'More ability, less disability' - these sentiments were uttered by a veteran wheelchair tennis player during the Paralympic Games, which aim to emphasise participants' athletic prowess, not their disability.
Modern management of hepatobiliary disease in children
Dogs are not always man's best friend ...
Nevirapine for PMTCT in immunocompetent pregnant women - a warning
Cape Town TB cure rates
SA's deepening skills shortage ahead of NHI
We do a fine job, but ...
The recent article about the new paediatric sub-specialty to improve child health in South Africa quotes grim child health statistics to illustrate the need to look for new strategies to improve child health. Can the re-engineering of primary healthcare (PHC) and/or the introduction of community paediatricians be the solution?
Feasible universal health coverage in South Africa seemed ever more remote last month as a dysfunctional Department of Public Works continued to stymie vital public hospital revitalisation projects, and five provinces proved grossly incapable of spending their health budgets.
Until the Health Professions Council of South Africa (HPCSA) comes up with acceptable tariff guidelines or the courts definitively rule on the validity of regulations governing prescribed minimum benefits (PMBs), internecine warfare in the healthcare industry is set to continue.
Most doctors can recall a career-defining moment of choice when events combined to offer divergent paths. For Kelly Gate, this year's Rural Doctor of the Year, it was, he declares dryly, 'either fame and fortune, or peace and tranquillity'.
One of the Cape Metropole's busiest district hospitals and a long-standing trauma and emergency care hub for the gang-ridden Cape Flats, G F Jooste, is to be decommissioned and reconstructed over three years from next April, posing complex healthcare capacity problems.
Steph Potgieter was born on 22 September 1928. He received his MB ChB in 1951 at the University of Pretoria. He did his internship in Bloemfontein and was in geneneral practice there from 1952 to 1956. He trained in anaesthesiology at Karl Bremer Hospital and received the MMed Anaesthesiology from Stellenbosch University in 1959. He then visited several departments of anaesthesiology in Europe, including those in Stockholm (Karolinska Institute), Amsterdam, London, and Oxford, and attended a Royal College of Surgeons anaesthesia course in London. He was in private practice as an anaesthesiologist in Bloemfontein from 1960 to 1985, and thereafter to 1994 was a consultant in the Department of Anaesthesiology, University of the Free State.
Eugen Ulrich Schmid was born on 30 July 1927, the youngest of five children of a devoted Lutheran family. After a happy childhood in South-West Africa (Namibia), he qualified as a medical doctor in Pretoria in 1952. After an extended period in private practice in Namibia, he returned to Pretoria where he obtained his Master's degree in surgery before he entered the missionary field.
There is a creative artist within every person and everyone has something unique to explore. Few realise and actualise it; many have no time or interest, or are overcome with the apprehension of self-revelation.
Jacques Grobbelaar was a Medical Officer at Nelspruit Hospital when he died tragically in a road accident on 22 August - 20 years ago - in 1992. On 28 June 2012 he would have been 45 years old. I write this obituary on behalf of those who lived and worked closely with Jacques.
In November 2011, a draft National Development Plan (NDP) was released that addresses two of South Africa's major challenges: poverty and inequity. Health and economic development are interdependent, presenting an important opportunity through the NDP to integrate health within goals of broader socioeconomic development. Reviewing the NDP identified gaps based on evidence and the epidemiological risk profile of South Africa. Recommendations to improve the NDP and to deal with poverty and inequity should focus on prevention and addressing the social determinants of health, including: (i) a multisectoral approach to establish a comprehensive early childhood development programme; (ii) fiscal and legislative policies to bolster efforts to reduce the burden of non-communicable diseases; (iii) promoting and maintaining a healthy workforce; and (iv) promoting a culture of evidence-based priority setting. Achieving the goal of 'a long and healthy life for all South Africans' will require healthy public policies, well-functioning institutional and physical infrastructure, social solidarity, and an active and conscientious civil society.
A stable human resource base in the health sector is critical to achieving health-related Millennium Development Goals. There is a severe quantitative and qualitative shortfall of healthcare professionals in South Africa, and the existing and future health workforce production is inadequate for our healthcare needs. The production model must include all healthcare disciplines because the quadruple burden of disease necessitates multi-professional healthcare teams working synergistically to improve health outcomes and life expectancy.
South Africa has developed an innovative mid-level medical worker model that can contribute substantively to the development of quality district-level health care. These clinical associates entered the South African job market in 2011 and have reportedly been received favourably. The first cohorts performed well on local and national examinations, with pass rates >95%. They have demonstrated confidence and competence in the common procedures and conditions encountered in district hospitals; reportedly fitted in well at most of the sites where they commenced working; and made a significant contribution to the health team, resulting in a demand for more clinical associates. Universities and provinces involved in producing clinical associates are enthusiastic and committed. However, priorities are to establish sustainable funding sources for training and deployment, provide adequate supervision and support, monitor the initial impact of the new cadre on health services, and manage the sensitivities of the medical and nursing professions around scopes of practice and post levels. Longer-term concerns are national leadership and support, scaling up of training, the development of career pathways, and the improvement of working conditions at district hospitals.
