Tag: South Africa

Categories : Respiratory DiseasesTags :

The Complex Interplay Between TB and Liver Problems

On By ModernMedia
Tuberculosis bacteria. Credit: CDC

By Tiyese Jeranji for Spotlight

People in South Africa who fall ill with tuberculosis (TB) often also have other health issues. HIV, which drives much of the TB epidemic in South Africa, is the most obvious co-infection, but people who fall ill with TB are also more likely to have diabetes and mental health problems than the general public.

Another issue that is often mentioned at conferences and in journal articles, but that doesn’t often make the headlines, is the complex set of links between TB and liver problems. With the World Health Organization estimating that in the region of 300 000 people fall ill with TB in South Africa every year, the scale of the issue is likely to be substantial, although we do not have particularly good data on liver problems in South Africa, and even less so on people experiencing TB and liver problems together.

Complex interactions

Broadly speaking, the link between TB and the liver can be divided into two categories. First, there are the liver-related side effects of some TB treatments, and second, there is the interaction between TB and liver conditions such as viral hepatitis. In some cases, TB itself can also cause liver problems directly.

Start with hepatitis. Dr Louisa Dunn, Think TB Provincial TB Technical Lead in KwaZulu-Natal, explains that hepatitis is a general term meaning inflammation of the liver. She says that there are many causes of hepatitis, such as infections, alcohol, or an overdose of certain medications. There is also autoimmune hepatitis, where a person’s own immune system is attacking the liver. “Even lifestyle can cause inflammation in the liver from a build-up of fatty tissue, which is more common in people who are overweight and obese,” she says.

Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are thought to cause significant illness and death in South Africa. According to a study published in 2022, over 1.9 million people in South Africa are living with chronic HBV infection – earlier research put the number at 3.5 million. HBV can be treated and there is an effective childhood vaccine for it that has been used in South Africa since 1995.

Estimates for HCV are less certain than for HBV – an estimate of 400 000 chronic infections was quoted in an HBV and HCV investment case for South Africa. Highly effective cures for HCV infection have been developed over the last decade, although access to these cures remains limited. The Department of Health published viral hepatitis treatment guidelines in December 2019.

Given these numbers, some people in South Africa would simply, by chance, get both TB and hepatitis. But since there are common risk factors, co-infection will be higher than what one would expect purely through chance. HIV infection, for example, increases both a person’s risk of TB and HCV.

“There is no data from South Africa about viral hepatitis and TB co-infection that I am aware of,” says Dr Andrew Scheibe, a Technical Advisor for TB HIV Care and an infectious disease specialist at the University of Pretoria. He points out that people who use drugs and other groups of people who are marginalised, including people experiencing homelessness or people in prison, are at increased risk for these co-infections. The risk of HCV transmission is particularly high when people who inject drugs share needles.

In addition, as Dunn points out, TB itself can also cause hepatitis.

Hepatotoxicity

The picture is further complicated by the fact that several of the medicines used to cure TB have liver-related side effects. Drug-sensitive TB is treated with a combination of four different medicines, while drug-resistant TB is treated with anything from three to eight different medicines.

“Medications used to treat both drug-sensitive and drug-resistant TB can cause hepatitis through drug-induced liver toxicity (hepatotoxicity),” says Dunn. “The presence of other risk factors may further increase the risk of hepatitis in TB patients. These risk factors could be alcohol use, older age, malnutrition, co-infection with HIV or viral Hepatitis B, and taking other potentially hepatotoxic drugs with TB treatment.”

Wieda Human, project coordinator and communications officer at TB advocacy group TB Proof says 3 to 28% of people with TB may experience hepatotoxicity and other side effects. “Those who are already infected with the hepatitis B infection are at an increased risk for hepatotoxicity,” she says.

She refers to a study done in Ethiopia that found having hepatitis B and hepatitis C infection made having TB disease more severe. “This study also found that people with TB who have hazardous alcohol use have a 1.5 times increased risk of developing hepatitis C,” says Human.

What it means for treatment

Dunn says although it is less straightforward to treat a person with TB and hepatitis than a person with just TB, it is important to understand treatment is still available. “It involves establishing the cause for hepatitis and treating this where possible, for instance, treating a viral hepatitis [and TB] co-infection at the same time or [providing] support to reduce alcohol intake. It may involve closer monitoring and follow-up, changes to medications, including stopping treatments either permanently or temporarily, and using alternative more ‘liver-friendly’ treatment regimens,” she says.

