Dream of access for all could be a reality soon

He has consulted to the Springboks, the Proteas and elite soccer players, he has been chief medical officer at four Olympic and Paralympic Games and travelled to Russia to learn zero-gravity medicine as Mark Shuttleworth's personal physician during his trip into space. But one of veteran sports physician Prof Wayne Derman's biggest ambitions is to bring sports medicine to the public health sector.

Appointed as Professor of Sport and Exercise Medicine within the Division of Orthopaedic Surgery at the Faculty of Medicine and Health Sciences, Derman joins Stellenbosch University during a coming of age of this discipline of medicine in South Africa. One hopes that by the end of 2015, doctors will be able to specialise in sports medicine in the same way as they can in orthopaedics, paediatrics, surgery or any of the other 25 specialisations currently recognised by the Colleges of Medicine of South Africa.

A familiar face

Despite having spent most of his professional life at the Sports Science Institute of South Africa at the University of Cape Town, Derman considers his move to Stellenbosch University "a natural progression". His involvement here dates back to 2008, when he became the sports physician for the Coetzenburg-based Maties Paralympic athletes. He has co-authored numerous academic articles with Stellenbosch star Paralympic coach Dr Suzanne Ferreira, and also collaborates with the Department of Psychology in research on athletes with disabilities.

"Stellenbosch has a very rich sporting history and it's a hub of sport for both local and internationally-based athletes. Maties Sport is a large, influential organisation. And there are already many professionals involved in sport and exercise science and medicine at Stellenbosch.

"On the main campus there are the Sports Science and Physiology departments as well as the Psychology department which are all working with athletes with disabilities. Then there's Coetzenburg, Maties Rugby, Hockey, Tennis as well as Maties Athletics, which is the hub of South African Paralympic training. And then there's Campus Health, which has three sports physicians on their staff who also play an important role. There is also a very productive and research driven Physiotherapy division here on the Tygerberg Campus.

"The aim of the future institute will be to include stakeholders across different faculties, and to augment collaboration and utilisation of facilities," says Derman, who is also co-director of the International Olympic Committee (IOC) Research Centre of South Africa.

"The Institute will mostly facilitate and conduct research which will be focused on injury prevention and protection of the health of both recreational and highly competitive athletes. It will also provide input into the teaching and training of multidisciplinary professionals involved in sport and exercise medicine, as well as being involved with service delivery. One hopes this will have a high social impact.

"In teaching we hope to bring sports and exercise medicine into the undergraduate medical curriculum, and into postgraduate studies in the form of MPhil and MMed degrees for specialists, for doctors and other health professionals who want to specialise in those areas, or do a Masters degree or a PhD in specific areas."

Sports medicine for the masses

The biggest opportunity Derman sees with the establishment of the institute is the possibility of getting sports medicine into the public sector, perhaps even as early as mid-2016.

"My vision would be that somebody can come to the hospital and, while sitting at the outpatient clinic getting medication, can also come to see a counsellor who can advise them on a healthy lifestyle. Maybe there would be a facility where you can get advice on your exercise injury, on how to recover from it and what exercises you can do to help the healing process.

"It would involve a multidisciplinary team, the input of a physiotherapist, a nutritionist, perhaps even a psychologist on how to reduce psychosocial stress, as well as biokineticists who prescribe exercise programmes. This doesn't exist at all at the moment."

His experience in private practice has shown him that sports medicine is extremely relevant outside high-performance, competitive, professional sport. "Orthopaedics is great. If you have a fracture, you can sort it out. There's a resolution to it that may or may not involve surgery. But what about that niggle, those chronic injuries? They have a very important effect on quality of life, but they don't feature in the public health sector, because there surgeons have to look after multiple trauma, such as motor vehicle accidents – big, serious injuries.

"Medicine dealing with physically active individuals is often very subtle. Sports and exercise medicine is the specialty that learns to deal with chronic, subtle things.

"Exercise is often a disease exposer. Consider a person living a sedentary lifestyle. There's no problem getting up to go to the bookshelf or walking up and down a few stairs. But now you start exercising and your weakest link is unmasked, whether it's exercise-induced asthma or abnormal biomechanics of the lower limb that causes knee pain.

"Exercise medicine is a quite complex and challenging medicine, and that's why I like it. It has a very broad spectrum and a complexity where you're unmasking the weakest link in the chain, and also working with physiology at the limits. When we exercise, we take ourselves to the max. That's a challenge to the system. That's also why I like working with athletes with disabilities, because it adds a different layer of complexity."

Exercise as medicine

Another important field where Derman sees the potential for growth is where exercise- and other lifestyle interventions are used in the management of chronic non‑communicable diseases such as cardiovascular illness and diabetes.

He mentions that more than 50% of what he has seen in private practice are chronic lifestyle-related diseases such as diabetes, cancer recovery, cardiac disease and lung disease. That is really rewarding work. The sicker the patient, the bigger the reward, because the bigger the improvement of their lifestyle.

"A chronic disease is often perceived by a patient as their body letting them down, that there is a lack of trust as to how far they can exert their body. Then you start on a lifestyle intervention, and after a while the patient realises that he or she can actually do something, I can get around this track, or ride this bike. It's about regaining trust in the body, and it makes a significant difference in people's lives. I get a real kick out of that."

This article was originally published in the Faculty of Medicine and Health Sciences' annual publication.