Nurses shut down hospital in Limpopo – no health care because of politics!

Nursing staff at Lebowakgomo Hospital have been protesting outside the premises since Monday, demanding that the recently appointed acting Nurse Manager step down as she allegedly does not have adequate qualifications or experience for the position.

The employee in question apparently lacks both the experience and academic credentials required by the position yet was appointed to act in it for a second time in 12 months. It is claimed that Anna Mokoena’s appointment was politically influenced.

The Democratic Nursing Organisation of South Africa (Denosa) in Limpopo has urged the facility’s management to accept responsibility for the shutdown caused by the perceived parachuting of Mokoena, an ordinary professional nurse with general nursing and midwifery qualifications, when there are better qualified assistant managers at the hospital. The nursing staff have vowed to shut down operations at the hospital if her appointment is not rescinded.

Denosa Provincial Organiser, Jacob Molepo explained that Mokoena is a junior nurse who had acted from June to end of November last year and is now given a second opportunity to do so. He stated that organised labour and the hospital’s nursing population was against this perceived political decision.

Nursing staff are demanding that politics be put aside and quality nursing be respected and those adequately qualified nurses with at least additional nursing education, administration and management qualifications as part of their experience are given an opportunity to assist as the institution is fortunate to have such staff.
“Denosa and the nurses are demanding fairness because the hospital is an academic institution and, for the sake of its reputation, it must be led by health professionals with the necessary skills and experience. We warn that nursing care will be severely affected and thousands of people will suffer if the decision is not reversed as nurses are revolting. The feeling of nurses is that politics and political connections are being rewarded with positions ahead of the interest of quality nursing care at the institution,” he explained.
Denosa further called on the hospital management to start doing things fairly, and for the Health Department to intervene if the institution refuses to acknowledge the crisis it brings to the institution because of unfair and partisan decision.

Department of Health Spokesperson, Thabiso Teffo said nurs­es were urged to go back to work to av­oid harsh consequences. He said: “Nurses who are unhappy with the way things are done should quit their job and find employment elsewhere.”


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Would you test for HIV in your living room?

It starts with a swab but does it end with a diagnosis? Why the trickiest part of DIY HIV testing happens after the test

The trick, says Ann Moore as she pulls the small white stick from the plastic packaging, is not just to swab the gums but to scrape them.

The doctor sticks the rod under her lip and drags it first along one side of her gums, then the other.

“You don’t want saliva. You want the cells – the antibodies.”

She places the stick into a tube of clear liquid and waits. One line would mean she is HIV negative; two, HIV positive.

In 2013, the United Nations set the world an ambitious target of “90-90-90”: the idea was that, by 2020, 90% of all HIV-infected people would know their status, 90% of those diagnosed with HIV would be on antiretrovirals, and 90% of people receiving treatment would be virally suppressed.

Just three years away from the goal date, and with only 65% of South Africa’s 6.8-million people living with HIV diagnosed, that first 90 is still tripping us up, according to a December 2016 policy brief by the National Health Laboratory Service.

“Not enough people who have HIV actually know their status,” says Moore, who works for Doctors Without Borders (MSF). She recently led a Khayelitsha-based study offering self-testing kits to people who declined a clinical test with a trained counsellor. Some refused because they were too scared to take the test alone. Others pulled out after being asked to provide names and contact details for follow-up. But the majority were sold on the idea of the 20-minute oral test.

“They really liked that they could test in their own space,” says Thobelani Mcayiya, one of the counsellors who worked on the study.

Many even asked whether they could take an extra test home for their partners.

Over the course of a year, 655 people who had refused a clinical test, which requires a counsellor to obtain a blood sample with a finger prick, signed up.

For all the apparent demand, it wasn’t so long ago that pharmacies were prohibited from selling HIV self-testing kits, a restriction that was only lifted by the South African Pharmacy Council (SAPC) in February 2015.

Still, the health department said it would not allow public clinics and hospitals to distribute tests that had not passed the World Health Organisation’s rigorous “prequalification” assessment. In July, an oral test called OraQuick became the first kit to meet that benchmark.

“Self-testing has moved faster than anything I have ever seen in the HIV space,” says Mohammed Majam, technical head of HIV self-testing at Wits Reproductive Health and HIV Institute (Wits RHI), which did some of the data-gathering for the OraQuick pre-qualification. “I think there’s been a global drive to get this working. People have recognised the importance and role it could play in closing the testing gap.”

