Healthcare Gazette - 2016 Jan/Feb

HEALTHCARE GAZETTE

JANUARY/FEBRUARY 2016 • ISSN 2078-9750

THE NUTRITION “TRIAL OF THE CENTURY”?

PG 13

LESSONS FROM THE COUNTRY’S SNAKEBITE CAPITAL PG 20 09

16

NEWS

Pressure to act on HPCSA dysfunction

24

RESEARCH

Malaria treatment and Ebola disease

38

FEATURE

High tech drones the answer to diagnostics and delivery

H EALT H CARE G A ZE TTE | J A NU A RY 2 0 1 6 WWW.HMPG.CO.ZA

FOCUS

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Contents | 03

Co nt ent s NEWS

07

People on the move

08

Anaesthesia to blame in Limpopo mother deaths

13

Tim Noakes back in HPCSA dock in February

17

SA needs to speed up TB control – WHO

14

Generics could save health system R4 billion

18

Pressure to act on HPCSA dysfunction

34

SAMA president: Medico-political veteran, psychiatrist and treatment pioneer

RESEARCH

16

FOCUS Fry vegetables in olive oil for better health

Malaria treatment and Ebola disease

Higher-fat DASH diet lowers blood pressure and triglycerides

17

Reduce sugar in soft drinks to tackle obesity and disease

11

Mayosi: Eskom and health system share similar woes

17

38

Facelift therapy for the oesophagus?

Innovative GERD research

CLINICIAN’S VIEW

FEATURES

41

Apartheid’s chemical and biological weapons programme: Lessons from the country’s snakebite Equivalent to developing new AIDS drugs? capital

20

10

SA’s doctors brace for wave of climate change diseases

Basson’s private ECG tutoring sets pulses racing

Can anxiety damage the brain?

18 09

30

PROFILES

18 09

A new viral threat in 2016

Atrial fibrillation a stronger predictor of cardiac disease in women

24

High-tech drones the answer to life-saving diagnostics and delivery

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Ed’s Letter | 05

Ed’s Letter EDITOR Chris Bateman CONTRIBUTORS Marika Sboros, Salim S Abdool Karim, Bridget Farham

C H R I S B AT E M A N

FROM GROUND ZERO TO LOFTY HEIGHTS IN HEALTHCARE PROVISION

T

HIS MONTH

reach a clinic or hospital.

the White Paper is finally

we move from

Early disease detection

out, we profile how Western

grassroots early

and treatment will both

Cape GPs, among the first to

healthcare

ease the massive pressure

engage with pilot projects,

delivery –

on healthcare facilities and

are pulling out, citing

the holy grail of disease

the workload of hugely

inadequate pay and delays

prevention – to a high-

overburdened, thinly-spread

in payment. We also profile

flying story on the massive

healthcare professionals. In

an outstanding healthcare

potential drones have for

a similar vein, small fixed-

leader, veteran psychiatrist and

improving healthcare delivery

wing drones can deliver

new SA Medical Association

to isolated rural populations.

disinfected ultra-lightweight

President, Prof. Denise White,

Ward-based outreach teams

DNA samples (which pose no

whose empathetic ear is

in and around the Pretoria

infection threat) from distant

firmly on the heartbeat of

area have so far collected

outlying areas, enabling

current healthcare delivery.

invaluable data on the 60 000

same-day laboratory results,

Among other topics covered

families they are treating

to allow life-saving treatment.

are a story that includes an

and referring onwards in

A sturdier unmanned

invaluable 101 lesson on

their own backyards, the raw

aerial vehicle (UAV) with a

snakebite treatment by one

and incipient equivalent of

2.5 metres wingspan, and

of the country’s top experts

the mighty private sector

manufactured commercially

and one province’s desperate

medical aid Discovery whose

in South Africa, can deliver

bid to reduce its R3 billion

high-tech use of wellness

a 3 kg payload hundreds

litigation bill. Finally, in our new

and preventive medicine

of kilometres, boasting a

Clinician’s View column, Dr

has built an empire. Called

continuous flying time of 6

Wouter Basson, who equated

Community Oriented

hours. All very exciting, but

his nefarious apartheid-era

Primary Health Care (COPC),

there’s some unavoidable

research to developing an

battalions of basically

turbulence: safety issues,

antibiotic or a new drug

skilled healthcare workers,

written into new legislation,

against AIDS, is confronted by

supported by designated

are preventing projects

top HIV/AIDS researcher and

GPs and specialists, are

getting off the ground. A

epidemiologist, Prof. Salim

making a much-needed

multi-stakeholder health task

Karim.

societal impact. COPHC is

team is hoping to address

based on the hard truth that

the very real constraints.

only half of South Africans requiring treatment ever

With the NHI on everybody’s lips, now that

All articles written by Chris Bateman unless stated otherwise.

SUB-EDITOR Diane de Kock Published by the Health and Medical Publishing Group (HMPG) CEO AND PUBLISHER Hannah Kikaya EDITOR-IN-CHIEF Janet Seggie EXECUTIVE EDITOR Bridget Farham MANAGING EDITOR Ingrid Nye TECHNICAL EDITORS Emma Buchanan, Paula van der Bijl PRODUCTION AND ADMINISTRATION MANAGER Emma Jane Couzens HEAD OF SALES AND MARKETING Diane Smith | +27 (0) 12 481 2069 | sales@hmpg.co.za SALES REPRESENTATIVES Charles Duke Renee van der Ryst Azad Yusuf Benru de Jager Ladine van Heerden CUSTOMER SERVICE & ONLINE SUPPORT Gertrude Fani | +27 (0)21 532 1281 | publishing@hmpg.co.za FINANCE AND ADMINISTRATION Tshepiso Mokoena | +27 (0)12 481 2140 | tshepisom@hmpg.co.za LAYOUT AND DESIGN Tenfour Media Printed by Paarl Print Publisher website: www.hmpg.co.za The Health and Medical Publishing Group is a wholly owned subsidiary of the South African Medical Association (www.samedical.org).

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News | 07

PEOPLE ON THE MOVE

PHARMA DYNAMICS FOUNDER STEPS DOWN

P

HARMA

enviable brand image and

Dynamic’s found-

corporate reputation. This,

er, Paul Anley,

combined with what could

handed over the

be the largest product

chief executive

pipeline in the industry, will

reins of one of South Africa

ensure its continued suc-

(SA)’s fastest growing phar-

cess,” he said.

maceutical firms to industry

The company’s products

veteran Erik Roos, former

include central nervous sys-

CEO of Mylan, SA, at the

tem (CNS), gastrointestinal,

end of November last year.

diabetes, gynaecological and

Anley, who started

men’s health therapies. In

Pharma Dynamics in 2001,

2013, it entered the SA anti-

has driven the Cape Town-

infective market, supplying

based company’s meteoric

IV antibiotics to hospitals.

rise to national recognition

The firm’s over-the-counter

and prominence, making

(OTC) product portfolio

it SA’s biggest distributor

includes antihistamines,

of cardiovascular medi-

cold and flu medication and

cine and the fourth largest

heartburn treatment.

generic pharmaceutical company in the country.

Following the full purchase of the company in April last year by the Lupin Group, India’s third largest pharma-

Paul Anley

ceutical company by total sales, Anley will step down

first South African President

World Trade Organization

as director and CEO at the

of the International Generic

(WTO), the World Health

Pharmaceutical Alliance (IGPA)

Organization (WHO) and

on 1 October last year.

the World Intellectual Prop-

end of March this year. Roos

Vivian Frittelli

ics was ideally positioned to

FIRST SOUTH AFRICAN MAN TO HEAD GLOBAL GENERIC PHARMACEUTICAL ALLIANCE

continue the sales momen-

Vivian Frittelli, CEO of the

International Generic and

SA, Taiwan and the USA,

tum into the next phase of

National Association of

Biosimilar Medicines Asso-

represents the interests of

its growth. “The company

Pharmaceutical Manufacturers

ciation (IGBA), affording it

the generic pharmaceutical

has an experienced man-

(NAPM), the organisation rep-

hugely valuable formal links

and the biosimilar

agement team, an extensive

resenting generic drug man-

with eminent United Na-

medicine industries in

and strong sales force, an

ufacturers in SA, became the

tions agencies such as the

those countries.

will work closely with him in the upcoming months to ensure a smooth transition.

Anley said Pharma Dynam-

DID YOU KNOW?

Biologicals and biosimilars are made from living organisms, and the manufacturing process is highly complex. They are used mostly in the treatment of various forms of cancer and rheumatoid arthritis. Generic medicines contain the same active ingredient and are as

The organisation is to

erty Organization (WIPO).

register as an association

The association, which com-

in Geneva, Switzerland,

prises members from Cana-

and change its name to the

da, Europe, Japan, Jordan,

effective as the originator or branded equivalent but in most cases cost much less. When a generic medicine has been approved by the Medicines Control Council (MCC) it has met the standards required on aspects such as strength, quality, identity and potency.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

“

At one stage, the province had even considered using dentists on overtime to provide anaesthesia

to do spinal blocks with no airway skills, no intubation equipment and insufficient drugs, explains Lundgren.

Natalie Zimmelman, CEO of the South African Society of Anaesthesiologists (SASA) told Healthcare Gazette that in response to the findings from Limpopo, a multistakeholder task team was immediately formed, drawing up a plan for university-led support and reaching a “memo of understanding” with the province.

Prof. Christina Lundgren

ANAESTHESIA TO BLAME IN LIMPOPO MOTHER DEATHS

D

EATHS DUE

section patients died due

to anaesthesia

to anaesthesia in 2014,

among

compared with the national

mothers

public sector caesarean-

for the Comserves. When we

who have

section death rate from

requested the province to

anaesthesia of 2.4%.

give them 2 months’ training

caesarean sections in Limpopo are four times

Limpopo has a 70%

Dr Natalie Zimmelman “I feel desperately sorry

in the tertiary hospital, they

higher than the national

vacancy rate for both general

said it was against policy. So

average, according to 2014

practitioners and specialists,

they all had to go to district

data presented by Prof.

with just four anaesthetists,

hospitals without training,”

Christina Lundgren, Clinical

one a district specialist

she explained.

Head of Anaesthesia at

(mainly administration), two

Chris Hani/Baragwanath

at the local university (one

at one stage, the province

Academic Hospital,

about to retire) and one in a

had even considered using

Soweto, at the University

regional hospital.

dentists on overtime to

of the Witwatersrand’s

These workforce gaps

Lundgren added that,

provide anaesthesia “but

National Forum on Surgery

mean that unsupervised

they recognised very quickly

and Anaesthesia held

community service doctors –

that was not a solution.

in Johannesburg 7 - 8

with little or no anaesthetic

It’s probably cheaper and

December 2015.

training – perform between

quicker to train existing MOs

two and three caesarean

and even Comserves in an

the National Committee

sections per week across

anaesthesia diploma than

for the Confidential Enquiry

the province’s 70 mainly

it would be to train nurse-

into Maternal Deaths

rural district hospitals.

anaesthesiologists,” she

found 10% of all caesarean-

These doctors are forced

observed.

