Making a difference to the diabetes pandemic

Dr Joanna Skelton
Senior Registrar in Endocrinology, Groote Schuur Hospital
MMed by dissertation: Phenotype of patients with diabetic ketoacidosis in Cape Town

Under the microscope

Dr Joanna Skelton is mom to a 21-month-old son and lives in Newlands, Cape Town. When not at work she runs and swims to keep fit and stays as far away from the oven as possible. “Luckily I have a husband who can cook!”

Never tell a 10-year-old what not to do. Dr Joanna Skelton is living proof of that.

More than two decades ago Dr Joanna Skelton’s parents tried to warn her off medicine. It would be too difficult to get into medical school, they argued. But the determined pre-teen persisted, shadowing a GP in rural KZN during her holidays.

“I was hooked.” Hours of extra lessons and holiday cramming sessions eventually paid off when she was accepted at the University of Cape Town. “I remember every word of that phone call and the tears of relief and sheer joy.” Dr Skelton, a recently-qualified endocrinologist, is particularly concerned with diabetes. “The International Diabetes Federation has predicted a 98% increase in diabetes numbers by 2030 in Africa and a recent report from our university says that one in five black Capetonians have diabetes. This has profound implications for our already overburdened public healthcare system,” she says. Type 2 diabetes is largely preventable and all forms of diabetes are treatable. The better the treatment, the lower the risk of complications. “I’m particularly interested in the large impact that can be made by good motivation and education and appropriate treatment,” says Dr Skelton.

According to Prof Naomi Levitt, head of the Division of Diabetic Medicine and Endocrinology at UCT, increasing numbers of black Africans are presenting with DKA, the hallmark of type 1 diabetes, but who over time demonstrate a lack of dependency on insulin to live. This type of diabetes, also known as ketosis prone type 2 diabetes, is a particularly ripe area for research.

Dr Skelton suspects that if properly diagnosed, some patients with true type 2 diabetes will be able to discontinue insulin therapy and be managed on oral treatment. This will have a significant impact on the individuals and huge cost savings for the state.

It’s been more than two decades since Dr Skelton closed her ears to her parents’ pleas. And she’s still not listening. “We are told not to become personally attached to our patients but show me a doctor who is able to do that when you become all that the child has,” says Dr Joanna Skelton, recalling her interaction with an eight-year-old blinded by toxoplasmosis. When a bucket of chicken was brought for a patient in a ward and it was shared with everyone except the blind child, Dr Skelton was outraged. But the little girl simply said: ‘don’t worry doctor, I know my day will come’. “I drove around at 11pm that night to find more chicken for the girl. When I handed her the two chicken wings and drumsticks she ate one drumstick and asked me to share the rest with the other children. She died a week later. That little girl taught me a great deal.” “Joanna has all the attributes of a good doctor: compassion, understanding, honesty, empathy, humanity and respect. This, and her intellect, broad knowledge, additional scientific experience and international exposure will turn her into an exceptional endocrinologist and clinician scientist,” says Dr Peter Raubenheimer, head of the Division of General Medicine at UCT.