The notion of feminisation of a profession signifies a variety of meanings. In much of the literature, a profession is feminised when women constitute the majority of its practitioners. However, Menkel-Meadow identifies two other meanings: those who recognise certain attributes as uniquely feminine regard the profession as feminised 'when traits such as empathy, relatedness, nurturance and collectiveness are recognised, valued and expressed in the performance of professional tasks and functions'. Women purportedly impart these traits when they join a profession. Then there is the feminist premise that a profession is feminised not by stereotypic attribution of gender qualities, but when its practice and substantive rules adapt and change in such a manner that women who enter the profession do not have to conform to a male model of what it means to be a professional. This editorial considers feminisation of the South African medical profession from all three perspectives.
To the Editor: We believe the guideline by Bryer et al. to be overdue and well constructed, and generally to contain excellent recommendations. However, the authors note that intravenous tissue plasminogen activator (tPA) 'is an accepted therapy' and 'significantly improves outcome'; particular reference is made to the ECASS III trial to justify its use within 4.5 hours of stroke onset. We believe that this is a dangerous and unsupported recommendation.
To the Editor: The good intentions in the proposed National Health Insurance (NHI) scheme are not doubted, but I suspect that the authorities have not been correctly advised on why the health system is often inadequate.
To the Editor: I am a former UCT Medical School graduate (1958) who spent a good deal of last year as an inpatient in the UK. This has highlighted for me the changes that have taken place in the intervening years - not the medical advances, but the social ones. I was one of about ten female medical students, a very different ratio to that which obtains today. Then propriety dictated that women and men had to have separate dissecting rooms for anatomy. One wonders what moral turpitude was feared should we have shared the same facilities. Obstetric practice was also taught in single-sex groups!
To the Editor: South Africa has a huge potential for organ transplantation. Deceased donation is well established, and we are one of the few African countries with brain death legislation. However, despite adequate legislation and well-established transplant units, donor numbers are decreasing and in some areas living donation now outnumbers deceased donation. Saudi Arabia has set an excellent example in utilising deceased donors and is a role model for other Muslim countries in the Middle East and Africa. In a few years they have built up a deceased donation programme and donor numbers are increasing yearly.
HIV in Zimbabwe is disappearing like 'snow in the desert', in dramatic contrast to its neighbouring countries, mystifying epidemiologists, one of whom firmly believes the anomaly can be attributed to the country's relatively high level of education.
A group of 50 Port Elizabeth nurses are fighting off their colleagues and the doctors they work with to hold onto SmartPhones that provide them with instant and almost limitless access to a clinical library and treatment guidelines.
Provincial health departments are beginning to show modest success in meeting President Jacob Zuma's exhortation to root out fraud and corruption, but their efforts have revealed a national pandemic of looting, conservatively costing hundreds of millions, much of it deeply systemic.
The need for a burns disaster plan integrated with national and provincial disaster plans was highlighted during the South African Burns Society Congress in Pretoria in 2009. In recent times, a fire at a large printing works in Paarl and a nightclub in Durban, and bush fires around Cape Town, have questioned both the prevention strategies and our preparedness to cope with the potential number of burn casualties. The likelihood of a burns disaster increases when large numbers of people are gathered in an environment where powerful sources of energy are harnessed in industry or where there has been a significant growth in transportation and technology.
'The life of a patient is the only life the patient has - can we really make a judgment call on who to treat or not?' J Puchula (from his address at the 2008 congress of the European Club for Paediatric Burns, Gdansk). The matter of triaging severe burns so that expensive and potentially futile treatment should not be initiated was discussed in a priority setting process by the Western Cape Health Department, and led us to question the validity of such an approach.
A pregnant woman nearing delivery, with an uncomplicated pregnancy and no immediate indication for caesarean section (CS), can either deliver vaginally or by CS. Historically CS has been viewed as more dangerous than vaginal delivery. However, CSs are far safer today and the complications of unmonitored labour are increasing, especially in the public sector.
Knowledge around HIV has evolved extremely rapidly over the past three decades, providing formidable challenges for the editors and writers of any reference text on the subject to remain up to date and relevant. Given such challenges, the recently published second edition of HIV/AIDS in South Africa is a remarkable achievement that serves as a broad-ranging and current overview of all aspects of the HIV/AIDS epidemic in South Africa. In addition, the book provides a historical record of the epidemic and the evolution of responses to it over the past 25 years and insights into what may be expected in the decades to come.
Professor Mphako Charles Modiba, the eldest son of Matome Titus and the late Salome Maletlabo Modiba, was born on 1 November 1952 at Pietersburg Hospital. He matriculated from Hwiti High School in 1971. He followed his calling in the field of medical science with dedication, empathy and a drive to impart his knowledge with those who had the opportunity and privilege to be his audience.
Sixty years ago Sidney and Emily Kark had a vision to make health care accessible to all South Africans, particularly those in rural and under-served areas. They established a comprehensive primary health care model that was replicated in over 40 rural communities before the apartheid government abolished their plan. In the light of these historic initiatives, what have health sciences training institutions achieved in the past 50 years to address the health care priorities of South Africans who are most in need?