Lundgren reported that

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

News | 9

SA NEEDS TO SPEED UP TB CONTROL – WHO

S

OUTH AFRICANS (SA) are

diagnostic approaches”.

the WHO to be 380 000

Isoniazid preventive therapy

last year (2015), placing

(IPT) uses one of the TB

the country ninth highest

treatment drugs, isoniazid, to

among the 22 high-burden

high TB incidence due to

suppress TB in people with

states. The figures show

HIV infection weakening

HIV. According to national

that the rate at which the

the immune system and

guidelines, people living

disease is spreading in SA

increasing susceptibility to

with HIV who have a positive

has fallen from its peak

TB. One glimmer of hope

reaction to TB skin tests

in the late 2000s (when

is that more than a decade

should take IPT for three years.

incidence stood at more

after preventive TB treatment

Those who are HIV positive

than 900 per 100 000 per

was introduced in SA, we are

and have a negative TB skin

population per year) but

starting to chart gains.

test should receive the daily

nevertheless remains high,

medication for a year.

underscoring TB’s deep

Landon Myer, of the

contracting

University of Cape Town’s

tuberculosis

School of Public Health

Tuberculosis Report, released

(TB) at a higher

said: “The government

in October last year (2015),

director of the TB

rate than in any other

is implementing state-of-

estimates that the annual

programmes at the Gold

country except Lesotho,

the-art TB programmes

incidence rate in SA stands at

Mines-initiated but now

according to the World

recommended by the WHO,

834 per 100 000 population,

stand-alone research

Health Organization

but our tools are really limited.

while Lesotho’s stands at 852

organisation, the Aurum

(WHO)’s latest report on the

We haven’t had new drugs for

per 100 000 for 2014.

Institute, credits research

disease. The country has

ages, drug resistance is on the

The total number of

been hard hit by HIV, and

increase, and we’ve struggled

people infected with TB

recent rise in uptake of the

consequently saw extremely

to come up with better

in SA was estimated by

treatment.

in their jobs, months after

report”, SAMA said the

refusing to co-operate with

probe recommended radical

an official probe. Dr Kgosi

reform.

PRESSURE TO ACT ON HPCSA DYSFUNCTION

N

The WHO’s Global

hold on the country.

Dr Liesl Page-Shipp,

on IPT’s benefits for the

ATIONAL

recently came under pressure

Letlape, outspoken HPCSA

Health

to explain why the defiant

president and a former

representative body called

Minister,

top three Health Professions

long-standing chairman of

on Motsoaledi to use his

Dr Aaron

Council of South Africa

the South African Medical

statutory power to suspend

Motsoaledi,

(HPCSA) officials were still

Association (SAMA) flatly

the entire structure,

rejected what SAMA called

appointing an interim

the “breathtaking arrogance”

management team to

of his top officials in refusing

oversee the process instead.

to resign, as recommended

Never one to stand

by the Ministerial task team

back, Letlape replied: “We

late last year.

expected SAMA to raise its

The team was headed

Dr Kgosi Letlape

The doctor-

concerns first with Council

by widely respected

before raising them in the

University of Cape Town

media. More importantly,

Medicine chief, Dr Bongani

since this was the Minister’s

Mayosi. Calling on Letlape

initiative and as courtesy

“as a fellow doctor”

to him, it was expected

to “demonstrate the

that SAMA would engage

requisite ethical leadership

the Minister to request

required and transform

progress”. He said he’d had

the HPCSA in line with the

already written to SAMA

recommendations of the

saying he would respond to

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

their concerns, but they’d gone public instead.

Had SAMA engaged Council it would have been

LEADERSHIP TRIO “UNFIT FOR OFFICE”

Mayosi’s findings came

briefed on the corrective

after the HPCSA board

measures. The minister was

failed to act on damning

“continually kept abreast on

earlier forensic reports,

all the developments and

or to claim hefty court-

actions taken, having already

ordered legal fees from

received three reports”.

its chief operating officer,

Joe Maila, spokesman for

Advocate Tshepo Boikanyo.

Motsoaledi, told Healthcare

Boikanyo, along with chief

Gazette that nobody had

executive officer (CEO),

“ever reported” to the health

Buyiswa Mjamba-Matshoba

ministry that the HPCSA was

and head of legal services,

resisting implementation of

Phelelani Khumalo, refused

the recommendations. While

to give evidence to the

he would not pre-empt the

ministerial task team

latest discussions between

which found them “unfit

Letlape and Motsoaledi

for office”. Boikanyo had

(then due on 29 January) it

earlier taken the HPCSA

was “safe to say if indeed

to court for not accepting

there is any resistance, the

his application to be CEO,

minister will act within the

losing with costs. The money

prescripts of the law”.

was never recouped.

Prof. Bongani Mayosi

SA’S DOCTORS BRACE FOR WAVE OF CLIMATE CHANGE DISEASES

F

in local mitigation and adaptation efforts. Urgent, practical measures are called for.

The World Health

AST-RISING

drinking water, a loss

Organization (WHO) and

temperatures and

in production and food

the Climate and Health

rainfall/humidity

security and an increase in

Council are drawing

patterns will

extreme weather events.

inevitably lead

SA faced a “desperate

increasing attention to the a draft position on climate

“catastrophic impact” of

to a surge in vector-borne

climate change emergency

change and health and is

climatic shifts on human

and water-related diseases,

situation” with heat waves

printing climate change

health, and the role

especially in sub-Saharan

above 40° C already

posters. “Human health is a

healthcare professionals

Africa, says the South

common and persistent.

priority sector in responding

can play. The WHO puts a

African Medical Association

Pledging to continue his

to climate change and we

high number of deaths and

(SAMA), the largest doctor

association’s collaboration

commend the government

disease globally down to

grouping in South Africa

with the national

for identifying it as such,”

avoidable environmental

(SA). The direct and indirect

departments of health

he said.

risks, including urban

consequences of climate

and environmental affairs,

change – with five SA

SAMA chairman, Dr Mzukisi

provinces already declared

Grootboom, said extreme

drought disaster areas –

weather would result in

would see increases in malaria, dysentery, cholera and dengue, compromised

READY FOR THE CHALLENGE

outdoor pollution, indoor smoke from the burning of solid fuels and biomass in

SAMA will partner in

poor countries; unsafe water,

floods, droughts and heat

government efforts and

sanitation and hygiene;

waves. SAMA has set up a

contribute its knowledge,

chemical exposure; and

climate change task team,

authority and influence

occupational diseases.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

News | 11

Tragically, says Grootboom, the greatest burden falls

HEALTH IMPACTS resulting from extreme

crushingly on the health

weather events that are likely to increase in certain areas of South Africa under future climatic conditions

systems of developing countries – mostly in subSaharan Africa – and poorer

FLOODS AND STORMS

DROUGHT

FIRE

segments of the society.

n Increased or decreased

n Changes in abundance

n Burns and smoke

Water is fast becoming a

vector (e.g. mosquito)

of vectors that breed in

inhalation

scarce resource, with the

abundance (e.g. if breeding

dried-up river beds

n Soil erosion and

next world war anticipated

sites are washed away)

n Food shortages

increased risks of

to be over water resources.

n Increased risk of

n Illness

landslides

respiratory and diarrhoeal

n Malnutrition

n Increased mortality

for optimism: the 2015

diseases

n Increased risk of infections

and morbidity

Lancet Commission on

n Drowning

n Death (starvation)

n Increased risk of

Health and Climate Change

n Injuries

n Health impacts

hospital and emergency

asserted that climate change

n Health effects

associated with population

admissions

could be the biggest

associated with population

displacements

global health opportunity

displacements

of the 21st century, if an

n Impacts on food supply

urgent and multidisciplinary

n Mental health impacts

There is, however, cause

approach is adopted.

MAYOSI: ESKOM AND HEALTH SYSTEM SHARE SIMILAR WOES

Source: International Climate Initiative (ICI). Climate and impacts factsheet, factsheet 5 of 7. http://www.sanbi.org/sites/default/files/documents/ documents/ltas-factsheetclimate-change-and-human-health2013.pdf

urgent need for smarter use

a thousand times more is

of facilities and teachers to

needed – government needs

expand capacity”.

to be a little more ambitious.

More strategic use of

If we did this (to scale) over

resources will help reduce the

the next five years there’d

poverty and inequity-driven

be a real prospect of doing

healthcare crisis, aggravated

it well and not seeing our

by a globally unequalled

children going to other

quadruple burden of disease,

countries to learn medicine

Mayosi said, adding that “in

in another language” (a

the current fiscal space”, the

reference to the stop-gap

government simply did not

controversial Cuban medical

have sufficient resources.

education programme for

Many universities were working at under-capacity. If

Prof. Bongani Mayosi

T

HE HEALTHCARE

He explained to the

South Africans).

Mayosi’s comments were

the government strategically

a response to Discovery

invested more money in

Health Chief Operating

creating posts for medical

Officer, Dr Ryan Noach, who

specialists, teaching would

suggested that the private

quickly expand. “We need

sector could help the public

human

Discovery Health Non-

to begin with people who

sector in expanding teaching,

resources

Communicable Diseases

can teach and use them to

thus increasing the output of

crisis in South

Summit, Johannesburg,

create new medical schools.

healthcare professionals.

Africa is similar

that South Africa’s health

Yes, there has to be a public/

to Eskom’s energy crisis,

system is “still operating with

private partnership and the

the private healthcare sector

according to Professor

the same number of staff/

health ministry has begun

was unanimous in agreeing

Bongani Mayosi, head of the

facilities we had 20 years

such an initiative to enhance

that it would “co-operate in

Department of Medicine,

ago but the population has

public sector capacity. But

any way to try and improve

University of Cape Town.

doubled, prompting an

we need to do it on scale:

training”.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Noach reiterated that

P

Service

Excellence ar

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The wider implications of the results have been hailed as hugely significant because it is the first time any medicine has slowed the rate at which the disease damages the brain

News | 13

From left to right: Adam Pike, of Adam Pike Law; Durban advocate Ravin “Rocky” Ramdass; Johannesburg advocate Michael van der Nest SC; Prof. Tim Noakes; articled clerk Brigid Kell, and South African dietition Dr Caryn Zinn, who now works and lectures in New Zealand, and who was to be an expert witness for Noakes at the November hearing which ended a day early, before the defence could begin its case. Photograph courtesy of Caryn Zinn.

TIM NOAKES BACK IN HPCSA DOCK IN FEBRUARY By Marika Sboros

T

throughout by twists and

high-carbohydrate, low-fat

surprise turns, including

dietary advice may play in

procedural problems and

the growing epidemics of

delays. The hearing is being

non-communicable diseases

HE UNPRO-

seen as Noakes’ fight for his

in SA and many other

fessional

reputation against his own

countries.

conduct trial

professional body and against

brought against

dietitians who do not want

that the HPCSA’s own

Prof. Tim

It is also expected

him giving nutrition advice

reputation will be affected

Noakes, emeritus professor of

that challenges medical and

by the conduct and outcome

the University of Cape Town,

dietetic dogma.

of this hearing after a

by the Health Professions

It is anticipated that the

damning report described

Council of South Africa

weak evidence base for the

the organisation as being

(HPCSA), was reconvened

government-sanctioned

in a state of “multi-system

on 8 Feburary 2016, after

dietary guidelines will also

organisational dysfunction”

the initially scheduled

be interrogated during the

by a ministerial task team set

hearing, along with the role

up in March 2015.

dates were postponed from

about a tweet sent by

November 2015.

