Category: Hospitals

Categories : General Interest HospitalsTags :

Interview: Rural Doctor of the Year Reflects on the Rutted Road to Quality Healthcare 

On By ModernMedia
Dr Bukiwe Spondo recently received the Rural Doctor of the Year award at the Rural Health Conference held in Chintsa in the Eastern Cape. PHOTO: Supplied

By Biénne Huisman for Spotlight

Describing the rutted gravel road between Butterworth and Tafalofefe District Hospital in the Eastern Cape, Dr Bukiwe Spondo uses the word “terrible” at least eighteen times. Dipping through the Amatole District, the 55-kilometre journey can take several hours. With heavy rain, tractors may be required to dislodge ambulances and often even staff have difficulty getting to work because of the mud.

Since 2007, Spondo and her colleagues have offered a multitude of services at Tafalofefe in the lush but impoverished Centane village. First off, she moved the hospital’s ARV clinic from an out-building to inside the premises – reducing stigma – “because if patients went into that building on the outside, automatically everyone knew,” she says.

In 2012, having observed how patients stopped taking treatment due to travel costs, she started driving up to 40 kilometres a day twice weekly to nine clinics in the area, where up to fifty patients would be queuing to see her. To make life easier for patients, she started pre-packing medication to take to them at the clinics. Later she opened a CHAMP (Clinical HIV /AIDS Management Programme) site at Tafalofefe to see complicated cases referred from the clinics, and a multi-drug-resistant TB (MDR-TB) review clinic in conjunction with Butterworth Provincial Hospital.

“As a rural doctor, you become a social worker, a pharmacist, a priest – you do everything,” she says, laughing.

Rural doctor of the year

Spondo’s efforts have not gone unnoticed. Last month at the Rural Doctor’s Association of South Africa (RuDASA’s) annual Rural Health Conference, she received the Rural Doctor of the Year award. RuDASA chairperson Dr Lungile Hobe conferred the award at the event hosted near Chintsa. Spondo is quick to point out that she also won an Amatole District leadership award last year.

Speaking to Spotlight over Zoom, she says, “So the roads here at Centane are terrible. It becomes a challenge to get ambulances through and the chopper cannot fly either when it’s raining. I mean, the other day a truck was stuck, crossing the road so the ambulance couldn’t pass. We had to take a private car from the hospital to go meet the ambulance halfway.”

She adds that the community hoped that roads would be improved after a devastating accident five kilometres from Tafalofefe in 2020 when an overloaded 65-seater bus plunged into a gorge, causing 25 deaths and 62 injuries. But, she says, the improvements never come.

At Tafalofefe, the two nearest referral hospitals are Cecilia Makiwane and Frere Provincial in East London, situated an additional 110 kilometres or 90-minute drive from Butterworth along the N2 highway. Housed in a pale building, Tafalofefe has 160 beds served by 41 professional nurses and seven doctors – including three community service doctors who joined last year. The additions have increased capacity, for example, emergency caesareans are now available around the clock.

Taking healthcare to the people

The hospital has three 4×4 bakkies [pick-ups] for visiting or transporting patients. It is in one of these that Spondo travels to see patients in remote corners between the Kobonqaba and Kei Rivers on Tuesdays and Thursdays.

“Clinics are part of decentralised primary healthcare goals,” she says. “But the problem was that if there were complicated cases – like if a patient is taking ARVs and then develop side effects, the sisters are not equipped to handle that. For example, if there is a kidney problem, they [cannot] do anything about that.

“And in time, I realised that for these people traveling to the hospital costs too much money. Let’s say, for example, the clinic at Qolora – for a person to travel from Qolora to Tafalofefe is R100. A return ticket is R200. And you know, most people here are unemployed. They can’t afford this. By the time they have saved up enough money to travel to the hospital, it’s too late. Like it would be the end stage of their kidney problem. You could not send this patient for dialysis, nothing could be done to help them. This is why I started my outreach trips.”

In motivating for Spondo to receive the RuDASA award, Tafalofefe’s CEO Masizakhe Madlebe pointed out how her work days start at 7am, only finishing once all patients had been seen, whether at the hospital or at one of the local clinics. In addition, he notes how, over the years, Spondo has mentored youth in the area, including children whose parents had succumbed to AIDS, and school girls on topics like life goals and contraceptives. He adds that Spondo even reached into her own pocket to pay school fees for children without parents.

Spondo relays how she noticed girls as young as twelve years old in their maternity ward, giving birth. “Myself and some nurses we went to two schools in the area to educate them, to discuss goals and contraceptives,” she says. “We started with grade 12 pupils. No teachers were present. It was just us and them. And I was surprised at how free they were talking. I said to them education is more important. I said to them – You see me? I am a doctor. One day you can be a doctor too, but you need to be educated. I told them they could come to Tafalofefe any time if they needed to talk, that I could help them apply for tertiary degrees, to college or to university.”

