P e d ia tric a n d D e v e lo p m e n ta l P a th o lo g y 17, 4 1 3 -4 1 8 , 2014 D O I: 1 0 .2 3 5 0 /1 4 -0 4 -1460-PB.1 © 2 0 1 4 S o c ie ty f o r P e d ia tric P a th o lo g y
PERSPECTIVES IN PEDIATRIC PATHOLOGY
Founders of Pediatric Pathology: Roc Kaschula H elen W
ainwright *
D ivision o f A n a to m ic a l P a th o lo g y , U n iv e rs ity o f C a pe T o w n , F aculty o f H e alth Sciences, C a pe T o w n , W e s te rn Cape, S o u th A fric a
Received April 14, 2014; accepted August 5, 2014; published online August 8, 2014.
Ronald Otto Christian Kaschula, known as Roc, is a man of Africa. He was born in the former Southern Rhodesia, now known as Zimbabwe, in 1935, the eldest of 5 children. His father was a farmer of Western Slav origin whose family immigrated to South Africa in 1858, and his mother was of Afrikaans origin. His parents married in Zimbabwe. He was raised on a farm in the Gutu District in central Zimbabwe. At the age of 5 Roc was homeschooled by his mother for the 1st year. At the age of 6 he went as a boarder to the nearest farm school, which was called the Soti Source Primary School. This was during World War II, when there was a shortage of petrol. In order to conserve petrol the fathers from his area would take turns fetching the 6 local children home 3 times a year for the school holidays. Roc has memories of traveling in his father’s pick-up truck with the other boys; on other occasions he came home in a horse and muledrawn cart belonging to one of the other fathers. After 4 years at the farm school he was sent as a boarder to schools in Gwelo— the Cecil John Rhodes Primary School, followed by the Chaplin School. Although unknown to him at that time, he watched his future wife play hockey for Girls’ High School, when she traveled with her team from Salisbury to play against Chaplin School farther to the south. Roc developed rheumatic fever and schistosomiasis as a child. His ill health brought him into contact with the family general practitioner, Dr McGladdery, from Ireland, who realized his potential and encouraged the young Roc to spread his wings and study medicine in Cape Town, South Africa. In order to do this, he won a scholarship provided by the State Lottery and was assisted by a government loan. A medical classmate, J.P. van Niekerk, also a former Dean of the Medical Faculty at the University of Cape Town, remembers traveling down to Cape Town with Roc in his Simca car after the university vacation. The trip from Gwelo to Cape Town spanned 2000 km, and it took *Corresponding author, e-mail: [email protected]
Roc 2 days to complete the journey. Roc appeared more serious than the rest of his class, but he had a wry sense of humor and was adventurous in a quiet and understated way. He played 2nd-league field hockey for the University of Cape Town Hockey Club, and once he qualified as a doctor, he played social tennis and squash. He was also interested in South African cricket and rugby. Roc completed his undergraduate training in 1959. As an intern, Roc spent 2 months of the following year at the Red Cross Children’s Hospital in the surgical wards. He was then advised to spend a year studying pathology prior to returning to Zimbabwe to work off his government loan. He planned to work for the well-known physician Michael Gelfand in Salisbury. However, after a year of pathology, his request to serve Zimbabwe was turned down, as the government medical service wanted medics with basic training in forensic pathology. He remained in Cape Town and completed his MMed in Pathology in 1964. In 1965, he joined the South African Society of Pathologists. The Red Cross Children’s Hospital opened its doors to patients in 1956, when Roc was a 3rd-year medical student. His future wife Sheila had also moved from Zimbabwe to Cape Town and was one of the 1st student nurses to work there as part of her training. The pathology department at Red Cross Children’s Hospital was opened in 1957 by Dave Mackenzie, who played a major role in establishing Roc as a pediatric pathologist. As a lst-year registrar in pathology, Roc met a glamorous staff nurse, Sheila Darby, in the Urology Department at Groote Schuur Hospital (GSH). They both shared an upbringing in Zimbabwe. They married in 1963 and produced 3 healthy children. Sheila put her nursing career on hold to raise the family until the youngest child, Wendy, began school. She then started working part time at Red Cross Hospital with Professor Cyril Karabus. She took an oncology course in 1986 and spent the last 12 years of her career working in a gynecologic practice providing individually tailored chemotherapy for patients. She retired in 2003. Roc and Sheila’s 2 eldest children followed the family’s medical tradition and studied medicine in Cape Town. Roc’s son is an orthopedic
Figure 1. Family p h o to ta ke n a t Roc's 70th b irth d a y (2 m ore g ra n d ch ild re n have fo llo w e d th is m ilestone).
Figure 2. Taken a t th e PPS M e e tin g in O xfo rd in 1985: Roc w ith A ngus Gibson fro m G lasgow and John Emery fro m S heffield, U nite d K ingdom .
surgeon, and his elder daughter is a general practitioner. Both children work in the Eastern Cape. Roc and Sheila’s youngest daughter is a chemical engineer. Roc and Sheila have 7 grandchildren to date, ranging in age from 18 years to infancy, and they have been of great assistance with the grandchildren when required. Wendy, their younger daughter, and her husband live in Cape Town, and Sheila enjoys the company of each of their 3 children separately for an afternoon each week. She takes her granddaughter horseback riding; the boys are provided with their favorite lunch of mince and vegetables and then they participate in various activities at Roc and Sheila’s home. Roc is very patient when playing trains with his 2 grandsons. The playroom carpet is usually occupied by a complex arrangement of railway lines with figures of eight, intersections, and bridges that they have built together. Great fun is had by all as they try to avoid head-on collisions as the trains speed along the tracks. Roc was appointed as a pathologist to Professor Jim Tomson’s department at GSH in 1965, when there was a vacancy in pediatrics, and he started performing baby autopsies and lecturing in pediatric pathology. Roc’s early teachers in the field of anatomical pathology included Golda Selzer, Dirk Uys, Chick Campbell, and Alan Timme. While working with Jim Tomson, Roc authored an article entitled “ Asbestos as a modem urban hazard.” Blue asbestos was mined in the Northern Cape and was in widespread use in Cape Town at the time. After 10 months at GSH, Roc was transferred to the pathology department at the Red Cross Children’s Hospital, where he worked under the guidance of Dave Mackenzie, who set a fine example of running a department during the period from 1956 to 1977, aiming for quality care for children. Dave Mackenzie emphasized the need to have highly skilled and dedicated staff by ensuring that they received appropriate training, rather than by trying to recruit staff elsewhere. Professors at the Red Cross who functioned outside of anatomical pathology taught Roc to learn from his mistakes. Roc
was promoted to Senior Specialist in 1967. In that year, he joined the Pathological Society of Great Britain and Ireland. Roc was appointed Principal Specialist in 1975 and Associate Professor in Pediatric Pathology in 1978, and he functioned in this role until his retirement in 2000. He completed 35 years of continuous service at the Red Cross Children’s Hospital. The International Academy of Pathology (IAP) was responsible for bringing excellent pathologists to South Africa and for fostering transcontinental contacts. The late John Emery came to South Africa as an IAP visitor and spent time in Cape Town lecturing on sudden infant death syndrome. Roc was attracted to John Emery’s teaching style, which encouraged thinking and commitment. Another IAP visitor was Lauren Ackerman, who influenced the young Roc. Lauren suggested to Roc that if you feel you are not making mistakes in diagnostic anatomical pathology, you are probably sending out reports in which you are not entirely correct in 10-15% of your cases. Striving for diagnostic excellence requires mental gymnastics to obtain the most accurate diagnosis for your clinicians. Dave Mackenzie recommended Roc to the Interna tional Pediatric Pathology Association and put him in contact with international figures such as Ben Landing, John Craig, and Albert Clareaux. They all assisted him in developing an enquiring mind so that he could develop his expertise and broaden his experience. In 1969, Roc went on sabbatical to the United States. Boet Heese, Professor of Pediatrics at Red Cross Children’s Hospital, was very interested in the manage ment of hyaline membrane disease. Tracheostomies were being performed locally to ventilate sick babies, and Boet asked Roc to find investigate the complications associated with the American usage of endotracheal tubes in these sick infants while he was in the United States. Roc spent 6 weeks at the Boston Children’s Hospital, where Dr Sidney Farber was the semi-retired Chief of Pathology and where he met John Craig, Shirley Driscoll,
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Figure 3. Roc w ith Past Presidents o f the SPP attending the 1991 "E ncounter in Paediatric Pathology" in Cape Town, South Africa. Back row, from le ft to right: Roc Kaschula, Bill Blanc. Front row: Harvey Rosenberg, M olly Valdes-Dapena, M Daria Haust, Enid Gilbert-Barness, and Don Singer.