“If the hepatitis is stable, then TB can be treated,” Scheibe says. He explains hepatitis B requires long-term treatment (there is no cure), while hepatitis C can be cured with direct-acting antivirals (recently registered in SA, but not yet on the Government Essential Medicines List, so not easily available in the public sector). He says HCV treatment may be delayed until the TB is cured.

No routine screening

South Africa’s National Strategic Plan for HIV, TB, and STIs 2023-2028  under Goal 2 sets out to reduce viral hepatitis morbidity through scale-up of prevention, diagnostic testing, and treatment. However, according to Dunn, screening for viral hepatitis infections, such as HBV, is not part of the current drug-sensitive or drug-resistant TB guidelines.

But she says everyone should be assessed for symptoms and risk factors for liver disease at the start of TB treatment – a sentiment Scheibe shares. According to them, these screenings are however performed at diagnosis of HIV infection before a person is commenced on antiretroviral treatment for HIV, as chronic hepatitis B infection has specific implications for HIV treatment.

“During [TB] treatment, it is critical that clinicians assess people for signs and symptoms that may suggest hepatitis at each visit and educate them on recognising these side effects as well,” says Dunn. “This includes loss of appetite, feeling tired and unwell, nausea, vomiting, abdominal pains, yellowing of the eyes and skin, and darkening of urine.”

Treatment guidelines for drug-induced liver injury are available here. The guidelines focus on the management of suspected drug-induced rash, kidney injury, and liver injury for patients on TB treatment and or antiretroviral treatment.

Scheibe adds that people at high risk for HCV should receive TB screening regularly due to potential exposure to TB (eg if living in closed settings with many people in contexts of high TB prevalence and /or with HIV co-infection).

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : Ethics and LawTags :

Court Dismisses MEC’s Attempt to Quash Inquiry into her ‘Killing my Health System’ Remark

On By ModernMedia
Photo by Bill Oxford on Unsplash

By Tania Broughton for GroundUp

Limpopo MEC for Health Dr Pophi Ramathuba has failed in her attempt to put a stop to a Health Professions Council of South Africa (HPCSA) inquiry into comments she made to a Zimbabwean patient when she visited Bela Bela Hospital last year.

A disciplinary inquiry had been set down for July to probe complaints against her emanating from the conversation which was widely broadcast.

While Pretoria High Court Judge Anthony Millar, in his judgment refusing to grant Ramathuba an interdict, did not detail the complaints, it is public record that she told the patient that Zimbabweans were putting a huge strain on the provincial health system.

She said: “You are killing my health system. It’s unfair.”

Ramathuba brought the application in her capacity as the MEC for health, in two parts, divided into Part A and Part B.

Part A was for an interdict pending Part B – a review application in which she would seek an order declaring the decision of the HPCSA issued against her on 9 February 2023 as unconstitutional, unlawful and invalid, and declaring that the HPCSA lacks jurisdiction over the conduct of the applicant as an MEC.

Only Part A was considered by Judge Millar this week and he ruled on Friday.

In his judgment, he said many complaints had been laid against Ramathuba with the HPCSA as a result of the conversation.

Ramathuba disputed the complaints, both in her capacity as the MEC for Health and as a medical practitioner.

“It is not in issue that the applicant has at all material times been registered as a health professional and remains so and the HPCSA is the custodian of the medical profession,” Judge Millar wrote.

The judge explained that the HPCSA has a two stage complaints procedure. The first is a preliminary inquiry, which may result in the complaint being resolved. If it is not, it is referred to a formal inquiry.

Judge Millar said a preliminary committee had considered the complaints at a meeting at the end of January. The committee had resolved that the applicant was guilty of unprofessional conduct but that it was only a “minor transgression” and that she should be cautioned for unprofessional behaviour, unbecoming of a medical professional for “shouting at a patient’s bedside as the patient was vulnerable at the time”.

The HPCSA, in a letter to Ramathuba, said the acceptance of this penalty would not constitute a conviction and would not be reflected against her name. The matter would be regarded as finalised.

But Ramathuba refused to accept the finding. She wrote to the HPCSA in February this year, challenging it on the basis that it had no jurisdiction over her.

The HPCSA disagreed with this, and set the formal hearing dates.

“The applicant does not want the inquiry to proceed or to attend it … she says she conducted the conversation in her capacity as an MEC and not as a medical practitioner,” Judge Millar said.

“The crisp question is, is the applicant in her capacity as MEC a separate persona from the applicant as a medical practitioner. The office of the MEC is a political one whereas her status as a medical practitioner is a professional one.

“The holding of political office and remaining registered as a medical practitioner are not mutually exclusive. The one hallmark of both is that the individual concerned accepts that they are, and subject themselves to being accountable for their actions.

“It seems to me to be a wholly contrived and self-serving assertion that conduct is determined depending upon ‘which hat a person is wearing at the time’,” the judge said.

“This is simply not consistent with our constitutional values or the law. There is to my mind no distinction to be drawn between the different offices a person holds and their conduct.”

He said Ramathuba had maintained her registration with the HPCSA so she had no right to avoid its jurisdiction. If she had de-registered then the situation would be different.

“Her refusal to accept the finding of the preliminary committee means that the entire matter will serve before a different committee … she will have the opportunity to raise whatever challenge she wishes at the inquiry.

“Delaying the matter unnecessarily ending a review does not serve the interests of any of the parties.”

Judge Millar dismissed the application and ordered Ramathuba to pay the HPCSA’s costs.

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

Source: GroundUp

Categories : Ethics and Law HospitalsTags : 1 Comment

Hospital Association of South Africa Joins Chorus of Criticism Against NHI Bill

On By ModernMedia

The Hospital Association of South Africa (HASA) has added its objections to the proposed National Health Insurance (NHI) Bill to the growing volume of objections from professional medical organisations. In common with them, HASA strongly supports universal health coverage but stands against the NHI Bill in its current form.

Their statement reads: “We believe that approving the Bill without substantive consideration of the many valid and significant recommendations and contributions made by many participants during the Parliamentary hearing is deeply regrettable and a missed opportunity by the Committee.”

Chief among their objections were the potential for corruption and mismanagement in the centralisation of medical funds as well as the many legal objections to the Fund.

Despite serious, credible concerns being raised at every turn, the NHI Bill continues to progress, with Parliamentary Portfolio Committee for Health recently giving the Bill its approval on 26 May, moving it forward to debate within the National Assembly. To support healthcare professionals, Quicknews will be running a series of articles discussing the Bill and providing resources to help them take positive action to protect healthcare services for all of their patients. The Gauteng e-toll saga has already shown that ill-conceived and damaging legislation can be brought down if there is sufficient, coordinated public opposition.

With HASA’s statement, three of the largest medical associations in South Africa have now spoken out against the controversial bill. The South African Medical Association (SAMA) and South African Private Practitioners Forum (SAPPF) have both unequivocally stated their opposition to the Bill as it is currently formulated.

In addition to other risks, South Africa faces a potential exodus of healthcare professionals. Indeed, the UK’s National Health Service has for some time been actively poaching nurses and midwives from lower-income countries like South Africa.

HASA urges National Assembly and the National Council of Provinces in their deliberations on the Bill “to insist on a multi-payer model to mitigate against the concentration of risk, an iterative rollout based on milestones rather than dates and to pay heed to the nation’s concerns that the proposed National Health Insurance Fund is susceptible to theft and corruption by proposing and approving alternate and appropriate governance structures.”

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Categories : COVID General InterestTags :

New Podcast Series Reflects on Childhood in South Africa Through and Beyond COVID-19

On By ModernMedia
Photo by Hush Naidoo Jade Photography on Unsplash

The ‘Phezulu: Looking Up’ podcast series launched today by UNICEF South Africa (https://www.UNICEF.org/SouthAfrica/) tells the stories of the impact of the COVID-19 years on children and young people and how, with the right support and opportunities, children and young people are determined to build a safer, fairer and better post pandemic South Africa.  

The eight-part series delves into issues such as mental wellbeing, disrupted education and access to child healthcare; including routine childhood immunisations, through the voices of children and young people and experts working to mitigate the impact.

“Children and adolescents were affected by every aspect of the COVID-19 pandemic and this podcast series tells their stories of resilience,” said Muriel Mafico, UNICEF South Africa Deputy Representative. “Importantly, the episodes also reflect on the response to share learnings, including how the roll-out of the COVID-19 vaccine saved countless lives and re-opened our world,”

The podcast series features expert analysis and voices, including contributions from academics, all of whom continue to play a critical role in the ongoing recovery for every child. The series not only highlights the indirect impact of COVID-19 on children and youth, but also how COVID-19 vaccinations changed the trajectory of the crisis by enabling children and adolescents to resume their childhoods.

The series will be available on a weekly basis, on all major podcast platforms from 23rd May 2023. Listeners can now subscribe and join the conversation. This production was made possible thanks to the generous support of the German Federal Foreign Office and other partners.

For more information, please see the following links:
https://www.UNICEF.org/southafrica/
https://apo-opa.info/42dIxHD

Categories : Hospitals Surgeries & ProceduresTags :

Groote Schuur Hospital Clears Backlog of 1 500 Surgeries

On By ModernMedia
Photo by Quicknews

By Elri Voigt for Spotlight

Much of South Africa’s public health sector is plagued by long waiting times for surgery, a situation that was made much worse by the COVID-19 pandemic. Now, an inspiring project at Groote Schuur Hospital in Cape Town has reached the target of slashing its backlog by 1 500 elective surgeries – two months ahead of target.

At the end of March, a small team of healthcare workers completed the project called ‘Surgical Recovery’. The project ran from May 2022 and was originally planned to conclude 12 months later.

While this hasn’t cleared the entire backlog of people waiting for surgery at Groote Schuur, it has helped the hospital return to about the same waiting list level as it had before the COVID-19 pandemic, according to Professor Lydia Cairncross, the head of general surgery at Groote Schuur. (Spotlight previously reported on the human cost of surgical waiting lists and on what could be done about it.)

The surgeries took place mainly in the E4 Surgical Day Ward at Groote Schuur. Cairncross explains that ward E4 was built as a Day Ward – meaning it handles surgeries where patients don’t require an overnight stay pre- or post-surgery – with the aim of increasing daycare surgery capacity for the hospital. And for the last 12 months, it has been the host of the Surgical Recovery Project.

E4 has 16 patient beds, four recovery beds, and two theatres, which were completed just as the COVID-19 pandemic hit the country. During the third wave of the pandemic, it was used as a COVID High Care Unit.

According to Dr Shrikant Peters, a public health specialist and the medical manager of theatre and ICU services at Groote Schuur, the hospital’s CEO Dr Bhavna Patel “had the foresight to request provincial use of COVID funding to develop the space as COVID High Care, and eventually to be used long-term as an Operating Suite and High Care Ward in line with prior hospital plans”.

The Surgical Recovery Project

By the end of the third wave of the COVID-19 pandemic, according to Cairncross, there were discussions about how to catch up on the surgeries that had to be postponed because of COVID-19.

“The backlog in surgery comes on top of a pre-existing backlog. So, it’s not that the backlog was created by COVID, but it made it much, much, much worse,” she says, “In November 2021, we did an audit of how many patients were just physically waiting for surgery at the hospital. It was around 6 000 plus. We don’t actually have a baseline for pre-COVID, but we knew that we lost about 50% of our operating capacity,” Cairncross says.

“So, the idea was really to find a way to utilise this theatre space so that we could catch up with some of that backlog.”

From here, the Surgical Recovery Project for Groote Schuur was born with the ambitious target of performing 1 500 surgeries in 12 months.

Funds from the project came from three sources. Kristy Evans, head of the Groote Schuur Hospital Trust, tells Spotlight that fundraising for the project was kick-started by a R5 million donation from Gift of the Givers. The recently established Groote Schuur Hospital Trust focused on Surgical Recovery as their first project to fundraise for. An additional R1 million was raised by the Trust from over 500 corporate and private donors.

“People are always willing… [they] give what they can. We had donations from people who would transfer R10 into the account, sometimes people transfer R180 000,” Evans says.

She adds that the Project will continue into its second year, but the details regarding targets had not yet been finalised by the time of publication.

The Western Cape Provincial Department of Health also donated around R6.5 million to the project from their budget for surgical recovery post-COVID-19. According to Mark van der Heever, the provincial health spokesperson, this money was part of the R20 million that the department allocated to various surgical backlog recovery initiatives.

“[The] COVID-19 pandemic meant that elective surgical services had to be significantly de-escalated, as staff were deployed to COVID services, and this resulted in an increase in the backlog of operations. Hence, a specific practi[cal] plan to address this backlog in the short and long term has been developed,” says van der Heever. “Similar projects and initiatives across hospitals have already taken shape and also yielded success, such as at Karl Bremer Hospital, which also received a portion of the R20 million from the department. The hospital was able to perform an extra 328 procedures since August last year.”

Working around difficulties

At Groote Schuur, the project had to find a way to work around the difficulties of surgical catch-up. According to Cairncross, with any surgical catch-up, the challenges don’t just come from needing a physical space to operate in but also from having the appropriately trained staff. Not having enough trained staff in the public health sector, like theatre and surgery nurses, makes it hard to implement a surgical catch-up programme, even if there is money to do so.

To work around these difficulties, they came up with a centralised model for surgical recovery, where one theatre team of nurses could be employed on a contract rate for the 12 months. This team, led by Sister Melinda Davids, the nursing operations manager for the E4 theatre, would work Monday to Thursday in one of the E4 theatres and occasionally other theatres in the hospital for each of the 1 500 surgeries.

According to Cairncross, many surgeons, herself included, would come and operate on patients in addition to their normal surgeries and other duties. The funds, a total of about R 12.5 million, were used to pay the staff involved in the surgeries. The day-to-day operations were run by Davids and Peters.

According to Peters, the 1 500 operations occurred across all surgical specialities, ranging from cataract to cardiothoracic.

Success factors

Cairncross attributes the success of the project to the existing systems at Groote Schuur, supportive management, and the dedication of the surgical team and surgeons that gave their time to the project.

She says that because the hospital has a relatively functional system to start off with and a supportive management team, it allowed for “enough of a regulatory environment to keep things safe and above board but not to the extent where you can’t move”.

It was also about having the right person in charge of the team, she adds, gesturing to Davids.

Davids, who started her nursing career in 1989 and qualified as a theatre nurse in 2009, started working at Groote Schuur six years ago. She explains that the surgical team at E4 consisted of about 18 people. This includes herself, five scrub nurses, three anaesthetic nurses, three floor nurses, a registered nurse who assists in recovery, and a clerk. Peters adds that there are also two surgical medical officers and two anaesthetic registrars.

According to Davids, when the project started, several of the nurses had not worked in a theatre before so had to be trained and upskilled by her and some of the specialist nurses who make up the scrub nurse team. She also had to get creative about having the right equipment for each surgery, which sometimes meant she had to borrow equipment from other theatres.

“It’s been a challenge, but it’s a good challenge that’s kept me going,” she says. “We’re a good team.”

“Trust [in staff] has been fundamental to this,” says Peters, “I mean, the ability to trust junior staff to upskill themselves to become scrub nurses, to hand surgeons the right instrument when they asked for it. That’s been really heart-warming.”

‘Behind every number on the list is a patient’  

When asked why it was so important to do this kind of catch-up, Cairncross says the surgeries that were postponed during the COVID-19 pandemic were ones that weren’t urgent or emergent, but those patients who were bumped still struggled physically because of the delays.

“Behind every number on the list is a patient with a story of either progressive blindness, invasive skull tumours, or tumours around the auditory canal that result in hearing loss, chronic pain from joint problems and urinary retention with recurrent infections and admissions or having a stoma bag [a colostomy bag] with them for months longer than needed,” Cairncross says. “Heart-breaking stories and often these were the patients who kept getting cancelled [on]. They would come in and if something urgent would come up, they would be cancelled or the COVID wave would come.”

She adds that at the time when the idea for Surgical Recovery came about, the morale amongst the surgical teams was at a real low. Patients would be coming to the outpatient clinics and asking, for the umpteenth time, “when am I going to have my operation?” to which the healthcare workers had to keep responding that they don’t know.

“It’s just a terrible thing and so people [staff] started to feel disempowered and disillusioned and I really think that the project helped them to at least see some progress. That there were some changes or some shift in what they were dealing with,” Cairncross says. “It hasn’t cleared our entire backlog, and a once-off project will not do that, but it has reset us pretty close to where we were pre-COVID-19.”

Peters adds that while the backlogs haven’t been fully cleared, “for every case that we’ve done in the project, it’s someone off of a waiting list”.

Health system at a ‘precipice’

While the COVID-19 pandemic caused many surgeries to be postponed and added tremendously to surgical waiting lists, it isn’t the only factor contributing to backlogs. According to Peters, the issue of a shrinking health budget for tertiary services is and will continue to add to the existing backlogs across the country.

“There’s this building backlog coming up against the shrinking budget. And that’s going to be with us for multiple years going into the future and if the clinicians aren’t protecting the budget for these patients that get missed, we’re going to focus on as we have been the emergency patients that come through the door,” he says. “But it’s always difficult for tertiary academic services because to keep up the skills of surgeons to maintain the quality of care, they do need to be managing waiting lists of booked patients. And so, I think across the country we’re going to be struggling with that across all tertiary services.”

Cairncross tells Spotlight that the project is just a temporary measure. In the long term, healthcare systems need to be fixed in order to address issues like surgical backlogs.

“The lesson, I suppose, is that these are temporising measures. We can do them, but fundamentally we need to fix the health system at a core, structural level. And we can’t work in isolation from the rest of the country because we are one health system and tertiary hospitals are only a part of that ecosystem,” she says. “The services at Groote Schuur Hospital, for example, cannot be sustained if the health systems from primary care to district health facilities, in urban and rural facilities, and across provinces are not supported and strengthened.”

The health system is at a precipice, according to Cairncross, and big academic hospitals need to be anchoring elective surgical services together with emergency services, as the problem with emergency services will only get bigger down the line if electives aren’t dealt with now.

“We know that postponed elective surgery just becomes emergency surgery over time, making cancelling elective surgery a false economy. We need to plan robust systems that ensure all types of surgical services are maintained,” she says.

“The strongest voice [in defence of the health system] is a conscious and motivated health workforce. So, where the nurses and doctors and managers are standing and defending patient services, they are supporting the health system,” she says. “I think this is an example of health workers standing up and saying, we can’t allow this deterioration in services. We’ve got to do more. We really want to tell the story, so that people can see it can be done.”

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight

Categories : Ethics and LawTags :

HPCSA’s Nationwide Crackdown on Bogus Doctors Continues

On By ModernMedia
Photo by Bill Oxford on Unsplash

The Health Professions Council of SA (HPCSA) has caught out another individual impersonating a doctor. Mr Tshifata Katembwe, a Congolese national, was practising illegally in Kuruman, Northern Cape while not being accredited with the Council, said spokesperson Christopher Tsatsawane.

According to IOL, since January 2022. Mr Katembwe had been working at a medical practice registered under the name of Dr TK Gopane. This was in in contravention of Section 17(1) of the Health Professions Act, 56 of 1974, said Tsatsawane.

The nationwide crackdown on health-care practitioners operating illegally is gaining momentum with arrests made around the country, Health Professions Council of SA (HPCSA) has noted.

Katembwe appeared before the Kuruman Magistrate’s Court last week, and his case was postponed. Meanwhile, Dr Gopane, registered with HPCSA as a medical practitioner, is to be reported to the Medical and Dental Professions Board for appointing an unregistered person and putting unsuspecting members of the public at risk.

In a separate incident, HPCSA announced the arrest of Mr Simba Koromani, an undocumented Zimbabwean national who applied to practise by using the credentials of Dr Lesne Pucjlowski. The doctor notified the HPCSA that someone had tried to apply for a job with her credentials, which led the Council to collaborate with police in tracking down and arresting the fraudster.

Source: IOL

Categories : Healthcare Politics and RegulationsTags : 2 Comments

South African Medical Association Rejects NHI Bill as it Now Stands

On By ModernMedia

The South African Medical Association (SAMA) issued a statement stating that they reject the current form of the National Health Insurance (NHI) Bill, with a major objection being that the mere establishment of the NHI fund does not embody the Constitutional principle of universal health coverage (UHC).

The NHI Bill is designed to provide one pool of healthcare funding to all South Africans and long term residents.

They state that the NHI Bill was developed without regard to expert concerns and opinions, especially on key issues such as Contracting Units for Primary Healthcare (CUPS), Benefit Packages and Reimbursement Models.

Given the mismanagement of COVID funds by the government and state-owned entities, there is further concern over its ability to regulate the R500bn fund.

SAMA spokesperson Dr Mvuyisi Mzukwa said: “Misappropriation of funds in various state-owned entities casts doubt on government’s ability to handle the health care budgets responsibly. The public, alongside healthcare stakeholders, cannot simply entrust their lives to a government with an established history of financial mismanagement.”

SAMA contends that while the UHC is intended to improve the health and livelihoods of all South African citizens, the Bill as it stands will set the healthcare system up for failure.

“SAMA believes that a robust approach to health systems strengthening is indispensable, as it would rectify the current deficiencies and overcome the challenges posed by the NHI,” the statement concludes. “This approach seeks to enhance the efficiency, effectiveness, and resilience of the healthcare system, ensuring the delivery of optimal care to all individuals. Governance within the healthcare sector must be strengthened, with transparency and accountability at its core. Effective management of funds and meticulous budget allocation is imperative to rebuild trust and demonstrate responsible stewardship of public resources.”

Categories : General InterestTags :

500-year-old Horn Container Discovered in South Africa Sheds Light on Pre-colonial Khoisan Medicines

On By ModernMedia
Both the Khoi and the San believed in a mythical animal, resembling a cow, whose horns were thought to have medicinal attributes. Credit: Rodger Smith

By Justin Bradfield, The Conversation

In 2020, a chance discovery near the small South African hamlet of Misgund in the Eastern Cape unearthed an unusual parcel – a gift to science. The parcel turned out to be a 500-year-old cow horn, capped with a leather lid and carefully wrapped in grass and the leafy scales of a Bushman poison bulb (Boophane disticha). Inside the horn were the solidified remnants of a once-liquid substance.

Thanks to chemical analyses, we now know that the horn was a medicine container. It is the earliest known object of its kind from anywhere in southern Africa and offers the first insights into pre-colonial medicines in this part of the world.

My colleagues and I conducted chemical analyses of the contents. We identified several secondary plant metabolites, the most abundant of which were mono-methyl inositol and lupeol. Both of these compounds, and indeed all of those identified, have known medicinal properties.

This remarkable find is the oldest example in southern Africa, of which we are aware, of two or more plant ingredients being purposefully combined into a container to form a medicinal recipe. Several museums in South Africa house examples of medicine horns collected during the 19th and 20th centuries – but none has ever been found in an archaeological context.

Various plant uses

The medicine container was found in a painted rock shelter. A radio carbon date of the horn container places the parcel at around AD 1461-1630. Although the rock shelter contains several San paintings, we do not know if they are the same age as the horn container. At this time the area was occupied by both San hunter-gatherers and Khoi pastoralists; both believed in a mythical animal, resembling a domestic cow, whose horns were considered to have medicinal attributes.

People have exploited the pharmacological properties of plants for at least the last 200 000 years. The descendants of these communities still live in Southern Africa today. During the Middle Stone Age (which started about 300 000 years ago and ended between 50 000 and 20 000 years ago), people burnt certain aromatic leaves to fumigate their sleeping areas. Plant extracts also seem to have been the main component of glues and adhesives and hunting poisons around this time.

But not much is known about traditional medicines from the pre-colonial era of southern Africa. What information there is derives mainly from early traveller accounts and modern ethnographic studies. The horn offered us a chance to learn a little more about traditional knowledge of medicine and pharmacology during this early period.

The descendants of these communities still live in southern Africa today.

Medical and spiritual applications

The main compounds present in the container, mono-methyl inositol and lupeol, are still found today in a variety of known medicinal plants in the Eastern Cape. They have a wide range of recorded medicinal applications, including the control of blood sugar and cholesterol levels, and treatment of fevers, inflammation and urinary tract infections. They can also be applied topically to treat infections – rubbing ointment into cuts in the skin is one of the ways the San are known to have administered certain medicines.

Both mono-methyl inositol and lupeol are pharmacologically safe compounds. This means that they can be ingested without the risk of overdose. Both compounds stimulate the production of dopamine in the brain; mono-methyl inositol is used to treat anxiety, and plants containing lupeol are used as aphrodisiacs.

For the Khoi and San people, not all medicines were meant to treat physiological illnesses. Healers were specialised individuals whose task was to treat both physical and spiritual ailments. Indeed, one of the principal functions of traditional medicine, both in the past and today, is to treat supernatural bewitchment. Medicine and culture remain intimately entwined and traditional medicine, which is highly adaptive, continues to play an important role in much of Africa as a primary health service.

A treasured possession

We cannot know exactly what the medicine stored in the horn was used for, how it was administered or who precisely used it. But it was clearly a treasured possession, judging by the way it was carefully wrapped and deposited in the rock shelter. Its owner evidently intended to retrieve it but never returned.

The absence of any evidence of long-term occupation of the shelter means that the medicine horn is an isolated, chance discovery. Nevertheless, this is a find that sheds new light on traditional medicines used in the Eastern Cape 500 years ago.

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

Source: The Conversation

Categories : Diseases, Syndromes and ConditionsTags :

Gauteng Cholera Deaths Rise as Government Sets up Field Hospital

On By ModernMedia

As of Sunday, reports indicate that 23 people have died so far in the recent cholera outbreak in Hammanskraal, a direct result of the town’s neglected water sanitation infrastructure. A further 48 have been hospitalised, with six emergency field tents being set up to prop up the overburdened Jubilee Hospital, which has seen 215 patients since 19 May, as reported in the most recent Gauteng Department of Health bulletin.

The temporary field hospital has been set up to immediately attend to cases of dehydration, supplying oral rehydration solution (IRS) as well as intravenous fluids. More critical patients are taken to Tshwane hospitals.

The Gauteng Department of Health also notes that as of Friday, 27 of the 75 confirmed cholera cases had recovered and been discharged. The Gauteng Department of Education has said that it will intensify efforts to supply schools in Hammanskraal with clean drinking water.

South Africa’s most serious outbreak of cholera in recent history was from November 2008, when a massive cholera outbreak occurred in Zimbabwe and spread to South Africa. Within the first 5 months of the outbreak, more than 73 000 cases and 3500 deaths (case fatality rate of >4.7%) had been reported, and it spread to South Africa through Musina. Between 15 November 2008 and 30 April 2009, a total of 12 706 cases of cholera were reported by the National Department of Health. Of the total number of cases, 1114 (9.0%) were laboratory-confirmed cases, and 65 deaths (case fatality rate of 0.5%) were recorded. In this outbreak, microbial analysis published in the Journal of Infectious Diseases found the emergence of antimicrobial resistance in Vibrio cholerae 01 strains.

The National Institute of Communicable Diseases has posted guidelines [PDF] for the management of suspected cholera chases.

Categories : HospitalsTags :

Nurses Protest Against Staff Shortage at Hospital Treating Cholera Patients

On By ModernMedia

By Chris Gilili for Groundup

Almost 100 former nurses at Jubilee District Hospital in Hammanskraal are calling on the Gauteng Department of Health to employ them permanently. Originally contracted in July 2020 to deal with the Covid pandemic, their employment contracts were periodically renewed but terminated at the end of March 2023.

The nurses have been sitting outside the hospital since Monday.

“They want us to work under agencies, and we don’t want that,” said a nurse.

“This hospital is very understaffed, but they are being stubborn. Inside the wards there are only two nurses working, and they are overstretched. They are struggling but the department doesn’t want to employ more nursing staff,” she said.

“It’s heartbreaking to see our people in distress, and I know I am a qualified person and could help. We are told there is no budget for us,” she said.

In a statement on Monday, the Democratic Nursing Organisation of South Africa (DENOSA), said as a result of the cholera outbreak “Jubilee Hospital is now experiencing an influx of patients, which is stretching the facility to breaking point.”

“Nurses in the facilities in the area will also be made to perform duties that are outside their scope of practice where they may be expected to carry water buckets to the water tankers. DENOSA does not encourage that nurses perform duties that are outside their scope.”

DENOSA Gauteng provincial secretary Bongani Mazibuko said there was a shortage of nurses and that it had been agreed at the provincial level to extend the contracts of Covid contract nurses.

Mazibuko said the contracts were due to end on the 31 March 2023 and the Gauteng health department was supposed to have given the nurses new contracts for 1 April 2023 to March 2024.

He said nurses whose contracts had been terminated should contact the union.

GroundUp made several attempts, all in vain, to get comment from the Gauteng health department.

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

Source: GroundUp