Spondo has kept a close eye on children orphaned by AIDS in the area. “I tell them to bring me their June, September, and December school reports, so I can see how they’re doing, so I can motivate them,” she says.

“These kids, I’ve seen them grow up. Some of them I saw angry – with everyone, with their own deceased parents. And I explained to them, don’t be angry. It’s not your mother’s fault. It’s not your father’s fault. It was the government’s fault for not giving your parents access to ARVs. But now, take your own ARVs and you will be fine. Some of them have passed high school with distinction, some even now have access to universities.”

Bringing her skills back home

Alongside two brothers whom she describes as “wonderful”, Spondo grew up in the village of Nqamakwe, on the opposite side of Butterworth. Her parents have passed away, but she still considers Nqamakwe her home. Here her family’s farming interests include cattle, goats, and sheep.

She attended Blythswood Secondary School in Nqamakwe – excelling at biology and physics, even though maths was hard work. “Becoming a doctor was just something I always wanted,” she says, relaying how in her formative years she had been a sickly child who often required medical care. This changed, she says, as she cannot remember ever being sick as an adult.

Spondo graduated from medical school at the University of KwaZulu-Natal in 2002, completing her internship at Cecilia Makiwane and her community service at Tafalofefe and Frere in 2004.

Speaking with rapid enthusiasm, she says how happy she is to bring her healthcare skills back home to serve the community that shaped her own humanity.

“I mean, I know these people inside out. I was born in front of them, raised in front of them,” she says. “These are our relatives, our aunts, our grannies. It’s giving back to them, to the community that raised you, that has done everything for you. Who supported you through all these years.”

She adds that Tafalofefe’s clinical manager, Sambona Ntamo, grew up near Butterworth too.

“Who would look after these people if we didn’t?” she asks.

Where does she find the resilience that drives her passion to care for sick people, often queuing at the end of long rutted roads?

“Lots of exercise,” she says, smiling.

At Tafalofefe there is a staff gym with a treadmill, a bicycle, weight lifts, and pilates balls.

“I tell the guys after work it’s gym time, it’s gym time, it’s gym time!” she says. “We’ve got a key and everyone knows that even if they want to go to the gym after midnight, they may get the key and go.”

Photographs capture an air of camaraderie at Tafalofefe. Staff sharing a meal of tripe and creamed spinach on heritage day, a farewell gathering for a retiring nurse with balloons and huge gifts in silver wrapping, [and] women knitting countless bright beanies for babies delivered in the maternity ward. A picture inside the hospital’s paediatric room shows youngsters on plastic motorbikes and mothers holding toddlers wrapped in blankets.

Spondo and her own eight-year-old son, Lutho desperately – which means the greatest one – live in a doctor’s house on the hospital’s premises. They travel to their family home in Nqamakwe over weekends.

For Spondo, being a doctor does not feel like a job. “When you do something you love, it doesn’t feel like a job,” she says. “Being a doctor is something I look forward to every morning. When patients return to me, saying they feel better with a smile on their faces, saying thank you for the treatment – that just makes my day.”

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : HospitalsTags :

Department of Health in Last-minute Bid to Avoid Stand-off with Nurses over Uniforms

On By ModernMedia
Photo by Jeshoots Com on Unsplash

By Marecia Damons for GroundUp

The Department of Health is scrambling to avoid a stand-off with nurses who have threatened to work in their own clothes if a dispute over the provision of uniforms is not resolved.

Since 2005, nurses had received an annual allowance to buy their uniforms. But this ended on 31 March this year, after a new agreement was signed in the Public Health and Social Development Sectoral Bargaining Council in terms of which they would get uniforms instead.

As a result, nurses did not get the usual allowance in April – R2600 a year, according to Spokesperson for the Democratic Nursing Association of SA (DENOSA) Sibongiseni Delihlazo.

Instead, they were supposed to be provided with uniforms by 1 October 2023. The agreement stated that in the first year, government must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, government must provide three sets of uniforms, one belt, and one jacket.

The plan was that the procurement process would be centralised. But at another bargaining council meeting, in June 2023, the health department said it would be difficult to provide the uniforms on time.

Then on 12 July, Sandile Buthelezi, director-general for the DOH, issued a circular to all provincial health departments notifying them that the uniforms would be provided from January 2024 to January 2025.

The circular stated that the DOH would use a decentralised approach to providing uniforms by using provincial tenders.

“Provincial heads are responsible for participating and facilitating in tender processes through the bid specification in terms of colour, fabric composition and garment, development, review of the policy and monitoring and evaluation,” Buthelezi wrote.

Until January 2026, the circular said, nurses would be expected to wear the new uniform from Monday to Thursday and wear their old uniform from Friday to Sunday. From January 2026, when they would have both years’ issue, nurses would be expected to wear the new uniforms every day.

