As I write this, our universities are in crisis - a crisis that has been coming since last year when the first protests about fees started. These prompted a zero fee increase for 2016, which has crippled most of our institutions of higher learning, already struggling with falling government funding. Between 1994 and 2014, the number of students in public universities more than doubled. During the same period the proportion of black students at universities increased from 52% to 81% of the student population. However, as an open letter from 1 200 university academics to president Jacob Zuma and higher education minister Blade Nzimande in August this year (2016) says, this increase in student numbers has not been matched by adequate funding. In fact, every year has seen a decrease in real terms of government funding to public universities. The letter goes on to say that 'our public universities can in fact barely be called public, with national government subsidies to university budgets falling from an already low 49% in 2000 to 40% in 2012'. At the same time, employment of full-time staff has not matched increases in student numbers, potentially decreasing the quality of teaching and adding to the administrative burden on full-time academic staff. The situation in our medical schools is arguably even worse, with frozen posts in the public hospitals that provide much of our medical teaching.
To the Editor: In 2013, Rogers et al. highlighted the desperate need for a skin bank in this country. Earlier this year, Allorto et al., in a letter to this journal, reported the establishment of South Africa (SA)'s first skin bank, and advocated for increased donation, as well medical and lay education to increase tissue donation to meet the enormous need.
To the Editor: We read the article about Kounis syndrome published in an earlier issue of your journal with great interest. This letter is intended both to correct a mistake in the article and to emphasise its importance by sharing our own clinical experiences.
To the Editor: Requests for medical practitioners to perform age estimations in children and juveniles without formal documentation in South Africa (SA) are usually made by the courts or social workers in line with the provisions of the Child Justice Act. The involved individuals may be undocumented SA children - possibly abandoned or in conflict with the law, or, more commonly, unaccompanied or separated foreign minors with no proof of their chronological age.
To the Editor: The first reported case of Wohlfahrtiimonas chitiniclastica infection in South Africa presented as a soft-tissue infection and the organism was cultured from pus. We describe, to our knowledge, the first case in South Africa of W. chitiniclastica bacteraemia.
In addition to the cost in grief and trauma to families and the shattered confidence of under-resourced, under-supervised and over-worked doctors, South Africa (SA)'s nine provincial health departments face a ZAR24 billion patient litigation bill (2010 - 2014, with ZAR500 million paid).
Stellenbosch University (SU) research findings published online in Nature Medicine in September show that that 86% of HIV-negative 'cured' tuberculosis (TB) patients examined still had actively inflamed lung lesions, while a third of them had new or exacerbated lesions.
After 16 years of discovery, excitement, and getting to know some of the best scientific and medical hearts and minds in this country (in many cases, the world), I am leaving Izindaba to take up a freelance career in the healthcare field.
Sexual violence in South Africa (SA) has reached epidemic proportions. Clinicians need to be fortified with knowledge and skills to meet the challenge of caring for those who have suffered or are at risk of gender-based violence (GBV). This issue of CME focuses on sexual violence as the second of three special editions on violence against women and children in SA. Sexual violence involves a continuum that is far broader than sexual assault, mirroring the complex phenomenon of sexuality itself. Our recent human rights review identified entrenched stigma against persons based on their sexual or gender orientation, gender identity or bodily diversity, highlighting such persons' ongoing experience of harassment, discrimination and sexual and physical violence. In addition, irregular migrants, trafficked and refugee women, orphans and other vulnerable girls such as those living with disabilities, face increased risk of GBV. Health professionals need to remain mindful of the inherent dignity of each patient, particularly those marginalised and neglected by mainstream society.
Intimate partner violence is a major public health and human rights issue in South Africa. This violence tends to run in families and generations, with little change over time and devastating consequences at individual, family and community levels. Understanding the mechanisms for intergenerational transmission of violence may offer important clues for prevention and intervention to halt this recurrence. Health professionals are well placed to identify patients at risk and intervene in families characterised by interpersonal violence.
The adequate management of survivors of sexual offences is vital to ensure that both the healthcare and medicolegal needs of survivors are met. This article provides step-wise guidelines on current approaches to the management of adult survivors of sexual offences, which include the collection of evidence, medical management and treatment.
Violence against children represents a sobering reality for South African health professionals. Dealing with violence against children can easily take a heavy toll on health professionals' health, often resulting in compassion fatigue, or secondary traumatic stress, which is characterised by a blunted response to patients' suffering, in turn causing them secondary traumatisation. This article prepares health professionals in choosing the most appropriate and comfortable management for these unfortunate young victims of violence.