and Gordon Vawter. Sidney Farber sponsored Roc so that he could attend a Pediatric Pathology Club conference, where he met Bill Blanc. The latter read a paper on esophageal atresia and quoted Professors Jannie Louw and Chris Barnard, both renowned South African surgeons, in his references. Roc and Bill Blanc ended up sitting next to each other at the conference dinner and that was the start of a lifelong association and friendship. Bill Blanc invited Roc to New York and showed him around the Columbia Presbyterian Babies’ Hospital and gave him a quick tour of New York. Roc then traveled to Atlantic City to the American Pediatric Society’s Annual Conference with John Craig’s recommendation. At this conference, he met American pediatricians interested in collaborative studies. At the Pediatric Pathology Club he came into contact with Ben Landing, Bill Donahue, Harvey Rosenberg, and Don Singer. Bill Blanc was also a member. These contacts stimulated and assisted his interest in pediatric tumors through the sharing of cases and information. Subsequent to this visit, Roc corresponded regularly with Bill Blanc and visited him whenever he was in the United States. Roc invited Bill Blanc as a University of Cape Town visiting lecturer to Cape Town for a 2-month period in 1972. During this time, Blanc worked and taught at Red Cross Children’s Hospital and at GSH. Two local women pathology registrars, Drs Susanna Mouton and Genevieve Learmonth, were performing neonatal autopsies at GSH at the time. They benefited from Blanc’s expertise in congenital malformations. Both were pregnant at the time and understandingly found the topic of congenital malformations disturbing. Three local neonatologists, Professors Atties Malan, Vincent Harri son, and Dave Woods, also enjoyed interacting with Blanc and his teaching. Jack Katz came from Johannes burg to Cape Town to train in pediatric pathology under Roc, and he also experienced training with Bill Blanc.
Bill Blanc fell in love with Cape Town on this visit, ended up buying a house, and subsequently visited Cape Town annually, strengthening his contact with Roc. In 1974, Roc was invited to participate in a slide seminar at the IAP conference in Hamburg. He chose a case of plasma cell granuloma of the lung. However, he was unable to obtain funding to attend the meeting, so Jean Keeling presented the case on his behalf. In 1976 Roc attended the IAP conference in Washington, DC. At this conference he met Daria Haust, who had corresponded with Dave McKenzie, fostering international contact. She had driven the formation of the International Pediatric Pathology Association (IPPA) at Hamburg in 1974 to improve the standard of pediatric pathology. The idea was to unify and provide training in pediatric pathology in the United States, Europe, Latin America, and Australia. The establishment of IPPA in 1976 as an international umbrella organization for pediatric pathology societies stimulated coordinated outreach and cooperation among pediatric pathology societies around the world: the Australian-New Zealand Pediatric Pathology Group; the Paediatric Pathology Society already established in 1955; the Japanese Pediatric Pathology Society in 1978; SLAPPE in 1978; and the Society of Pediatric Pathology formed from the Pediatric Pathology Club in 1983-1984. The decision was made to run IPPA as a biennial companion meeting to the IAP. The president of the council of the IAP was John Emery. Daria Haust was secretary, and Roc was made a member representing Africa. Roc and John Emery met up again in 1983 at the Pediatric Meeting in Manila when they formulated the initial constitution of IPPA. In 1976, Roc also visited St Thomas’ Hospital in London, Nottingham University, and the Royal London Hospital, where he attended the Royal College of Pathologists’ Pediatric Renal Pathology Course, the Reticulo-Endothelial System Course in Sheffield, and a Perinatal Infection and Immunity Course at the University of Western Ontario in Canada. In 1977, an intensive training course in pediatric pathology, separate from IPPA influence, was organized in Sheffield by John Emery. It was planned as a formal training program for practicing pediatric pathologists in Europe. Two American pediatric pathologists were sent by Daria Haust to assist with the course. There were 40 participants, who were mainly from countries that had children’s hospitals—France, The Netherlands, and Scandinavia. The aim was to have a specialist-trained pediatric pathologist/perinatal pathologist at every med ical school. Roc was an invited tutor for the IPPA courses, which lasted for a week apiece on 6 occasions during his career: Sheffield, United Kingdom, in 1977; Lubeck, Germany, in 1984; Barcelona, Spain, in 1986; Palic, Yugoslavia, in 1988; Loutraki, Greece, in 1992; and Guidel, France, in 1998. Through these courses, Roc came in contact with large numbers of aspiring pediatric pathologists and was able to assist them with his expertise in a friendly, stimulating, and educational setting. F ounders
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In 1983, Roc was sponsored to attend a Measles Conference in Washington, DC, where the virologists were most interested in his presentation on the pathologic findings in young children with malnutrition and measles pneumonia. He made contact with others workers in the field, including the Russian virologist Nicolai Paradze and David Morley from the School of Tropical Disease in the United Kingdom, who had worked in Nigeria. During his career Roc took 4 sabbaticals, between 1985 and 2000, with time spent at children’s hospitals in Glasgow, Scotland; Liverpool, United Kingdom; Perth, Australia; and Edinburgh, Scotland. In 1991, during the Gulf War, Roc put Cape Town, South Africa, on the ‘International Pediatric Pathology’ map by hosting an extremely successful joint Paediatric Pathology Society and Society of Pediatric Pathology Meeting. This was followed in 2004 by an IPPA Update Course in Pediatric Pathology at Goudini Spa, Rawsonville, Cape, followed by a Paediatric Pathology Society Meeting in Cape Town that was well attended and enjoyed. At Red Cross, Roc’s research activities honed in on diseases of childhood that were important in South Africa. He described the changes in the small and large intestine in kwashiorkor and noted the importance of gem squash as a good, cheap source of vitamin A in the diet of impoverished young children. He reported on the infantile jejunal mucosa in infection and malnutrition. He wrote several seminal papers on measles in malnourished children, describing the occurrence of viral pneumonia due to adenovirus and herpes infection following measles. This combination resulted in necrotizing bronchitis and bronchiolitis and follicular bronchiectasis, important causes of morbidity and mortality. The secondary infection was mediated by transient immunosuppression as a consequence of measles and inadequate nutrition. Measles vaccination was available to lower socioeco nomic groups