The drug trade has increased globally in intensity and reach, and substance abuse in South Africa has escalated rapidly. Drug misuse is a major social, legal and public health challenge despite the war on drugs, in which the USA has a disproportionate influence. Why this lack of progress and what can be done about it? The use of psychotropic substances is as old as human history. Some use drugs as part of religious observations. The majority of people who partake of drugs use them for recreational purposes. Some become addicted and may cause harm to themselves, their families and society. If drugs are bad it seems logical to wage war on them. However, although 'get tough' measures sound attractive they are often counterproductive.
To the Editor: Tonsillectomy is a very common operation done by ENT surgeons and general practitioners in South Africa. Our impression is that the procedure and its peri-operative care vary greatly. We conducted a web-based survey (approved by the UCT ethics committee) to evaluate tonsillectomy practice among South African ENT surgeons and discuss the findings in relation to evidence-based practice from the literature. We report only on the controversial and interesting aspects. Ninety-three surgeons (27% of the ENT surgeons in active practice in South Africa) completed the survey, of whom 65 were in private practice.
To the Editor: Retrospective antimicrobial susceptibility profiles from bloodstream infection isolates in Tanzania indicated increasing antimicrobial resistance to the first-line and inexpensive antimicrobial agents. Prospective methicillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum beta-lactamase (ESBL) screening should be accompanied by watching multidrug-resistant (MDR) isolates and their susceptibility to first-line antibiotics. MDR isolates in local circulation might still turn out to be susceptible to such drugs, as was found at Sant Parmanand Hospital, a 140-bed private, tertiary care, multidisciplinary hospital in Delhi. From January to November 2010, 5 MDR bacteria were isolated from patients with serious infections.
To the Editor: It took 3 continents and 11 years post-qualification for me to realise that Western medicine's approach to improving health care in Africa may be flawed. The realisation occurred as a result of reading Belfrage's experiences of working within the Aborigine community in terra nullius (Australia's vast inhabited interior) and seeing how, as a doctor of European descent, she and her culture, and the local Aborigines (Alyawarr) and their culture, perceived the world in fundamentally different ways.
A recently released study powerfully suggests that doctor resistance to prescribing highly effective isoniazid preventive therapy (IPT) to their TB-negative HIV patients is contributing to the national TB epidemic.
In spite of an enlightened constitution and enabling legislation, South Africa's small transgender population continues to battle medical prejudice and ignorance in addition to huge societal pressure to conform to socially constructed sexual stereotypes. An Izindaba investigation showed that transgender people need precise information and deep pockets to access hormone treatment and/or gender-reassignment surgery, be it in the public or private sector.
Ever since he can remember (at least from around 3 - 5 years old), Lex Kirsten (born a girl) identified himself as a boy. His deepest wish was that 'maybe if I wake up tomorrow my body will be right ... that there's been a big mistake'.
The first experimental heart transplantation was performed by Demikhov in Moscow in the very early 1940s. His experiments were discontinued during World War II but, when they resumed in 1946, he produced a large volume of work devising 24 different methods of heterotopic heart transplantation within the chest. During the 1950s, many research workers transplanted the heart in the orthotopic position and also transplanted the heart and lungs en bloc. They used various methods, including cardiopulmonary bypass (heartlung machine). During the 1960s, Lower and Shumway established beyond doubt that heart transplantation was a possibility. Christiaan Barnard, using their surgical techniques, performed the first human-to-human heart transplant, in December 1967 in Cape Town.
The double aortic arch is a form of vascular ring that constitutes a class of congenital anomalies in which the trachea and oesophagus are encircled by connected segments of the aortic arch and its branches. Although it takes various forms, the common defining feature is that both the left and right aortic arches are present.
A 30-year-old woman was seen at 24 weeks for a discrepancy between the symphysis-fundal height and the gestation by dates. Ultrasound examination revealed a twin pregnancy and showed the placentas to be implanted 'back-to-back' over what appeared to be a septum that extended from the uterine fundus to the cervix (Fig. 1). A bicornuate unicollis uterus was confirmed on MRI and revealed two divergent uterine horns separated by a deep fundal cleft, surrounded by myometrial tissue, containing a fetus within each horn (Fig. 2). A single cervix and vagina was visualised (Fig. 3), in keeping with a Class IVA Müllerian duct abnormality. At 33 weeks, an emergency caesarean section delivery was performed via two separate classic incisions into each corpus.
Barry Adams, Emeritus Professor of Medicine at the Nelson R Mandela School of Medicine, University of Natal, Durban, was a highly esteemed clinician and teacher. He is best remembered for instilling in his students an enduring recognition that acquisition of skills in eliciting and interpreting signs and symptoms was fundamental to good clinical practice. He began his postgraduate training at Oxford University, where the subject of his interest was aplastic anaemia. He was Foundation Professor of Medicine at the University of Natal from 1954 to 1978.
John sadly passed away in Cape Town after a major joint operation. He was born in Cape Town on 27 March 1935. His father was a respected, true family GP in Sea Point, fondly remembered by former patients, including Stuart Saunders, former UCT Vice-Chancellor. John's friends remember his mother's charming hospitality. John adored her and visited her frequently from the USA. John excelled at St George's Grammar School, where he was head boy. He was an outstanding scholar and sportsman. He represented UCT in the 1st 15, and in the UK he played in the Combined London Hospitals rugby teams.
Given its title this slim volume, running to just 200 pages, is deceptive. With elegance, accessibility and easy readability, it deals with complex, and it must be said potentially dry, matters of great importance to health practitioners in the South African health delivery environment.
Derek was born in Pretoria on 14 February 1926. He was educated at Pretoria Boys High, where he matriculated in 1944. After serving in the artillery in 1945, he started his medical training at Wits in 1946, graduating in 1951.
South Africa has failed to treat its children well, as demonstrated by our failure to achieve adequate progress towards the Millennium Development Goal of reducing the under-5 mortality rate, doing far worse than many poorer countries.
The World Health Organization (WHO) estimates that there are 10 million new cases of tuberculosis (TB) reported worldwide each year, and 1.7 million people die from the disease. The incidence of TB in sub-Saharan Africa (SSA) remains very high at over 300 new cases of TB per 100 000 population in 2007. The TB epidemic in SSA is fuelled by the HIV epidemic, and up to 70% of adults with TB are co-infected with HIV. There are few data on drug-resistant TB from SSA, probably owing to poor TB programme performance, inadequate laboratory facilities for drug susceptibility testing (DST), and poor surveillance, data collection and reporting procedures. The WHO estimated that 69 000 cases of MDR-TB emerged in 2008 in Africa, which is most probably an underestimate
To the Editor: The South African public health sector follows a hierarchical referral system. District hospitals play a central role between the primary health care (PHC) clinics, community health centres (CHCs), regional and tertiary hospitals. They provide level one (generalist) services to in- and outpatients referred from PHC clinics and CHCs. District hospitals should ensure that patients are treated at the appropriate level of care and receive continuity of care. However, patients often go directly to district hospitals, resulting in increased caseloads. Studies have identified several factors (e.g. accessibility, acceptability, efficiency and effectiveness) that might influence a referral system and its usage. We aimed to develop an understanding of the South African district referral system.