Noakes to a new mother,

Noakes was accused of

advising that her child should

unprofessional conduct by

be weaned onto a low-

the HPCSA after it received

carbohydrate, high-fat diet.

a complaint in Feburary 2014

The “Banting for Babies

from the president of the

trial”, as the HPCSA hearing

Association for Dietetics,

against Noakes has become

Claire Julsing-Strydom,

known, has been punctuated

THE TWEET THAT LED TO THE TRIAL

Prof. Tim Noakes

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

GENERICS COULD SAVE HEALTH SYSTEM R4 BILLION

H

EALTHCARE

trends in the UK and the USA

spending could

– but is still nowhere near

be reduced

their levels. Frittelli asserts

by R4 billion

it will require a major shift in

Vivian Frittelli

“

It’s the fear factor and prejudices many doctors against generics – which the patient obviously follows

A recent NAPM study comparing the cheapest generics versus originator drug prices found that for

if doctors

perceptions by both doctors

prescribed some of the

and their patients in order to

newer generic drugs on

increase the use of generics

the market, rather than

further so that the health

more expensive brand

system can benefit from the

“Basket for basket,

name products, according

potential cost savings.

you’d save 56.1% by

the 200 most prescribed medicines in the private sector, generic alternatives were 56.1% cheaper.

to Vivian Frittelli, CEO of

Frittelli told Healthcare

the National Association

Gazette that generics were

explains. Considering that

of Pharmaceutical

often wrongly perceived by

production standards and

Manufacturers (NAPM),

both doctors and patients

manufacturing costs for

which represents the

to be inferior because they

both original and generic

interests of generic medicine

were cheaper. Sophisticated

medicines were similar,

manufacturers and marketers

marketing by originator

these findings were ‘’highly

in South Africa (SA).

drug companies reinforced

significant”, he added.

using generics,” Frittelli

He explained the R4

this message. “I worked for

billion saving calculation was

an originator company for

a global organisation which

based on the assumption of

20-odd years and one our

tracks data at sales level,

18% of brand name drugs

messages was this: ‘If your kid

generics account for about

reaching the end of their

had meningitis would you use

65% of all items dispensed

patent periods, allowing

generics?’ It’s the fear factor

in SA’s private sector yet

generic versions to be sold.

and prejudices many doctors

account for only 40% of the

against generics – which the

R22-billion expenditure

patient obviously follows.”

on drugs.

The use of generics in SA is growing in line with

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

According to IMS Health,

Lead with answers.

Better Answers for Better Care.

ClinicalKey drives better care by delivering fast, concise answers when every second counts, and deep access to evidence whenever, wherever you need it.

It’s time for Elsevier ClinicalKey

Contact g.deysel@elsevier.com

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Malaria treatment and Ebola disease

used against malaria. When an Ebola treatment centre in Foya, Lofa County, Liberia, ran out of artemetherlumefantrine, they used artesunate-amodiaquine

The outbreak of Ebola virus

instead. The upshot was

disease (EVD) in West Africa

that the Ebola patients

led to more than 28 000 cases

who received artesunate-

and has claimed more than

amodiaquine showed a

11 000 lives since the outbreak

31% lower risk of death than

was first declared in March

those prescribed artemether-

2014, with most of the burden

lumefantrine. Questions

of disease observed in Guinea,

about the mechanism remain

Sierra Leone and Liberia.

and the authors of this study

Among the few candidate

urge healthcare providers

compounds identified for

in countries affected by the

treatment are artemisinin-

Ebola virus to try to confirm

based combinations, usually

these findings.

“

The outbreak of Ebola virus disease (EVD) in West Africa led to more than 28 000 cases and has claimed more than 11 000 lives since the outbreak was first declared in March 2014

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Gignoux E, Azman AS, de Smet M. Effect of artesunate-amodiaquine on mortality related to Ebola virus disease. N Engl J Med 2016;374:2332. [http://dx.doi.org/10.1056/ NEJMoa1504605]

Research | 17

Reduce sugar in soft drinks to tackle obesity and disease one cause of pandemic

obesity is sugar – mainly

A new viral threat in 2016

in soft drinks. A modelling study, using nationally

The Zika virus is a growing

representative data from

concern in Central and South America and is posing a

Consensus is that at least

the UK National Diet and Nutrition Survey rolling

programme from 2008 to

2012 and British Soft Drink Association annual reports

to calculate sugar-sweetened beverage consumption,

Atrial fibrillation a stronger predictor of cardiac disease in women A meta-analysis of cohort studies published between January 1966 and March 2015 picked out sex-specific associations between atrial fibrillation and all-cause mortality, cardiovascular-

suggests that a 40%

reduction in free sugars

in soft drinks over 5 years would lead to an average

reduction in energy intake of 38 kcal per day by the

end of 5 years. This would

lead to an average reduction

mortality, stroke, cardiac events and heart failure. They found that atrial fibrillation is associated with a higher risk of all-cause mortality in women

growing threat to global health security. Locally

transmitted cases have

been detected in Columbia, El Salvador, Guatemala,

Mexico, Paraguay, Puerto Rico and Venezuela. In

“

They found that atrial fibrillation is associated with a higher risk of all- cause mortality in women and a significantly stronger risk of stroke and cardiovascular events and mortality

December 2015, the

Brazilian health ministry

reported a 20-fold annual

increase in cases of newborn babies with microcephaly in the north-eastern region of

the country. The fundoscopic changes in the macular

region in three of these

and a significantly stronger risk of stroke and cardiovascular events and mortality.

of body weight of 1.2 kg,

reducing the prevalence of

babies with microcephaly

and obesity by 2%, with

with the Zika virus. Other

may be linked to infection

overweight in adults by 1%

congenital neurological

concomitant reductions in

abnormalities and increased

type 2 diabetes.

frequency of Guillain-Barré syndrome linked to the

Ma Y. Gradual reduction of sugar

Zika virus have also been

in soft drinks without substitution

Emdin CA, Wong CX, Hsiao AJ et

as a strategy to reduce overweight,

al. Atrial fibrillation as risk factor for

obesity, and type 2 diabetes:

cardiovascular disease and death in

A modelling structure. Lancet

women compared with men: Systematic

Lancet editorial. Zika virus: A new

Diabetes Endocrinol. Published

review and meta-analysis of cohort

global threat for 2016. Lancet

online 6 January 2016 [http://dx.doi.

studies. BMJ 2016;19(532):h7013.

2016;387(10014):96. [http://dx.doi.

org/10.1016/S2213-8587(15)00477-5].

[http://dx.doi.org/10.1136/bmj.h7013]

org/10.1016/S0140-6736(16)00014-3]

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

reported.

Higher-fat DASH diet lowers blood pressure and triglycerides

Fry vegetables in olive oil for better health Can anxiety damage the brain?

We know that stress exacerbates illnesses such as depression and also increases the risk of dementia, suggesting a common mechanism for stress-induced mood and cognitive disorders. But, does anxiety damage the brain? A recent review found that pathological anxiety and chronic stress lead to structural degeneration and impaired functioning of the hippocampus and the prefrontal cortex, suggesting a mechanism

“

A mechanism for anxietyrelated brain damage potentially leading to depression and dementia

The Dietary Approaches to Stop Hypertension Researchers from the

University of Grenada

have shown that frying vegetables in extra-

virgin olive oil increases

the antioxidants and the phenolic fraction in raw

vegetables common in the Mediterranean diet, for

example, potato, squash

and eggplant. In contrast, boiling these vegetables

reduces their antioxidant content. Frying these vegetables in extra-

virgin olive oil therefore improves the quality of

the raw foods and may in turn lead to a lower risk

of heart disease and some chronic or degenerative conditions.

for anxiety-related brain

(DASH) diet, high in fruit and vegetables and low-fat dairy products, significantly lowers blood pressure as well as lowdensity lipoproteins (LDL).

However, a recent study published in the American Journal of Clinical Nutrition suggests that a higher-fat DASH diet lowered blood pressure to the same extent as the traditional DASH diet and also reduced triglycerides and did not raise LDL. Compared with the DASH diet, the HF-DASH diet has more total and saturated fat and less carbohydrate, achieved mainly by reducing fruit juices and other sugars.

damage potentially

Anaya R. Phenols and the

leading to depression and

antioxidant capacity of

Krauss R. Comparisons of the

dementia.

Mediterranean vegetables

DASH diet and a higher-fat DASH

prepared with extra virgin olive

diet on blood pressure and lipids

Mah L, Szabuniewicz C, Fiocci AJ.

oil using different domestic

and lipoproteins: A randomized

Can anxiety damage the brain?

cooking techniques. Food

controlled trial. Am J Clin Nutr

Curr Opin Psychiatry 2016;29(1):56-

Chem 2015;188:430-438.

2015. ajcn.nutrition.org/content/

63. [http://dx.doi.org/10.1097/

[http://dx.doi.org/10.1016/j.

early/2015/12/29/ajcn.115.123281.full.

