For better or for worse, the date 31 May will remain embedded in the annals of South African history. On this date in 1902 the second Anglo-Boer War officially ended, and in 1910 the four British colonies of the Cape of Good Hope, Natal, Transvaal and the Orange Free State united to form a single country under British dominion. Bar this event, these colonies would have traversed separate historical trajectories eventually leading to four independent sovereign states. Ironically, the name South Africa (and the ZA international country code) harks back to Paul Kruger's Zuid-Afrikaanse Republiek, itself an amalgamation of several tiny Afrikaner republics in the territory that came to be known as the Transvaal. Finally, on 31 May 1961, South Africa was declared a republic, with Hendrik Verwoerd exulting 'God regeer!' (God reigns!).
To the Editor : I read Dr Mlombe's letter on clinical haematology training in South Africa in the June SAMJ with interest. Patients with haematological disorders must be treated with a seamless connection between the laboratory and the clinic. The FCPath (SA) (Haem) (Fellowship of the Colleges of Pathologists of South Africa in Haematology) final exam also includes clinical cases.
To the Editor : Twenty years ago two Eastern Cape urological surgeons documented their experience with treating initiates of umkhwetha, the ancient custom of ritual circumcision practised by the amaXhosa people of southern Africa. Crowley and Kesner followed up 45 consecutive patients and documented a mortality rate of 9%. Recent press reports from the Eastern Cape claim an annual death rate of more than 70 per year. The death toll for the 2010 winter initiation period stood at 40 at the time of writing. These statistics not only point to the fact that little has changed, but suggest that the situation may in fact be deteriorating.
To the Editor : I read the article on CRP and toxic granulation with great interest. The authors concluded : 'The proposed system can be applied to patients with inflammatory or infectious conditions, where grading of toxic granulation of neutrophils can possibly be used as a surrogate marker to assess infection or inflammation and their response to treatment.' I agree that the new system can be useful in clinical practice. However, there are some points of concern.
To the Editor : The vuvuzela, or lepata (Tswana), or 'stadium horn', has recently become an object of intense interest because of its prominence during the FIFA World Cup in South Africa. Its history has been well documented. We all now know what a vuvuzela is. Its monotonous sound, if produced simultaneously by, say, 40 000 soccer enthusiasts, can fill an entire stadium for hours on end, to the intense irritation of players, coaches, non-participating spectators, TV audiences, and many more (for miles around the stadium).
To the Editor : The Department of Medicine at the University of Cape Town (UCT) has recently celebrated 90 years of its existence. The first Professor of Medicine, Professor A W 'Oubaas' Falconer, from Aberdeen, Scotland, established the then Division of Medicine at the new UCT Medical School in February 1920. He contributed greatly to the establishment of clinical teaching, then at Somerset Hospital. In 1938 Groote Schuur Hospital (GSH) opened, at which time Falconer retired as Professor of Medicine to become Vice-Chancellor and Principal of UCT.
The tragic Haitian earthquake that claimed at least a quarter of a million lives this January and devastated that island has provided a sobering wake-up call for volunteer South African emergency medics who pitched in to help. South Africa's response was fragmented, with two NGOs operating separately and independently. The lessons learnt have led to a joint initiative between the largest emergency academic medicine divisions in the country.
A draft bill that targets the internet and cell phones exclusively to ban all pornography will enable the plugging of 90% of the corrosive IT deluge that floods past current legislation and causes untold damage to society, especially adolescents and young children.
June 2013 - that's the 'realistic' date by which vulnerable South African women can expect to begin using an officially approved vaginal microbicide gel that would provide them with an unprecedented tool to protect themselves from HIV infection.
Pilots, cabin crew members and air traffic controllers, frustrated by outdated protocols for medical certification which lead to lengthy delays and unnecessary and expensive appeals, will by this September begin benefiting from a major systemic upgrade.