The health department is now developing guidelines for implementing self-testing – or self-screening, as they call it. Those won’t be ready for approval until the end of September, the department said, but recommendations put forward by the South African HIV Clinicians Society in May give a glimpse into how self-testing might work here, including clear 
messages for users about how to access treatment services and an emphasis on having any self-test results confirmed by a healthcare worker.

Self-screening is not a replacement for traditional testing, health department spokesman Popo Maja says, but it is an option for those not using the testing facilities. Figuring out how to reach that group is where things get interesting.

When MSF crunched the numbers from their Khayelitsha study, one statistic was painfully apparent: only 5% of the participants were men. In some ways, this made sense. Of the two clinics at which MSF was offering self-testing kits, one was specifically geared at family planning and drew a crowd that was predominantly used by women. But even at the general clinic, where counsellors hung about waiting rooms trying to recruit men, the numbers were thin.

‘To me, that says facility-based distribution is not the right place to reach men,” says Moore.

But what about taxi ranks? Or offices? Or shebeens? These are the ideas that Majam is hoping to explore in an ambitious upcoming study. The HIV Self-Testing Africa (Star) initiative will distribute two million OraQuick tests throughout the country over the next two to three years. Wits RHI and the Society for Family Health will be responsible for 1.2-million of those – enough kits to proceed with tried-and-tested distribution models, while leaving room to push the boundaries in reaching undertested key populations.

“We’ll go out there and we’ll do the facility-based testing, but we 
want to use a lot of the time and resources that we have to try other things out,” says Majam. “We might fail horribly on some of the models. But I think we need to push the envelope.”

The department of health will be watching as the researchers try to hit the sweet spot of distribution models that are both cost-effective and effective. The goal is to deliver to the government an investment case for taking self-testing forward after donor funding dries up. To do that, researchers will need a way of getting answers back from the people using the tests.

MSF collected its data by asking participants to SMS their results to a toll-free number.

Majam cites another study conducted among truck drivers and sex workers by the Integration of TB in Education and Care for HIV and Aids (iTeach) programme last year. The research, the results of which have not yet been published, experimented with giving free airtime to participants: R5 for signing up, another R10 for sending back a cellphone photo of the test result.

The outcome? About 70% of users who signed up at the Gauteng study site completed the tests and sent back their results. At the Mpumalanga site, that number was 81%.

The study also had a strict entry requirement: only participants who agreed to having a blood sample taken — so that researchers could compare the self-test results against a “gold-standard” clinical test – were accepted.

“The key lesson learned was that people want self-testing,” says iTeach director Krista Dong. “They want it so bad that, even when made to get blood drawn and fill out paperwork, they were still willing to do it. It kind of goes against what people believed years ago, which was that a person would never want to test alone – that it’s too sensitive, too dangerous, that they’re going to commit suicide.

“It’s quite the reverse. People are so interested in having the opportunity of privacy during that very sensitive time that they’ll do almost anything to get it.”

What happens after that private moment is largely out of researchers’ hands.

Linking HIV-positive people to care remains the holy grail but, of the 17 newly diagnosed participants in the MSF study, only four were known to have begun antiretroviral treatment by the time Moore presented her findings at the International Aids Conference in Paris in July. When the truck drivers roll out and participants stop answering their phones, there’s little anyone can do.

Quite often people need to test several times before they’re able to accept their status, Moore says. And, more and more, she believes that South Africans need to be given the responsibility to make their own health decisions – to test in private without any responsibility to report the result and then to decide on their own when to get treatment. The desire to know, at least, was undeniably there.

“For the last two years, we have kept a box of tests freely available at the reception here, no questions asked,” says Moore. “They go steadily. I put 12 more in just today.”

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Anger as KZN hospital sends child home with gaping wound

A child is back in a KwaZulu-Natal hospital after being discharged with a gaping bleeding wound‚ forcing his aunt to turn to Twitter to demand help.

But the health department disputes the version of events.

The 8-year-old boy was discharged from Madadeni hospital in Newcastle on Monday with an open wound‚ following an appendix operation.

His aunt‚ Gabi Manana‚ asked her friend to tweet the pictures of the child’s festering incision without identifying him.