DENOSA responded to this a week later, and said the department’s circular went against the bargaining agreement.

Delihlazo said they proposed that if the department is unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.

If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84 000 members would embark on an indefinite protest action by wearing their own clothes to work from 1 October.

Delihlazo said the yearly allowance did not cover the cost of a full uniform. “Their uniforms are tearing and the colour is fading. So how can you expect nurses to wear uniforms if you don’t pay them a uniform allowance?”

He said the tender process meant the colour of the nurses’ uniforms and the quality of the fabrics might differ from one province to the next. The process also “opens a window of opportunity for corruption,” Delihlazo said. “Money may be given for uniforms but the tender process is porous.”.

Then, at a last-minute meeting of the bargaining council last Thursday, the department proposed to put on hold the supply of uniforms until 2024, according to a DENOSA statement. Meanwhile the health department would pay nurses an allowance of R3,153 by 30 November.

DENOSA said the agreement should be signed by the end of the week. If not, the union said, nurses would work in their own clothes.

The health department did not respond to GroundUp’s questions.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Environmental Effects HospitalsTags :

Netcare Group Signs Landmark Clean Energy Agreement

On By ModernMedia

Netcare well on track with environmental strategy targets

Photo by Sungrow Emea on Unsplash

In a tangible step towards further reducing its carbon footprint, the Netcare Group has successfully agreed commercial terms for a Renewable Energy (RE) Supply Agreement with independent clean energy solutions provider NOA Group Trading (NOA).

Netcare chief executive officer Dr Richard Friedland noted that the development is a significant milestone in realising the Group’s environmental sustainability strategy, which has made considerable strides since its implementation in 2013.

“Improvement of our energy efficiency initiatives remains a key focus area of this strategy. Netcare has also committed to procuring 100% of its purchased electrical energy from renewable energy sources by 2030, supporting the Race to Zero global campaign with targets that exceed the requirements of the Science Based Target initiative (SBTi) aimed at limiting global warming.

“This transaction represents Phase 1 of achieving this aim and includes six of our facilities where RE will be wheeled through the electricity grid from a combination of wind and solar farms, covering up to 100% of energy consumption at these facilities. This represents approximately 11% of the Group’s total energy consumption which is currently being supplied by Eskom’s predominantly coal fired power stations.

“In combination with other initiatives already implemented under Netcare’s sustainability programme, this transaction will increase the proportion of Netcare’s total energy consumption that is derived from RE sources to around 26%,” he says.

Dr Friedland noted that Netcare’s management teams are actively working towards finding viable solutions to supply RE to the remaining municipal-connected sites in the Group while continuing to build on existing renewable energy initiatives. The Group’s environmental sustainability programme also continues to demonstrate an impressive return on investment to date, illustrating the commercial opportunities in environmentally conscious engineering.

According to Karel Cornelissen, chief executive officer of NOA Group, renewable energy will be wheeled through the national grid to the six designated Netcare facilities via the existing Eskom distribution transmission network and delivery of renewable energy to these facilities is expected to commence by the first quarter of 2026. “The agreement represents a significant step towards a clean-energy future by one of South Africa’s healthcare industry leaders, and we are pleased to partner with Netcare on this crucial advancement,” he says. 

Netcare joined the Race to Zero global campaign in 2021 and was the first healthcare institution in Africa to do so. The campaign strives to rally leadership and support from businesses, cities, regions and investors for a healthy, resilient, zero carbon recovery that prevents future threats, creates jobs, and unlocks inclusive, sustainable growth.

“The devastation of climate change to the environment and among communities is already resulting in enormous hardship and tragedy not only in South Africa but around the world. We cannot sit idly by while this happens. Urgent action must be taken by implementing innovative solutions,” says Dr Friedland.  

“During the past decade, Netcare has actively been engaged in several planned energy, waste and water management initiatives. This meaningful transaction is yet another step towards implementing appropriate green solutions while contributing towards a healthier environment for the people of South Africa in the decades to come and beyond,” he concludes.   

Categories : Hospitals Medical IndustryTags :

Hospice Palliative Care Association Rebrands as the Association of Palliative Care Centres

On By ModernMedia

As of the 1st of September 2023, the Hospice Palliative Care Association (HPCA) is known as the Association of Palliative Care Centres (APCC).

“This rebranding is not just a visual change,” says Ewa Skowronska, CEO of the APCC. “It is an important message to all medical professionals and the public that our members (many of whom still refer to themselves as hospices) offer quality, specialised and expert palliative care services. Too many people equate hospice with end-of-life only and many medical professionals refer very late. This leads to thousands of patients, and their loved ones, missing out on the holistic support that palliative care provides – support that, ideally, should be from diagnosis of a life-threatening illness and not solely in the last few days of life.”

