Apprenticeship has long been established in the medical profession. This was graphically brought home to me when reviewing Mike du Preez's expanded document on the early years of Dr James Barry (personal communication). Dr Barry (1789 - 1865) was an army doctor who was posted to the Cape of Good Hope, among other appointments elsewhere in the world. The drama of 56 years of hidden identity was revealed when Dr Barry died and was found to be a woman. After graduating from the Edinburgh medical school with an MD, Barry enlisted as Surgeon's Pupil at the United Hospitals of Guy's and St Thomas's. At that time it was possible for non-graduates to apprentice themselves to a surgeon for a period of 7 years in order to qualify to practise, but physicians required a medical qualification. This was why such surgeons were called 'Mr' and not 'Dr'. Today surgeons often still use the title Mr as a mild form of inverted snobbery.
Nearly half a million South Africans look online for solutions to mental health problems every month. The Mental Health Information Centre (MHIC) of Southern Africa aims to provide the most complete and up-to-date online directory of mental health service providers in sub-Saharan Africa. This online service allows anyone to search for a mental health service provider in their area.
Sudden cardiac arrest (SCA) in athletes has once again been brought into the spotlight as a result of the recent widely publicised collapse and resuscitation of Fabrice Muambo during a FA Cup soccer match in the United Kingdom. The efforts of the trained medical responders in his successful resuscitation must be applauded. This incident resulted in the South African Premier Soccer League announcing more rigorous screening of players as a primary prevention measure. Sadly, Muambo's case was followed by the sudden cardiac death of Olympic swimmer Alexander Dale Oen.
While visiting our kids and grandson last year, I had a recurring thought: being a grandparent is not for 'sissies'. My wife and I thought about how grandparenting challenged our health; each day saw some insult to body homeostasis and we were grateful each night for another day survived. Don't get me wrong, we wouldn't trade days with our little man for all the gold in China or the USA, but I came to think that grandparents are special people, not for giving love or gifts, but for putting our bodies on the line. Occupational illness is a given - the Compensation Commissioner needs to take note.
We appreciate Drs Stefan and Stones highlighting the value of cancer registries. Establishing a comprehensive population-based cancer registry in South Africa is most important and long overdue. This does not preclude specialised registries, provided that all cancers are reported to the main, statutory registry. Best practice is inclusive reporting of all cancers to a single registry for all age groups, which enables national trends to be described for the entire South African population, including rural areas.
A young former Chris Hani/Baragwanath Hospital intern, troubled by a high patient load of pregnant teenagers, many with complications, has begun conducting 'shock therapy' school workshops across Johannesburg, aimed at reducing long-term emotional and physical harm.
South Africa's overcrowded prisons are massive TB breeding grounds but there is 'little political will' to prioritise interventions which a joint university study in the Western Cape shows could reduce transmission by up to 94%.
The first person to identify and highlight the alarming prevalence of fetal alcohol spectrum disorder (FASD) in South Africa and respond with groundbreaking prevention, awareness, and training programmes, Professor Denis Viljoen, has received an international award.
Healthcare workers in KwaZulu-Natal have up to three times greater chance of developing drug-resistant (DR) TB than the general population and face double the average risk of their professional colleagues elsewhere in the country - whether they work exclusively with TB patients or not.
It is with great sadness that we record the passing of Dr John Eidelman (14/12/1936 - 5/11/2011), general practitioner, Magaliesberg. How does one encapsulate the life of a dedicated doctor and family man whose presence, personality and multi-talented skills touched so many?
The book is an edited collection written by experienced scholars as well as practitioners which makes it especially useful in providing an evidence-based approach to understanding substance use and abuse. The fields of expertise range from psychiatry, clinical and neuro-psychology, and human genetics to economics and mathematics. As such, it represents an active cohort of researchers and practitioners working in the area of substance use and abuse in South Africa.
The internationally accepted practice of prescribing prophylactic antibiotics to individuals at risk of infective endocarditis has come under scrutiny. There are no published high-quality randomised controlled trials of the intervention, but new insights have emerged. Bacteraemic episodes are common following simple activities such as brushing teeth. Endocarditis following procedures is extremely rare, and systematic reviews of the evidence for prophylactic antibiotics have failed to demonstrate efficacy.
Owing to a chronic shortage of medical staff in South Africa, sleep-deprived medical interns and community service doctors work up to 200 hours of overtime per month under the state's commuted overtime policy. Nurses moonlight in circumvention of the Basic Conditions of Employment Act. For trainee doctors, overtime over 80 hours is unpaid, and rendered involuntarily under threat of not qualifying to practise medicine in South Africa. As forced labour, and sleep deprivation amounting to cruel and degrading treatment, it is outlawed in international law. No other professional group in the country is subjected to such levels of exploitation and discrimination by the state. These abuses should be challenged under the Constitution. Solutions include the installation of electronic time-recording in state hospitals, cessation of unpaid overtime, limits on medical intern shifts to a maximum of 16 hours, and an investigation by the Human Rights Commission of South Africa.
Reports about The Horn of Africa Famine Crisis in 2011 flooded our news bulletins and newspapers. Yet the nations of the world failed to respond and alleviate the unfolding disaster. In August 2011, the Gift of the Givers Foundation mobilised what was to become the largest humanitarian mission ever conducted by an African organisation. Almost a year later, the effort continues, changing the face of disaster medicine as we know it.
The presence of a familial disease among royal members of 18th dynasty of the new kingdom who ruled in Egypt from the mid-16th to the early 11th centuries BC has been established, largely prompted by the bizarre body shape of Akhenaten (the iconoclastic pharaoh of this dynasty) and his family, as demonstrated in statues and artwork. It had been thought previously that this was an expression of a revolutionised artistic style that followed radical reforms by Akhenaten of Egyptian society, but recent studies on mummies confirmed the presence of a constellation of corresponding pathologies. Several illnesses have been suggested to solve this enigma; we propose Loeys-Dietz syndrome as a probable diagnosis for this genetic affliction within the royal family.
We describe the diagnosis of a 77-year-old woman admitted to our outpatient department with a 3-month history of abdominal bloating and distension. Abdominal computed tomography revealed a large cystic lesion in the posterior segment of the right hepatic lobe, with a separated germinal layer and widespread ascites with dense internal echoes and septal appearance. The result of a serum Echinococcus indirect haemagglutination test was positive and findings were indicative of the spontaneous rupture of a hydatid cyst into the peritoneal cavity without trauma. Ascites is rarely seen in the course of hydatid disease, but can result from cyst rupture into the peritoneal cavity. This should be considered in the differential diagnosis of ascites, especially in areas such as Turkey, where hydatid disease in endemic.
In considering the likelihood of South Africa (SA) attaining the 2015 Millennium Development Goals, many health issues require urgent attention. The adverse effect of insufficient or excessive exposure to solar ultraviolet radiation (UVR) may exacerbate an already stressed public health service. These concerns become important when considering climate variability and patterns of behaviour.
There is growing concern about the increased demand for and limited access to substance abuse treatment in South Africa. The government has responded by allocating more money to the delivery of substance abuse treatment, expanding the number of state-funded treatment slots, and training additional health and social workers to deliver these services, particularly in provinces where the prevalence of substance-related problems is high, such as the Western Cape. While these efforts should be commended and continued, steps to improve service availability have occurred without adequate consideration of the quality of services provided. This is not surprising, as there is little or no routine monitoring and evaluation of substance abuse services in the country. It is also disquieting, as access to treatment is necessary but not sufficient for positive treatment outcomes.