Spotlight Interview with Dr. Lebogang Phahladira

“You need patience, you need empathy, and you need love for human beings to do this job.” – Dr. Phahladira

Location: Stellenbosch, South Africa

Bio: Dr. Lebogang Phahladira was born and raised in Limpopo Province. He graduated with a Bachelor of Medicine and Bachelor of Surgery degree from Medical University of Southern Africa (MEDUNSA) in 2005 and subsequently completed postgraduate training in psychiatry at the University of Cape Town in 2012 before he joined Stellenbosch University as a senior lecturer. Dr. Phahladira is a PhD graduate and core member of the Psychosis Research Program of the Department of Psychiatry at Stellenbosch University. His current research interests include the long-term treatment outcomes following the first episode of psychosis and has co-authored more than 30 peer reviewed articles in international journals. He is a member of the Schizophrenia International Research Society (SIRS) and serves on its Diversity Committee. He has presented his work at various conferences locally and internationally. Dr Phahladira was recognized as an emerging leader at the National Health Awards in 2018 and has received several grants and awards. He is the lead-clinician at the psychotherapeutic unit at Lentegeur Hospital and mentors many undergraduate and postgraduate students.

How did you begin your career in psychiatry?

I was born and bred in South Africa in one of the most remote, rural provinces in the country. I was raised by my maternal grandparents on a farm during the time of transition from apartheid times to a democratic government. My parents thought it would be best that I developed in a rural area, rather than in the cities that had violent disruptions. I always knew at an early age that I had an idea that I wanted to go into medicine and many of my peers, family members, and teachers encouraged me to. My initial ideas entering medical school were to go into gynecology, but that soon changed in my early stages in medical school. I really fell in love with psychiatry. I remember my first interactions with my psychiatry patients, and I told my peers I found my love. After completing internship and community service I went on to the University of Cape Town (UCT) for my residency, and I’ve never looked back since.

What aspects of psychiatry made you fall in love with the field?

I think about the concepts of psychosis. In general medicine, it is a lot simpler to link a cause to symptoms. You can see certain things very directly, for example using an X-ray or blood tests. But with the brain and the mind, it was just a fascination with the unknown that attracted me to the discipline. It is not straightforward. It was just a desire to try and understand it better. Also, in my country, people with serious mental illness (SMI), particularly schizophrenia, would seek help from public institutions and are amongst the most vulnerable. The suffering is quite palpable. Psychiatry just ignited something in me and made me want to contribute to making the field better.

Can you share with us what you love most about your job?

My job entails teaching medical students and residents, seeing patients with a wide variety of disorders, performing clinical research while trying to find answers to some of the problems people with mental illness have, and contributing to scientific knowledge internationally. It is a privilege to have this role because not many jobs in the world would give you that kind of variety. All my responsibilities are equally rewarding. I always say that the best way to learn psychiatry is to teach it. I really enjoy documenting the story of mental illness as it really goes the long way and that's what we are doing in research. We are telling people about the South African story and the story of the continent in terms of what we do in science and what contributions were made to the discipline. You need patience, you need empathy, and you need love for human beings to do this job.

What is a project that you are currently working on?

Our team has really been on the forefront of and pioneers of using long acting injectables on psychotic patients with first-episode psychosis and schizophrenia on the continent. We have done a lot of work over the last ten years in the field. We are treating patients while telling the story of the South African context given the environmental factors which include poverty, violence, and other social determinants of health. We use a very cheap molecule which allows us to show that outcomes can improve regardless of where you are and how much you have if you just do things a little bit differently in treating patients with schizophrenia. So, for the future, we are looking to build on research and continue to look at a different kind of molecule that patients can receive every three months compared to two weeks. We want to look at the health economics so we can show policy makers even though the treatment may be expensive, the long-term benefits far outweigh the costs of treatment. Our patients would require less frequent admissions to hospital, general improvement in quality of life, and function better. If we are able to package that well, then we can move closer to solving some of the problems in South Africa. I think that is where we are going. If we can treat patients with the right medication and get them better for longer, that will be the best contribution one could make in the field of science.