The rebrand includes a new logo element that reflects that palliative care can be provided alongside curative treatments and into end-of-life care, including bereavement support (if needed). 

“Our members adhere to the Standards for Palliative Healthcare Services, 4th edition, 2020 approved by the Council for Health Service Accreditation of South Africa (COHSASA) and the International Society for Quality in Health Care (ISQua),” says Leigh Meinert, Advocacy and Operations Manager of APCC. “This is important as sometimes there is a perception that our members are only servicing patients who do not have private healthcare support and might not be at the same level as private organisations. In reality, they have decades of palliative care experience, and compliance with these Standards ensures an ongoing level of excellence.”

As much as 90% of APCC member’s services are provided to the patient in the comfort of their own home. The patient’s loved ones are also supported by way of an interdisciplinary team. Such a team typically consists of a medical doctor, nurse, social worker, and home-based carers who can work alongside the patient’s healthcare professional and support quality of life.

Palliative care covers conditions such as HIV/AIDS, drug-resistant TB, chronic respiratory diseases, cardiovascular and neuromuscular diseases, MND and more. “Both adults and children are catered for,” says Meinert. “While patients can move in and out of a palliative care service, they may remain beneficiaries of the services for as long as they (or their loved ones) need or wish to.  Patients may be discharged from the service if they are doing well and able to function independently.  This is always negotiated between the patient, family, and members of the care team. We encourage patients to engage with an APCC member from the point of diagnosis as this helps to dispel fears and provides insight into the holistic services that can be offered. We believe that all patients have benefitted from an improved quality of life through the supportive care received from APCC members.”

“APCC has a cloud-based patient care monitoring, evaluation and reporting system able to report in detail on interventions given to any patient,” says Skowronska. “Our members are comfortable working alongside the primary clinician or specialist.  They can provide a supportive extension of care to the patient and their loved ones and, in most cases, the APCC members inter-disciplinary teams collaborate and work alongside the referring doctors who are treating the patient. They also provide supportive care to the patient’s loved ones. This may include advanced healthcare planning, as well as psychosocial and spiritual support.” 

“Our palliative care definition says it all,” concludes Meinert. “Palliative care is the physical, psychological, social and spiritual care provided by an interdisciplinary team of experts to anyone with a life-threatening illness and their loved ones. Care is offered from the point of diagnosis and extends to bereavement support if needed. Over 90% of the care that APCC members provide is home-based with a focus on promoting quality of life.

We sincerely hope that this rebranding results in more people receiving the support that they so desperately need during some of the most difficult times in a person’s life.”

For more info, visit www.apcc.org.za

Categories : Healthcare Politics and Regulations HospitalsTags :

Concerns Raised at Public Health Conference over Freezing of Healthcare Worker Posts

On By ModernMedia

By Luvuyo Mehlwana for Spotlight

Photo by Hush Naidoo Jade Photography on Unsplash

The National Treasury’s Cost Containment Letter sent to government departments instructing, among others, the freezing of posts was one of the big themes underlying talks about building South Africa’s healthcare worker capacity during the Public Health Association of South Africa’s (PHASA) conference held recently in Gqeberha.

With Finance Minister Enoch Godongwana expected to deliver the medium-term budget policy statement on 1 November, the freezing of posts will further hamstrung already strained health services, some presenters at the conference warned.

An oversight visit to TB hospitals by members of the provincial legislature (MPLs) in the Eastern Cape in the first week of September (5 to 8 September) showed just how bad the staff shortages are. The only remaining hospital in Nelson Mandela Bay dedicated to TB services, Jose Pearson Hospital in Bethelsdorp, has had staff vacancies hovering around 20% since 2019. The hospital provides dedicated TB services to the western part of the province. MPLs heard that in some other hospitals, vacancy rates are even higher, and non-filling of critical posts in some cases results in further medico-legal claims against the department, as the current staff buckles under massive patient loads.

Last year, in response to a parliamentary question, figures the health department released showed that there were 3 892 vacant healthcare worker posts in the province. In the nursing categories, there was a vacancy rate of 15.3%. For paramedics (EMS) the vacancy rate was 10.7%, medical practitioners 8.4%, and pharmacists 13.7%. By June this year, in another response relating to specialist nurses, the vacancy rate in the province had dropped to 13%.

Dr Prudence Ditlopo Senior Researcher at the University of the Witwatersrand, was presenting her research on the impact of nurse workloads and professional support on healthcare outcomes at the PHASA conference. Ditlopo said nurses already have a huge workload and issues around budget cuts impact morale. “I am sure they are asking themselves what will happen to [them] when we [they’re] already understaffed.

“This is not the first time that this monotonous cycle has been happening. Yes, we understand the economic side of it, but at the very same time, what does it say about the well-being of the nurse practice environment, the patients, and the quality of patient care? If nurses see that they are overwhelmed by the workload, they will make sure to find ways that will enable them to cope.

