Local newspapers have recently carried vivid headlines following the arrest of several individuals at the hands of the Hawks. Quite who among those arrested hold valid qualifications, who were impostors, who were legitimately registered and accredited with the Health Professions Council of South Africa (HPCSA) and who were fraudulently borrowing practice numbers to defraud the medical aid services, and whether they were operating as part of a syndicate (or syndicates), is still to be established. Reassuringly, the magistrate before whom the alleged miscreants appeared demanded proof of the medical qualifications and the Department of Health and the HPCSA are undertaking their own investigations, as is the Board of Health Care Funders (an industry body for medical aids), since some are accused of using other doctors' practice numbers in order to claim monies from medical aids. Patients of the alleged bogus doctors are now also supplying evidence.
To the Editor: Recent articles addressed the duty of health care professionals and researchers to report sexual activity involving children. They discuss the interpretation and practical implications of section 54 of the Criminal Law (Sexual Offences and Related Matters) Amendment Act No. 32 of 2007 (Sexual Offences Act), which requires that 'a person who has knowledge that a sexual offence has been committed against a child must immediately report such knowledge to a police official'. The articles give guidance on the circumstances under which health care professionals and researchers, respectively, should report child abuse and who to report it to. However, it is of concern that some of their arguments seem to be based on a misinterpretation of section 56(2) of the Sexual Offences Act.
To the Editor: It has been proposed that routine care of paediatric and adolescent patients with type 1 diabetes (T1DM) in the Western Cape should be devolved from centres of excellence to centres at secondary or even primary level. Experience with adults with type 2 diabetes (T2DM) in another African country is cited to support this notion. However, these two conditions have completely different aetiologies. While T2DM is entirely preventable and treatable by simple measures, this is not the case with T1DM.
To the Editor: The recent case in the media to motivate active euthanasia is tragic. A doctor dying of cancer in New Zealand, tried to starve herself to death, which suggests that she was deeply depressed, because suicidal ideation 'appears exclusively linked to mental disorder'. Her son, from outside the country, was her lone caregiver and refrained from looking for help in terms of the wording of her 'living will'. He became drawn into her desperation, was not medically trained, and did not consider her to be depressed. At her request, he eventually gave her an overdose of crushed morphine pills that she had hoarded for the purpose. He was arraigned on a charge of murder.
A combination of patient-claims litigators becoming smarter, fast evolving (and expensive) medical technology and growing patient awareness has sent the cost of reported negligence claims soaring by 132% in South Africa over the past two years.
Teaching hospitals are national assets that must urgently be taken out of the hands of provincial governments and doctors must exit the central bargaining chamber where their negotiating power is reduced to that of 'labourers and sweepers'.
A 35-year-old South African entrepreneur firmly believes he can revolutionise the local alcohol and drug testing market through gold standard hair testing technology that provides up to three months (and often more) of accurate abuse history.
A comprehensive blueprint for rehabilitating provincial health departments, drawn up during the brief tenure of former national health minister, Barbara Hogan, is being largely ignored by the current health leadership regime.
Cryptococcal meningitis (CM) is a major cause of death among HIV-infected individuals. It causes an estimated 957 900 cases and 624 700 deaths worldwide annually, the vast majority of them in sub- Saharan Africa. In Cape Town, CM is now the most common cause of adult meningitis (63% of all microbiologically confirmed cases), and acute outcomes are poor. Even with optimal treatment in study settings, 10-week mortality rates are between 24% and 37%. In 2009, in a routine care setting at an urban hospital in Johannesburg, 67% of patients had died or were lost to follow-up at 3 months (N Govender et al., unpublished data). Unfortunately almost half of South African patients still receive sub-optimal initial treatment with oral fluconazole rather than intravenous amphotericin B. Clearly, given the substantial mortality and morbidity associated with CM, preventive interventions should be prioritised.
Deaths during or after a surgical procedure may be considered medico-legal and subjected to medico-legal autopsy and inquest. We define death in medical terms and discuss the implications of the provisions of the Amended Health Professions Act of 1974 and its recent amendment. Problems with the old and new definitions of such deaths and whether the amendment provides additional patient protection for the patient are considered. We challenge the South African law-makers to review the all-inclusive terminology in relation to such deaths.
The South African (SA) National Department of Health (DoH) released new guidelines for the management of HIV/AIDS in April 2010. We discuss here controversial issues and operational challenges in the guidelines; the stimulation of debate and contributing to future guidelines; the timing of initiation of antiretroviral treatment, scope and timing of laboratory monitoring and testing of concomitant conditions, operational challenges such as paediatric HIV treatment and nurse-driven care, and procedures relating to the guidelines such as the need for transparency of the guideline committee and the standard of evidence used to develop the guidelines. We welcome comment and sharing of further insights that will contribute to future guidelines.
Parenteral artesunate should be used in preference to quinine for the treatment of severe malaria, given its significant mortality and safety benefits. As the product has not yet been registered for use in South Africa, the Parenteral Artesunate Access Programme has been launched to reduce malaria-related mortality. Severe malaria is a medical emergency that requires prompt treatment to prevent death, which occurs in 10 - 50% of patients. Based on high-quality evidence, the World Health Organization (WHO) now strongly recommends intravenous (IV) artesunate in preference to IV quinine for the treatment of severe malaria in adults.
The patient sustained an accidental injury that resulted in broken glass causing a penetrating eye injury in her left eye. A corneal laceration with iris prolapse was not identified at a secondary hospital. Eight weeks after the injury, she presented at Groote Schuur Hospital complaining of decreased vision and severe pain in both eyes. The diagnosis was sympathetic ophthalmitis after all infective and inflammatory causes were excluded. Her visual acuities were counting fingers at 30 cm with her left eye and 6/60 in her right eye. On cursory examination, the left eye seemed normal (Fig. 1) but a corneal scar with prolapsing intra-ocular tissue was visible on elevating the upper lid (Fig. 2). She was treated with systemic immunosuppression (intravenous methylprednisolone) and topical corticosteroids. The prolapsed iris was excised and the corneal laceration repaired. Vision in the left eye did not improve but improved to 6/36 in the right eye.
Issues related to ethics, law and human rights enter into the everyday work of medicine and the health sciences. Almost daily we encounter scenarios that raise ethical concerns - from laboratory work on stored human tissue, interactions between health care providers and patients, to the shape of policies and programmes to deliver services to populations. Yet, most health care providers and managers have had little formal training in ethics, law and human rights. As a result, most deal with ethical concerns with little preparation, or, worse, fail altogether to recognise the potential implications of their work.
In this issue of the SAMJ, Lessells et al. highlight the unacceptably high mortality due to HIV-associated cryptococcal meningitis (CM) in routine clinical practice in South Africa. CM is now the most common cause of adult meningitis in much of central and southern Africa, accounting for 63% of all microbiologically confirmed cases in the largest published series. There are an estimated 720 000 cases annually in sub-Saharan Africa, leading to 504 000 deaths; expanding access to antiretroviral therapy (ART) has not yet led to a decline in these numbers.
To the Editor: The political and economic decline in Zimbabwe has forced many Zimbabweans to migrate to neighbouring countries and abroad. A large number of Zimbabwean migrants live in poverty in the border region. The high demand for shelter forces some people to create and occupy very basic dwellings and cook food in tin cans over fires. Many live in cardboard and plastic shelters, some in the back yards of overcrowded homes where they have to pay rent. Others sleep under trees next to roads or on open fields on farms, at railway stations or on the street.