I was a rookie doctor on the goldmines in the early 1960s. Part of my duties was to look after the families in the villages of the Anglo American mines at Welkom in the Free State. Their invariably large numbers of children prompted me to enquire whether they wished to have assistance in family planning. Their positive response led me to visit family planning clinics in Johannesburg. The standard methods in use at the time were condoms (spoken about in hushed whispers), the 'Dutch cap' or diaphragm, and an intra-uterine device (Lippes loop). However, I found that a small number of women in the private sector were using a new product known as 'the Pill'. As this was very expensive, it could not be used in public sector family planning clinics.
To the Editor: I read the article on HIV diagnosis in mobile unit with great interest. Van Schaik et al. concluded that 'Mobile services are accessed by a different population compared with facility-based services'. I agree that the HIV diagnosis via a mobile unit can be a useful approach for early diagnosis. However, there are some problems to be kept in mind.
To the Editor: I wish to bring to the attention of readers an opportunity for them to play international football in the next medical world cup! How would you like to play against Brazil, Germany or Great Britain?
To the Editor: The National HIV Health Care Worker (HCW) Hotline was established in 2008, in collaboration with the Foundation for Professional Development (FPD) and PEPFAR/USAID, to support the safe and effective roll-out of antiretroviral treatment in South Africa. It is based in the Medicines Information Centre, Division of Clinical Pharmacology, UCT, and has access to the latest information and numerous clinical experts.
To the Editor: After malaria, schistosomiasis is the second most prevalent tropical infection, but is first among the neglected tropical diseases (NTDs). Worldwide, an estimated 750 million people are at risk of schistosomiasis, and 200 million have the disease; 85% of the latter and all 20 million with severe disease are concentrated in Africa.
To the Editor: While working for the National Pathology Group (NPG) to help them understand the pathology cost trends in medical schemes from publicly available data, we came across two interesting relationships between costs in the private industry.
To the Editor: Emergency medical services (EMS) throughout South Africa are of unequal quality owing to historical population inequalities and under-resourced EMS in rural areas. There are no data regarding the quality of ambulance services in the rural Eastern Cape. The assessment of EMS is not easy, but an assessment tool has been established. We prospectively audited the response time to ambulance requests from a community health centre in the rural Eastern Cape.
It's not often that 360 doctors of varying disciplines, anxiously awaiting the birth of a much-fêted infant, agree on the diagnosis and urgent treatment of its severely ailing mother. That's what happened at the South African Medical Association (SAMA)'s prenatal 'check-up' of the impending National Health Insurance (NHI), at Emperor's Palace in Gauteng early this October. Everyone, from NHI midwives Dr Aaron Motsoaledi (national health minister) and Dr Olive Shisana (its chief nurse), to individuals like social security economist Alex van den Heever (who at best fears a failure to thrive), believes the diagnosis of the health care system upon which an effective NHI will depend is blindingly obvious. They also agreed on a 10-point treatment plan for the ailing matriarch (one aspect of which is the NHI, aimed at providing vital health equity and access for all). That left only one real question: Does 'Mama Nzantsi' have the human and financial capital, let alone the management capacity, to carry, give birth to and then nurture this NHI child to maturity?
The Hospital Association of South Africa (HASA) has mooted the idea of training critically needed specialists in its member hospitals while reaffirming its commitment to helping patients stranded by State shortcomings.
South Africa (SA) commands financial health care resources comparable to Brazil, Mexico and Thailand. Despite spending similar amounts in the public sector (3.5% of gross domestic product (GDP) in terms of purchasing power parity, these and other countries have far better health outcomes than SA on almost all measures including life expectancy and maternal mortality (Table I). While the combined impact of HIV and tuberculosis (TB) on all-cause mortality has been immense, this only partially explains the plummeting life expectancy in SA from 63 years in 1990 to 45 years in 2007. Furthermore, SA is one of only 12 countries worldwide with a marked reversal of maternal and infant mortality, reflecting the complex epidemiological transition underway. An increasing percentage of the population now dies from chronic, non-communicable diseases such as vascular illness, diabetes and cancers and from violence and injury.
Improving health systems performance in order to achieve good health care outcomes and meet the Millennium Development Goals (MDGs) has received increased global attention. Using the World Health Organization (WHO)'s framework on health system strengthening, an overview is presented of key aspects of performance of the South African (SA) health system that are likely to impact on the Disease Control Priorities (DCP) initiative.
Boulle et al. queried whether a clinical trial was needed to provide the evidence for the mortality benefits of antiretroviral therapy (ART) initiation during tuberculosis (TB) treatment. While several experts, including foremost TB-HIV scientists from South Africa and the USA, senior World Health Organization (WHO) and UNAIDS officials at the time the study was initiated, the 2003 WHO AIDS Treatment Guidelines Committee Chair, the Chair of the Ethics Committee and the researchers, have previously addressed the points raised, the SAPIT (Starting Antiretroviral Therapy at Three Points in Tuberculosis) research team welcomes the opportunity also to address the comments. We hold Boulle and his colleagues in high regard and appreciate their contributions to the field of HIV and tuberculosis co-infection. More importantly, we share with them the common goal of rigorously and relentlessly seeking answers to critically important research questions as we confront the devastating dual AIDS and tuberculosis epidemics.
Ralph Hendrickse was born in Cape Town on 5 November 1926. He was the son of William and Johanah (née Dennis) Hendrickse. He was raised in a coloured community of richly educated teachers who regarded teaching and learning as pathways to upliftment. He matriculated first class from Livingstone High, a coloured school, at the age of 15 years.
Willem Lubbe, an exemplary physician-scientist, recently died at the age of 72 on his farm in New Zealand. He was born on 30 October 1938 and obtained his MB ChB degree at UCT in 1962 and his MD in 1969. He passed the FCP (SA) in April 1971.
To the Editor: Studies of HIV prevalence in sub-Saharan Africa usually focus on the age group 15 - 49 years. However, estimates of HIV prevalence in older people are required for health policy and planning. The health care and social needs of older HIV-infected individuals differ from younger people; e.g. because of different co-morbidities, different responses to antiretroviral treatment (ART), and the central role of older adults in African households. In South Africa, a nationally representative survey provided first insights into the burden of HIV in the population ≥ 50 years of age, reporting HIV prevalence in men/women as 10.4%/10.2% (in the age group 50 - 54 years), 6.2%/7.7% (55 - 59 years), and 3.5%/1.8% (≥ 60 years). However, the South African HIV epidemic is highly heterogeneous6 with substantial variation by geographic location and ethnic group, limiting the value of national averages.