Bringing quality healthcare to all people in Johannesburg is the mission of the executive director of its health directorate. Dr Refik Bismilla is true to his medical oath.

Concerned with the plight of the city's sickly: Johannesburg's executive director of health, Dr Refik Bismilla

DR REFIK Bismilla may be far removed from his stethoscope and white coat, but as executive director of the City's Health Directorate, his heart still lies with the plight of the sickly.

He has, in his own words, a genuine desire to contribute towards the improvement of quality and quantity health services for everybody in Johannesburg. Quality for him means taking "what we are doing" and making it even better.

"I want to reduce the time people have to spend at clinics, waiting to be helped."

Quantity implies that the Department of Health has to do more of what it is already doing. This means improving the monitoring systems and where gaps occur, stopping the blight before it spreads. This is his vision for the next year.

Bismilla studied at Dublin University in Ireland, where he specialised in medicine, surgery, obstetrics, gynaecology and paediatrics. His internship was done at Baragwanath Hospital, and he worked for many years as a doctor in the clinics of Soweto.

Concerned with the plight of the city's sickly: Johannesburg's executive director of health, Dr Refik Bismilla

Some of his experiences there were not pleasant: he recalls the time a couple approached him late one night. Their child, wrapped in blankets, was desperately ill. Living in an informal settlement meant that medical services were not close at hand for them. On unwrapping the little bundle, however, he realised the baby was already dead.

This incident left a lasting mark on him - that baby should never have died, Bismilla felt. And the realisation that world-class medical help should be available to all members of society became more pronounced daily.

Today his department faces the challenge of ever-increasing numbers of people in need, and of needs that go beyond the scope of basic health issues. Johannesburg has one of the highest rates of HIV and Aids infections in the country. And the recent discovery of a new drug-resistant TB-strain has not made things easier.

"We have to become assertive in promoting good health," he says, explaining the challenges faced in fighting dread diseases. As far as Aids is concerned, greater services need to be rolled out, Bismilla feels.

Not a man short on words, some charged with emphasis, his empathy for the physical ills of humankind and his passion for the job in hand filter through. "Why do we still have severely malnourished children?" he stresses. "How can we ensure that unnecessary deaths do not happen?" These and other questions keep him focussed, especially as far as the most vulnerable are concerned. These are the ones with no access to facilities, no means of getting to what is available.

While medicine may be Bismilla's first love, his daily tasks now entail lots of paperwork. As head of the department he has to make sure that good administrative policies and co-ordinated medical structures are in place to serve the whole community.

Part of his plan for the department is to keep in direct contact with the clinics through a programme of hands-on administration. That means he and his staff intend to work at the clinics a few times a year so that they "experience first-hand what is happening in the field".

With the constant influx of migrants into the city, the pressure to provide basic health services to vulnerable communities is growing. And true to his medical creed, he wants to include everyone.

Much of what he says points to the fact that the department will focus on tackling general and existing problems first. Health promotion is the cornerstone of a good health policy and within the health directive it stands on two basic legs – personal health promotion and environmental health promotion. But the department cannot tackle the challenges alone - it is vital, critical even, to create partnerships, Bismilla reiterates.

Some partnerships are already up and running. For example, Johannesburg has a partnership with the University of the Witwatersrand on public health and one with the University of North-West for training its environmental health officers.

It has also created linkages with several independent practitioners' associations and has set up pilot projects that the department expects will reduce the medical load on clinics. Instead of patients flocking to their nearest clinic for medical assistance, they can receive the same care from associated general practitioners in their areas, albeit with the additional cost of a doctor's consulting fee.

This is especially important as far as birth control and basic needs are concerned.

Having a well-administered city health system linked to national and provincial health administration will be the cornerstone of the City's preparation for the 2010 Fifa Soccer World Cup. "With so many different people converging on the city, it is important that our laboratory and emergency systems are in place," Bismilla explains.

And small but crucial details must be looked at as well. Keeping public areas clean and being tough on by-law implementation are key, he feels.

He warns, however, that as a department concerned with the growth and care of humans, it must keep pace with any new medical inventions and developments; he believes in the principle of "best practice". It is especially the links with academics that have to be strengthened and maintained.

Bismilla himself has had to adjust his lifestyle after being diagnosed with diabetes. "It was the best thing that happened to me. My whole lifestyle changed." This included following a healthier diet and working out at the gym - and climbing the four flights of stairs to his office.

Among the world's most exciting medical breakthroughs, he rates the discovery of penicillin because "it changed the whole scenario of how we look at and control infections". And certain events, particularly the Industrial Revolution, which changed the face of healthcare and human existence as a whole - improving basic living conditions and basic hygiene principles, was crucial to medical care overall.

And these are the basics he still wants to concern himself with first and foremost: educating people about basic health and hygiene.

Like a forerunner in the medical field, Dr Norman Bethune, who is remembered for his humanitarian work in China and to whom he refers, Bismilla feels strongly about this public health responsibility. "Genuinely, I believe I will be judged on what I was able to produce."