Spotting diseases and curing them

Katrien Dehaeck is a doctor who specialised in gynaecology and obstetrics, with an additional focus on gynaecological cancer and white spot disease. She tells Margaret Harris she likes the detective work involved in making a diagnosis

What does your job entail?

I consult some days and see women with gynaecological problems. On other days I do surgery, which is sometimes quite long and difficult.

On some days, I go to Groote Schuur Hospital in Cape Town to teach students, doctors and gynaecologists on ward rounds. I also teach them about, and assist with, surgery.

What is Lichen sclerosus?

It's a long-term inflammatory skin problem that mostly affects the genital and anal areas of the body, although it can sometimes affect other parts. Lichen sclerosus is a very uncomfortable disease that is often misdiagnosed for years as thrush or a yeast infection.

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It starts with small white spots appearing on the skin, and these spots become bigger patches of inflamed, thin and wrinkled skin. The skin tears easily, and bright purply-red bruises are common. The skin can also become scarred and causes itching genitals and bum, bleeding, blisters and pain. In severe cases, women may experience pain when urinating or sitting for extended periods. They may not be able to have sex, because scarring narrows the vagina.

Until recently,Lichen sclerosus was treated with cortisone creams and ointments to reduce the itching, burning and inflammation. But these ointments do not cure the disease.

How did you become involved in this field of work?

I became interested in vulval [the area outside of the vagina] diseases and problems about 20 years ago as part of precancerous problems at first. That led to further interest in all kinds of itches, burns and lesions of the vulva.

One particular interest of mine became Lichen sclerosus. It is not very common but should be handled in a specific way. There are only a handful of doctors in the world treating the disease with a stem-cell procedure that takes fat from the patient's own body and injects it under the skin in the affected areas. It is minimally invasive, and, within a few weeks, there is so much relief to the patient.

What did you want to be when you were a child?

I never dreamt of becoming a doctor. I saw myself as an explorer of some sorts, an adventurer in faraway lands. I suppose that was because of my love of the outdoors.

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What do you enjoy most about the work you do?

I am a diagnostician at heart, which is a bit like being a detective. I enjoy putting all the pieces of information together to come to a diagnosis. I also love working with my hands, so I love doing surgery.

What do you wish you could ask someone else to do?

Admin is my pet hate. However, I am fortunate that my partner at work does most of it.

What mistake at work led to your biggest lesson?

I have made a lot of mistakes, as I am only human. But my mistakes cannot really be big, as that could cost someone's life! Over the years, my mistakes have humbled me.

What is the best career advice you have ever received?

A psychologist friend advised that I sit back in my chair while consulting. That way I would get some "distance" from the patient. You see, my mistake was, and still is to an extent, to get very involved in the patient's problem, and it eventually drains you.

What I have learnt is that the best thing that can happen to us is to enjoy what we do as a career. I am fortunate that my path led me to where I am today. I still love what I do.

What would people find most surprising about your work?

It involves a lot of psychology. Patients tend to pour their hearts out.