Henrietta Lacks died of cervical cancer at the Johns Hopkins Hospital in Baltimore, Maryland, on 4 October 1951 at the age of 31. Some 25 years later, her husband received a jaw-dropping call from Dr Susan Hsu, an immigrant Chinese genetics researcher in Baltimore. 'We've got your wife. She's alive in a laboratory. We've been doing research on her for the last 25 years. And now we have to test your kids to see if they have cancer.' At least that is how Day Lacks, an indigent black tobacco farmer from Virginia with only a third-grade education, recalled the conversation. But he had only grasped half the story. The other half was lost in the scientific jargon of cells and cell culture, the halting English of the researcher, and Day's deep-Southern black vernacular.
To the Editor: It is encouraging that our very high maternal and perinatal mortality rate has been identified as an important part of South Africa's fourfold national epidemic. I hope that, as the Department of Health sets out to find solutions to the former, it will recognise that some very basic issues need to be acknowledged.
To the Editor: Motor vehicle accidents are a leading cause of death in children of all ages worldwide, and responsible for 32% of all childhood injury deaths. When used correctly, restraint devices such as seat belts and child restraint systems significantly decrease mortality and serious injuries in children. Many studies have been done on the use of seatbelts and car safety seats in America, Asia and Europe; however, none exist for African countries.
To the Editor: I refer to the scientific letter entitled 'Emergency centres lack defibrillator knowledge'. I am a recently retired UK accident and emergency consultant who is now attempting to plough back knowledge gained in the discipline of emergency medicine (EM) and trauma to peripheral hospitals in the Western Cape and KwaZulu-Natal (KZN) under the umbrella of Outreach. This includes ward rounds, clinics, shop-floor teaching, checking and demonstrating equipment (defibrillators, ventilators, monitors) pertinent to emergency departments (EDs), and most importantly demonstrating correct drug usage to doctors and nurses. In KZN many doctors are foreign qualified and poorly taught in emergency medicine.
To the Editor: Isn't it disconcerting what some international keynote speakers demand in terms of remuneration, first-class travel and luxury accommodation, whether visiting rich or developing countries? I have just discovered why this may be not just deserved but necessary, as it results in local organisers anxiously awaiting the arrival of keynote speakers at the airport.
A protracted and lonely campaign for safe male circumcision in the traditional, male-dominated rural Eastern Cape is finally saving multiple lives - its chief protagonist a medical doctor and mother of 10 who is now Port Elizabeth's Municipal Health Chief.
Poor planning, incompetent budgeting and dysfunctional administration are killing patients, prolonging suffering and driving some specialists, who could otherwise deliver world-class medicine, to the point of resignation at Johannesburg's two top hospitals.
Sanlam's CEO, Johan van Zyl, has admitted that his company made a 'mistake' in holding onto what grew into about R600 million in reserves for two major medical aids it once owned and ran, but denied being deliberately obstructive towards them in the courts.
A trauma system involves the interaction of prehospital care, emergency centre care and definitive care (including prevention and rehabilitation services), providing an organised approach to acutely injured patients within a defined geographical area, from primary care to advanced care. Trauma is, after infectious disease, the second leading cause of death and disability in Africa (Table I), and must therefore feature on the national health agendas of all African countries. The requirements for developing cost-efficient, patient-centred trauma systems relevant to South Africa are outlined below (each item commencing with a P, and hence the title).
The Professional Board for Emergency Care at the Health Professions Council of South Africa (HPCSA) has approved pre-hospital rapid sequence intubation (RSI) as part of the scope of practice for registered emergency care practitioners (ECPs). RSI is an advanced airway management process that facilitates endotracheal intubation in adults and children. Features of this technique include pre-oxygenation, rapid pharmacological induction of unconsciousness, and neuromuscular blockade to enable the placement of an endotracheal tube. RSI has become widespread as the procedure of choice for definitive airway management by pre- and in-hospital emergency care personnel worldwide. In the emergency department setting, RSI is superior to intubation with deep sedation, a technique not incorporating pharmacological paralysis as part of the intubation sequence. For this reason, the implementation of RSI in the prehospital environment is supported, provided that it is practised within an appropriate framework of clinical governance.
Disclosures of unreported incriminating information are rarely documented in research; researchers therefore often do not know how to respond when cases arise. Disclosure may occur when respondents volunteer information, without necessarily being asked, and presents an ethical dilemma. Researchers have to choose between maintaining confidentiality and public protection. Debate on confidentiality in research is ongoing; some advocate for totally preserving confidentiality, while others argue that certain situations warrant a breach of confidentiality.
George Nurse was born on 7 August 1928 in Vryheid, Natal, South Africa, the first of six children of a station master and his wife. Able to read and write at an early age, he read widely and voraciously, amassing knowledge which he deployed for the rest of his life. George was educated at Durban Boys High School and qualified in medicine at the University of Cape Town in 1951.
For most of us December 2010 is a fading memory; we will not share the pain felt by 1 500 families, grieving another festive season of carnage on South Africa's road system. From the top strong words have been spoken and promises made, but will anything change? Every month, 1 200 deaths occur on our roads, and this shows no sign of decreasing. If a jumbo jet crashed into OR Tambo's main runway each and every week, how long would we wait before we demanded action? The body count grows, but as we enter the World Health Organization (WHO)'s Decade for Action for Road Safety, is 2011 the year that we will stand up and do something? What also of the 60 000 South Africans who meet their end violently every year? If simple numbers cannot motivate us, can we be shamed into action by the fact that we have one of the highest rates of traumatic death in the world? Trauma is at epidemic levels in South Africa, but are we taking this epidemic seriously? Statistics suggest not.