“Enable them to cope” means nurses will find a way that works for them. If what works for them is only seeing ten patients per day, they will do that and they will be gatekeepers for other patients who are coming to the facility. That alone will influence the quality and standard of care in primary care in South Africa,” said Ditlopo.

‘Will create more problems’

Dr Busisiwe Matiwane of the University of The Witwatersrand’s School of Public Health also weighed in on the implications of the Treasury letter.

“In the current system, health professionals have to work for the government to fulfil their community service obligations. However, it can be challenging for them to be assigned to specific hospitals when it is time for their community service. Additionally, with the government announcing a freeze on posts, many individuals who are not government-funded may be compelled to seek employment outside of the government after completing their community service,” Matiwane told delegates.

“If these posts are indeed frozen, does that mean that the government will also halt the placement of individuals who are required to complete community service? The current structure dictates that if you fail to fulfil your community service, you will not be recognised by the statutory bodies as an independent practitioner.

“The implication of this proposal by the government will create more problems, as we already face the challenge of health professionals’ placement or their community services,” she said. “The main concern is whether the posts will be frozen and what will be done. I think this concern has raised questions for many people, who wonder what it means if they are unable to complete their community service or the internship. Does it mean they cannot work?” she asked.

‘protect what is already there’

Speaking on the sidelines of the three-day conference, director of the Rural Health Advocacy Project, Russell Rensburg, said the wage agreement on a 4.5% increase for the public sector had Treasury’s back against the wall since that was not budgeted for in their February budget.

“Treasury is playing hardball and the provinces must decide what they need. The national government must also decide what they need. If they follow through on this, they won’t be able to sustain the public health system. There is concern that doctors will leave as part of cost containment measures, and you can’t run a healthcare system without healthcare workers. But we will only know the true position of the Treasury when they publish the medium-term budget policy statement,” said Rensburg.

“I believe at the moment they are just testing the market. They are saying we must have one thing, but we can’t have both, so that is the game they are playing. Our position is clear on this issue. Before any salary cuts or job freezes, we need to protect what is already there. We need to retain this year’s cohort of community service doctors, pharmacists, and nurses because these people helped us during COVID-19. Some were interns during COVID-19 and they are the core that can build the health service in the post-COVID-19 era. So, the immediate priority is to retain those posts because we don’t know if there will still be community service going forward,” said Rensburg.

‘working with what we have’

Several speakers and presenters at the PHASA conference raised concerns about the existing scarcity of healthcare workers and urged the Department of Health to take action. The experts, academics, researchers, students, non-governmental organisations, and civil society members all agree that healthcare is a fundamental human right, but that right won’t be fulfilled without healthcare workers, as there cannot be health services without workers. The government’s key policy document on human resources for health warned as far back as 2020 that the country is facing a critical shortage of healthcare workers.

Dr Krish Vallabhjee, former Chief Director of Strategy and Health Support in the Western Cape Health Department, believes that management must use whatever resources are available to achieve good results.

Vallabhjee said, “Budget cuts are a reality, so whatever we talk about here and in many of these conference sessions, we can’t be talking about wanting more and more. We need to work with what we have. How can we repurpose the people we have? Can’t we use them more effectively to achieve the same effect?” he asked.

“Managers need to work with their staff instead of just sitting in some corner and making budget cut decisions. Managers need to engage with staff to address the problem of not having enough budget. How do we work together? What are our priorities? As managers, we must listen to what people are saying on the ground. What are the doctors, nurses, and local managers saying? We must be united. [It should not be a thing that one hospital, clinic, and the district [are] fighting for their own piece. We are one department and we have this problem of a budget. How do we unite and do the best we can?”

Government will clarify

In a cabinet statement issued on 14 September, Minister in the Presidency, Khumbudzo Ntshavheni said that Finance Minister Enoch Godongwana would clarify the cost-containment letter issued on August 31.

“Cabinet appreciates the current fiscal constraints which are not unique to South Africa but have resulted in budget shortfall. Cabinet has iterated that measures to address the budget shortfall must not impact negatively on service delivery. The Minister of Finance will shortly issue guidelines clarifying the unintended misunderstanding arising from the Cost Containment Letter issued on 31 August 2023. In addition, as part of the in-year performance review of progress in implementation priorities agreed to with Ministers, the President, and Deputy President will meet with individual Ministers to ensure that fiscal management does not derail the agreed to priorities.”

Source: Spotlight

Categories : Diseases, Syndromes and Conditions HospitalsTags :

The Greater Clostridioides Difficile Threat may Come from Within

On By ModernMedia
Clostridioides difficile. Credit: CDC

Despite strenuous control efforts, hospital-acquired infections still occur – the most common of which is caused by the bacterium Clostridioides difficile, which creates lingering spores and resists alcohol-based hand sanitisers. Surprising findings from a new study in Nature Medicine suggest that the burden of C. diff infection may be less a matter of hospital transmission and more a result of characteristics associated with the patients themselves.

