Traditional healers are the first to be called for help when illness strikes the majority of South Africans. Their communities have faith in their ability to cure or alleviate conditions managed by doctors, and much more.
Mini-slings - concern regarding marketing of these devices in South Africa
Management guidelines for common kidney disorders relevant to South Africa
Health professionals should be speaking out about the victimisation of doctors in Bahrain
Side-effect of acetazolamide in prevention of acute mountain sickness
The lack of diligent administrative checks (either due to collusion with the applicant or alarming dysfunction) during internal pre-registration procedures misled the Post-Graduate Education and Training Committee (PGETC) for Medicine into registering a bogus neurosurgeon.
The South African medical aid systemhas evolved in such a way (fragmented risk pools, legally beholden to prescribed minimum benefits (PMBs), a free-for all on provider tariffs), that there's little wonder it's adversarial and riven with antagonism, exploitation and mistrust.
These were some opinions expressed by funders and administrators in response to a KPMG medical scheme anti-fraud survey last month which found that code manipulation by service providers had increased by 51%.
One local doctor, by grasping random overlapping educational opportunities, has become the catalyst for 'Doctors without Border' (MSF) wanting to adopt the South African Triage Scale (SATS) as its standard emergency protocol for resource-poor countries world-wide.
MSF volunteer and Stellenbosch University-trained Dr Mohammed Dalwai tested out the highly flexible and simple-to-use SATS in an emergency room at Timugara Hospital in Pakistan's volatile Khyber Pakhtunkhwa province - emerging with a 96% correct triage rate.
The thoughtful editorial by Professor Ncayiyana concerning the national circumcision programme in South Africa rests on two central arguments: first, that the scientific evidence is insufficient to justify such 'serious energy, money and resources', particularly when circumcision programmes have the potential of diverting money from other more effective interventions; and second, that risk compensation (the potential increase in risky behaviour after circumcision) may nullify any benefits of circumcision.
The editorial on voluntary medical male circumcision (VMMC) has many scientific inaccuracies and ignores the latest literature. Previous 'scientific' challenges on the VMMC evidence have had rebuttals co-signed by many local prevention scientists. Ncayiyana does not acknowledge that despite the long presence of the prevention 'abstain, be faithful and condomise' (ABCs), the impact on HIV prevention progress has been slow, resulting in hundreds of thousands of mostly young South Africans dying. Substantially lowering incidence will only be achieved with the introduction and scale-up of new technologies.
I thank the above authors, all acknowledged HIV / AIDS experts, for their robust responses. South Africa and the SA HIV / AIDS research community have indeed been at the forefront of the global effort to better understand and to contain the HIV / AIDS epidemic, and there is no gainsaying the motive of the VMMA proponents to control and ultimately to eradicate the disease. That said, the envisaged mass roll-out of a surgically invasive prophylactic intervention is without historical parallel, and it is only appropriate that the VMMC project is deliberated within the medical profession beyond the immediate circles of the panels and committees driving the initiative.
A key issue facing countries that are scaling up circumcision services is the technical difficulty, resources used, complications, and time to healing using open surgical techniques, the only methods approved by the major external funding agency, PEPFAR. The WHO has developed a framework for evaluating new circumcision devices, and two promising disposable plastic devices that have been partially evaluated are the Shang Ring and the Prepex system. However, given South Africa's disastrous experience with the Tara KLamp, healthy scepticism about plastic ring devices is justified.
The Gomco clamp has been used in children and adults since 1935 in the USA, but there are no published studies demonstrating its use in adults. Cyanoacrylate tissue adhesive, widely used in all areas of medicine, has been shown to be superior to sutures in circumcision in terms of safety, ease of use, operative time, and cosmetic results. Our experience in Mozambique suggests that Gomco clamp circumcision plus tissue adhesive closure meets all the WHO criteria for the ideal circumcision technique, and we strongly recommend that African researchers conduct clinical trials to compare it with open surgical circumcision.
Traditional health practitioners (THPs) play a significant role in South African healthcare. However, the Basic Conditions of Employment Act (BCEA) does not consider sick notes issued by THPs to be valid. This creates a dilemma for employees, whose right to consult a practitioner of their choice is protected by the Constitution. We assessed the current legislation and highlight the challenges that employees face in selecting a healthcare system of their choice. The services of THPs represent an untapped capacity that can complement and strengthen healthcare services, especially in the workforce. The BCEA legislative technicality, coupled with the delayed establishment of the Interim THP Council, does not relieve the employer's burden of 'illegitimate' medical certificates issued by THPs. While seen as a dilemma for some employers, others have accommodated African cultural beliefs and accept THP-issued sick notes. Finalising the Interim THP Council will allow THP registration and oblige employers to honour sick notes issued by THPs. The empowerment of THPs to play a meaningful role in healthcare delivery is of national importance.