YCO.0000000000000223]

foodchem.2015.04.124]

pdf+html

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

5th Annual

OUTBREAK CONTROL AND PREVENTION AFRICA CONFERENCE

CPD ACCREDITED

Dates: 20 & 21 April 2016

Venue: Indaba Hotel, Fourways, Johannesburg

CONFIRMED SPEAKER FACULTY Dr Chika Asomugha Senior Medical Advisor for Public Health and the Communicable Diseases Programmes GAutenG DepArtment oF HeAltH professor Stella Anyangwe Honorary Professor of Epidemiology unIVerSItY oF pretorIA Dr Salim parker President SoutH AFrICAn SoCIetY oF trAVel meDICIne mandla Zwane Deputy Director - Health mpumAlAnGA DepArtment oF HeAltH Dr lourens robberts ‎Clinical & Public Health Microbiologist unIVerSItY oF CApe toWn

Dr Jacob Sheehama Deputy Associate Dean SCHool oF meDICIne - unIVerSItY oF nAmIBIA Dr lesego Bogatsu Senior Manager-Aviation Medicine SoutH AFrICAn CIVIl AVIAtIon AutHorItY Thulisa Mkhencele Epidemiologist nAtIonAl InStItute For CommunICABle DISeASeS thomas Dlamini Epidemiologist & Researcher eAStern CApe DepArtment oF HeAltH professor Bethabile lovely Dolamo Professor: Health Services Management and Leadership DepArtment oF HeAltH StuDIeS - unIVerSItY oF SoutH AFrICA

Diana Chebet Microbiologist & Infection Control Unit Team Leader pHArmAKen ltD - KenYA

PRACTICAL CASE STUDY WORKSHOP

Godwill mlambo Assistant Malaria Control Manager tFm proJeCt DemoCrAtIC repuBlIC oF ConGo CPD Accredited: Level 1 – 10 Clinical Points (1pt per hr) 10 Speaker points (per instance)

• • • •

DISCuSSInG tHe InternAtIonAl reSponSe pArADIGm to pAnDemIC DISeASe Control In AFrICA AnD tHe nexuS WItH peACeKeepInG reSponSe meCHAnISmS In tHe lIGHt oF tHe WeSt AFrICAn eBolA outBreAK Andre Juan roux Conflict Management, Peacekeeping and Peacebuilding Expert

Sp e o CIA reg FFer l del iste e rec gate r 5 eiv s del e the and e th Fr gate 6 ee

KEY STRATEGIES TO BE DISCUSSED

Analysing the effects of outbreak pandemics on developing countries within Africa Collaborating with national multi-sectoral outbreak response teams managing outbreaks at a national and global level Examining the role of medical and health innovation to prevent and treat deadly infectious diseases

• • • •

Formulating solutions to enhance airport preparedness guidelines for outbreaks of communicable disease Improving the management and control of outbreaks in hospitals and public health centres Discussing the management and control of Tuberculosis within confined spaces Investigating cases of Malaria and providing prevention and control strategies ItC is a proud member of:

Re

se

ar

ch

ed

&

De ve

lop

ed

By

:

For easy registration contact Therisha +27 (0) 11 326 2501 or email bookings@intelligencetransferc.co.za

ItC IS etDp SetA ACCreDIteD & AorleVel 1 B-BBee CompAnY or fax: +27 (0) 11 326 2960 visit: www.intelligencetransferc.co.za

LESSONS FROM THE COUNTRY’S SNAKEBITE CAPITAL The best advice any physician can give anyone calling in about a snakebite victim is: “Get them calm and still and to a hospital as soon as possible”

T

HAT’S THE

Zimbabwean medical doctor

(SA), DNA sampling at

take-home

who worked at the nearby

the bite site was possible

message

Eshowe Hospital), is currently

(but hugely expensive) to

from the

writing his PhD based on an

help identify the type of

immediate

analysis of snakebite data in

snake responsible, with a

KwaZulu-Natal.

high degree of accuracy.

past medical snakebite advisor to the South

Head of the Emergency

Researchers in Australia were

African Vaccine Producers

Medicine Department and

also looking at identifying

(SAVP) Dr Darryl Wood,

the hospital’s academic

snake species from blood

of Ngwelezane Tertiary

division, Wood is also

samples, using biochemical

Hospital in Empangeni,

compiling a national

polymerase chain reaction

probably the country’s

snakebite treatment

leading snakebite referral

guideline after seeing

facility at the centre of what

an average of 200 - 300

is considered the top snake

snakebite victims annually,

hotspot region – northern

most of them victims

coastal KwaZulu-Natal.

of either the nocturnal

“

Please, no tourniquets, sucking, burning or electrocuting of wounds, or visits to traditional healers

(PCR) testing – also costly.

FATALITY RATE BELOW 1%

Dr Wood’s snakebite victim mortality rate in the 9 years he has been at Ngwelezane

Wood, who has followed

Mozambican spitting cobra

in the footsteps of the highly

or puff adder, both of them

Hospital is less than 1%,

respected herpetologist

cytotoxic (tissue-destroying

tragically three of them

and medical doctor, the

poison).While there were

children last year. He said

late Dr Roger Blaylock (a

no studies in South Africa

many doctors made the

SA OLD HAND AT ANTIVENOM PRODUCTION Antivenom production in SA began as early as 1928 at the then South African Institute of Medical Research (now the NHLS), with collaboration between Dr P A Christensen (SAIMR) and Dr Chippaux (Pasteur Merieux Ltd, the forerunner of Sanofi Pasteur) resulting in the products currently produced by the two countries.

The Pasteur Merieux (Sanofi) polyvalent product neutralises the venoms of the Gaboon viper (Bitis gabonica), puff adder (Bitis arietans), white-bellied carpet viper (Echis leucogaste), carpet viper (Echis ocellatus), Egyptian cobra (Naja haje), forest cobra (Naja melanoleuca), black-necked spitting cobra (Naja nigricollis), black mamba (Dendroaspis polylepis), western green mamba (Dendroaspis viridis) and Jameson’s mamba (Dendroaspis jamesoni).

The SAIMR polyvalent antivenom (NHLS) neutralises the venoms of the Gaboon viper, (Bitis gabonica), puff adder (Bitis arietans), Egyptian cobra (Naja haje), forest cobra (Naja melanoleuca), Mozambican spitting cobra (Naja mossambica), Cape cobra (Naja nivea), black mamba (Dendroaspis polylepis), eastern green mamba (Dendroaspis angusticeps), Jameson’s mamba (Dendroaspis jamesoni) and the rinkhals or ring-necked spitting cobra (Hemachatus haemachatus). Monovalent antivenoms for the Saw-scaled viper Echis (Ocellatus/Carinatus), boomslang (Dispholidus typus), scorpion (Parabuthus transvaalicus) and spider (Latrodectus indistinctus) are also produced by SAVP and have been available for nearly 75 years.

H EALT HH EALT CARE H CARE GAZ EG TTE A ZETTE | J A NU | FEBR A RY /FE U ABRU RY 2A0RY 16 2016

Feature | 21

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Puff adder

mistake of injecting just 2 - 3 vials of antivenom, labelling this homeopathic. “We start with about five vials, see how the patient is responding and then give another five – it’s

“

Dr Wood’s snakebite victim mortality rate in 9 years is less than 1%

at 30 - 40%, with children

a very difficult one, especially

generally presenting with

with swelling. We’re about to

more severe symptoms and

publish a scoring system as

posing a higher anaphylactic

part of the guidelines, which

risk. “The appropriate use

will obviously need peer

of antivenom is where we’re

review,” he revealed. Woods

an active dynamic process”.

at on the research barrier at

explained that when swelling

He stressed that the risk of

present – when you do use it,

at the bite site was “grossly

an anaphylactic reaction

you have to give enough. The

severe”, the earlier the

to the antivenom stood

decision to give antivenom is

antivenom was administered,

ANTIVENOM SHORTAGE RUMOURS LAID TO REST

In sub-Saharan Africa alone, an estimated 30 000 people die from snakebite every year and an estimated 8 000 undergo amputations. Distribution inefficiency, maintenance of product integrity and lack of available clinical skills are probably more responsible for these alarming figures than any actual antivenom shortages. However, South Africa (SA) can now expand its production of antivenom to assist with any shortfalls in Africa after the French pharmaceutical company, Sanofi Pasteur, which produced a high-quality polyvalent antivenom stopped manufacturing it in 2012/2013.

This was the assurance given to Healthcare Gazette by Megan Saffer, managing director of SA Vaccine Producers, a subsidiary of the National Health Laboratory Services (NHLS) in January after rumours ran rife that the anti-snakebite serum Fav-Afrique would be unavailable and without a substitute from June 2016. This prompted unfounded fears that victims of snakebite in SA might also be left vulnerable, when the opposite is true. Any public hospital in SA that requests antivenom from a central provincial pharmacy will receive adequate supplies, provided sufficient orders are

made timeously by its resident chief pharmacist. Saffer said there was “no reason” for any healthcare facility, public or private, not to have stock of antivenom. The SAVP had not had a single stock-out over the past 12 years, she emphasised.

Priced out of the antivenom market by higher-producing snakebite serum manufacturers, Sanofi Pasteur provided about 500 ampoules of polyvalent (able to treat the bites of 10 different venomous African snakes) per annum, described

by Saffer as “pretty low”. Her unit produces 15 000 ampoules (mainly polyvalent, also covering 10 snake species, plus a monovalent serum for the dreaded boomslang) and could easily increase production to assist in continental shortfalls.

Médicins Sans Frontières (MSF or Doctors without Borders) initially sounded the alarm, claiming Africa faced a potential crisis. However, academic research subsequently found that the industry could increase antivenom production from around 80 000 treatments to as many as 600 000 if capacity was fully used, bringing down the price due to economies of scale.

Feature | 23

SNAKEBITE TREATMENT 101 Dr Wood and celebrated author and guru of herpetology in SA, Pretoria-based Johann Marais, generously provided Healthcare Gazette with a brief Snakebite Treatment 101 for healthcare workers: Get the victim to a hospital as soon as possible: “Please, no tourniquets, sucking, burning or electrocuting of wounds, or visits to traditional healers. Only a herpetologist will know if the bite is that of a mamba or similar neurotoxic snake and only appropriately trained medical personnel will know how to apply a tourniquet. If you try this with a puff adder or other cytotoxic bite you will destroy that limb”.

Wood said immobilising the affected limb, providing pain relief and getting the patient to the hospital were top priorities.

“Don’t do all kinds of weird and wonderful things. If you can positively ID the snake, great, but we follow the syndromic approach and find species identification notoriously unreliable,” he added.

Mfezi – Mozambican spitting cobra

the better. “It’s difficult and

fangs able to inject big

takes experience. It also has

doses of venom with a single

to be administered safely in a

bite. All three species were

hospital where resuscitation

cytotoxic. He stressed that

equipment is available,”

mambas, one of the most

he cautioned. He sees an

feared snakes in SA, were

average of two snakebite

very shy and “don’t bite

victims per day.

easily”. The other feared

MFEZI, THE BIGGEST CULPRIT

“

If you can positively ID the snake, great, but we follow the syndromic approach and find speciesidentification notoriously unreliable

snake, the boomslang, was docile but its venom induced coagulopathy (bleeding), and without

Asked about the local

antivenom, there was “very

snakes most responsible

little you can do”. Without

for bites, he described the

treatment its bite was

Mozambican spitting cobra,

universally fatal. “We’ve had

also known in Zulu as the

two deaths from bleeding

mfezi, as “the biggest culprit

out here.” Wood added

– it’s a bad-ass, aggressive

that with neurotoxic bites,

snake and being nocturnal,

a victim should be moved

often creeps into huts where

as little as possible as this

people are asleep on their

encouraged lymphatic

grass mats. He’s at our

spread of the poison.

business end”. However,

Once again, like all

the most severe bites were

medical treatment in Africa,

inflicted by puff adders and

access to facilities and

gaboon vipers, much slower-

skills is central to life-

moving snakes with larger

saving therapy.

HIGH-TECH DRONES THE ANSWER TO LIFESAVING DIAGNOSTICS AND DELIVERY South Africa (SA) a world leader in legislation regulating the use of drones, is set to fine-tune the law by allowing samples for life-saving diagnostic tests to be flown from rural hospitals and clinics to high-tech urban laboratories.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Feature | 25

W

HILE this represents the

end goal of a highly feasible project – with a wide array of medical applications (snakebite serum, vaccines for disease outbreak, plasma or blood, rabies-immune globulin, adrenaline for anaphylactic reactions to bee stings) – air safety considerations have stalled progress.