The study team, led by Evan Snitkin, PhD; Vincent Young, MD, PhD; and Mary Hayden, MD, leveraged ongoing epidemiological studies focused on hospital-acquired infections that enabled them to analyse daily faecal samples from every patient within the intensive care unit at Rush University Medical Center over a nine-month period.

Arianna Miles-Jay, a postdoctoral fellow in Dr Snitkin’s lab, analysed 1141 eligible patients, and found that a little over 9% were colonised with C. diff. Using whole genome sequencing at U-M of 425 C. difficile strains isolated from nearly 4000 faecal specimens, she compared the strains to each other to analyse spread. But she found that, based on the genomics, there was very little transmission.

Essentially, there was very little evidence that the strains of C. diff from one patient to the next were the same, which would imply in-hospital acquisition. In fact, there were only six genomically supported transmissions over the study period. Instead, people who were already colonised were at greater risk of transitioning to infection.

“Something happened to these patients that we still don’t understand to trigger the transition from C. diff hanging out in the gut to the organism causing diarrhoea and the other complications resulting from infection,” said Snitkin.

Hayden notes this doesn’t mean hospital infection prevention measures are not needed. In fact, the measures in place in the Rush ICU at the time of the study – high rates of compliance with hand hygiene among healthcare personnel, routine environmental disinfection with an agent active against C. diff, and single patient rooms were likely responsible for the low transmission rate. The current study highlights, though that more steps are needed to identify patients who are colonised and try to prevent infection in them.

Where did the C. diff come from? “They are sort of all around us,” said Young. “C. diff creates spores, which are quite resistant to environmental stresses including exposure to oxygen and dehydration…for example, they are impervious to alcohol-based hand sanitiser.”

However, only about 5% of the population outside of a healthcare setting has C. diff in their gut – where it typically causes no issues.

“We need to figure out ways to prevent patients from developing an infection when we give them tube feedings, antibiotics, proton pump inhibitors – all things which predispose people to getting an actual infection with C. diff that causes damage to the intestines or worse,” said Young.

The team next hopes to build on work on AI prediction for patients at risk of C. diff infection to identify patients more likely to be colonised and who could benefit from more focused intervention.

Said Snitkin, “A lot of resources are put into gaining further improvements in preventing the spread of infections, when there is increasing support to redirect some of these resources to optimise the use of antibiotics and identify other triggers that lead patients harbouring C. diff and other healthcare pathogens to develop serious infections.”

Source: Michigan Medicine – University of Michigan

Categories : Hospitals NeurologyTags :

New Evidence of Patients Recalling Death Experiences after Cardiac Arrest

On By ModernMedia

Up to an hour after cardiac arrest, some patients revived by cardiopulmonary resuscitation (CPR) had clear memories afterward of experiencing death and had brain patterns while unconscious linked to thought and memory, report investigators in the journal Resuscitation.

In a study led by researchers at NYU Grossman School of Medicine, some survivors of cardiac arrest described lucid death experiences that occurred while they were seemingly unconscious. Despite immediate treatment, fewer than 10% of the 567 patients studied, who received CPR in the hospital, recovered sufficiently to be discharged. Of the survivors, four in 10 recalled some degree of consciousness during CPR not captured by standard measures.

The study also found that in a subset of these patients, who received brain monitoring, nearly 40% had brain activity that returned to normal, or nearly normal, from a “flatline” state, at points even an hour into CPR. As captured by EEG, the patients saw spikes in the gamma, delta, theta, alpha, and beta waves associated with higher mental function.

Survivors have long reported having heightened awareness and powerful, lucid experiences, say the study authors. These have included a perception of separation from the body, observing events without pain or distress, and a meaningful evaluation of their actions and relationships. This new work found these experiences of death to be different from hallucinations, delusions, illusions, dreams, or CPR-induced consciousness.

The study authors hypothesise that the “flatlined”, dying brain removes natural inhibitory (braking) systems. These processes, known collectively as disinhibition, may open access to “new dimensions of reality,” they say, including lucid recall of all stored memories from early childhood to death, evaluated from the perspective of morality. While no one knows the evolutionary purpose of this phenomenon, it “opens the door to a systematic exploration of what happens when a person dies.”

Senior study author Sam Parnia, MD, PhD, associate professor in the Department of Medicine at NYU Langone Health and director of critical care and resuscitation research at NYU Langone, says, “Although doctors have long thought that the brain suffers permanent damage about 10 minutes after the heart stops supplying it with oxygen, our work found that the brain can show signs of electrical recovery long into ongoing CPR. This is the first large study to show that these recollections and brain wave changes may be signs of universal, shared elements of so-called near-death experiences.”