Tuberculosis is the major cause of morbidity and mortality in HIV-infected patients in sub-Saharan Africa. HIV infection is often first diagnosed following a diagnosis of tuberculosis, with many patients needing antiretroviral therapy (ART). Starting ART in HIV-infected patients with tuberculosis (TB) may be associated with complications, including side-effects from co-administration of multiple drugs with many overlapping toxicities, reductions in concentrations of certain antiretroviral drugs following the induction of metabolising enzymes and drug transporters by rifampicin, and paradoxical deterioration due to the immune reconstitution inflammatory syndrome (IRIS). Furthermore, the high pill burden of co-treatment could reduce adherence, resulting in poor treatment outcomes for both diseases. These potential harms must be weighed against the high mortality rates in patients with HIV-associated tuberculosis who do not receive ART, especially those with low CD4 counts. The optimal time to initiate ART in patients with tuberculosis is an important research question, and randomised controlled trials are addressing this issue.
In a resource-deficient environment, liability for medical malpractice depends on whether there was intentional or negligent wrongful conduct by the parties concerned, or whether they were vicariously liable for the wrongful acts or omissions of others. Departments of health and private sector hospital bodies will be liable for the wrongful conduct of their administrators where, through maladministration, they have harmed patients by intentionally or negligently diverting funds from health care services. Such bodies cannot escape liability for harm caused to patients arising from a shortage of resources where these were caused by the intentional or negligent wrongful conduct of their administrative employees. Departments of health and private health bodies will also be vicariously liable for the intentional or negligent wrongful acts or omissions of their clinical health care and support staff. Clinicians and support staff working in a resource-starved environment, however, will be judged by the standard of how reasonably competent health care practitioners or support staff employees in the same field and faced with similar conditions would have acted.
Communicable Disease Epidemiology and Control : a Global Perspective is designed as a compact reference guide and framework to assist in understanding the plethora of communicable diseases by grouping these according to common modes of transmission, which in turn often defines interventions for control.
Ferdie Stern passed away peacefully in Durban on 1 June 2010 in his 91st year, a victim of hairy cell leukaemia. His parents, Simon and Bertha, had emigrated from a small village, Rohatten, in Austria and settled in Dordrecht in the Eastern Cape where they farmed. His father became mayor, but unfortunately died when Ferdie was only 8 years old. Ferdie was one of 7 children. His mother moved to Cape Town and managed to give all her children a university education.
Documenting, quantifying, intervening in and preventing interpersonal violence is a leading global public health challenge of this decade. Apart from HIV/AIDS, TB and malaria - where violence arguably plays an exacerbating role - what other disease process claims more than half a million lives annually, generating a burden of 'approximately 1400 deaths a day, the equivalent of three long-haul commercial aircraft crashing every single day'? Yet even death may not be the most sensitive measure of the profound impact of interpersonal violence on the lives of individuals, communities, societies, nations, regions and our very humanity. With interpersonal violence occurring anywhere that humans function, both publicly and privately - at home, at work, in the streets, markets and cinemas, and on the battlefield - this social problem poses an increasing threat to the quality of our lives and the planet. The urgency of confronting this issue cannot be clearer.
To the Editor : The role of family planning in achieving the Millennium Development Goals is well recognised. The benefits of family planning, in developing countries in particular, extend beyond decreasing fertility and include poverty reduction, improved health for both mother and child, the promotion of gender equality by increasing women's opportunities beyond reproductive and domestic activities, and environmental sustainability. In addition, prevention of undesired pregnancies among HIV-positive women by eliminating unmet need for contraception is a highly cost-effective means of preventing mother-to-child transmission.
To the Editor : Myiasis is the infestation of tissues of live vertebrates (humans and/or animals) by dipterous larvae. Human myiasis is classified according to the type of larva producing the lesion, location and clinical signs. Myiases in humans are thought to have originated from the close association between humans and domestic animals in ancient times.
Objectives. An association between intimate partner violence and adverse physical health outcomes and health-risk behaviours among women has been established, most scientific research having been conducted in the USA and other developed countries. There have been few studies in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. We therefore sought to study the association between physical intimate partner violence and physical health outcomes and behaviours among South African women.
Methods. Using data from the cross-sectional, nationally representative South African Stress and Health Study, we assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1 229 married and cohabiting women.
Results. The prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance.
Conclusions. Partner violence against women is a significant public health problem in South Africa, associated with healthrisk behaviours and increased use of medical services. Public health programmes should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health behaviours is needed to inform the design of such programming.