in Cape Town in 1974 and had an immediate beneficial effect. However, vaccinations became temporarily unavailable over a 6-month period in 1977, and Roc noted the upsurge in deaths following measles during this period compared to the preceding and subsequent years. Roc also devoted his attention to congenital syphilis and wrote about the nephrotic syndrome occurring in very young infants with untreated and frequently undiagnosed congenital syphilis. He also described a series of newborns with intestinal obstruction due to congenital syphilis. Roc reported on a series of cases of necrotizing enterocolitis after the neonatal period in severely malnourished and immunosuppressed infants. Longstanding interests for Roc were Hirschsprung’s disease (HD), acquired aganglionosis following surgery for HD, and degenerative leionryopathy, a megacolon syndrome affecting indigenous Africans in the southern parts of Africa. More recently, Roc described abnormal ities in smooth muscle in the bowel of children with intestinal pseudo-obstruction. In addition, in association
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with Ulane Neveling, Roc reported on 86 autopsy cases of fatal meningococcal disease at Red Cross Children’s Hospital. Childhood tumors were of major interest to Roc, and he coauthored the results from the Red Cross Children’s Hospital on the outcome of solid tumors occurring in the neonatal period over a 34-year period, with long-term follow-up of 10 years. He reported on his experience with hepatoblastoma over a 31-year period and commented on the occurrence of teratoid hepatoblastomas postche motherapy. Other articles included those related to gastrointestinal lymphoma, the pathology of Wilms’ tumor, therapy in adult Wilms’ tumor, primary pulmonary tumors, childhood peripheral primitive neuroectodermal tumors in Cape Town, the diversity of malignant rhabdoid tumors, Castleman’s disease in children, myopathy associated with chronic renal failure, and many others. Roc’s published book chapters reflect his unique experience in Southern Africa—veno-occlusive disease, infectious diseases, malnutrition and intestinal malab sorption, pediatric AIDS, and infectious diseases. Roc has been a stalwart proponent for the teaching and dissemination of knowledge in all aspects of pediatric pathology. Throughout his career, he identified gifted junior staff and guided them along a course to gain needed skills and to become future leaders. He is still the coordinator, lecturer, and tutor for the Postgraduate MPhil Course in Pediatric Pathology at UCT, which he started in 1997-2000 and recommenced again in 2009, despite his ‘retirement.’ Roc is still involved in teaching pediatric pathology for Stellenbosch University at Tygerberg Hospital, which he started prior to his retirement. Roc was one of the lecturers and tutors at a recently held certificate course in perinatal autopsy and placental pathology held at Tygerberg Hospital, which attracted a wide spectrum of participants, including local forensic pathologists. Over the years Roc has assisted in advancing the careers of aspiring pediatric pathologists. Werner Dutz, who was interested in malnutrition and infectious diseases, spent 2 weeks at the Red Cross Children’s Hospital and was most interested in Pneumocystis carinii/ jirovecii. Gabriele Amann, who trained in Vienna, was sent to train with Roc for 6 months. Marta Cohen was introduced to Roc at an international congress in Argentina and came and spent 2 years training in pediatric pathology with Roc. Friederich Struwe from Freiburg, Germany, came and spent a year with Roc in Cape Town. Enid GilbertBamess recommended Jeanne Ackerman from Florida to visit Red Cross Children’s Hospital, and she has made 3 visits to date, spreading her expertise to all those with whom she has made contact. Being a farmer’s son, Roc is very handy about the house fixing things. He enjoys gardening, loves watching cricket and rugby, and is very patient with his grandson David, who has di George syndrome. He is involved with his church and assists as a lay minister. When his children
were growing up, family holidays were spent camping at game parks and game spotting by car. The Kalahari Game Park was a top family favorite. Sheila recalls an eventful trip when their younger daughter was aged 4 and hoped to see a lion during their visit. On entering the park, the game ranger gave them some useful advice: If they saw a lion in the campground, they should get in the car and blow the hom. Unfortunately, the lion they saw was right outside their tent, blocking access to their car and its horn. Their daughter was thrilled that they had seen a lion and oblivious to the danger. Roc tried to be an activist for change within the hospital and the university, and he initiated the appoint ment of people of color in posts previously reserved for “ whites.” These actions had repercussions. In 1985, after 20 years at Red Cross and after serving the university on Senate, the UCT Faculty Board of Medicine, the Conditions of Service Committee, the Nominations Committee of UCT, the Terms of Employment Commit tee of UCT Senate, and as an elected member of the Executive Committee of the Faculty Board of Medicine, Roc decided to give up on the university and instead concentrated his attention on international pediatric pathology. He was elected to office in the 1AP and 1PPA. He spent 16 years as the ViceP resident of the IAP, with responsibility for Anglophone Africa. Eight years were spent as secretary and 2 years as president of the 1PPA. He served for 4 years on the Council of the Association of Pathologists from East, Central and Southern Africa. He brought new skills and techniques back to Cape Town and South Africa, initiating the reporting on placentas in 1969; using methenamine stains on renal biopsies; using acetylcholinesterase stain on frozen section biopsies to improve the diagnosis of HD, and many others. This led to the popularity of Red Cross Children’s Hospital for either short-term visitors or for long-term trainees, who were often supported by bursaries from overseas. Roc built up a quality laboratory with high standards of practice and delivery by his team of technologists and his molecular scientist and outstanding mortuary staff, ably assisted by his pediatric pathology colleague, the late Professor Colin Sinclair-Smith. While Secretary of the IAP, Roc invited Zimbabwe to join the South African Division of the IAP, which it did, until 1999. He sent educational material to Malawi. In 1972 at the IAP Congress in Helsinki, Roc met Olifemi Williams from Nigeria, who was the editor of the Journal o f Pathology for Africa and co Vice President of the IAP for Africa with Roc. This resulted in Professor Williams being invited by Professor Stuart Saunders to attend the Liver Conference in Cape Town in 1973. South Africans were not welcome in Kenya at that time, and the Professor of Pediatrics in Nairobi persuaded the 1PA to ban the South African Pediatric Society. Pediatric pathology outreach was closed to Kenya and East Africa. Roc represented Africa on the IAP Council and Executive, and his major problem was the rapid turnover of heads of departments in Africa. Professor Olifemi