SA’s MEDICAL DRONE PIONEER Prof. Barry Mendelow,

founder and former head of the Molecular Medicine and Haematology Department at the University of the Witwatersrand, led the way internationally in 1998 with a “proof of concept” trial that triumphed 12 years later with a lightweight drone that could reliably deliver

Denel’s e-Juba during trials

“

We have a very big remote controlled industry that’s driven this development, and we’ve been tinkering for years; it was almost an advantage to us that there wasn’t an authority throwing people in jail

fibreglass/carbon drone

“shocked a lot of people”

(among others), which is

when SA came up with the

waterproof and UV-resistant

drone legislation on 1 July

and able to handle extreme

2015. “We’re very much

winds and temperatures,

ahead of the (international

could hugely boost equity of

curve) and other countries

access to healthcare across

are using us as a legal case

Africa. Adam Rosman, the

study. Basically our Civil

Gauteng-based founder and

Aviation Authority (CAA)

MD of Aerial Monitoring

realised that banning

Solutions, the only drone

drones outright wouldn’t

manufacturer of its kind in SA,

work. We have a very

says that conceivably his UAV,

big remote-controlled

15 km before returning to

powered by a 2-stroke petrol

industry that’s driven this

base. While his focus was on

engine and transportable

development, and we’ve

delivering disinfected ultra-

in the back of a bakkie,

been tinkering for years; it

lightweight DNA samples

could fly from Cape Town

was almost an advantage

(which pose no infection

to Durban, taking about 10

to us that there wasn’t an

threat) from outlying

hours (weather and payload

authority throwing people

areas (enabling same-day

dependent). Ironically,

in jail. The industry basically

laboratory results), a sturdier

however, the pioneering civil

developed illegally, so it

unmanned aerial vehicle

aviation laws that SA has just

was in their best interests

(UAV), with a 2.5 metres

adopted, prevent this – for

to address this before it

wingspan and manufactured

the moment anyway.

became an even bigger

a 400 g medical package

commercially in SA, can today deliver a 3 kg payload hundreds of kilometres, boasting a continuous flying time of 6 hours. Already in use for geo-mapping,

LIMITLESS POTENTIAL – IF AIR SAFETY RISKS ARE OVERCOME

problem. I say hats off to them (the CAA).” However, a quick look at the new laws might, on the face of it, impede any cap-doffing.

Rosman takes the long view.

An aeronautical engineer

“The main drive is safety

agriculture and nature

who once designed

and a lot of the regulations

conservation, the

rockets, Rosman believes it

are adapted from the full-

mineral exploration,

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Adam Rosman, crouching right, with his drone team

“

The industry basically developed illegally, so it was in their best interests to address this before it became an even bigger problem

size aviation industry, but

planes), must now have

I’m pretty certain it’s going

a slightly watered-down

to change. The CAA is the

version of a private pilot’s

first to admit the legislation

licence, plus an air-band

is not perfect, but it’s a

radio operator’s licence. A

start. They won’t get it right

remotely piloted aircraft

the first or second time

(RPA) requires a CAA letter

but it’s a step in the right

of approval, valid for 12

direction. Their thinking

months and must at all

motivated and with proof of

is very progressive and

times be in full control of

humanitarian need, the CAA

they have work groups on

one piloted aircraft station.

director may well entertain

operating drones beyond

The biggest hindrance to

these as the new law adjusts

line of sight,” he says.

medical applications – and

its feathers. An RPA may not

the plethora of other uses

fly more than 122 m above

– is the stipulation that

the ground, within 10 km

WHAT THE NEW LAW SAYS

nor carry dangerous goods.

The regulations, however, allow for exceptions for “approved beyond-lineof-sight operations” and registered operators may file for other special exceptions. Sufficiently

a drone must remain in

of any aerodrome or within

Any operator (called a pilot

unobstructed visual line of

a lateral distance of 50 m

in the legislation) of a drone

sight of its operator and not

from any structure, building

(excluding recreational

“release, dispense, drop,

or person. No aerial or

remote-controlled toy

deliver or deploy objects”

aerobatic displays are

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Feature | 27

organisation to do that and only that organisation can develop an operations manual with a safety and quality management system and standard operating procedures,” he added, referring the Healthcare Gazette to the CAA’s website to study the new law. Regulations governing the flying of an RPA are similar to flying a full-size manned aircraft; RPA pilots are required, using the registration of Prof. Mendelow and Saggie Pillay, then CEO of the NHLS, look on during a trial

the drone as a call-sign, to make the required radio calls indicating the altitude, location and intended operation of the RPA in a specific area and at regular intervals that ensure its separation from other aircraft.

SA ONCE LED, NOW TRACKING ALONGSIDE OTHERS Prof. Mendelow and Saggie Pillay, NHLS CEO in 2010 with a cargo drop

allowed, nor is the towing of another aircraft, or flying adjacent to or above a nuclear power plant, prison, police station, crime scene, court of law or strategic installation.

PLAY IT AGAIN, SAM

“

UAVs could deliver blood or expensive and rarely used medications to smaller or far-flung hospitals

Mendelow said Denel (the Armscor subsidiary) – a

more a logistical problem

world leader in military

than a technical one”.

drone development – had

Citing the example of West

initially crafted a number

Africa’s Ebola outbreak, he

of prototype drones

says drones could deliver

for the National Health

vaccine packs just outside

Laboratory Service (NHLS),

disease outbreak zones.

including one called e-juba

“Legally you’d have to

(electronic pigeon, from

prove operational safety. It’s

i-juba, Nguni for pigeon)

trickier, but not impossible.”

which could fly 53 km,

Says Rosman: “What we

Sam Twala, a certification

(or double this distance

need to do is repeat what

engineer in the CAA’s

when an extra battery was

Mendelow has done … get

Unmanned Aircraft Systems

added). However, Denel

a few case studies and test

Department, said such a

wanted R5 million for

pilot (sic) programmes set

scenario was illegal under

further development, so he

up, probably with the health

the new dispensation,

turned to several private

department, to prove that

“but the flip side is there

individuals and companies,

it’s feasible and sufficiently

are certain processes

who came up with 10

safe. The tech is there and

and procedures… You’d

prototypes of four separate

it’s relatively low cost, it’s

have to be an approved

designs with names like

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

using an inexpensive, easyto-use app that does the piloting and most of the mission planning itself. The user simply ‘tells’ the craft where to go and the drone devises an appropriate route that avoids obstacles and restricted airspace, carrying 1 kg up to 19.3 km on a single charge (charging stations along the route can extend that range). The technology is built upon Matternet’s experience in delivering diagnostic tools in places like Haiti, Bhutan, the Dominican Republic and Papua New Guinea. Their UAV proved it could fly beyond the

The Nightingale during the 2010 trials

sight of its operators and

Nightingale, Kiwit and even

sample collection initially)

in bad weather, and be

a Miggie. “We put out a

were “spectacularly low”,

adept at retrieving medical

tender in 2009 for actual

amounting to a 99% saving.

samples and delivering

service implementation,

Rosman told Healthcare

medicines to places that

stipulating that the

Gazette that his entry-level

are often inaccessible due

successful applicant had

fixed-wing drone system

to bad roads. Matternet’s

to obtain CAA clearance.

cost R1 00 000 and included

vision – unlike Amazon or

They had to make the safety

one year’s maintenance,

Google who want to deliver

coming in at one-tenth

products anywhere to

of the price of the next

anyone (but are also being

(imported) comparative

held up by line of sight

system. He explained that

safety considerations) – is

multi-rotor helicopter drones

to use UAVs along regular,

used too much energy for

fixed routes for high-speed

lift whereas a fixed-wing

delivery of medical supplies

drone used forward motion

and pharmaceuticals.

for a far more efficient lift-to-

Mayo clinical surgeon, Dr

energy ratio, making it the

Cornelius Thiels, is quoted

ideal long-distance craft.

as saying that their UAVs

case, based on experience in the field.” None of the applicants succeeded in obtaining CAA approval, though the technical knowhow and capability were proven in an extensive field trial. Mendelow said many rural communities live within 10 km of a road.

“If you had a number of collection points along the road you could set up quite an effective network – it would literally be a few minutes’ flight”. He said the operational costs of medical drones, when compared with traditional land-based transport costs (the NHLS even used motorcycles for

DRONE 101 n A sturdy unmanned aerial vehicle (UAV), with a 2.5 metres wingspan and manufactured commercially in SA, can today deliver a 3 kg payload hundreds of kilometres, boasting a continuous flying time of 6 hours n An estimated 800 million people around the world have limited access to emergency services while 2.5 billion people (40% of the world’s population) live in rural and remote areas of developing countries, emphasising the huge potential of a costefficient, safe, dronebased diagnostic and delivery system

A review of drones use

could deliver blood or

internationally (for saving or

expensive and rarely used

improving lives, not taking

medications to smaller

or degrading them), shows

or far-flung hospitals.

several start-up companies,

“Our advanced transport

among them the world-

team makes about 2 000

renowned Mayo Clinic

flights per year and in

and Matternet, both in the

2013 delivered more than

USA, the former piloting a

200 units of packed red

programme in Switzerland

blood cells and 200 units of

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Feature | 29

plasma, so the need for pre-

medical uses are aerial

hospital products is clear,”

photography, elections

he said.

monitoring, remote sensing,

NOT JUST SAFETY ISSUES

automated package delivery, search and rescue, territorial surveillance, vessel traffic

“

Between now and 2025 the dollar equivalent of R821 billion will be spent on UAVs in the US alone

between now and 2025 the dollar equivalent of R821 billion will be spent on UAVs in the US alone, creating 100 000 high-paying jobs, 70% in the first three

Issues such as temperature

monitoring and surveillance

years and all in the civilian-

control for medical supplies,

and 3D mapping. In

commercial sector. The USA’s

airspace safety and security

Virginia, USA, an Australian-

Federal Aviation Authority

against accidental or

made drone – the Flirtey

(FAA) is expected to finalise

deliberate tampering still

(a hexa-copter) – recently

new drone laws within the

needed to be worked out

delivered 4.5 kg of medical

next 12 months. Current

but were not considered

supplies to a rural health

UK legislation is in line with

as insurmountable, given

clinic, in the first-ever US

the new SA legislation. An

the enormous benefits. In

government-approved single

estimated 800 million people

the Netherlands a social

demonstration. The event

around the world have limited

venture called Drones for

was widely publicised. The

access to emergency services

Development, in conjunction

proliferation of cheap and

while 2.5 billion people (40%

with the United Nations

readily available drones in

of the world’s population)

Population Fund and the

the USA has left the law

live in rural and remote areas

Ghana Health Service, is

outdated and caused several

of developing countries,

testing drones for a wide

near misses with commercial

emphasising the huge

variety of applications to

aircraft. The Association

potential of a cost-efficient,

accelerate development in

for Unmanned Vehicles

safe, drone-based diagnostic

Ghana. Among the non-

International estimated that

and delivery system.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

SAMA chairperson, Dr Mzukisi Grootboom, health minister Dr Aaron Motsoaledi and former SAMA president, Prof. Ames Dhai

BASSON’S PRIVATE ECG TUTORING SETS PULSES RACING Professionally disgraced apartheid-era architect of chemical and biological “dirty tricks” weaponry, Dr Wouter Basson, continued tutoring Stellenbosch medical students at a private medical hospital for 11 months after being convicted of unethical conduct.