Manana said: “I was looking for help‚ that is why I put that thing on Twitter.”

The tweet asked national health department officials for help.

The boy was in too much pain to walk on Monday‚ said Manana.

People who viewed the tweet were worried the large uncovered wound could become septic.

On Monday night‚ Health Department spokesman Joe Maila responded to the tweet saying he had called Kwazulu-Natal health officials.

They called the child’s aunt on Monday night.

On Tuesday‚ the child was taken back to the clinic‚ as the family does not have money to take him to a different hospital.

The nurse at the clinic said they were not able to help the child as the wound was too infected.

Manana said her sister took the child home‚ following the failed clinic visit.

Manana was also called early on Tuesday morning by a man identifying himself as Steve from the hospital legal department.

“He said I am putting the life of the child in danger.”

“He said how we are going to go back to same hospital if I am putting things on Twitter?”

Later on a Tuesday‚ a nurse from the hospital called the family and organised for an ambulance to fetch him.

Manana explained: “She said ‘don’t mind I will take care of him’ but also said she was on leave.”

The child was fetched and returned to hospital where he is receiving treatment.

The KwaZulu-Natal department has a different version of events.

Spokesman Desmond Motha said that the child underwent an operation on August 24 and that a clinical team determined that the care could be continued on an out-patient basis.

“This plan was discussed with the caregiver and agreed upon. The plan was that the dressings would be done closer to home at a local clinic every second day‚ with the child returning to hospital on September 21 to be assessed by the clinical team. The child was discharged on September 4‚” said Motha.

But Manana says it is not true. His mother was told to get the boy’s wound cleaned at the clinic.

Motha said: “Following receipt of the complaint‚ the nursing services manager contacted the caregiver and arrangements were made for the child to be brought to the clinic for re-assessment and a debriefing session with the caregiver. The nursing services manager physically went to the local clinic to attend to the child and the caregiver. On discussion…it emerged that she was still in agreement with the clinicians’ plan of action‚ even though the size of the wound still concerned her‚” said Motha.

He added that the picture appeared to have been from five days after the operation.

“On the fifth day post-operation there was wound dehiscence (a surgical complication in which a wound ruptures along a surgical incision) and pus continued to ooze. It appears that this is when the photograph was taken‚ and it was before wound care had been continued until the operation site closed up‚” he said.

Manana said this is claim was “a lie”. The picture of the open wound was taken on Monday and tweeted on the same today‚ she claims.

Motha was also critical of the pictures being shared on Twitter‚ saying this was “a violation of the child’s human right”.

Manana said she used Twitter to get help.

The child’s face was not shown.

She also said Motha called her and asked‚ “why did you put this on Twitter?”

Manana is currently on her way to Newcastle to visit her nephew in hospital and monitor his treatment.

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Medical aids spying on doctors with hidden cameras – High Court claim

The National Healthcare Professionals Association of South Africa has filed papers in the Pretoria High Court accusing 19 medical aid schemes of spying on doctors and sneaking hidden cameras into their consulting rooms.

The Sunday Times reported that medical aids are also allegedly holding back payments to doctors due to unproven misconduct.

The association – formed in October 2016 – has 320 members around South Africa, of which 65 are part of the court application.

Many medical aids will oppose the application and deny any wrongdoing, stating that fraud and false claims amount to millions of rand each year and were on the rise.

The lawsuit specifically named Discovery, stating that the scheme has sent spies and private investigators with concealed video cameras and recording equipment into private consultation rooms without consent.

According to the association, this is unlawful as it infringes on the doctor-patient relationship, and the doctor’s constitutional right to privacy.

It said spies include women bringing cases designed to tug on doctors’ heart strings, such as a young child who has allegedly been raped or was desperately ill.

Discovery Health told the Sunday Times that only a small minority of over 20,000 health professionals in South Africa commit fraud and billing abuse, and that they have a responsibility to deal with the issue.

Investigations adhere to the strictest standards, said Discovery.

The report follows a recent announcement by Health Minister Aaron Motsoaledi that the new NHI policy is on track, and South Africans will have to contribute to the national insurance scheme.

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Probe exonerates Livingstone Hospital in death and maggots row

Livingstone Hospital investigations have found that nobody can be held liable for two shocking incidents in which a patient fell to his death from the fifth floor and maggots hatched in the wound of another.