Dr Parnia adds, “These experiences provide a glimpse into a real, yet little understood dimension of human consciousness that becomes uncovered with death. The findings may also guide the design of new ways to restart the heart or prevent brain injuries and hold implications for transplantation.”

The AWAreness during REsuscitation (AWARE)-II study followed 567 adults who suffered in-hospital cardiac arrest between May 2017 and March 2020 in the US and UK. Only hospitalised patients were enrolled to standardise the CPR and resuscitation methods used, as well as recording methods for brain activity. A subset of 85 patients received brain monitoring during CPR. Additional testimony from 126 community survivors of cardiac arrest with self-reported memories was also examined to provide greater understanding of the themes related to the recalled experience of death.

The study authors conclude that research to date has neither proved nor disproved the reality or meaning of patients’ experiences and claims of awareness in relation to death. They say the recalled experience surrounding death merits further empirical investigation and plan to conduct studies that more precisely define biomarkers of clinical consciousness and that monitor the long-term psychological effects of resuscitation after cardiac arrest.

Source: Elsevier

Categories : General Interest HospitalsTags :

South Africa’s Traditional Medicines Should be Used in Modern Health Care

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Both the Khoi and the San believed in a mythical animal, resembling a cow, whose horns were thought to have medicinal attributes. This centuries-old medicine horn contained herbal remedies used by the Khoi-san. Credit: Rodger Smith

By Zelna Booth

Traditional medicines are part of the cultural heritage of many Africans. About 80% of the African continent’s population use these medicines for healthcare.

Other reasons include affordability, accessibility, patient dissatisfaction with conventional medicine, and the common misconception that “natural” is “safe”.

The growing recognition of traditional medicine resulted in the first World Health Organization global summit on the topic, in August 2023, with the theme “Health and Wellbeing for All”.

Traditional medicines are widely used in South Africa, with up to 60% of South Africans estimated to be reliant on traditional medicine as a primary source of healthcare.

Conventional South African healthcare facilities struggle to cope with extremely high patient numbers. The failure to meet the basic standards of healthcare, with increasing morbidity and mortality rates, poses a threat to the South African economy.

In my opinion, as a qualified pharmacist and academic with a research focus on traditional medicinal plant use in South Africa, integrating traditional medicine practices into modern healthcare systems can harness centuries of indigenous knowledge, increasing treatment options and provide better healthcare.

Recognition of traditional medicine as an alternative or joint source of healthcare to that of standard, conventional medicine has proven challenging. This is due to the absence of scientific research establishing and documenting the safety and effectiveness of traditional medicines, along with the lack of regulatory controls.

What are traditional medicines?

Traditional medicine encompasses a number of healthcare practices aimed at either preventing or treating acute or chronic complaints through the application of indigenous knowledge, beliefs and approaches. It incorporates the use of plant, animal and mineral-based products. Plant-derived products form the majority of treatment regimens.

Traditional medicine practices also have a place in ritualistic activities and communicating with ancestors.

South Africa is rich in indigenous medicinal fauna and flora, with about 2000 species of plants traded for medicinal purposes. In South Africa the provinces of KwaZulu-Natal, Gauteng, Eastern Cape, Mpumalanga and Limpopo are trading “hotspots”. The harvested plants are most often sold at traditional medicine muthi markets.

Uses of medicinal plants

Medicinal plants most popularly traded in South Africa include buchu, bitter aloe, African wormwood, honeybush, devil’s claw, hoodia, African potato, fever tea, African geranium, African ginger, cancer bush, pepperbark tree, milk bush and the very commonly consumed South African beverage, rooibos tea.

The most commonly traded medicinal plants in South Africa are listed below along with their traditional uses:

Buchu – Urinary tract infections; skin infections; sexually transmitted infections; fever; respiratory tract infections; high blood pressure; gastrointestinal complaints.

Bitter aloe – Skin infections; skin inflammation; minor burns.

African wormwood – Respiratory tract infections; diabetes, urinary tract disorders.

Honeybush – Cough; gastrointestinal issues; menopausal symptoms.

Devil’s claw – Inflammation; arthritis; pain.

Hoodia – Appetite suppressant.

African potato – Arthritis; diabetes; urinary tract disorders; tuberculosis; prostate disorders.

Fever tea – Respiratory tract infections; fever; headaches.

African geranium – Respiratory tract infections.

African ginger – Respiratory tract infections; asthma.

Cancer bush – Respiratory tract infections; menstrual pain.

Pepperbark tree – Respiratory tract infections; sexually transmitted infections.

Milk bush – Pain; ulcers; skin conditions.

Rooibos – Inflammation; high cholesterol; high blood pressure.

There are many ways in which traditional medicine may be used. It can be a drop in the eye or the ear, a poultice applied to the skin, a boiled preparation for inhalation or a tea brewed for oral administration.