T

HE MAVERICK

The latest twist in the

but vigorous debate on

Medical Association (SAMA)

clinician’s

tortuous 14-year-plus drama

the Stellenbosch medical

statement supporting a

involvement

surrounding the unrepentant

campus. His second appeal

petition calling for the

with young

cardiologist, found guilty

to the Supreme Court to

“strongest possible censure”

medical

of unethical conduct in

have the MDPB tribunal

of him, was heard on 9

minds has drawn fire from

December 2013 by a Medical

recuse itself on grounds

February. Basson’s lawyers

top ethicists and the

and Dental Professionals

of it being “biased” by

walked out of what would

official campus student

Board (MDPB) conduct

having failed to disassociate

have been the start of his

medical body.

tribunal, prompted belated

itself from a South African

sentencing last December,

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Feature | 31

claiming tribunal members,

hearing this, the Stellenbosch

University, described the

Dr Jannie Hugo and Dr Eddie

medical faculty (in an

anomaly as “a technical

Mhlanga, were members

unprecedented step) revoked

difficulty. There’s a difference

of SAMA and therefore

Basson’s teaching rights

between being appointed

inherently biased. Basson’s

on 6 November 2014, a full

and being on the teaching

team returned in April last

11 months after the MDPB

staff, and being accredited

year, bearing a High Court-

guilty finding, his tutelage

as a clinical supervisor,”

approved order that the

reportedly having rendered

she explained, adding that

tribunal hear their application

several students “acutely

Basson had never taught on

for recusal. The tribunal

uncomfortable”.

campus. While MediClinic

complied, but turned it

Prof. Ames Dhai, director

had been accredited as

down flat, with chairperson

of the Steve Biko Centre for

a “group” the individuals

Dr Hugo saying he and his

Bioethics at Witwatersrand

giving tutorials also had to

colleague were inactive

University, asked what

be named, she confirmed.

in SAMA management,

responsible parent would

and their association was

want their child taught by a

confined to academic and

man dubbed “Dr Death”.

professional work. Hugo

She said it was “shocking

assured Basson that he and

that in this day and age and

Mhlanga were “acutely aware

with our history of human

of our duties in this matter”

rights abuse, Stellenbosch

and pledged to ensure that

would not have taken a

he continued to experience a

decision immediately in terms

fair trial. Undeterred, Basson

of his guilty finding. Going

and his lawyers then applied

through all those committees

to the High Court to overrule

is not a reasonable sort of

the MDPB response. The

explanation for an 11-month-

committee, moved to the

application was heard on 9

long delay”.

faculty undergraduate

and 10 February with Judge

“

His tutorials to fourth-year undergraduates around interpreting electrocardiograms, were part of a public-private initiative to increase early exposure of students to private sector practice

Stellenbosch student

“People use the word ‘taught’ loosely,” she said.

Explaining the 11-month delay in revoking his teaching rights after Basson was found guilty, she said the process began after the 2013/14 festive season academic break. The unprecedented revocation followed a quality assurance process that began with the MB ChB programme

committee, to the faculty

Unterhalter AJ reserving

council chairperson, Nick

board and finally to the

judgement.

Wayne, said his council

university senate – all of which

stood by its call that no

had student representation.

student should be taught

She conceded that the

ETHICISTS SPEAK OUT

by Basson. While nobody

student representatives of the

Meanwhile Prof. Keymanthri

was forced to take his class,

time would not have been

Moodley, head of the Centre

there were students who did

Wayne or any of his

for Medical Ethics and Law

not want to be taught by

current committee.

at Stellenbosch University,

him and believed he should

criticised both students and

not be practising at all, let

her own Faculty of Medicine

alone teaching. “Teachers

for allowing Basson’s

instill certain qualities of

continued tutelage at the

themselves in their students

Durbanville MediClinic for

and his lack of remorse and

11 months after he was

involvement in apartheid

found guilty. His tutorials to

warfare makes students very

fourth-year undergraduates

uncomfortable. They would

student body had allowed

around interpreting

rather have other tutors,”

Basson to continue tutoring

electrocardiograms, were

he added. Prof. Marietjie

for so long without speaking

part of a public-private

de Villiers, deputy dean of

up. “Perhaps it is because

initiative to increase early

Education in the Faculty

student protests around the

exposure of students to

of Medicine and Health

country have empowered

private sector practice. Upon

Sciences at Stellenbosch

and liberated students to

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

INITIAL STUDENT SILENCE ON BASSON’S TEACHING QUESTIONED

Moodley questioned why the

freely express their views,”

the hidden curriculum and

we find reprehensible about

she speculated, expressing

the behaviour patterns of our

him may reflect a poignant

concern that “a subset of

teachers. The Remunerative

sense of injustice induced

students had no discomfort

Work outside the Public

by the apartheid regime and

with his apartheid-related

Service (RWOPS) abuse is

the institutional culture of

activities that transgressed

an excellent example of this.

some tertiary educational

the foundational principles

Is he worthy of our trust? In

institutions”. She hoped that

of the profession and basic

my opinion he’s lost people’s

institutions of higher learning

respect for human rights”.

trust and is not worthy of it,

would in future ensure that

Yet other students, “showed

not only because of what

“such debate is encouraged

a profound dialectical

he did, but the manner in

contemporaneously and

capability in sharing the

which he’s conducted himself

same space with someone

subsequently. His lack of

they respected as a clinician,

remorse and continuous

yet someone they deplored

opposing of council is

as a health professional

absolutely cynical.” Basson

and human being”. De

said he had “no idea what

Villiers said there was a

the fuss is about. I teach

well-publicised and regularly

many groups of people

used complaints procedure

and have received no

for students, emphasising

complaints, related to either

that there was no complaint

the giving thereof or the

on record about Basson’s

quality thereof at all over

tutelage. Attendance at his

the years, from any of my

been spoken. “He has rights

tutorials was voluntary, she

students. My lectures are a

like any other citizen and

re-affirmed.

given – the attendees are

the laws of the country still

there of their own volition”.

prevail,” he stressed.

Dhai, who is chairperson

“

It is shocking that in this day and age and with our history of human rights abuse, Stellenbosch would not have taken a decision immediately in terms of his guilty finding

that safe spaces are created for face-to-face discussion, in addition to social media discussions”.

Dr Kgosi Letlape, president of the HPCSA, said there were no limitations on Basson’s registration with the MDPB. No healthcare practitioner could be restricted in his or her practice until the last legal word had

of SAMA’s human rights

Many doctors and specialists

and ethics committee,

regularly received Continuing

said: “It boils down to a

Professional Development

question of trust. Clearly,

(CPD) points by attending

through everything that’s

his lectures, he added.

happened and what he was

Moodley challenged the

convicted of by the HPCSA,

student and lecturer bodies

Mzukisi Grootboom, said he

there’s been a real erosion

to “examine the extent

understood what MediClinic

of integrity on his part.

to which we idolise and

was “trying to drive

Medical students are in their

exaggerate the competence

towards”, but disagreed with

formative years of study.

of Wouter Basson, perhaps

“the constant call among

They learn not only from the

because his worldview of

the leadership of academic

formal curriculum but the

human rights abuses parallels

health centres to allow a

informal one. Bad habits

our own worldviews about

private practice platform to

have been picked up from

racism – or conversely, what

teach medical students.

SAMA CHAIR: “DON’T LEAN ON PRIVATE SECTOR” SAMA chairperson, Dr

GUILTY AS CHARGED In December 2013 the MDPB found Basson guilty of co-ordinating the large-scale production of illegal psycho-active drugs (including ecstasy), arming mortars with teargas and providing military operatives with disorienting substances to make illegal cross-border kidnappings easier. He also made cyanide capsules available to apartheid-era military spies so they could

commit suicide if captured – a slow and painful death.

Dr Jannie Hugo said in his judgement that medical ethics were “especially important” in times of war and conflict.

Basson had “defiled the unique and sacred position” of trust in doctors by society that impelled them to stay true to the ethical values of “beneficence, non-maleficience, justice and autonomy”.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Feature | 33

was a founding member of the World Medical Association, formed in direct response to Nazi atrocities performed by doctors on living human beings. The same “covenant” was abused by MASA when black consciousness leader Steve Biko was murdered in custody – a covenant which held that even in times of war no doctor should use their training to kill instead of heal. Basson only recently withdrew his membership of SAMA. South African military health service surgeon general, Lieutenant General AP Sedibe, said Basson was no longer on their payroll, but declined to answer questions on how long he had been. Head of communications in the national defence ministry, Siphiwe Dlamini confirmed that the SANDF was footing Basson’s hefty legal bill “by Dr Wouter Basson

“I don’t think it’s

we won’t have a teaching

appropriate. What we need

platform.” Focussing on

is for these same leaders to

primary healthcare was vital,

advocate for government to

but not at the expense of

do what is correct; and that

tertiary health centres, he

is to equip and capacitate

added.

academic hospitals to cater

The Tygerberg/Boland

“

The state is paying both the HPCSA and Basson’s legal bills, but no state official will reveal or even estimate what this has cost so far

virtue of his having been in the SANDF in the past”.

The state is paying both the HPCSA and Basson’s legal bills, but no state official will reveal or even estimate what this has cost so far. The professional conduct hearing has dragged on six times

for and be accessible to

branch of SAMA supported

the majority of people. The

Basson in complaining

trial of the late former police

unintended consequence of

about the petition against

commissioner, Jackie Selebi

this (private sector) approach

the cardiologist (launched

(2009-2012) – and that cost

is that it perpetuates the

by the People’s Health

was R17 million. Basson

perception that the system

Movement, not SAMA).

was acquitted in a lengthy

has failed. Academic

However, SAMA refused to

criminal trial which predated

teaching platforms should

apologise for supporting

the current ethics-related

meet the requirements of

the petition, responding

hearing. When he will be

teaching medical students.

that its predecessor, the

sentenced remained an

If they allow the situation

Medical Association of

open question at the time

to deteriorate any further,

South Africa (MASA)

of writing.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

longer than the corruption

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Profile | 35

SAMA PRESIDENT: MEDICO-POLITICAL VETERAN, PSYCHIATRIST AND TREATMENT PIONEER

K

EEPING A

dragging in implementing

with catatonic illness and

cool head,

the Occupation-Specific

neuroleptic malignant

listening and

Dispensation (OSD) and at

syndrome (NMS), with an

communicating

odds with SAMA over tactics

associated 20% mortality

while being

to bring about change, won

rate. By probing why some

“relevant and realistic”, is

her widespread respect

what the new President of

among both medical “friend

the South African Medical

and foe”. What was a short-

Association (SAMA), top

lived but highly effective

psychiatrist, Prof. Denise

revolution (striking doctors

White, a 12-year veteran

kept one step ahead of their

of SAMA leadership, hopes

employers by networking

to bring to her executive

via Facebook to orchestrate

and council.

wild-cat nation-wide

Battle-hardened

“

White is described as ‘an inspirational negotiator, a quiet and dedicated leader and clinician of immense skill and intuition’

patients developed NMS and others not, they identified the administration of neuroleptic drugs to patients with a catatonic illness as the major culprit. When the international scientific and cultural embargoes were lifted on apartheid South

unprotected strikes, at one

Africa (SA), she immediately

in the trenches of the

stage even commandeering

became a highly sought-

unprecedented June 2009

SAMA’s HQ to stage a press

after speaker at international

doctor strike (while acting

conference), led to the first

psychiatric conferences.

as SAMA chairperson) and a

decent increases for doctors

Described as “an

pivotal negotiator for huge

in decades, with White and

inspirational negotiator, a

improvements in doctors’

the SAMA exco subsequently

quiet and dedicated leader

salary packages via changes

championing the defence

and clinician of immense skill

to commuted overtime

and job reinstatement

and intuition”, on receiving

a decade earlier (as

of hundreds of young

this year’s South African

chairperson of SAMA’s public

physicians.