But the family of Zakes Mbeki, 29, who fell from the fifth story of the hospital early on Christmas morning, after he was admitted forseizures, want an inquest magistrate to decide who was responsible.

Clint Morris, whose leg wound became infested with maggots after he allegedly begged nurses for days to change his surgical dressings, has vowed to ensure that the hospital admits to wrongdoing.Morris, 40, had been injured in a scooter accident in December.

Eastern Cape health department superintendent-general Dr Thobile Mbengashe ordered an investigation into why maggots had hatched in Morris’s wound.

Provincial health department spokesman Sizwe Kupelo said investigators had concluded in both cases that nobody could be held responsible.

He said it was not department policy to make the reasons for the decisions public. “With regard tothe Mbeki case, no individual was found to be responsible for Mr Mbeki’s death.

“The management had redress meetings with the family and they have accepted the investigation report. The complaint was closed.”

Livingstone Hospital chief executive Thulane Madonsela said interviews with patients who saw what happened revealed that Mbeki had thrown himself out of the window.

Mbeki’s uncle, well-known businessman Weza Moss, said they had been informed of the outcome of the internal investigation.

“It is neither here nor there for us,” he said.“We have given our statement to the police last Friday and the in- quest investigation is going ahead.

“We want a magistrate to decidewho is responsible.”Of the Morris case, Kupelo said:“The Morris case was investigated by a team from infection prevention and control and the hospital’s quality assurance unit, and the report found nobody was responsible for the incident.”

Morris was not informed of the outcome of the internal investigation, but his lawyers were.“They [hospital] had the opportunity to come clean, but they didn’t,” he said.

Morris said he was taking the matter further and the hospital had already received a lawyer’s letter.“I am not stopping. We will get the law to force them to admit they are wrong.”

Eastern Cape health crisis coalition action group spokesman Fikile Boyce said the medical ombudsman should be called in to investigate.

“These findings are very disap- pointing, how can the hospital absolve their staff?” he said.DA health spokeswoman Celeste Barker said she would ask Health MEC Pumza Dyantyi to explain.

“This is a cover-up or a deliberate dereliction of duty,” Barker said.“The Mbeki case was highly suspect from the outset.

“The DA is appalled to hear that our department of health lacks either the will or the capacity to conduct a meaningful investigation into these cases.

“This non-finding is highly dubious and an embarrassment to the province. It cannot be possible that such overt neglect is brushed under the carpet.”

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Is SA’s healthcare getting better?

Globally, noncommunicable diseases were responsible for 70% of deaths in 2015, up from 60% in 2000. Ischaemic heart disease was the leading cause of death accounting for 8.8 million deaths in 2015, followed by stroke (6.2 million deaths) and lower respiratory infections (3.2 million deaths).

Communicable (infectious) diseases, on the other hand, were the cause of 12 million deaths worldwide in 2015 (in total), especially in low-income countries. These diseases include lower respiratory tract infections, diarrheal diseases, HIV/AIDS, tuberculosis and malaria.

In South Africa, the number of deaths recorded in 2015 totalled 460,236 (compared to over one million births), indicating a 3% decline in deaths processed between 2015 and 2014. The majority of deaths were due to noncommunicable diseases (55.5% in 2015), an increase from 42.9% in 2005.

Interestingly, when compared to the global situation, the leading cause of natural deaths in South Africa in 2015 was tuberculosis (a communicable disease), accounting for 7.2% of all recorded deaths for that year, followed by diabetes mellitus (accounting for 5.4% of deaths) and cerebrovascular diseases (which accounted for 5.0% of deaths) – both of which are noncommunicable diseases.

In South Africa, the vision for health by 2030, according to the National Development Plan, is to achieve a health system that works for everyone and produces positive health outcomes. To achieve this 2030 vision, certain targets have been set, including progressively improving HIV/TB prevention and cure, reducing maternal and child mortality, and reducing prevalence of noncommunicable chronic diseases by 28%. Furthermore, due to the high prevalence of citizens living with HIV and/or TB in the country (7.05 million HIV/AIDS patients in 2016, for example), the National Strategic Plan (2017-2022) on HIV, STI’s and TB includes more specific objectives and goals.

The National Health Insurance (NHI) initiative was finally gazetted on 30 June 2017 and as per the gazette, the NHI is a health financing system that is designed to pool funds together to provide access to quality and affordable health services to all South Africans based on their health needs irrespective of their socio-economic status. The NHI will be implemented through the creation of a single fund that is publicly financed and publicly administered.

Several options are being considered for raising revenue to fund NHI and this funding will also occur through various sources. A large amount of funding will be generated from general taxes to support the NHI fund. Furthermore, all individuals earning above a set amount will be required by law to contribute directly. Employers will also be required to assist the NHI Fund by ensuring that their workers’ NHI contributions are collected and submitted in a manner similar to UIF contributions and employers will be required to match employees’ NHI contributions as well.

Healthcare consumers will be free to continue their medical scheme membership, but they will not be able to opt out from making contributions to the NHI Fund. Furthermore, Government will also no longer provide tax subsidies for medical scheme contributions.

However, the future success of the NHI will be based on achieving collaborative solutions to multiple issues. For example, in June 2017, there were more than 18,700 Medical Practitioners in the private sector versus only 5,325 Practitioners in the public sector and thus a clear necessity is for the NHI to include private medical practitioners through a win-win solution.

The South African Healthcare Industry Landscape Report 2017 (137 pages) provides a dynamic synthesis of industry research, examining South African Population Demographics, Global and SA Burden of Disease, Medical advancements in major chronic diseases, Healthcare Policy (NDP 2030, Strategic Plan 2017-2022, NHI as per government gazette), Healthcare Practitioner Stats, Hospitals and Clinics, Medical Aids, and the Pharmaceutical Services Sector.

Some key questions the report will help you to answer:
What is the burden of disease faced on a global and local scale?
Which examples of major chronic diseases are currently prevalent in South Africa, including their characteristics, treatments and medical advancements associated with these diseases?
What does the SA Healthcare Policy entail, including the Medium-term Strategic Framework 2014-2019, the National Strategic Plan on HIV, STIs and TB, and National Health Insurance?
What are the latest healthcare practitioner, hospital and clinics stats?
What are the characteristics of the South African medical aid landscape, including trends and details of medical aid beneficiaries, medical aid schemes, administrators, major company profiles, and benefits paid by medical aids?
What are the key characteristics of the South African pharmaceutical services?

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The maddening state of Gauteng’s psychiatric facilities

A massive shortages of hospital beds for psychiatric patients in Gauteng is compromising patient care.

Gauteng is short of about 2700 psychiatric beds which means that psychiatric patients have to be admitted to general wards where there is no security, thus posing a threat both to themselves and others.

This was revealed recently by Gauteng Health MEC Gwen Ramokgopa in a 22-page statement handed to the Gauteng Legislature in response to questions about the state of psychiatric care for hospitalised patients.

By the time a person with a psychiatric illness is hospitalised, their symptoms are usually severe and patients may be suicidal or psychotic.

The World Health Organisation (using prevalence US figures) estimates that up to three percent of a population will have severe psychiatric conditions and need hospitalisation. This excludes figures for people with substance abuse-related disorders and post-traumatic stress – so it is likely to be an under-estimation.

But using this calculation, this would assume that there should be at least 4000 psychiatric beds for Gauteng’s 13.5 million residents. But the province only has a quarter of this number available – a mere 1 058 beds.

Ramokgopa said that Gauteng’s public hospitals had admitted 18,387 psychiatric patients last year, of which almost a quarter (4 425) had been placed in ordinary wards alongside other patients.

The worst affected hospital was South Rand Hospital, which had taken in 2586 psychiatric patients last year and placed 972 of them in ordinary wards because its two psychiatric wards were full.

‘Tiny psychiatric wards’

Four district hospitals don’t even have psychiatric wards at all, yet still accepted large numbers of psychiatric patients last year. These are: Pholosong, which admitted 763 psychiatric patients, Far East Rand (711), Heidelberg (285) and Bheki Mlangeni (95). Other hospitals have tiny psychiatric wards and also had to house mentally ill patients alongside others.

“This means that many patients admitted to hospitals for the required 72-hour treatment and observation period are not placed in dedicated psychiatric wards,” said Jack Bloom of the Democratic Alliance.