To the Editor: The birth of a child with Down syndrome (DS) has many serious implications - physical and mental deficiencies, medical conditions and lifestyle challenges. The high incidence (1 in 600 births in South Africa) and high cost of medical care highlight the need for effective health care. The South African Human Genetic Policy Guidelines include a rudimentary list pertaining to the management of DS. In the USA, the American Academy of Pediatrics (AAP) has addressed this issue by devising clinical protocols focusing on improving the level of functioning and quality of life of children with DS. Countries such as Thailand and, to a lesser extent, South Africa, in KwaZulu-Natal, have adopted and adapted these guidelines. The importance of the guidelines for clinical and counselling practices and their routine adherence is a daily challenge for 3 Durban hospitals with a total of 2 staff members dedicated to genetic matters.
Setting. The influence of undergraduate and postgraduate training on health professionals' career choices in favour of rural and underserved communities has not been clearly demonstrated in resource-constrained settings.
Objectives. This study aimed to evaluate the influence of educational factors on the choice of rural or urban sites of practice of health professionals in South Africa.
Methods. Responses to a questionnaire on undergraduate and postgraduate educational experiences by 174 medical practitioners in rural public practice were compared with those from 142 urban public hospital doctors. Outcomes measured included specific undergraduate and postgraduate educational experiences, and noneducational factors such as family and community influences that were likely to affect the choice of the site of practice.
Results. Compared with urban doctors, rural respondents were significantly less experienced, more likely to be black, and felt significantly more accountable to the community that they served. They were more than twice as likely as the urban group to have been exposed to rural situations during their undergraduate training, and were also five times more likely than urban respondents to state that exposure to rural practice as an undergraduate had influenced their choice of where they practise. Urban respondents were significantly more attracted to working where they do by professional development and postgraduate education opportunities and family factors than the rural group.
Conclusions. Evidence is provided that rural exposure influences the choice of practice site by health professionals in a developing country context, but the precise curricular elements that have the most effect deserve further research.
Setting. The Collaboration for Health Equity through Education and Research (CHEER) was formed in 2003 to examine strategies that would increase the production of health professionals who choose to practise in rural and under-served areas in South Africa.
Objectives. We aimed to identify how each faculty is preparing its students for service in rural or under-served areas.
Methods. Peer reviews were conducted at all nine participating universities. A case study approach was used, with each peer review constituting its own study but following a common protocol and tools. Each research team comprised at least three reviewers from different universities, and each review was conducted over at least 3 days on site. The participating faculties were assessed on 11 themes, including faculty mission statements, resource allocation, student selection, first exposure of students to rural and under-served areas, length of exposure, practical experience, theoretical input, involvement with the community, relationship with the health service, assessment of students and research and programme evaluation.
Results. With a few exceptions, most themes were assessed as inadequate or adequate with respect to the preparation of students for practice in rural or under-served areas after qualification, despite implicit intentions to the contrary at certain faculties.
Conclusions. Common challenges, best practices and potential solutions have been identified through this project. Greater priority must be given to supporting rural teaching sites in terms of resources and teaching capacity, in partnership with government agencies.
Objective. Tuberculosis (TB) in patients with or without advanced HIV infection may present as smear-negative, extrapulmonary and/or disseminated forms. We studied the role of pericardial and abdominal ultrasound examinations in the determination of extrapulmonary or disseminated TB.
Methods. A prospective descriptive and analytic cross-sectional study design was used to determine the ultrasound findings of value in patients with subsequently proven TB. Ultrasound examinations were performed on 300 patients admitted to G F Jooste Hospital with suspected extrapulmonary or disseminated TB.
Outcome measures. The presence of hepatomegaly, splenomegaly, lymphadenopathy (location, size and appearance), ascites, pleural effusions, pericardial effusions and/or splenic micro-abscesses was noted. Clinical findings, microbiological and serological data were also recorded, correlated and analysed.
Results. Complete data sets were available for 267 patients; 91.0% were HIV positive, and 70.0% had World Health Organization clinical stage 4 disease. Active TB (determined by smear or culture) was present in 170 cases (63.7%). Ultrasonically visible abdominal lymphadenopathy over 1 cm in minimum diameter correlated with active TB in 55.3% of cases (odds ratio (OR) 2.6, 95% confidence interval (CI) 1.5 - 4.6, p=0.0002). Ultrasonographically detected pericardial effusions (OR 2.8, 95% CI 1.6 - 5.0, p<0.0001), ascites (OR 2.2, 95% CI 1.2 - 4.2, p=0.005) and splenic lesions (OR 1.9, 95% CI 1.0 - 3.5, p=0.024) also predicted active TB.
Conclusion. Pericardial and abdominal ultrasound examinations are valuable supplementary investigations in the diagnosis of suspected extrapulmonary or disseminated TB.