Society of Psychiatrists

sector committee), White,

She changed an aspect

Distinguished Service Award,

now 70, is both “honoured”

of global psychiatry practice,

White came through a major

and ready for a more

receiving international

illness in 2014 and lost her

ceremonial role. Her calm

recognition early in her

psychologist husband,

composure and steady hand

career when she and a

Hans, last September. She

in the face of thousands of

colleague identified a

was asked by Healthcare

angry, striking young public

link between patients

Gazette why she would now,

sector doctors, outraged by

admitted to Groote

of all times, return to such a

2 years of government heel-

Schuur’s Psychiatric wards

historic “site of struggle”.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Chuckling, she said: “I

“

I am very humbled being elected as President. It is a ceremonial, titular role, and I think I have an advantage in knowing the organisation inside-out

which the MDB, one of 12

spoke to family and friends

professional boards falls,

who thought it would be a

she had this to say: “The

good thing, plus I think I can

most pertinent issue is that

add some value. Obviously

any recommendations they

I am very humbled being

make are put into effect. The

elected as President. It is a

report (due for imminent

ceremonial, titular role, and

release at the time of going

I think I have an advantage

to press) must not just gather

in knowing the organisation

dust”. SAMA has a strained

inside-out. As vice-chair I sat

relationship with the HPCSA,

next to five or six different

given that the MDB pays

presidents. I won’t be in the frontline of the political fracas, but hopefully I can lend some experience and insight to processes that won’t be unfamiliar to me”.

Two years before leaving the SAMA leadership cadre in 2009, White was appointed to the Medical and Dental Professions Board (MDB), where she served two five-year terms and was appointed to several subcommittees of the Board dealing with matters of professional conduct, as well as serving on the health committee of council (assessing and ruling on “impaired” practitioners), tasks she says she found “very worthwhile”.

“It felt like I was really making a contribution to the profession as a whole. As a Board member our mandate was largely non-political and carried out strictly within the legislative framework governing the operations of the HPCSA,” she adds. Asked her opinion on the ministerial probe led by her University of Cape Town (UCT) colleague, cardiologist Prof. Bongani Mayosi into dysfunction within the statutory Health Professions Council of South Africa (HPCSA) under

the lion’s share of its costs SOUTH AFRICAN MEDICAL ASSOCIATION

PROF. DENISE WHITE n 1969 – graduated from the University of Cape Town n Intern at Groote Schuur Hospital and a senior house officer at Red Cross Children’s Hospital n Practised as a rural general practitioner in both Touws River and the then Transkei n Medical officer in the Department of Medicine and at Victoria Hospital n 1984 – embarked on her registrarship in psychiatry n Lecturer and senior lecturer in the Department of Psychiatry and Mental Health n Ran the psychiatric emergency ward at Groote Schuur Hospital n 1999 – appointed clinical head and principal psychiatrist of Lentegeur Hospital n Lentegeur Hospital gains status as a psychiatric teaching hospital recognised by the Health Department and both the universities of Stellenbosch and Cape Town n 1999 – appointed associate professor at the University of Cape Town n 2009 – awarded the status of emeritus professor n Worked in the United Kingdom and in private practice in Cape Town

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

but suffers vastly diluted bargaining power. There are long-standing calls by SAMA for the MDB to step outside the HPCSA and form its own council (like the nurses and pharmacists), giving it far more autonomy and individual voice. Of the HPCSA dysfunction probe, White said that with many “critical, experienced” people having left the council (shaken by administrative fraud scandals and charges of not carrying out its statutory duties), a great deal of institutional memory had been lost, when the entire structure was dependent on efficient and effective administration.

Asked what lessons she had learnt and could bring in her counsel of the SAMA executive, White replied: “Communication is hugely important: To listen and communicate around issues and to be realistic and relevant in dealing with matters. To keep channels of communication open with various stakeholders is essential. SAMA is a collective – teamwork is necessary in brainstorming and decision making. We have to put personal issues

Profile | 37

plan – we have the research but what comes of it?

Unfortunately mental health is the Cinderella of the healthcare professions, always the Oliver Twist”.

Grossly inadequate and uncoordinated government spending on the treatment of mental illness – which affects one in six South Africans – is costing SA 2.2% of its annual GDP. It is also failing to reduce the 230 attempted suicides recorded daily while 48% of people living

aside for the greater good of health in SA. SAMA is a

“

Communication is hugely important: To listen and communicate around issues and to be realistic and relevant in dealing with matters. To keep channels of communication open with various stakeholders is essential

with HIV/AIDS continue to suffer from a mental health Unsurprisingly, her

condition. Mental health

“signature theme” during her

disorders comprise five of the

year-long presidential tenure

10 leading causes of health

will be mental health. With

disability in SA. According

the lifetime adult prevalence

to research published by

of common mental disorders

White’s colleagues, UCT

in SA standing at 30%, a full

head of Psychiatry, Prof. Dan

11% of citizens experiencing

Stein and his associate, Prof.

substance abuse problems

Crick Lund, mental health

and maternal mental

issues cost the South African

disorders three times higher

economy six times the cost of

in low-income areas, her

its treatment. Over the past

advocacy will be highly valued

two decades, a seemingly

by coal-face organisations.

progressive national policy

is being effective for very

Says White: “The maternal

shift to decentralisation of

disparate groups. To be a

mental disorder statistic (for

care has reduced the number

trade union and to represent

one) is totally unacceptable.

of mental hospitals – with

the interests of both public

Again, it appears the

no corresponding increase

and private sector doctors. It’s

country is not focussing on

in community-based mental

not an easy task. This is not

developing its resources. The

health facilities – leading to

an organisation where you

multi-professional team is

7.7% fewer beds across all

can step up to any leadership

essential for the delivery of

provinces and a downward

position being timid or naive

good mental health. You need

spiral in delivery.

– you have to don an asbestos

mental health workers out

shield to deflect the heat of a

there in the community clinics

SAMA presidency reins from

crisis and remain cool.” She

and rural areas. It can’t just be

ground-breaking medical

said she was fortunate to no

hospital-based. We need to

educationalist, former

longer be in the day-to-day

work out ways of task-shifting,

Medical Research Council

political decision-making

with doctors supervising

chairperson, advisor on

engine room and hoped she

those who actually do the

upgrading academic hospitals

could be “that person who

work. I don’t think we’ve

and Eastern Cape healthcare

can add a perspective in times

developed an effective and

planning commissioner, Prof.

of crisis or decision making”.

adequate human resources

Lizo Mazwai.

critical roleplayer and we have to stay internally intact as a team when big matters such as the NHI are discussed”.

She said the organisation was challenged by the fine line it has to tread between politics and professional issues as well as the need to keep its “ear to the ground” to ensure it was fulfilling its mandate for members. “The challenge

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

White takes over the

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Focus | 39

FACELIFT THERAPY FOR THE OESOPHAGUS? INNOVATIVE GERD RESEARCH CSIR research, conducted over the last 8 years, which has huge potential to provide relief from gastro-oesophageal reflux disease (GERD), was halted due to a lack of funding to conduct trials.

A

NOVEL

Says its award-winning

injectable

co-inventor, Council for

suspension

Scientific and Industrial

that

Research (CSIR) engineer,

expands

Kersch Naidoo: “We

tissue and induces

stopped it at prototype

regeneration – ideal for

stage (in 2008) because we

long-term relief from gastro-

couldn’t get the funding for

oesophageal reflux disease

animal and human trials –

– has been sitting on a

and without the trials you

Catch-22 patent shelf for

can’t get development

8 years because of lack of

funding – a kind of a

funding to conduct animal

Catch-22 situation,” he told

and human trials.

Healthcare Gazette ruefully.

Biopolymeric microparticle with cell growth

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

While Naidoo and his

to anti-reflux medication

“

The minimally invasive endoscopic treatment would be far preferable to surgery

custom-designed micro-

CSIR co-innovators, Dr

within 10 years. Naidoo told

Wilhelm Richter and Dr

Healthcare Gazette that he

Schalk van der Merwe, have

believed the product had

secured the patent, the

huge potential and in theory

relatively low 3% prevalence

would keep a patient reflux-

of GERD among South

free for 3 - 5 years, before

bulking effect compared

Africans (compared with

having to be redone due

with current facial micro-

15% in North America,

to the

particle dermal fillers.

particles were hypothesised to induce regeneration of the surrounding soft tissue, potentially leading to a more permanent

for example), has meant

GERD is caused by chronic

local research funding

inflammation of the lower

goes predominantly to

oesophageal sphincter

high-priority diseases like

muscle, resulting in a state

TB and HIV, filtering down

of permanent relaxation

as disease prevalence

of the smooth muscle,

decreases. The basis of

allowing gastric fluids to

this unique new potential

enter the oesophagus and

intervention consists of a

cause chronic heartburn.

polymeric micro-particle of

It may, over time, also

just less than 250 microns,

lead to increased risk In 2008 Naidoo

enabling it to be suspended

received

in a solution and injected

the Chemical

endoscopically via syringe,

Technology

directly into the sphincter

Innovation award

muscle mass, bulking it up

of oesophageal cancer.

Naidoo likened his solution to that used in cosmetic applications for bulking facial muscles and removing

and narrowing it to prevent

re-absorbable

from the South African

crease lines for soft-tissue

stomach acid from refluxing

nature of the biopolymers

Institute of Chemical

facial augmentation. He

into the oesophagus.

used. The CSIR said the

Engineering and Crown

stressed that the current

According to the CSIR,

suspension had potential

Publications and in 2006

product was aimed at

the minimally invasive

applications in several

the CSIR’s promising young

treating the disease itself

endoscopic treatment would

areas of soft-tissue

researcher award from the

and not just the symptoms,

be far preferable to surgery,

augmentation and was

Materials Sciences and

unlike other medication

where 62% of patients return

re-absorbable. The specific

Manufacturing Division.

therapies.

