When you are the only experienced expert with almost no professional support system in a particular field, it tends to be difficult to do a proper and adequate job.
Dr Johannes Willem Bruwer (42) has felt this for a while as Namibia’s only pulmonologist, saying one of the biggest challenges that add more undesirable weight to the healthcare system is the scarcity of pulmonologists in the country.
He, therefore, strongly encourages interested health practitioners to specialise in it.
A pulmonologist is a medical practitioner who diagnoses and treats diseases of the respiratory system, specifically the lungs and other organs that help people breathe.
Bruwer, who has assisted many Namibians, including the first couple, President Hage Geingob and First Lady Monica Geingos, is known to be the first – and for quite some time, the only pulmonologist in the country.
“A pulmonologist recently joined me from South Africa, and I am happy with that. The pulmonology service can expand a bit. We can offer quite a lot more than we are doing because of our numbers,” said the Katutura-born pulmonologist.
He said adequate service will follow
suit because of this expansion happening in the industry, as there is a demand.
Bruwer said pulmonology was not in his plans while attending medicine at Stellenbosch University, South Africa.
“At that time, I wanted to do cardiology – but then, as you do training in internal medicine, you go through the different rotation, and I liked the time I spent at pulmonology at Stellenbosch. It is critical care and pulmonology combined, and that is pretty much the norm worldwide,” stated Bruwer.
He added: “I realised that’s interesting for me and a field where I felt at home working in that department.”
Cases and lung capacity
Statistics provided by the World Health Organisation (WHO), Centre for Disease Control (CDC), World Bank and the United Nations show that lung disease is the eleventh cause of death among Namibians, with 756 deaths reported as of 27 July 2021.
According to these statistics, HIV and AIDS top the list, followed by the Covid-19, Influenza, Pneumonia and Tuberculosis.
“Before Covid-19, I would see about 20 patients a day with lung-related issues, and I would say it’s close to double that number now during the pandemic – and that’s purely in my outpatients’ practice. In the hospital, it’s different. At one time, I had 55 in patients with the same disease,” outlined Bruwer.
Common issues that he comes across in the practice is asthma, chronic obstructive pulmonary disease (COPD), smoking lung-related disease, a moderate number of lung cancers and rare diseases such as interstellar lung disease, which is a condition affecting the lung tissue.
“Blood clots and infectious diseases are seen a lot, which have been keeping me very busy. Another thing seen quite a lot is the membrane around the lung where fluid often accumulates,” he added.
With many people around the world individually testing their lung capacities, Bruwer said holding your breath to determine how long you can do it does not add any benefits.
“Trying to see how long you can hold your breath does not contribute anything, and it is not worth doing,” he stated.
Bruwer said: “In my practice, we do a test, which is called a plethysmography or body box, where we measure different aspects of lung function, including lung capacity. The test, itself, is not dangerous: you breathe into a machine and hold your breath for a few seconds, and that measures the different capacity during your breathing cycle”.
He, however, mentioned that this is a costly exercise and won’t necessarily need to be done on everyone but it is a reliable method, especially for patients who struggle with respiratory issues if it is chronic.
Your time is not your own
“You are on call 24/7 for your patients because they are critically ill; you must be ready to help at any time. I wouldn’t have made a different choice knowing those aspects of the field; I would have still chosen pulmonology because I like it, and a difference can be made,” noted Bruwer.
He said: “The most challenging part is the critical care, the intensive care unit (ICU) type of medicine – but also, there is a rare pulmonology disease, and they can become quite tricky at times – but in general, the long hours that one works, you have to prepare yourself for them.”
Survival tips from the theatre
“Daily, I explain to patients the health benefits of stopping smoking and the risks is what I do mostly. I understand it’s an addictive drug, but there are health benefits once one stops smoking – and those benefits start within 15 minutes; that’s the first time when the blood pressure starts to come down. From thereon, the benefits increase,” informed Bruwer.
He said those who are fans of smoking shisha/hookah pipe, also known as hubbly bubbly, should be careful and avoid it.
“Living a healthy lifestyle is another way many people can avoid getting lung-related illnesses,” he concluded.