What do you see as the major challenges that either colleagues in South Africa or the United States, and more importantly, globally should be thinking about in taking as architects of the future of healthcare?
I think the, one of the global challenges facing the inherited bleeding disorder community is how to translate that December 2021 United Nations general assembly resolution. The resolution basically was for the first time that the United Nations recognize that there are over 300 million persons living with rare bleeding disorder in the world together off course with their families. And I I'd like to see, in fact, how we interpret that resolution in the 2022 World Hemophilia Day. How do we translate that into identifying, as you know, there are millions and millions of people living with inherited bleeding disorder that we have yet to identify to date.
I'm really happy to have the opportunity to speak with you today, especially on the eve of World Hemophilia Day. It's a great opportunity for you to share your insights and your experiences with the US audience. Any final words that you might want to share with the listeners here today?
From all the expertise and the experience that the National Hemophilia Foundation has certainly we can learn a lot more from you. Thank you.
Watch Dr. Johnny Mahlangu's Q&A video here:
