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
Facelift therapy for the oesophagus?
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The ESSENTIAL MEDICAL REFERENCE for every healthcare professional! The convenient pocket-sized design enables you to fit it comfortably into your hospital bag or coat pocket, so it can always be at hand for ready reference. South African Medicines Formulary (SAMF), a joint initiative of the University of Cape Town’s Division of Clinical Pharmacology and the Health and Medical Publishing Group, publishers for the South African Medical Association, provides easy access to the latest, scientifically accurate information, including full drug profiles, clinical notes and special prescriber’s points. The thoroughly updated 12th edition of SAMF is your essential reference to the rational, cost-effective and safe use of medicines.
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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). For information on subscribing to Healthcare Gazette, please contact sales@hmpg.co.za.
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. Register now for one of our exciting CEU programmes!
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
A member of the SAMA Group
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