U.S. flag

An official website of the United States government

NIH: Fogarty International Center NIH: Fogarty International Center
Advancing Science for Global Health
Advancing Science for Global Health
Home > Global Health Matters Nov/Dec 2022 > Tackling tobacco, TB, and mental health in South Africa Print

Tackling tobacco, TB, and mental health in South Africa

November / December 2022 | Volume 21 Number 6

Headshot of Ricahrd van Zyl-Smit

Dr. Richard van Zyl-Smit comes from a family of physicians: His parents were physicians, his sister, who is currently practicing, married a  physician, his uncle is a physician, and his aunt is a nurse. Before he applied to become a Fogarty Global Health Fellow, his cousin and fellow medical doctor, Jacqueline Firth, was accepted into the inaugural Fogarty Global Health Fellows & Scholars cohort.

A consultant pulmonologist at Groote Schuur Hospital in Cape Town, South Africa, and a deputy head of the division of pulmonology at the University of Cape Town Lung Institute, van Zyl-Smit credits his Fogarty Fellowship as the starting point for his current career. “The Fogarty program was instrumental in my career, launching me and pushing me in the direction I went. It was just a fantastic immersion into research and an opportunity I don't think anyone should pass up," van Zyl-Smit said.

For his Fogarty project, he exposed TB-infected macrophages to tobacco smoke and nicotine to test their immune responses. He found that this exposure significantly reduced the production of cytokines key in the defense against tuberculosis during infection. He later replicated his results using vaping products, suggesting a potential mechanism to explain the epidemiological link between tobacco smoking and the risk of TB infection.

Since his fellowship, van Zyl-Smit has been actively involved in poverty-related respiratory health issues in South Africa and has made it central to his research and career. South Africa has some of the highest rates of tuberculosis, chronic obstructive pulmonary disease  (COPD) and several other chronic respiratory illnesses in the world. He has co-authored publications on TB, COPD, smoking cessation programs, and the interplay between tobacco use and diseases such as HIV/AIDS and COVID-19.

“The intersection of poverty and respiratory disease is not unique to South Africa," said van Zyl-Smit.  “However, I fear that unless we address poverty, we will be ineffective at treating all the other components related to these high rates."

Dr. Richard van-Zyl Smit lights a cigarette which connected to a tube to capture smoke and nicotine to test their effects on macrophages exposed to tuberculosis.Photo courtesty of Richard van Zyl-SmitFor his Fogarty project, van Zyl-Smit exposed TB-infected macrophages to tobacco smoke and nicotine to test their immune responses.

Van Zyl-Smit currently serves as president of the South African Thoracic Society, co-chair of the American Thoracic Society International Health committee, and as a global ambassador for the Global Initiative for Asthma. He presented his Fogarty data at an American Thoracic Society meeting in 2008 and was awarded an international trainee scholarship from that presentation. Today he runs the American Thoracic Society's international scholarship program.

“My Fogarty project gave me access to an entirely new network outside of my region, and I would not be in the position I am today without those connections."

In addition to his work as a pulmonologist, in recent years van Zyl-Smit has become an advocate for mental health.

During his inaugural lecture at the University of Cape Town in 2022, van Zyl-Smit shared his personal struggles with mental health. After being diagnosed with stress-induced anxiety in 2016, he began writing his first book titled “They Don't Award Nobel Prizes to Dead People." The book, which helped him process his anxiety, advocates for a culture change with a stronger emphasis on work-life balance. He later went on to author another book, “Thoughts on a Saturday Morning: A collection of essays on life, work and relationships during COVID-19," in which he wrote about the stress he and his fellow health care workers suffered at the hands of the pandemic in South Africa.

As part of the closing remarks of his inaugural lecture, he reminded his colleagues to care for themselves and each other noting, “we are of greater value alive and functional than dead or dysfunctional."

More Information

Updated December 15, 2022

To view Adobe PDF files, download current, free accessible plug-ins from Adobe's website.

Related Fogarty Programs

Related World Regions / Countries

Related Global Health Research Topics