The recent development of emergency medicine in South Africa (SA) provides a shining example of how much can be achieved by so few when passion and vision are combined with a commitment to improving patient care. Maturation of the specialty in countries such as Australia has embedded the role of emergency physicians in clinical niches where it would seem unnatural, inappropriate and even unsafe to place doctors with alternative training. As British and Australian emergency physicians who recently enjoyed the privilege of a study tour around SA, we were impressed and bewildered by aspects of SA's emergency care. We observed care in 6 hospitals and 2 pre-hospital systems in 3 major cities and a rural town. We offer our perspectives, not as experts or superiors, but as outsiders free from political allegiance or local institutional affiliation.
Objectives. To use a quality improvement approach to improve access to and quality of tuberculosis (TB) diagnosis and care in Cape Town.
Methods. Five HIV/AIDS/sexually transmitted infections/TB (HAST) evaluations were conducted from 2008 to 2010, with interviews with 99 facility managers and a folder review of over 850 client records per evaluation cycle. The data were used in a local quality improvement process: sub-district workshops identified key weaknesses and facility managers drew up action plans. Lessons learnt and successful strategies were shared at quarterly district-wide HIV/TB meetings.
Results. Geographical access was good, but there were delays in treatment commencement times. Access for high-risk clients improved significantly with intensified TB case finding made routine in both the HIV counselling and testing and antiretroviral treatment (ART) services (p<0.01 for both). Access for children in contact with an infectious case has improved but is still low (42% investigated and treated). Quality of care was mostly high at baseline (adherence to treatment protocols 95%). Measurement of body mass index improved from 20% to 62%. The assessment of contraception improved from 27% to 58%. Care for co-infected clients showed improved use of customised HIV stationery and increased assessment for ART eligibility.
Conclusions. The HAST audit contributed to the improved TB cure rates by supplementing routine information and involving sub-district managers, facility managers and facility staff in a quality improvement process that identified local opportunities for programme strengthening.
Objective. The coloured population has the second-highest prevalence of diabetes in South Africa. However, the data were based on a study conducted almost 20 years ago in a peri-urban coloured population of the Western Cape. We aimed to determine the prevalence of diabetes mellitus and metabolic syndrome in an urban coloured population in South Africa.
Design. In a cross-sectional survey, 642 participants aged ≥31 years were drawn from an urban community of Bellville South, Cape Town, from mid-January 2008 to March 2009. Type 2 diabetes was assessed according to the WHO criteria, and metabolic syndrome was based on the International Diabetes Federation (IDF), ATP III and 2009 Joint Interim Statement (JIS) definition.
Results. The crude prevalence of 28.2% (age-adjusted 26.3%, 95% confidence interval (CI) 22.0 - 30.3) for type 2 diabetes was: 4.4% (age-adjusted 3.2%, 95% CI 1.6 - 4.9) for impaired fasting glycaemia, and 15.3% (age-adjusted 15.0%, 95% CI 11.4 - 18.6) for impaired glucose tolerance. Undiagnosed type 2 diabetes was present in 18.1% (age-adjusted 16.8%, 95% CI 13.3 - 20.4). The crude prevalence of metabolic syndrome was higher with the JIS definition (62.0%) than the IDF (60.6%), and the National Cholesterol Education Program (NCEP) ATP III (55.4%). There was good overall agreement between the MetS criteria, k=0.89 (95% CI 0.85 - 0.92).
Conclusion. The prevalence of diabetes has increased hugely in the coloured community, and the high prevalence of undiagnosed diabetes portends that cardiovascular diseases might grow to epidemic proportions in the near future in South Africa.
Introduction. Dog bites are a significant cause of morbidity and mortality worldwide, particularly where rabies is endemic. There is also a significant financial burden attached to prophylactic treatment to diminish the risk of rabies infection. KwaZulu-Natal (KZN) has a high incidence of human rabies yet little is known about the demographics of dog bites in the province.
Objectives. To analyse the demographics of dog bites in Northern KZN.
Methods. Records of all dog bites presenting to the main referral hospital in northern KZN between August 2007 and September 2011 were analysed.
Results. We collected data for 821 instances of dog bite. Male children aged 6 - 10 years are most likely to present with dog bites, while women >40 years are more likely to present than men in the same age bracket. While initial vaccine administration is high (98%) with all grades of bite, only 82% of grade 3 bites receive immunoglobulin.
Conclusion. Our results correlate well with two large studies of the demographics of dog bites, but are the first to show a reverse in male preponderance of presentations above the age of 40 years. Reasons for low rates of immunoglobulin administration in grade 3 bites are discussed. Finally, methods are suggested to improve data collection and the care of patients presenting with dog bites.