Williams subsequently went to the United States. During that period, Roc wrote to people but received no reply. He advertised educational material and sent it to those who responded, who were very appreciative. In 1992, when President De Klerk removed the ban on the African National Congress, South African passport holders were permitted to visit Kenya. Roc was invited to the Second Association of Pathologists of East, Central, and Southern Africa (APECSA) Congress, where Roger Cotton was present. While Vice President of the IAP, with responsibility for Anglophone Africa, Roc was an undergraduate and postgraduate examiner at Nairobi University, Kenya, from 1993 to 1996 and from 1999 onwards at Makarere University, Kampala, Uganda. The Association of Pathologists from East, Central and Southern Africa was launched in 1989 in Dar es Salaam. Three years prior to this, Roger Cotton spent a 6-month sabbatical in Harare, when Shawawa Gwavava was head of department. Roger Cotton and Michael Hutt were asked by the Common wealth Secretariat to evaluate the laboratory needs in Central and East Africa. They collaborated with Roc on this evaluation. Southern Africa included Botswana, Swaziland, and Lesotho. Roger Cotton was responsible for the formation of APECSA. The 1st APECSA meeting was held in Tanzania. After his sabbatical, Roger Cotton came to South Africa and gave a slide seminar. Individual South Africans provided limited access to educational material. Roc obtained funds from the IAP to bring key members from APECSA to the 1998 South African Conference in Pretoria. They were also provided with free IAP educational material. In 2000, Roc organized an APECSA meeting at Victoria Falls. He raised a significant amount of money from international donors and encouraged many of his exSouth African pathologist friends from around the world to attend at their own expense and to participate in seminars. This was a very successful meeting. Roc also attended the 9th APECSA meeting in Mombasa, at which an East African Division of the IAP, as well as a College of Pathologists from East, Central and Southern Africa, were formed. Postretirement Roc performed locums at Birming ham, Sheffield, and the Royal Manchester Children’s Hospitals on multiple occasions from 2001 until 2006. Marta Cohen and Dick Variend from Sheffield were both grateful for his assistance when they were practicing single handed, and the staff of Sheffield Children’s Hospital have fond memories of him. In the mortuary, Roc performed postmortems sitting on a stool with wheels and had to be rescued on several occasions when sliding inadvertently across the mortuary floor. The mortuary staff remembered his unusual attire in the mortuary. When confronted with the safety guidelines and asked why he was not wearing an apron he would reply “ it’s underneath my gown.” Roc received many accolades during his career—the Distinguished Certificate of the Latin American Society of F ounders
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Chile in 1988; Honorary Membership of the Chilean Society of Anatomical Pathology in 1988; Honorary Membership of the Kenyan Association of Clinical Pathologists in 1993; Honorary Life Member of the Association of Pathology for East, Central and Southern Africa in 2000; Honorary Life membership of the South African Division of the IAP in 2000; and he was the Farber-Landing lecturer to the Society for Pediatric Pathology in 2002. However, the highlights of Roc’s career are being awarded Lifetime Fellowship of the IPPA (only granted to a maximum of 12 living persons) for international service to pediatric pathology in 1994 and the Gold Medal of the IAP for international achievement in pathology, educa tion, and research in December 2004. Roc felt that he was rather young to have received this great honor. It places him among the other greats in pediatric pathology, starting with those who first received this award, namely Edith Potter and Agnes McGregor. Other doyens include Jim Arey, Ben Landing, J. Edgar Morrison, John Emery, Daria Haust, Jonne Huber, Christian Nezelof, Bill Blanc, and others. Thank you, Roc, for the support and encouragement you provided me in pursuing my interest in perinatal pathology.
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PUBLICATIONS 1. Kaschula ROC, Uys CJ, Kuitjen RH, Dale JRP, Wiggelinkhuizen J. Nephrotic syndrome of congenital syphilis: biopsy studies in four cases. Arch Pathol 1974;97:289-296. 2. Kaschula ROC, Druker J, Kipps A. Late morphological conse quences of measles: a lethal and debilitating lung disease amongst the poor. Rev Infect Dis 1983;5:395-404. 3. Kaschula ROC, Cywes S, Katz S, Louw JH. Degenerative leiomyopathy with massive megacolon. Myopathic form of chronic
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idiopathic intestinal pseudo-obstruction occurring in indigenous Africans. Perspect Pediatr Pathol 1987;11:199-213. Kaschula ROC, Gajjar PD, Mann M, et al. Infantile jejunal mucosa in infection and malnutrition. Israel J Med Sci 1979;15:356-361. Kaschula ROC. Malnutrition and intestinal malabsorption. In: Seifert G, Doerr W, eds. Tropical Pathology, 2nd ed. Berlin: Springer-Verlag, 1995;985—1030. Kaschula ROC. Infectious diseases. In: Berry CL, ed. Paediatric Pathology, 3rd ed. London: Springer-Verlag, 1995;729—820. Kaschula ROC. Paediatric AIDS. In: Berry CL, ed. Paediatric Pathology, 3rd ed. London: Springer-Verlag, 1995;821—835. Redmond AOB, Kaschula ROC, Freesemann C, Hansen JDL. The colon in kwashiorkor. Arch Dis Child 1971;46:470^173. McDonald R, Wiggelinkhuizen J, Kaschula ROC. The nephrotic syndrome in very young infants. Am J Dis Child 1971; 122:507— 512. Kipps A, Kaschula ROC. Viral pneumonia following measles: a virological and histological study of autopsy material. S Air Med J 1976;50:1083-1088. Beckford AP, Kaschula ROC, Stephen C. Factors associated with fatal cases of measles. A retrospective autopsy study. S Aff Med J 1985;68:858-863. Neveling U, Kaschula ROC. Fatal meningococcal disease in childhood: an autopsy study of 86 cases. Ann Trop Paediatr 1993; 13:147-153. Cohen MC, Kaschula ROC. Primary pulmonary tumors in childhood: a review of 31 years’ experience and the literature. Pediatr Pulmonol 1992; 14;222—232. Taylor KL, Kaschula ROC. Castleman’s disease in children: the experience of a children’s hospital in Africa. Pediatr Pathol Lab Med 1995;15:857-868. Davies JQ, de la Hall PM, Kaschula ROC, et al. Hepatoblastoma— evolution of management, outcome and significance of histology in the resected tumour. A 31 -year experience with 40 cases. J Pediatr Surg 2004;39:1321-1327. Kaschula ROC. The practice of pathology in Africa. Arch Pathol Lab Med 2003;137:752-755. Kaschula ROC. The pediatric autopsy in Africa. Arch Pathol Lab Med 2013;137:256-266.