Background. The researchers identified infection with HIV as the strongest risk factor in the reactivation of latent tuberculosis (TB) infection or progression to active disease. Isoniazid preventive therapy (IPT) is one of the interventions recommended by the World Health Organization and the South African (SA) National Department of Health to prevent progression to active TB disease in people living with HIV. Adherence to IPT is therefore the responsibility of healthcare clients and clinicians.
Objectives. To describe the incidence of TB among clients who received IPT, rates of completing and not completing IPT among those who started it, and the reasons for non-completion.
Methods. A quantitative, non-experimental, descriptive retrospective cohort study was undertaken. The clinic records of 104 HIV-positive adults receiving care at a clinic in SA who started IPT between 1 July 2010 and 30 November 2011 were analysed.
Results. Sixty-six of 104 study respondents (63.5%) completed the IPT course. None of the respondents who completed IPT was diagnosed with TB, and 86.8% of the respondents who did not complete the programme did so because of the poor quality of healthcare they received, and not by their own choice.
Conclusion. The study results strengthened the findings of similar local and international studies that IPT is advantageous in the prevention of TB. The finding that so many patients did not complete the programme as a result of drug dispensing or prescription problems is alarming, and revealed a major shortcoming in the healthcare system.
Behavioural risk factors such as tobacco smoking contribute significantly to the global and local disease burden. This article surveys three behavioural science interventions that could reduce rates of tobacco smoking in South Africa.
Three patients under treatment for grand mal epilepsy, and who were also suffering from chronic migraine, underwent vascular surgery for their migraine. A serendipitous benefit from the successful vascular surgery for migraine was a significant reduction in the frequency of their grand mal seizures.
Polyarteritis nodosa (PAN) of the urinary tract is rare. An unusual case of systemic PAN involving the bladder neck is described. A 27-year-old man, with known diastolic hypertension diagnosed 2 years earlier, was admitted with chronic urinary obstruction complicated by hydronephrosis. He had symptoms of myalgia and weight loss, was afebrile but had an elevated erythrocyte sedimentation rate and acute-on-chronic renal impairment. All virological and serological tests including hepatitis B and anti-neutrophil cytoplasmic antibody were negative. A computed tomography scan of the brain revealed small-vessel disease. A bladder neck mass was visualised on cystoscopy. Histological examination of this demonstrated a medium-sized necrotising vasculitis with small-vessel fibrinoid necrosis suggestive of PAN. At least six of the American College of Rheumatology criteria for PAN were met. The patient was treated with pulses of intravenous cyclophosphamide and oral corticosteroids with a good clinical response.
Background. Penile strangulation is a rarely described medical emergency. Removal of the strangulating object is challenging, with a lack of proper guidelines.
Objective. To describe the challenges faced during an attempt to urgently remove a metal object (wedding ring) constricting an erect penis.
Method. We report a case of penile strangulation with a wedding ring in an adult man who presented at Van Velden Hospital casualty department, Limpopo, South Africa, and review the related literature.
Result. The ring was successfully removed using an aspiration technique (via a pink needle).
Conclusion. No proper guidelines exist for the treatment of this condition, so the 'best method' is the one with a successful outcome.
A 20-year-old man presented with a 6-month history of intermittent chest pain. Initial imaging demonstrated approximately 15 sewing needles lodged in his myocardium, predominantly in the left ventricle. The patient has been referred to cardiothoracic surgery for further management. His progress will be monitored closely.
Background. The launch of the National Health Insurance (NHI) White Paper in December 2015 heralded a new stage in South Africa's advancement towards universal health coverage. The 'contracting in' of private sector general practitioners (GPs), though only one component of the overall reformed system, is nevertheless crucial to address staff shortages and capacity, and also to realise the broader vision of a single unified, integrated system.
Objective. To report on the views and experiences of GP providers tasked with implementing the reforms at one pilot site, Tshwane District in Gauteng Province, providing an insight into the practical challenges the NHI scheme faces in implementation.
Methods. The study was qualitative in nature, using a combination of convenience and purposeful sampling to recruit participants. A thematic analysis of the data was conducted using Nvivo 10 software.
Results. The overall experiences of the GPs exposed a number of problems with the pilot. These included frustration with lack of appropriate infrastructure and equipment in NHI facilities, difficulties integrating into the facilities and lack of professional autonomy, as well as unhappiness with contracting arrangements. Despite strong support for the idea of NHI, there was general scepticism that private doctors would embrace the scheme on the scale required.
Conclusion. The study suggests that the current pilots are still a long way from the vision of a single, integrated health system. While it may be argued that the pilots are not themselves the completed NHI, the findings suggest that it will take much longer to establish than the timeline envisaged by government.