To the Editor: Endotracheal intubation is performed in the prehospital and emergency department (ED) environments by advanced life support (ALS) paramedics and emergency doctors. Cuffed endotracheal tubes (ETTs) are used in adults and more recently in children to ensure that the airway is protected, and to prevent air leakage between the wall of the trachea and the ETT during positive-pressure ventilation. Cuffs are typically high volume, low pressure in their design and have a safe working pressure of <30 cm H2O in adults and <20 cm H2O in children.
To the Editor: A study of the parasites of invasive rats in the eThekwini Municipality of KwaZulu-Natal has led to this first report of Angiostrongylus (Parastrongylus) cantonensis, commonly known as the rat lung worm, in South Africa. A. cantonensis is clearly endemic in this region and probably also in other areas of South Africa. There are a few reports of this nematode from Africa (excluding South Africa): in rats and snails in Egypt (Fouad and Abdulla, 1978), in snails in Nigeria (Sowemimo and Asaolur, 2004), and a human case from Ivory Coast (1980). As humans are accidental hosts, the parasite cannot complete its life cycle, and immature worms lodge in the central nervous system where they elicit a condition known as eosinophilic meningitis.
Objective. To audit the performance of a new level I trauma unit and trauma intensive care unit.
Methods. Data on patients admitted to the level I trauma unit and trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, from March 2007 to December 2008 were retrieved from the hospital informatics system and an independent database in the trauma unit.
Results. Four hundred and seven patients were admitted; 71% of admissions were inter-hospital transfers (IHT) and 29% direct from scene (DIR). The median age was 27 years (range 1 - 83), and 71% were male. Blunt injury accounted for 66.3% of admissions and penetrating trauma for 33.7%. Of the former, motor vehicle-related injury accounted for 87.4%, with 81% of paediatric admissions due to pedestrian-related injuries. The median injury severity score (ISS) for the entire cohort was 22 (survivors 18, deaths 29; p<0.001). Patients in the DIR group had a significantly higher mean ISS compared with the IHT group (DIR 25, IHT 20; p<0.02). The overall mortality rate was 26.3%. There were 37 deaths (31.1%) in the DIR group and 70 (24.3%) in the IHT group (p=0.19). In patients surviving more than 12 hours the overall mortality rate was 21.1% (DIR 13.7%, IHT 23.5%; p=0.042).
Conclusions. Trauma is a major cause of premature death in the young. Despite a significantly higher median ISS in direct admissions, there was no difference in mortality. Of those surviving more than 12 hours, patients admitted directly had a significant decrease in mortality. Dedicated trauma units improve outcome in the critically injured.
Objective. The Government of Swaziland decided to explore the feasibility of social health insurance (SHI) in order to enhance universal access to health services. We assess the financial feasibility of a possible SHI scheme in Swaziland. The SHI scenario presented is one that mobilises resources additional to the maintained Ministry of Health and Social Welfare (MOHSW) budget. It is designed to increase prepayment, enhance overall health financing equity, finance quality improvements in health care, and eventually cover the entire population.
Methods. The financial feasibility assessment consists of calculating and projecting revenues and expenditures of the SHI scheme from 2008 to 2018. SimIns, a health insurance simulation software, was used. Quantitative data from government and other sources and qualitative data from discussions with health financing stakeholders were gathered. Policy assumptions were jointly developed with and agreed upon by a MOHSW team.
Results and conclusion. SHI would take up an increasing proportion of total health expenditure over the simulation period and become the dominant health financing mechanism. In principle, and on the basis of the assumed policy variables, universal coverage could be reached within 6 years through the implementation of an SHI scheme based on a mix of contributory and tax financing. Contribution rates for formal sector employees would amount to 7% of salaries and the Ministry of Health and Social Welfare budget would need to be maintained. Government health expenditure including social health insurance would increase from 6% in 2008 to 11% in 2018.
Objective. Phaeochromocytomas are catecholamine-secreting tumours, the majority of which arise from the adrenal medulla. Untreated, they are potentially lethal; early diagnosis and treatment offer a good chance of cure. They are rarely reported in blacks. The clinical presentation and outcome of phaeochromocytoma in a large cohort of black South Africans is reviewed.
Methods. Patients' records in a tertiary care university hospital were reviewed. Fifty-four black patients presenting with phaeochromocytoma between 1980 and 2009 were included. The clinical presenting features, tumour localisation and outcome were assessed.
Results. Fifty-four (41 female, 13 male; age range 8 - 57 years) patients were identified. Five (9%) had familial syndromes; 49 (91%) were deemed sporadic. All tumours were intra-abdominal: 34 (61%) were adrenal and 22 (39%) extra-adrenal in origin. The most common symptoms were headache (77%), palpitations (77%), and sweating (74%). All were hypertensive, almost equally divided between paroxysmal and sustained hypertension. Six (11%) presented in congestive cardiac failure including 2 with catecholamine-induced myocarditis. Two patients had features which simulated hypertrophic obstructive cardiomyopathy. Nine women presented in pregnancy: there was no maternal mortality; fetal mortality included 1 early neonatal death and 1 intrauterine death. There were 4 deaths: 1 from postoperative haemorrhage, 1 from multisystem crisis, 1 from metastatic medullary thyroid carcinoma, and 1 from catecholamine-induced myocarditis.
Conclusion. Phaeochromocytoma is an important although rare tumour in blacks, with similar clinical presentations and complications to those in white patients. Timely diagnosis and appropriate treatment resulted in a favourable outcome in over 90% of patients in this study.