Roots, bulbs and bark are used most often, and leaves less frequently. Roots are available throughout the year. There’s also a belief that the roots have the strongest concentration of “medicine”. Harvesting of the roots, however, poses concerns about the conservation of these medicinal plants. The South African government, with the draft policy on African traditional medicine Notice 906 of 2008 outlines considerations aimed at ensuring the conservation of these plants through counteracting unsustainable harvesting practises.

Obstacles to traditional medicine use

The limited research investigating interactions posed should a patient be making use of both traditional and conventional medicine is a concern.

During the COVID-19 pandemic, many patients used traditional remedies for the prevention of infection or treatment.

Understanding which traditional medicines are being used and how, their therapeutic effects in the human body, and how they interact with conventional medicines, would help determine safety of their combined use.

Certain combinations may have advantageous interactions, increasing the efficacy or potency of the medicines and allowing for reduced dosages, thereby reducing potential toxicity. These combinations could assist in the development of new pharmaceutical formulations.

Sharing information

The WHO in its Traditional Medicine Strategy for 2014-2023 report emphasised the need for using traditional medicine to achieve increased healthcare.

Key role players from both systems of healthcare need to be able to share information freely.

The need for policy development is key. Both conventional and traditional medicine practitioners would need to be aware of and engage with patients on all the medicines they are taking.

Understanding the whole patient

Patients often seek treatment from both conventional and traditional sources, which can lead to side effects or duplication in medications.

A comprehensive understanding of a patient’s health profile makes care easier.

This could also prevent treatment failures, promote patient safety, prevent adverse interactions and minimise risks.

A harmonious healthcare landscape would combine the strengths of both systems to provide better healthcare for all.

Zelna Booth, Pharmacist and Academic Lecturer (Pharmacy Practice Division, Department of Pharmacy and Pharmacology, University of the Witwatersrand), University of the Witwatersrand

This article is republished from The Conversation under a Creative Commons license.

Source: The Conversation

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Whistleblower Spills More Details of Alleged Fraud at Mediclinic Hospitals

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Photo by Scott Graham on Unsplash

The furore over claims of fraudulent account manipulation happening at Mediclinic hospitals continues to grow, as the initial whistleblower responded to a challenge for more information by providing a detailed list of of starting points for investigators, according to Daily Maverick.

Widely reported in media outlets such as News24, Radio 702, and eNCA, the initial email alleged that hospital codes were being altered to ones which drew higher remunerations from medical aid schemes and therefore which financially benefitted the hospitals. They further claimed that no action was being taken against employees who were engaging in this practice, which was supposedly happening at six hospitals.

The Council for Medical Schemes noted that hospital charges to beneficiaries had increased by nearly 19% from R7039.74 in 2020 to R8346.40. Just over 92% of the total hospital expenditure was paid to private hospitals.

Greg van Wyk, CEO of Mediclinic Southern Africa, was also emailed among the initial recipients. He responded swiftly, writing in a reply to all the cc’d recipients last week that Mediclinic had appointed Steven Powell, head of law firm ENSafrica’s forensics practice, to head its independent audit.

The Mediclinic CEO also challenged the anonymous whistleblower to come forward and reveal themselves, the whistle-blower then responded with an email cc’d to medical schemes and the media. The email contained extensive of details of the alleged fraud – plenty of information for investigators to get started with.

The whistle-blower told News24 that, for example, “When a patient died in a hospital emergency room, sometimes Mediclinic case managers were expected to change their accounts to reflect an ICU death instead. This is because of the fixed fees associated with emergency room deaths, which are lower than ICU-related fees.”

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The Hospital Association of South Africa Welcomes the Day Hospital Association as a Member

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Photo by RDNE Stock project

The Day Hospital Association of South Africa (DHASA) has joined the Hospital Association of South Africa (HASA), the representative organisation of private hospital groups in the country, including Netcare, Mediclinic, Life Healthcare, Lenmed, Joint Medical Holdings, and a range of leading facilities across the country like Zuid-Afrikaans Hospital and Arwyp Medical Centre.

Among the Day Hospital Association of South Africa members are the Advanced Health chain, Cure Day Hospitals, and various leading treatment facilities situated nationwide.

According to HASA Chief Executive Officer Dr Dumisani Bomela, DHASA perspectives on healthcare reform issues, like the National Health Insurance, will contribute to a rich healthcare reform discussion. 

He says, “Through HASA, the Day Hospital Association can provide additional critical perspectives that we believe are required in the collaborative approach that we are engaging in with Government to build a strong and accessible healthcare system for all in South Africa. We completely believe that the excellent leadership of DHASA will make full use of their membership in HASA to make their important contribution.”

The Chairman of the Day Hospital Association of South Africa, Raymond Foster, says “We are excited to be associated with HASA. We are confident that HASA will meet the expectations of our members.”