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PERSPECTIVES IN PEDIATRIC PATHOLOGY
Founders of Pediatric Pathology: Roc Kaschula H elen W
ainwright *
D ivision o f A n a to m ic a l P a th o lo g y , U n iv e rs ity o f C a pe T o w n , F aculty o f H e alth Sciences, C a pe T o w n , W e s te rn Cape, S o u th A fric a
Received April 14, 2014; accepted August 5, 2014; published online August 8, 2014.
Ronald Otto Christian Kaschula, known as Roc, is a man of Africa. He was born in the former Southern Rhodesia, now known as Zimbabwe, in 1935, the eldest of 5 children. His father was a farmer of Western Slav origin whose family immigrated to South Africa in 1858, and his mother was of Afrikaans origin. His parents married in Zimbabwe. He was raised on a farm in the Gutu District in central Zimbabwe. At the age of 5 Roc was homeschooled by his mother for the 1st year. At the age of 6 he went as a boarder to the nearest farm school, which was called the Soti Source Primary School. This was during World War II, when there was a shortage of petrol. In order to conserve petrol the fathers from his area would take turns fetching the 6 local children home 3 times a year for the school holidays. Roc has memories of traveling in his father’s pick-up truck with the other boys; on other occasions he came home in a horse and muledrawn cart belonging to one of the other fathers. After 4 years at the farm school he was sent as a boarder to schools in Gwelo— the Cecil John Rhodes Primary School, followed by the Chaplin School. Although unknown to him at that time, he watched his future wife play hockey for Girls’ High School, when she traveled with her team from Salisbury to play against Chaplin School farther to the south. Roc developed rheumatic fever and schistosomiasis as a child. His ill health brought him into contact with the family general practitioner, Dr McGladdery, from Ireland, who realized his potential and encouraged the young Roc to spread his wings and study medicine in Cape Town, South Africa. In order to do this, he won a scholarship provided by the State Lottery and was assisted by a government loan. A medical classmate, J.P. van Niekerk, also a former Dean of the Medical Faculty at the University of Cape Town, remembers traveling down to Cape Town with Roc in his Simca car after the university vacation. The trip from Gwelo to Cape Town spanned 2000 km, and it took *Corresponding author, e-mail: [email protected]
Roc 2 days to complete the journey. Roc appeared more serious than the rest of his class, but he had a wry sense of humor and was adventurous in a quiet and understated way. He played 2nd-league field hockey for the University of Cape Town Hockey Club, and once he qualified as a doctor, he played social tennis and squash. He was also interested in South African cricket and rugby. Roc completed his undergraduate training in 1959. As an intern, Roc spent 2 months of the following year at the Red Cross Children’s Hospital in the surgical wards. He was then advised to spend a year studying pathology prior to returning to Zimbabwe to work off his government loan. He planned to work for the well-known physician Michael Gelfand in Salisbury. However, after a year of pathology, his request to serve Zimbabwe was turned down, as the government medical service wanted medics with basic training in forensic pathology. He remained in Cape Town and completed his MMed in Pathology in 1964. In 1965, he joined the South African Society of Pathologists. The Red Cross Children’s Hospital opened its doors to patients in 1956, when Roc was a 3rd-year medical student. His future wife Sheila had also moved from Zimbabwe to Cape Town and was one of the 1st student nurses to work there as part of her training. The pathology department at Red Cross Children’s Hospital was opened in 1957 by Dave Mackenzie, who played a major role in establishing Roc as a pediatric pathologist. As a lst-year registrar in pathology, Roc met a glamorous staff nurse, Sheila Darby, in the Urology Department at Groote Schuur Hospital (GSH). They both shared an upbringing in Zimbabwe. They married in 1963 and produced 3 healthy children. Sheila put her nursing career on hold to raise the family until the youngest child, Wendy, began school. She then started working part time at Red Cross Hospital with Professor Cyril Karabus. She took an oncology course in 1986 and spent the last 12 years of her career working in a gynecologic practice providing individually tailored chemotherapy for patients. She retired in 2003. Roc and Sheila’s 2 eldest children followed the family’s medical tradition and studied medicine in Cape Town. Roc’s son is an orthopedic
Figure 1. Family p h o to ta ke n a t Roc's 70th b irth d a y (2 m ore g ra n d ch ild re n have fo llo w e d th is m ilestone).
Figure 2. Taken a t th e PPS M e e tin g in O xfo rd in 1985: Roc w ith A ngus Gibson fro m G lasgow and John Emery fro m S heffield, U nite d K ingdom .
surgeon, and his elder daughter is a general practitioner. Both children work in the Eastern Cape. Roc and Sheila’s youngest daughter is a chemical engineer. Roc and Sheila have 7 grandchildren to date, ranging in age from 18 years to infancy, and they have been of great assistance with the grandchildren when required. Wendy, their younger daughter, and her husband live in Cape Town, and Sheila enjoys the company of each of their 3 children separately for an afternoon each week. She takes her granddaughter horseback riding; the boys are provided with their favorite lunch of mince and vegetables and then they participate in various activities at Roc and Sheila’s home. Roc is very patient when playing trains with his 2 grandsons. The playroom carpet is usually occupied by a complex arrangement of railway lines with figures of eight, intersections, and bridges that they have built together. Great fun is had by all as they try to avoid head-on collisions as the trains speed along the tracks. Roc was appointed as a pathologist to Professor Jim Tomson’s department at GSH in 1965, when there was a vacancy in pediatrics, and he started performing baby autopsies and lecturing in pediatric pathology. Roc’s early teachers in the field of anatomical pathology included Golda Selzer, Dirk Uys, Chick Campbell, and Alan Timme. While working with Jim Tomson, Roc authored an article entitled “ Asbestos as a modem urban hazard.” Blue asbestos was mined in the Northern Cape and was in widespread use in Cape Town at the time. After 10 months at GSH, Roc was transferred to the pathology department at the Red Cross Children’s Hospital, where he worked under the guidance of Dave Mackenzie, who set a fine example of running a department during the period from 1956 to 1977, aiming for quality care for children. Dave Mackenzie emphasized the need to have highly skilled and dedicated staff by ensuring that they received appropriate training, rather than by trying to recruit staff elsewhere. Professors at the Red Cross who functioned outside of anatomical pathology taught Roc to learn from his mistakes. Roc
was promoted to Senior Specialist in 1967. In that year, he joined the Pathological Society of Great Britain and Ireland. Roc was appointed Principal Specialist in 1975 and Associate Professor in Pediatric Pathology in 1978, and he functioned in this role until his retirement in 2000. He completed 35 years of continuous service at the Red Cross Children’s Hospital. The International Academy of Pathology (IAP) was responsible for bringing excellent pathologists to South Africa and for fostering transcontinental contacts. The late John Emery came to South Africa as an IAP visitor and spent time in Cape Town lecturing on sudden infant death syndrome. Roc was attracted to John Emery’s teaching style, which encouraged thinking and commitment. Another IAP visitor was Lauren Ackerman, who influenced the young Roc. Lauren suggested to Roc that if you feel you are not making mistakes in diagnostic anatomical pathology, you are probably sending out reports in which you are not entirely correct in 10-15% of your cases. Striving for diagnostic excellence requires mental gymnastics to obtain the most accurate diagnosis for your clinicians. Dave Mackenzie recommended Roc to the Interna tional Pediatric Pathology Association and put him in contact with international figures such as Ben Landing, John Craig, and Albert Clareaux. They all assisted him in developing an enquiring mind so that he could develop his expertise and broaden his experience. In 1969, Roc went on sabbatical to the United States. Boet Heese, Professor of Pediatrics at Red Cross Children’s Hospital, was very interested in the manage ment of hyaline membrane disease. Tracheostomies were being performed locally to ventilate sick babies, and Boet asked Roc to find investigate the complications associated with the American usage of endotracheal tubes in these sick infants while he was in the United States. Roc spent 6 weeks at the Boston Children’s Hospital, where Dr Sidney Farber was the semi-retired Chief of Pathology and where he met John Craig, Shirley Driscoll,
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Figure 3. Roc w ith Past Presidents o f the SPP attending the 1991 "E ncounter in Paediatric Pathology" in Cape Town, South Africa. Back row, from le ft to right: Roc Kaschula, Bill Blanc. Front row: Harvey Rosenberg, M olly Valdes-Dapena, M Daria Haust, Enid Gilbert-Barness, and Don Singer.
and Gordon Vawter. Sidney Farber sponsored Roc so that he could attend a Pediatric Pathology Club conference, where he met Bill Blanc. The latter read a paper on esophageal atresia and quoted Professors Jannie Louw and Chris Barnard, both renowned South African surgeons, in his references. Roc and Bill Blanc ended up sitting next to each other at the conference dinner and that was the start of a lifelong association and friendship. Bill Blanc invited Roc to New York and showed him around the Columbia Presbyterian Babies’ Hospital and gave him a quick tour of New York. Roc then traveled to Atlantic City to the American Pediatric Society’s Annual Conference with John Craig’s recommendation. At this conference, he met American pediatricians interested in collaborative studies. At the Pediatric Pathology Club he came into contact with Ben Landing, Bill Donahue, Harvey Rosenberg, and Don Singer. Bill Blanc was also a member. These contacts stimulated and assisted his interest in pediatric tumors through the sharing of cases and information. Subsequent to this visit, Roc corresponded regularly with Bill Blanc and visited him whenever he was in the United States. Roc invited Bill Blanc as a University of Cape Town visiting lecturer to Cape Town for a 2-month period in 1972. During this time, Blanc worked and taught at Red Cross Children’s Hospital and at GSH. Two local women pathology registrars, Drs Susanna Mouton and Genevieve Learmonth, were performing neonatal autopsies at GSH at the time. They benefited from Blanc’s expertise in congenital malformations. Both were pregnant at the time and understandingly found the topic of congenital malformations disturbing. Three local neonatologists, Professors Atties Malan, Vincent Harri son, and Dave Woods, also enjoyed interacting with Blanc and his teaching. Jack Katz came from Johannes burg to Cape Town to train in pediatric pathology under Roc, and he also experienced training with Bill Blanc.
Bill Blanc fell in love with Cape Town on this visit, ended up buying a house, and subsequently visited Cape Town annually, strengthening his contact with Roc. In 1974, Roc was invited to participate in a slide seminar at the IAP conference in Hamburg. He chose a case of plasma cell granuloma of the lung. However, he was unable to obtain funding to attend the meeting, so Jean Keeling presented the case on his behalf. In 1976 Roc attended the IAP conference in Washington, DC. At this conference he met Daria Haust, who had corresponded with Dave McKenzie, fostering international contact. She had driven the formation of the International Pediatric Pathology Association (IPPA) at Hamburg in 1974 to improve the standard of pediatric pathology. The idea was to unify and provide training in pediatric pathology in the United States, Europe, Latin America, and Australia. The establishment of IPPA in 1976 as an international umbrella organization for pediatric pathology societies stimulated coordinated outreach and cooperation among pediatric pathology societies around the world: the Australian-New Zealand Pediatric Pathology Group; the Paediatric Pathology Society already established in 1955; the Japanese Pediatric Pathology Society in 1978; SLAPPE in 1978; and the Society of Pediatric Pathology formed from the Pediatric Pathology Club in 1983-1984. The decision was made to run IPPA as a biennial companion meeting to the IAP. The president of the council of the IAP was John Emery. Daria Haust was secretary, and Roc was made a member representing Africa. Roc and John Emery met up again in 1983 at the Pediatric Meeting in Manila when they formulated the initial constitution of IPPA. In 1976, Roc also visited St Thomas’ Hospital in London, Nottingham University, and the Royal London Hospital, where he attended the Royal College of Pathologists’ Pediatric Renal Pathology Course, the Reticulo-Endothelial System Course in Sheffield, and a Perinatal Infection and Immunity Course at the University of Western Ontario in Canada. In 1977, an intensive training course in pediatric pathology, separate from IPPA influence, was organized in Sheffield by John Emery. It was planned as a formal training program for practicing pediatric pathologists in Europe. Two American pediatric pathologists were sent by Daria Haust to assist with the course. There were 40 participants, who were mainly from countries that had children’s hospitals—France, The Netherlands, and Scandinavia. The aim was to have a specialist-trained pediatric pathologist/perinatal pathologist at every med ical school. Roc was an invited tutor for the IPPA courses, which lasted for a week apiece on 6 occasions during his career: Sheffield, United Kingdom, in 1977; Lubeck, Germany, in 1984; Barcelona, Spain, in 1986; Palic, Yugoslavia, in 1988; Loutraki, Greece, in 1992; and Guidel, France, in 1998. Through these courses, Roc came in contact with large numbers of aspiring pediatric pathologists and was able to assist them with his expertise in a friendly, stimulating, and educational setting. F ounders
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In 1983, Roc was sponsored to attend a Measles Conference in Washington, DC, where the virologists were most interested in his presentation on the pathologic findings in young children with malnutrition and measles pneumonia. He made contact with others workers in the field, including the Russian virologist Nicolai Paradze and David Morley from the School of Tropical Disease in the United Kingdom, who had worked in Nigeria. During his career Roc took 4 sabbaticals, between 1985 and 2000, with time spent at children’s hospitals in Glasgow, Scotland; Liverpool, United Kingdom; Perth, Australia; and Edinburgh, Scotland. In 1991, during the Gulf War, Roc put Cape Town, South Africa, on the ‘International Pediatric Pathology’ map by hosting an extremely successful joint Paediatric Pathology Society and Society of Pediatric Pathology Meeting. This was followed in 2004 by an IPPA Update Course in Pediatric Pathology at Goudini Spa, Rawsonville, Cape, followed by a Paediatric Pathology Society Meeting in Cape Town that was well attended and enjoyed. At Red Cross, Roc’s research activities honed in on diseases of childhood that were important in South Africa. He described the changes in the small and large intestine in kwashiorkor and noted the importance of gem squash as a good, cheap source of vitamin A in the diet of impoverished young children. He reported on the infantile jejunal mucosa in infection and malnutrition. He wrote several seminal papers on measles in malnourished children, describing the occurrence of viral pneumonia due to adenovirus and herpes infection following measles. This combination resulted in necrotizing bronchitis and bronchiolitis and follicular bronchiectasis, important causes of morbidity and mortality. The secondary infection was mediated by transient immunosuppression as a consequence of measles and inadequate nutrition. Measles vaccination was available to lower socioeco nomic groups in Cape Town in 1974 and had an immediate beneficial effect. However, vaccinations became temporarily unavailable over a 6-month period in 1977, and Roc noted the upsurge in deaths following measles during this period compared to the preceding and subsequent years. Roc also devoted his attention to congenital syphilis and wrote about the nephrotic syndrome occurring in very young infants with untreated and frequently undiagnosed congenital syphilis. He also described a series of newborns with intestinal obstruction due to congenital syphilis. Roc reported on a series of cases of necrotizing enterocolitis after the neonatal period in severely malnourished and immunosuppressed infants. Longstanding interests for Roc were Hirschsprung’s disease (HD), acquired aganglionosis following surgery for HD, and degenerative leionryopathy, a megacolon syndrome affecting indigenous Africans in the southern parts of Africa. More recently, Roc described abnormal ities in smooth muscle in the bowel of children with intestinal pseudo-obstruction. In addition, in association
