With many medical schools boldly piloting on-site clinical training in vastly underserved rural areas, the top generalist educators among South Africa's eight medical campuses last month agreed to urgently petition government for expanded rural teaching platforms.
In 2005 during Minister Kader Asmal's sweeping reconfiguration of the higher education system, the Medical University of Southern Africa (Medunsa) was merged with the University of the North, located some 300 plus km away, to form the University of Limpopo (UL). At the time, there was talk - patently nonsensical - of relocating Medunsa lock, stock and barrel to Polokwane. The merger raised many eyebrows, and was widely seen as irrational and ill-conceived. Indeed, the arranged marriage proved to be extremely difficult with too many irreconcilable differences.
To the Editor: How can a researcher protect the rights of adolescents who want to take part in school-based sexual health research, ensuring that informed consent to participate is properly obtained, without hindering the potentially beneficial research itself?
To the Editor: The title of the recent editorial applies too to a related theme: gender imbalance. The distinction between male and female is a key dimension of population dynamics. In some southern and eastern Asian countries, the sex ratio has become skewed towards men, partly in consequence of gender-selective abortions; in the People's Republic of China, for example, the newborn male/female ratio is about 119:100.
Tygerberg Hospital's Burns Unit chief, Dr Elbie van der Merwe, one of the country's most holistic and innovative burns specialists, has received international recognition for her ground-breaking local work in burns prevention, treatment and rehabilitation.
With a few brief and notable exceptions, his predecessors were either pedestrian or downright obstructive in delivering an overall life-saving, disease-preventing service to the nation - delighting those who spun millions in the vacuum of ineptitude.
'Medical professionalism is not optional. It is an essential part of being a doctor, no matter how many challenges face us.' (trainee doctor)
Against the background of current social criticism of the medical profession, well captured by Benatar in this journal in 1997, the medical profession has been intensely introspective over the past 5 years in seeking to respond to society's disquiet.
Cataract is the leading cause of blindness in South Africa, responsible for about 50% of the prevalence of blindness and identified as a national health priority. The cataract surgery rate (CSR) should be at least 2 000 per million population per year for elimination of cataract blindness. The national CSR target was planned to increase from 1 000 in 2005 to 2 000 in 2010, but since CSRs have failed to reach targets each year, the national target for 2010 was reduced from 2 000 to 1 500. We reviewed data from a situational analysis in 2007 of cataract surgery services to ascertain the obstacles to achieving CSR targets.
Breast cancer is one of the first recognisable cancers described in history, and we trace its recognition and treatment through antiquity. Galen saw cancer of the breast as the most common cancer of his time (and is still the most common cancer among South African women). Hippocrates in the 5th century BC possibly first described it. The Corpus Hippocraticum recorded a single case but mentioned no specific treatment. It was noticed that the cancer (karkinöma; carcinoma in Latin) could be preceded by an occult cancer (karkinos kruptos). Standard dogma through antiquity for close on a millennium was that all tumours resulted from an inflammatory process caused by an abnormal flux of tumours, in which an excess of black bile was crucial.
Phoebus Perdikis ('Fifi') died of a stroke on 3 June 2011. We lost a giant of the 'golden age' of surgery, when general surgery became established as a specialty in South Africa, and a colleague and dear friend to many.
The debate on the staffing of South Africa's health care system is old, and the issues have changed very little over the past 30 years. It may seem incredible that, with so much debate over such a protracted period, there's so little improvement in human resources for health in the country. What more can one add to the discussion than to lament our collective failure? Why is it that other developing countries with far lower per capita GDP have such radically better indicators of health?
Eighteen years after an opinion piece entitled 'Lessons from the 1992 measles epidemic in South Africa' was published in the SAMJ we now need to revisit the same message. This follows on the recent 2009/2011 outbreak, which has involved over 18 000 recognised cases and, presumably, several hundred deaths and many more children who will suffer permanent disabilities. This comes close to the 22 000 cases of the 1992 outbreak. The message remains the same. Why is this infectious disease, which is so easily prevented by a highly effective, safe and relatively inexpensive vaccine, still such a major cause of morbidity and mortality?
To the Editor: Increasing numbers of HIV/AIDS-infected individuals have presented to medical casualty at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) after attempting suicide by overdosing on their antiretroviral therapy. Since 2009, medical gastro-enterology at CMJAH has been the primary specialty unit for cases of accidental or intentional overdose. Psychiatry and other medical sub-specialties are consulted as needed. Our unit sees approximately 1 case a month of accidental/intentional overdose with antiretrovirals. Between January and September 2010, 6% of all overdoses seen at CMJAH were of antiretroviral origin. Supportive care is provided and patients undergo psychiatric evaluation.
Background. An aim of the Colleges of Medicine of South Africa (CMSA) project 'Strengthening Academic Medicine and Specialist Training' was to research the number and needs of specialists and subspecialists within South Africa.
Methods. Data were collected from several sources: Deans of the 8 Faculties of Health Sciences and the Presidents of the 27 constituent Colleges of the CMSA completed a survey; and the HPCSA's Register of Approved Registrar Posts for Faculties of Health Sciences was examined and the results tabulated.
Results. South Africa compares unfavourably with middle-income countries on the ratios of medical and dental professionals; many districts have limited access to specialists and subspecialists. The unacceptable ratio of doctors, dentists and other health professionals per capita needs to be remedied, given South Africa's impressive reputation for its output of health professionals, including the areas of medical training, clinical practice and clinical research. The existing output from South Africa's 8 medical schools of MB ChB and specialist graduates is not being absorbed into the public health system, and neither are other health professionals.
Conclusion. Dynamic leadership and policy interventions are required to advocate and finance the planned increase of medical, dental and other health professionals in South Africa.
Objectives. To define the patient population at Cape Town's district-level hospital offering specialist tuberculosis (TB) services, concerning the noted increase in complex, sick HIV-TB co-infected patients requiring increased levels of care.
Methods. A cross-sectional study of all hospitalised adult patients in Brooklyn Chest Hospital (a district-level hospital offering specialist TB services) from 27 to 30 October 2008. Outcome measures were: type of TB and drug sensitivity, HIV co-infection, comorbidity, Karnofsky performance score, and frequency and reason for referral to other health care facilities.
Results. More than two-thirds of patients in the acute wards were HIV-co-infected, of whom 98% had significant comorbidities and 60% had a Karnofsky performance score ≤30. Twenty-eight per cent of patients did not have a confirmed diagnosis of TB. In contrast, long-stay patients with multidrug-resistant (MDR), pre-extensively (pre-XDR) and extensively drug-resistant (XDR) TB had a lower prevalence of HIV co-infection, but manifested high rates of comorbidity. Overall, one-fifth of patients required up-referral to higher levels of care.
Conclusions. District-level hospitals such as Brooklyn Chest Hospital that offer specialist TB services share the increasing burden of complex, sick, largely HIV-co-infected TB patients with their secondary and tertiary level counterparts. To support these hospitals effectively, outreach, skills transfer through training, and improved radiology resources are required to optimise patient care.