“This led to three psychiatric patients dying because they jumped from windows, and one patient was raped another because of inadequate security,” said Bloom.

A number of suicides, injuries and sexual assaults had been reported at various hospitals because of inadequate security for patients, according to Bloom.

Meanwhile, many of the psychiatric wards need urgent repair. In March, Health-e News reported on the poor state of psychiatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) where the roof was leaking and the wards were in an appalling state.

Gauteng Infrastructure and Development spokesperson Theo Nkonki admitted that his department was aware of the shocking conditions at the hospital.

While the roof problems at the CMJH psychiatric ward have been partially fixed, the ward remains a bleak environment that is unsuitable for psychiatric patients.

In 2016, former Health MEC Qedani Mahlangu said a new 40-bed psychiatric ward for CMJAH would be completed by last September at a cost of about R10-million. But this has never happened.

Speaking about the non-completion of the promised psychiatric ward, Nkonki said “The project was planned to be completed last year September, but was not achieved due to non-performance of the appointed contractor.” He said that the project was now expected to be finished by April next year.

Shoddy state

When Nkonki was asked to comment on why the psychiatric wards at CMJAH had been left in a shoddy state for well over six months and whether any action had been taken against the contractors responsible for the failed job, he said that he could not respond immediately.

“We at the [Department] are running hundreds of projects across our hospitals and clinics,” said Nkonki, adding that he was unable to give “accurate information” without doing research. He said he would be able to respond only when he received a report from his team in the field but did not say how long this would take.

“This new ward should have been completed three years ago, but incompetent contractors were appointed who could not do the job. They are now on the third contractor who, hopefully, finishes it next year, but the delays have been inexcusable,” Bloom said.

He said psychiatric patients were increasingly vulnerable because of the grossly inadequate state of the current facilities: “I am greatly concerned by the shortage of acute psychiatric beds and the poor state of many psychiatric wards in Gauteng,” he said.

Gauteng has already been embroiled in the worst scandal involving psychiatric patients in South Africa’s history, after almost 100 patients died within a few months after being transferred from Life Esidimeni to privately run organisations, mostly completely unable to deal with mentally ill patients.

In February, Health Ombudsman Professor Malegapuru Makgoba released a report that revealed that 94 mentally ill people had died after the Gauteng Department of Health cancelled its contract with Life Esidimeni.

He found that the transfer of the 1 371 patients was “rapid” and “chaotic”, and the 27 “mysteriously and poorly selected” non-governmental organisations (NGOs) that they were transferred had “invalid licenses”. Many of the patients died due to extreme neglect – starving or freezing to death.

Makgoba gave the Gauteng health department 45 days to ensure that all remaining Esidimeni patients transferred to NGOs were “urgently removed and placed in appropriate health establishments”.

However, because of a lack of adequate step-down facilities for psychiatric patients, many ex-Esidimeni patients have ended up back in psychiatric hospitals – thus exacerbating the bed shortage.

Psychiatric patients are amongst the most vulnerable patients in the health sector. But proper psychiatric care is expensive and mental health has long been under-funded. Esidimeni was supposed to be a wake-up call, but the champions of the mentally ill seem to have fallen asleep again.

An edited version of this story was also published in Daily Maverick.


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Google search adds medical quiz to help diagnose depression.

Google has integrated a medially-certified quiz into its search results to help users determine whether they have depression.

Users in the United States who search Google for depression or clinical depression will now be greeted with a link labelled “Check if you are clinically depressed”.

The link opens an integrated PHQ-9 questionnaire, which helps to identify levels of depressive symptoms.

It is important to note that the PHQ-9 quiz is not meant to act as a standalone diagnostic tool, but it can help users to identify symptoms.

Google said users should consult a medical professional for an in-depth diagnosis to determine if they have clinical depression.

Take the test here!

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Nearly 2 million will lose private healthcare if tax reform happens

The government’s plan to ditch medical aid tax credits will have a disastrous effect on already cash-strapped South Africans and force nearly 2 million people onto the over-stretched state health system.

If the tax credit is removed, 22% of medical aid users will not be able to afford cover, Stellenbosch economics consultancy Econex warned in a report published on Friday – 1.9 million of the 8 million medical aid members, including children, will have to drop out of the private healthcare system.