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with Ulane Neveling, Roc reported on 86 autopsy cases of fatal meningococcal disease at Red Cross Children’s Hospital. Childhood tumors were of major interest to Roc, and he coauthored the results from the Red Cross Children’s Hospital on the outcome of solid tumors occurring in the neonatal period over a 34-year period, with long-term follow-up of 10 years. He reported on his experience with hepatoblastoma over a 31-year period and commented on the occurrence of teratoid hepatoblastomas postche motherapy. Other articles included those related to gastrointestinal lymphoma, the pathology of Wilms’ tumor, therapy in adult Wilms’ tumor, primary pulmonary tumors, childhood peripheral primitive neuroectodermal tumors in Cape Town, the diversity of malignant rhabdoid tumors, Castleman’s disease in children, myopathy associated with chronic renal failure, and many others. Roc’s published book chapters reflect his unique experience in Southern Africa—veno-occlusive disease, infectious diseases, malnutrition and intestinal malab sorption, pediatric AIDS, and infectious diseases. Roc has been a stalwart proponent for the teaching and dissemination of knowledge in all aspects of pediatric pathology. Throughout his career, he identified gifted junior staff and guided them along a course to gain needed skills and to become future leaders. He is still the coordinator, lecturer, and tutor for the Postgraduate MPhil Course in Pediatric Pathology at UCT, which he started in 1997-2000 and recommenced again in 2009, despite his ‘retirement.’ Roc is still involved in teaching pediatric pathology for Stellenbosch University at Tygerberg Hospital, which he started prior to his retirement. Roc was one of the lecturers and tutors at a recently held certificate course in perinatal autopsy and placental pathology held at Tygerberg Hospital, which attracted a wide spectrum of participants, including local forensic pathologists. Over the years Roc has assisted in advancing the careers of aspiring pediatric pathologists. Werner Dutz, who was interested in malnutrition and infectious diseases, spent 2 weeks at the Red Cross Children’s Hospital and was most interested in Pneumocystis carinii/ jirovecii. Gabriele Amann, who trained in Vienna, was sent to train with Roc for 6 months. Marta Cohen was introduced to Roc at an international congress in Argentina and came and spent 2 years training in pediatric pathology with Roc. Friederich Struwe from Freiburg, Germany, came and spent a year with Roc in Cape Town. Enid GilbertBamess recommended Jeanne Ackerman from Florida to visit Red Cross Children’s Hospital, and she has made 3 visits to date, spreading her expertise to all those with whom she has made contact. Being a farmer’s son, Roc is very handy about the house fixing things. He enjoys gardening, loves watching cricket and rugby, and is very patient with his grandson David, who has di George syndrome. He is involved with his church and assists as a lay minister. When his children
were growing up, family holidays were spent camping at game parks and game spotting by car. The Kalahari Game Park was a top family favorite. Sheila recalls an eventful trip when their younger daughter was aged 4 and hoped to see a lion during their visit. On entering the park, the game ranger gave them some useful advice: If they saw a lion in the campground, they should get in the car and blow the hom. Unfortunately, the lion they saw was right outside their tent, blocking access to their car and its horn. Their daughter was thrilled that they had seen a lion and oblivious to the danger. Roc tried to be an activist for change within the hospital and the university, and he initiated the appoint ment of people of color in posts previously reserved for “ whites.” These actions had repercussions. In 1985, after 20 years at Red Cross and after serving the university on Senate, the UCT Faculty Board of Medicine, the Conditions of Service Committee, the Nominations Committee of UCT, the Terms of Employment Commit tee of UCT Senate, and as an elected member of the Executive Committee of the Faculty Board of Medicine, Roc decided to give up on the university and instead concentrated his attention on international pediatric pathology. He was elected to office in the 1AP and 1PPA. He spent 16 years as the ViceP resident of the IAP, with responsibility for Anglophone Africa. Eight years were spent as secretary and 2 years as president of the 1PPA. He served for 4 years on the Council of the Association of Pathologists from East, Central and Southern Africa. He brought new skills and techniques back to Cape Town and South Africa, initiating the reporting on placentas in 1969; using methenamine stains on renal biopsies; using acetylcholinesterase stain on frozen section biopsies to improve the diagnosis of HD, and many others. This led to the popularity of Red Cross Children’s Hospital for either short-term visitors or for long-term trainees, who were often supported by bursaries from overseas. Roc built up a quality laboratory with high standards of practice and delivery by his team of technologists and his molecular scientist and outstanding mortuary staff, ably assisted by his pediatric pathology colleague, the late Professor Colin Sinclair-Smith. While Secretary of the IAP, Roc invited Zimbabwe to join the South African Division of the IAP, which it did, until 1999. He sent educational material to Malawi. In 1972 at the IAP Congress in Helsinki, Roc met Olifemi Williams from Nigeria, who was the editor of the Journal o f Pathology for Africa and co Vice President of the IAP for Africa with Roc. This resulted in Professor Williams being invited by Professor Stuart Saunders to attend the Liver Conference in Cape Town in 1973. South Africans were not welcome in Kenya at that time, and the Professor of Pediatrics in Nairobi persuaded the 1PA to ban the South African Pediatric Society. Pediatric pathology outreach was closed to Kenya and East Africa. Roc represented Africa on the IAP Council and Executive, and his major problem was the rapid turnover of heads of departments in Africa. Professor Olifemi