Clinical and technical information imparted in most African languages involves inexact terminology and code switching, so it lacks the explanatory power characterised by the English language. African languages are absent in the tertiary science education environment and forums where African scientists could present scientific material in the medium of African languages. This limits the development of African languages in the scientific domain. There has recently been a trend in several African languages to develop and intellectualise them, especially in the field of medical sciences. The ChiShona language is used to explore the ability of an African language to develop new terminology, to name the vertebral skeleton and describe it scientifically. It uses word compounding to demonstrate terminology development. ChiShona has similarities with several hundred other Bantu languages in East, Central and Southern Africa. Advancing this language can promote similar developments in others, making them more explanatory for the lay public and health professionals.
The eminent Dutch palaeopathologist, P A Jannsens, in his 1970 book on the disease and injuries of prehistoric humans, described burr holes in the skulls of early humans (a process now known as trephination). Presumably, this was to treat conditions such as headaches, epilepsy, mental illness, migraine, and head wounds and injuries. The latter would have included relief of subdural and extradural haemorrhage; if so, it required considerable diagnostic and clinical skill.
Lack of information appropriate for the epidemiological profile of a specific area is no less important. The need for population-specific evidence cannot be over-emphasised, as disease patterns and trends vary throughout the globe and treatment that is effective in one environment might not be in another. Data on local patterns of diseases urgently need to be collected and communicated to healthcare personnel, to aid in their delivery of care.
We aimed to evaluate the potential impact of a cataract surgery programme at the Good Shepherd Hospital, Siteki, Swaziland, on the care of orphans and vulnerable children in Swaziland. We studied consecutive patients aged 50 years and older undergoing surgery for age-related cataract who reported having children living in their household. Of 131 subjects recruited, 65 (49.6%) were the primary caregivers for the child(ren) in their household. Visual acuities measured 2 weeks after surgery significantly improved. Four weeks after surgery, there was a sizable increase in the proportions of subjects who were able to undertake self-care activities, attend to activities of daily living, undertake income-generating activities and care for children. Cataract surgery on elderly visually impaired patients has the potential to impact positively on the care of orphans and vulnerable children.
Context. Information on childhood poisoning in the developing world, including South Africa, is scarce, despite its contribution to morbidity and mortality.
Objective. We describe the profile of children with exposures and poisonings presenting to Red Cross War Memorial Children's Hospital (RCWMCH) in Cape Town, South Africa, from 2003 to 2008 and compare the trends of causative agents over the past two decades. Methods. Cases were identified by review of the RCWMCH case records.
Results. Of the total incidents (N=2 872), paraffin (kerosene) was the commonest agent (n=692, 24%) with 124 poisonings including two deaths. Drugs were the most common toxin group (n=988, 34%), including 139 single-drug poisonings with 5 deaths; 4 associated with traditional medicine use. Household cleaning product incidents (n=302, 10%) resulted in 29 single-product poisonings with no deaths. Pesticide incidents (n=311, 10%) included 6 deaths; 203 (65%) incidents were due to organophosphates or carbamates. The suburban distribution of the main toxin groups varied. Comparing 1987 and 2008, the number of incidents decreased from 1 116 to 447; drug and paraffin incidents decreased respectively (from 673 to 150 and from 332 to 87), household cleaning products and cosmetics increased (21 to 69) and pesticide incidents increased (7 to 69).
Conclusion. Despite a decrease in the overall number of incidents over two decades at RCWMCH, paraffin and drugs remain the principal agents responsible for paediatric exposures and poisonings, with increasing incidents due to household cleaning products and pesticides. Identification of these toxin groups coming from specific suburbs allows for targeted prevention initiatives.
Benefits derived from the Council for Health Services Accreditation South Africa (COHSASA) accreditation of the Universitas Academic Hospital (UAH) in Bloemfontein are illustrated. Accreditation assessments were performed between 2001 and 2007, and full compliance with the COHSASA standards for Academic Hospitals was achieved. An initiative to develop thoracic surgery in central South Africa (SA) was launched by the Department of Cardiothoracic Surgery at UAH. The synergistic effects of quality improvements in healthcare provision owing to the accreditation process, and the project to increase service provision in thoracic surgery in central SA, have led to a qualitative and quantitative increase in thoracic surgical service provision. The importance of academic hospital accreditation in strengthening postgraduate training programmes is shown, and the accreditation process is recommended for all South African academic teaching hospitals to support, improve and sustain our training platforms.