In a national health insurance policy document released in July, Health Minister Aaron Motsoaledi said he wanted to remove the tax credit to users, which amounts to R20-billion a year.

Medical aid schemes’ members get a tax reduction of R3,636 a year – or R303 a month. Motsoaledi said then that “the tax credit … we believe, is unfair”.

Economist Paula Armstrong, author of the Econex analysis, said the rebate was intended to “alleviate some pressure on the state [system]”.

Taking it away would make medical aid unaffordable for many middle-class people.

She calculated that the richest 20% of South Africans spend a maximum of 12.85% on medical aid premiums and on the fees of physiotherapists and dentists not paid for by medical aid.

The poorest 20% of medical aid users pay 22% of their income in premiums. The removal of the tax credit would push the poorest medical aid users into spending 35% of their salary on the premiums alone.

Premiums would “become excessively expensive”, said Armstrong.

“The removal of the tax credit affects the poorest [medical aid user] and that is the opposite of what national health insurance intends to achieve . this perpetuates inequality.”

Frans Cronje, CEO of the SA Institute of Race Relations, said removing medical tax credits was a form of taxation.

He said the government was adopting a short-term solution to countering the effects of a weakening economy.

“Instead of structural reform in order to position South Africa’s economy as competitive, and improve growth and tax revenues, the government is delaying the inevitable by finding extra taxes. This is unsustainable and it is going to end badly.

“The fiscal crunch means the government is desperate to raise new revenues from secondary taxation through the cutting of subsidies.”

The middle class has experienced sharp drops in living standards and cannot afford to lose the tax credit, he said.

Motsoaledi said in June: “Once national health insurance is up and running, what reason will you have to keep medical schemes?

“Once the law is passed it affects all citizens in the country; they have to belong to it, they don’t have a choice.”

By: Times Live

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Tygerberg Hospital performs its first deep brain stimulation

A man with tardive dystonia became the first adult to undergo deep brain stimulation (DBS) at a Western Cape state hospital. His condition drastically improved following the procedure at Tygerberg.

Until now it had only been performed on a few children at the Red Cross Children’s Hospital.

The dystonia was a side effect of an anti-psychopathic medication prescribed to the patient for bipolar disorder. However, the dystonia persisted after the medication was discontinued. By the time the DBS operation was performed, the patient had already been confined to bed for six months.

The operation was performed by Dr Armin Gretschel, a neurosurgeon with Stellenbosch University’s Faculty of Medicine and Health Sciences (FMHS). The equipment was provided by Medtronic.

According to Gretschel, two very thin electrodes were implanted in the globus pallidus on both sides of the brain to block the electrical impulses causing the movement disorder. Healthy brain tissue is not damaged by this and, if necessary, the procedure can be reversed.

The electrodes were then connected with a thin wire to a battery-driven neuro-stimulator, a device similar to a pacemaker, which was implanted under the skin just below the collar bone.

The whole process took approximately six hours. Programming the device is only done afterwards and was handled by Professor Jonathan Carr, Head of FMHS’ Division of Neurology.

Parkinson’s disease and other neurological conditions

The brain region where the electrodes are implanted depends on the reason for the DBS. According to Carr, the procedure has thus far been performed around 300,000 times worldwide and almost 90% of the cases involved Parkinson’s disease. Number two on the list is essential tremors, followed by dystonia. It has also been approved for neurological conditions such as obsessive-compulsive disorder and Tourette syndrome.

“Some dystonia patients are symptom-free after the implant for as long as the system works,” says Gretschel. “Parkinson’s disease is progressive and DBS relieves symptoms, but more stimulation is needed as the disease worsens,” he adds.

Patients with Parkinson’s disease are kept awake during DBS to communicate with them, but this is not possible with dystonia patients, because the abnormal movements can lead to injuries in the steel framework in which the head is placed for the procedure.

The implanted device is about the size of a matchbox (6cm x 4cm x 1,5cm) and is battery-driven. Depending on the tension required, the battery can last between two and five years before the device has to be replaced.

If the reloadable option is chosen – which was the case in this instance because high tension was required – the battery can simply be reloaded by holding the reloading unit next to the skin. However, practical considerations play a role in this decision. Patients in especially rural areas don’t have access to electricity and it is also not considered an option if there is uncertainty whether the patient is actually going to reload the device regularly.

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