Williams subsequently went to the United States. During that period, Roc wrote to people but received no reply. He advertised educational material and sent it to those who responded, who were very appreciative. In 1992, when President De Klerk removed the ban on the African National Congress, South African passport holders were permitted to visit Kenya. Roc was invited to the Second Association of Pathologists of East, Central, and Southern Africa (APECSA) Congress, where Roger Cotton was present. While Vice President of the IAP, with responsibility for Anglophone Africa, Roc was an undergraduate and postgraduate examiner at Nairobi University, Kenya, from 1993 to 1996 and from 1999 onwards at Makarere University, Kampala, Uganda. The Association of Pathologists from East, Central and Southern Africa was launched in 1989 in Dar es Salaam. Three years prior to this, Roger Cotton spent a 6-month sabbatical in Harare, when Shawawa Gwavava was head of department. Roger Cotton and Michael Hutt were asked by the Common wealth Secretariat to evaluate the laboratory needs in Central and East Africa. They collaborated with Roc on this evaluation. Southern Africa included Botswana, Swaziland, and Lesotho. Roger Cotton was responsible for the formation of APECSA. The 1st APECSA meeting was held in Tanzania. After his sabbatical, Roger Cotton came to South Africa and gave a slide seminar. Individual South Africans provided limited access to educational material. Roc obtained funds from the IAP to bring key members from APECSA to the 1998 South African Conference in Pretoria. They were also provided with free IAP educational material. In 2000, Roc organized an APECSA meeting at Victoria Falls. He raised a significant amount of money from international donors and encouraged many of his exSouth African pathologist friends from around the world to attend at their own expense and to participate in seminars. This was a very successful meeting. Roc also attended the 9th APECSA meeting in Mombasa, at which an East African Division of the IAP, as well as a College of Pathologists from East, Central and Southern Africa, were formed. Postretirement Roc performed locums at Birming ham, Sheffield, and the Royal Manchester Children’s Hospitals on multiple occasions from 2001 until 2006. Marta Cohen and Dick Variend from Sheffield were both grateful for his assistance when they were practicing single handed, and the staff of Sheffield Children’s Hospital have fond memories of him. In the mortuary, Roc performed postmortems sitting on a stool with wheels and had to be rescued on several occasions when sliding inadvertently across the mortuary floor. The mortuary staff remembered his unusual attire in the mortuary. When confronted with the safety guidelines and asked why he was not wearing an apron he would reply “ it’s underneath my gown.” Roc received many accolades during his career—the Distinguished Certificate of the Latin American Society of F ounders
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Chile in 1988; Honorary Membership of the Chilean Society of Anatomical Pathology in 1988; Honorary Membership of the Kenyan Association of Clinical Pathologists in 1993; Honorary Life Member of the Association of Pathology for East, Central and Southern Africa in 2000; Honorary Life membership of the South African Division of the IAP in 2000; and he was the Farber-Landing lecturer to the Society for Pediatric Pathology in 2002. However, the highlights of Roc’s career are being awarded Lifetime Fellowship of the IPPA (only granted to a maximum of 12 living persons) for international service to pediatric pathology in 1994 and the Gold Medal of the IAP for international achievement in pathology, educa tion, and research in December 2004. Roc felt that he was rather young to have received this great honor. It places him among the other greats in pediatric pathology, starting with those who first received this award, namely Edith Potter and Agnes McGregor. Other doyens include Jim Arey, Ben Landing, J. Edgar Morrison, John Emery, Daria Haust, Jonne Huber, Christian Nezelof, Bill Blanc, and others. Thank you, Roc, for the support and encouragement you provided me in pursuing my interest in perinatal pathology.
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PUBLICATIONS 1. Kaschula ROC, Uys CJ, Kuitjen RH, Dale JRP, Wiggelinkhuizen J. Nephrotic syndrome of congenital syphilis: biopsy studies in four cases. Arch Pathol 1974;97:289-296. 2. Kaschula ROC, Druker J, Kipps A. Late morphological conse quences of measles: a lethal and debilitating lung disease amongst the poor. Rev Infect Dis 1983;5:395-404. 3. Kaschula ROC, Cywes S, Katz S, Louw JH. Degenerative leiomyopathy with massive megacolon. Myopathic form of chronic
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idiopathic intestinal pseudo-obstruction occurring in indigenous Africans. Perspect Pediatr Pathol 1987;11:199-213. Kaschula ROC, Gajjar PD, Mann M, et al. Infantile jejunal mucosa in infection and malnutrition. Israel J Med Sci 1979;15:356-361. Kaschula ROC. Malnutrition and intestinal malabsorption. In: Seifert G, Doerr W, eds. Tropical Pathology, 2nd ed. Berlin: Springer-Verlag, 1995;985—1030. Kaschula ROC. Infectious diseases. In: Berry CL, ed. Paediatric Pathology, 3rd ed. London: Springer-Verlag, 1995;729—820. Kaschula ROC. Paediatric AIDS. In: Berry CL, ed. Paediatric Pathology, 3rd ed. London: Springer-Verlag, 1995;821—835. Redmond AOB, Kaschula ROC, Freesemann C, Hansen JDL. The colon in kwashiorkor. Arch Dis Child 1971;46:470^173. McDonald R, Wiggelinkhuizen J, Kaschula ROC. The nephrotic syndrome in very young infants. Am J Dis Child 1971; 122:507— 512. Kipps A, Kaschula ROC. Viral pneumonia following measles: a virological and histological study of autopsy material. S Air Med J 1976;50:1083-1088. Beckford AP, Kaschula ROC, Stephen C. Factors associated with fatal cases of measles. A retrospective autopsy study. S Aff Med J 1985;68:858-863. Neveling U, Kaschula ROC. Fatal meningococcal disease in childhood: an autopsy study of 86 cases. Ann Trop Paediatr 1993; 13:147-153. Cohen MC, Kaschula ROC. Primary pulmonary tumors in childhood: a review of 31 years’ experience and the literature. Pediatr Pulmonol 1992; 14;222—232. Taylor KL, Kaschula ROC. Castleman’s disease in children: the experience of a children’s hospital in Africa. Pediatr Pathol Lab Med 1995;15:857-868. Davies JQ, de la Hall PM, Kaschula ROC, et al. Hepatoblastoma— evolution of management, outcome and significance of histology in the resected tumour. A 31 -year experience with 40 cases. J Pediatr Surg 2004;39:1321-1327. Kaschula ROC. The practice of pathology in Africa. Arch Pathol Lab Med 2003;137:752-755. Kaschula ROC. The pediatric autopsy in Africa. Arch Pathol Lab Med 2013;137:256-266.
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