TRADITIONAL THERAPIES FOR GERD INVOLVE: n Medication (correct diagnosis and treatment resulting

unlike the Nissen fundoplication, it doesn’t alter anatomy and

in 45% of patients being effectively cured), but with

can be reversed with minimal risk and without eliminating the

documented long-term side-effects which can include

Nissen fundoplication as a treatment option.

anaemia, diarrhoea, clostridium difficile colitis,, increased risk

n Timing, choice and quantity of food ingested: lifestyle

of pneumonia and a thinner wallet.

modification can have dramatic results and is always

n Nissen fundoplication surgery, where a mobilised portion

recommended as a first option. Good foods include grilled

of the upper stomach is wrapped around the outside of the

and baked meat, all vegetables, bread, rice, oatmeal,

lower oesophageal sphincter, thus narrowing it. In the proper

melons, bananas, ginger, chamomile tea, alkaline water, soy

surgical hands this has a more than 90% success rate over 20

and coconut milk and Manuka honey. Bad foods to avoid

years, but in reality many patients fall foul of less than optimal

include alcohol, caffeine, chocolate, carbonated and citrus

expertise.

drinks, onions, raw tomatoes, breath mints and garlic. Light

n A Linx flexible anti-reflux magnetic bracelet, placed

meals in the evenings are recommended, while sleeping with

laparoscopically around the outside of the lower oesophageal

your head elevated on pillows and an overall weight-loss

muscle, has gained a foothold as a therapy, mainly because,

programme can also be pivotal in controlling symptoms.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

The Clinician’s View | 41

APARTHEID’S CHEMICAL AND BIOLOGICAL WEAPONS PROGRAMME: EQUIVALENT TO DEVELOPING NEW AIDS DRUGS?

By Salim S Abdool Karim

A

CCORDING

Health, the South African

of abuse, allegedly for

to a recent

Medical Research Council

purposes of crowd control,

article in

and the pharmaceutical

were amongst the projects

The Sunday

industry. While this research

of the programme”.

Times, Dr

is intended to benefit all

According to the TRC,

Wouter Basson was quoted

humanity, the predominant

Dr Basson also served on

as saying, “I was a soldier

beneficiaries of new drug

the management committee

doing a job and was helping

therapies for infectious

of the Civil Co-operation

South Africa (SA) with its

diseases are the poor, who

Bureau (CCB), whose

defensive abilities. That is

are most at risk for these

objective was “the maximal

the same as developing an

conditions.

antibiotic or a new drug

Dr Basson, by contrast,

against AIDS”. In justifying

dedicated his efforts to

his apartheid-inspired

chemical and biological

research, he describes it as

weapons to be used against

analogous to developing

those opposing apartheid.

drugs for AIDS or other

In its report, dealing with

pathogens. Is there any

SA’s Chemical and biological

merit in this analogy?

warfare programme, where

Several SA doctors

Dr Basson was the project

“

Dr Basson, instead, conducted his research during the apartheid era, clandestinely and with no independent ethical review or regulatory oversight

disruption of the enemy”.

The TRC report quotes a CCB planning document that described disruption as having five dimensions: “death, infiltration, bribery, compromise or blackmail, and destruction”.

Legitimate science is conducted transparently,

and scientists are actively

leader, the Truth and

subject to independent

involved in developing and

Reconciliation Commission

regulatory review and audit,

testing new antibiotics,

(TRC) found “evidence of

and presented openly at

antivirals and vaccines. It

science being subverted

meetings and conferences.

is estimated that over half

to cause disease and

Dr Basson, instead,

a billion rands were spent

undermine the health of

conducted his research

in SA on this research in

communities. Cholera,

during the apartheid era

2015, the bulk of these

botulism, anthrax, chemical

clandestinely and with no

funds emanating from the

poisoning and the large-

independent ethical review

US National Institutes for

scale manufacture of drugs

or regulatory oversight.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

“

Dr Basson’s leadership of the apartheid government’s chemical and biological warfare research fails on every count to fulfil these obligations SALIM S ABDOOL KARIM DIRECTOR OF CAPRISA AND PROFESSOR OF CLINICAL EPIDEMIOLOGY, COLUMBIA UNIVERSITY

Salim S Abdool Karim

Medical doctors are first

or destroy life”. Dr Basson’s

of assassination toxins

and foremost healers, not

leadership of the apartheid

and narcotic drugs as

soldiers, even in times of

government’s chemical and

weapons to incapacitate

armed conflict. The World

biological warfare research

anti-apartheid protestors,

Medical Association’s stance

fails on every count to fulfil

for the exclusive benefit of

on the responsibilities of

these obligations.

an oppressive minority and

doctors has been clear since

In summary, there is

an illegitimate government

1956: “The primary task of

no basis for Dr Basson’s

with the development of

the medical profession is

analogy that his research

drugs against AIDS seems

to preserve health and save

was similar to the work

to be a self-serving attempt

life. Hence it is deemed

currently being done

to confer retrospective

unethical for physicians

by researchers who are

respectability and legitimacy

to … employ scientific

developing new AIDS drugs.

to morally repugnant

knowledge to imperil health

To equate the development

research activities.

H EALT H CARE GAZ E TTE | J A NU A RY /FE BRU A RY 2 0 1 6

Salim S Abdool Karim, MB ChB, PhD, DSc (honoris causa) is a South African (SA) clinical infectious diseases epidemiologist who is internationally recognised for his research contributions in HIV prevention and treatment.

He is director of the Centre for the AIDS Programme of Research in South Africa (CAPRISA), professor of Clinical Epidemiology at Columbia University and adjunct professor of Medicine at Cornell University, having served as president of the South African Medical Research Council from 2012 to 2014.

He is chair of the UNAIDS Scientific Expert Panel and a member of both the World Health Organization (WHO), HIV-TB task force and the WHO Expert Panel on sexually transmitted infections and HIV as well as an elected fellow of the World Academy of Sciences, the African Academy of Sciences, the Academy of Science in SA and the Royal Society of SA. Karim is a foreign associate member of the US National Academy of Medicine and serves on the boards of Lancet-Global Health, Lancet-HIV and the New England Journal of Medicine.

Building a better society through Education and Capacity Development.

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EMERGENCY MEDICINE

DIAGNOSTIC ULTRASOUND

SHORT COURSE IN EMERGENCY MEDICINE

SHORT COURSE IN DIAGNOSTIC ULTRASOUND

Dealing with patients who present in an emergency department or as urgent appointments at a doctor’s consulting rooms can provide complex diagnostic challenges. The symptoms may be atypical and yet potentially life threatening. Normal routines are disrupted and the clinician has to cope with many interruptions and distractions. Unfortunately in such settings significant mistakes can be made. This course has been specially developed by experienced emergency medicine experts to equip doctors and nurses to understand the main reasons for diagnostic errors, the types of patients and the kinds of problems that are the main reasons for missing a potentially life threatening diagnosis.

In a report of a WHO scientific group on the future of new imaging technologies in developing countries it was stated that “the difficulties in making accurate diagnosis from ultrasound images are such that the purchase of ultrasound equipment, without making provision for the training of an operator, is contrary to good healthcare practice and is unlikely to be cost effective. Proper training and experience is required, preferably with facilitators who are highly skilled and who have practised ultrasound for many years.

COURSE CONTENT

After completing this course participants will be able to: • Choose ultrasound equipment; • Identify the organs in the abdominal cavities, normal abdominal and gynaecological ultrasound anatomy; • Recognise abdominal structures in multiple planes; • Recognise the sectional ultrasound anatomy in the transverse and longitudinal planes; • Describe the patient preparation and position; • Interpret ultrasound findings in common abdominal gynaecological pathologies; • Document ultrasound; • Demonstrate ultrasound imaging; • Understand the criteria for quality and • Understand the capabilities and limitations of ultra-sound.

This course covers the following modules: • The Emergency Department as an error prone environment (Including equipment) ; • Medical mistakes; • Clinical reasoning; • High risk presentations; • High risk patients and • Safety in triage, disposition and discharge.

ACCREDITATION Accredited according to the HPCSA CPD Guidelines for Health Professionals -November 2006, for 16 CEUs on level 2.

COURSE FEE, DATES AND VENUE R 1500 (Inclusive of all VAT and taxes where applicable) This amount includes everything except travel and accommodation.

DATE 27 February 2016 16 April 2016 14 May 2016 25 June 2016 16 July 2016

VENUE KwaZulu Natal Northern Cape Western Cape Gauteng Eastern Cape

ACCREDITATION Accredited according to the HPCSA CPD Guidelines for Health Professionals -November 2006, for 30 CEUs on level 2.

COURSE FEE, DATES AND VENUE R 5150 (Inclusive of all VAT and taxes where applicable) This amount includes everything except travel and accommodation.

REGISTRATION

DATE 20 - 21 February 2016 21 -22 May 2016 23 - 24 July 2016 27 - 28 August 2016

REGISTRATION

Daniel du Bruyn Tel: 012 816 9000 Fax: 086 558 9535 Email: danield@foundation.co.za

VENUE Gauteng Eastern Cape Limpopo Western Cape

Daniel du Bruyn Tel: 012 816 9000 Fax: 086 558 9535 Email: danield@foundation.co.za

SHORT COURSE IN ICD 10 CODING (DISTANCE) The implementation of the ICD-10 diagnostic coding in the healthcare environment took effect on 1 January 2005. The National Department of Health and the Council for Medical Schemes support this implementation of ICD-10 in the public and private health sector. The specific regulation pertaining to ICD-10 reads as follows: “(f) The relevant diagnostic and such other item code numbers that relates to such relevant health service”. Although the regulations do not specify the ICD-10 diagnostic system, this structure is regarded as the diagnostic standard of choice for South Africa. ICD-10 is a series of international A member of SAIHCM

COURSE CONTENT

classifications of diseases, originally introduced by the World Health Organisation in 1948. ICD-10 has become the international standard for the generation of health statistics, allowing relative comparison across countries.

ICD-10 operates in conjunction with other procedural and billing coding systems and replaces the “traditional” diagnosis with a code.

COURSE CONTENT This course will cover the following modules: • Background to ICD-10 coding; • Benefits of clinical coding; • Basic structure and principles of ICD-10 coding; • Rules and conventions of ICD-10 coding; • Accuracy in coding and practical applications.

DISTANCE COURSE COURSE FEE R 880. This includes all study material and assessment. (Inclusive of all VAT and taxes where applicable) REGISTRATION TSHEPO GAOFETOGE Tel: 012 816 9100 Fax: 086 567 0340 Email: tshepog@foundation.co.za

Foundation for Professional Development (Pty) Ltd, Registration number 2000/002641/07 Registered the Department Higher H EALTwith H CARE GAZof E Education TTE | asJaAPrivate NU AInstitution RY /FEofBRU A Education RY 2 0 1under 6 the higher education act, 1997. Registration number 2002/HE07/013

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