I am having the privilege of interviewing you in person here in Boston! Can you please share with us what brings you to Boston?

I think it's about meeting people, connecting with friends and colleagues to talk about the future and new ideas, and to get advice on how to build sustainable research projects in South Africa that are cost effective and that respond to South Africans and the continent’s problems. We want research projects with instilled capacity building components to produce other South Africans that can do even better in the field. If we can have more and more people on the African continent that lead in the field of science and understand and want to solve Africa’s problems through science, then the continent would be much better.

What do you look for in potential collaborations?

I think of the human factor; it’s even before science. People who have warmth, and people who can listen and advise. But also, I think people who have done it before and with experience and with a wide range of skills. I think a lot of people around the world do recognize that for the world to be better, Africa needs to come on board and to do that we have to share knowledge and exchange skills, we have to collaborate, and we have to mentor one another. And this is also why I am here in Boston. I am here to learn from many people, to see how your physicians work in your clinical settings and in the field of research, and to take a few notes to take home.

Do you have any advice for youth who are interested in pursuing a career in this field?

Mental health and the brain and the mind are fascinating. There is a lot we don't know. This is a field that young people should consider. Young people need to dream big; they must seek advice and seek council from those who have done it before. But most importantly, you need to persist. If you persevere, if you keep trying and trying, you will be successful there is no doubt about it.

The younger generation will bring new ideas and challenge what is already known. I am confident that this younger generation will bring new solutions to the table. I think we have many challenges in the country, but we need to start talking about how climate change will affect mental health overall, and presentations of mental illness, treatment response, migration, etc. I am really hoping that there are answers that the next generation will help us resolve. I think climate change on the African continent, particularly in sub-Saharan Africa, is going to have dire consequences for the most vulnerable. We need to be futuristic in how we think and how we plan. In anticipation of probably the greatest human tragedy, we need to ask ourselves how we make sure that in the next 10-20 years, when we reach that point that the most vulnerable people can be protected.

If you could ask for one wish and it would be granted, what would it be?

My one wish would be that my country and my continent would be free of poverty and human suffering. If Africa can take a step away from human suffering and underdevelopment, we would inadvertently address the problems of mental health because poverty is directly linked. Factors include nutrition, violence, all forms of trauma and abuse, substance use, ability to access education and access to health care, and a critical one now being migration. So, my one wish is hopefully in this lifetime that South Africa and the continent can take a step away from poverty and human suffering. I hope in a small way I can contribute to shine the light for many other people on the continent.

What is a lesson in your life that you would like to share?

The greatest lesson in my life has been that you can’t go far if you go alone. You have to find like-minded people and work with them. You always have to seek advice from those who came before you. If you have a dream, and you persist and keep working and you are patient, you will get there. I still admit I am not there yet, but I know I will get there.

What is something that you are proud of accomplishing?

When I look at success, I look at how I have been able to contribute to the lives of others. I think if we define success that way and we look at it beyond the individual self, we would be able to do more for others. When others do better, the country becomes better, and the continent becomes better. My greatest pride has been mentoring young people to the extent that I have been able to, and giving them opportunities, and showing them what they are capable of doing. I think many of them are better than me. Being able just to encourage people to reach for the stars, to live their fullest potential, and seeing them get there has been my greatest pride. But every day, the small successes have been seeing my patients get better and seeing families become more positive. Many other people would talk about personal accomplishments, but I think they mean nothing if other people are not getting better. If your neighbors are not good and their life is not better, regardless of what you achieve or what you have, your life becomes meaningless as well.

Closing Thoughts

It is my second time in America. Many people in your country don’t understand how much our partnership and your government has helped my country in response to the HIV/AIDS epidemic. If your leaders had not put money into the program and partnership, I believe the consequences would have been dire. I think I can speak for South Africans in how much we value the open door and warmth of which the American people have given in many disciplines. It has been a heartwarming experience to come here to America and actually see and experience the many things you hear about and read about. It has been eye opening in many ways. And I hope many more people from my continent can have the opportunities that I have had. My hope is that others will have the opportunity to be able to attempt to reach for the stars just as I have had. 

 By Joanne Won, September 2022