SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2021 | VOLUME 19 | ISSUE 2 | 35 IN REMEMBRANCE At an early age, Michael was recognised as a brilliant student and graduated with first class honours from Jeppe High School at 15 years of age in 1955. Mike had an enviable start to his academic career when he graduated from the University of the Witwatersrand medical school, cum honoribus primus, and top of his class at the age of 21. From this auspicious beginning, he conscientiously followed William Osler’s dictum that the magic word for success in medicine is “work, sustained hard work”. This was followed with an FCP (SA) in 1965, an MD in 1968, a PhD in 1974 and Doctor of Science (DSc) in 1982 and his success in academic medicine was recognised with his induction as a member of the Royal College of Physicians of London (MRCP) in 1971, followed by his election as a Fellow of the Royal College (FRCP) in 1979. The rapid acquisition of professional degrees and recognition is a testament to his academic and research performance at the Johannesburg Teaching Hospital Complex and University of the Witwatersrand. In 1970, Mike was awarded a Wellcome Research Fellowship to work in the Liver Unit at the Royal Free Hospital, London, with the world-renowned hepatologist, Dame Sheila Sherlock. At the Royal Free he pursued investigational studies on portal hypertension and renal impairment in patients with cirrhosis of the liver. In 1971, Mike published his first landmark paper on this topic in The Lancet, and also co-authored a paper with Dame Sheila on the spectrum of HCC, in what is now recognised as a classic clinical description of this little-understood cancer at the time. Mike was regarded as a shy but extremely knowledgeable doctor, and a formidable tennis player. This may have contributed to his making a favourable impression on Dame Sheila, who loved tennis and did not allow anyone to beat her. Professor Kew’s initial academic and research studies were on a broad spectrum of liver diseases including, heatstroke (a common problem in the gold mines at the time), viral hepatitis, drug-induced liver disease, portal hypertension, haemosiderosis and HCC. These were clinical conditions and challenges that he faced daily on the wards of the Johannesburg Teaching Hospital, and particularly at Baragwanath Hospital which serves the sprawling Soweto township. Returning to South Africa, Mike began what became a life-long commitment to the study of HCC, a special and demanding challenge, which in black Johannesburg gold miners, many who came from Southern Mozambique was an extremely aggressive, rapidly fatal cancer affecting young adults in their 20s and 30s, rather than in the middle-aged or elderly, as seen in the Western world. His initial studies were largely descriptive and clinical, but he rapidly initiated analyses of the pathogenesis based upon epidemiology and application of the serology, virology and molecular assays for the newly discovered hepatitis B virus. In 1978 at the 2nd International Symposium on Viral Hepatitis, held in San Francisco Mike gave the plenary overview presentation on hepatitis B and liver cancer and which confirmed his international status. Jay Hoofnagle, Director of the liver unit at the NIH in Bethesda, was in the audience and recalls - ‘The talk was clear, concise and convincing, and given in that crisp, distinctive South African accent. It was immediately apparent to all in the audience that this was someone who knew what he was talking about, a speaker who had seen and taken care of patients with liver cancer. It was clearly evident that he was a scholar, a careful thinker and, importantly, a clinical and basic scientist. Until that time, epidemiologists, pathologists, cell biologists and clinicians were individual experts on HCC but Mike combined all of these aspects. He brought a freshness and excitement to the topic, demonstrating a thoughtful and complete approach to the understanding of liver cancer and the role of hepatitis viruses, viral genes, host genes and environmental factors in its aetiology and pathogenesis. He also provided insights into what might ultimately be done for the prevention, early detection and treatment of HCC. ‘ Following the meeting in 1978, Mike became an regular presence as a speaker at international symposia on viral hepatitis. In addition to contributing data from South Africa and the African continent, he succeeded in providing an overview and a balanced understanding of HCC, the most dreaded complication of viral hepatitis. He contributed to our knowledge of hepatitis B and liver cancer, documenting the abysmal results of conventional chemotherapy, and initiated trials of new therapies for chronic HBV infection, while documenting the changing epidemiology of hepatitis B and liver cancer. In 1990 Mike was awarded a Fogarty Visiting Scientist position with Dr Robert Purcell in the Hepatitis Viruses section of the National Institutes of Health (NIH), and there he developed a working knowledge of the laboratory tools required to advance his research into the molecular virology of hepatitis B and liver cancer. Jay Hoofnagle, at the NIH at the time, and asked Bob Purcell why more wasn’t seen of Mike Kew. Purcell answered that Mike was too busy, and added that he was the hardest-working, most dedicated Fogarty scholar he had ever worked with. Following the 2-year sabbatical, Mike returned to Johannesburg, where he continued to make important contributions to the understanding of hepatitis B and HCC, using molecular tools to further elucidate the interaction of hepatitis B with the liver. He further explored co-factors that might alter viral carcinogenesis, defining the roles of genotypes and viral variants, the role of co-infection with hepatitis C and D viruses and viral host interactions. He also explored the potential role of chronic hepatitis B therapy as a means of decreasing the risk of HCC, and the changing epidemiology of hepatitis B and HCC in South Africa and worldwide. Not surprisingly, his routine altered little from its life- long pattern – up at 3.30 am and off to the University, an hour for lunch, more work until 4.00 pm, an hour or two cycling or gardening, ‘and so to bed’ at 7.00 pm. A karate black belt, he taught in a karate studio of Joe Robinson to help pay for his undergraduate training. An avid reader, with a special interest in grammar, a trained builder who constructed single-handedly an extra bathroom in his home, an accomplished cyclist, and a senior playing squash at the provincial level, gives a little insight into the range of Mike’s interests. He remained an active supporter of the Gastroenterology Foundation of SSA as a trustee from the time of the Foundation’s inception, offering sound ethical advice and contributing to the postgraduate education of the fellows at the annual SPIER meeting. Even when retirement beckoned, his enthusiasm remained undimmed, and the value of his wisdom and experience as a senior scholar was recognised and utilised by the Department of Medicine at the University of Cape Town for many years until a few years prior to his death.