The Life Esidimeni tragedy happened in the early months of 2016 when a long-standing contract with the Life Healthcare Group was terminated by the Gauteng Department of Health. Thereafter despite warnings that this was unwise around 1500 vulnerable mentally retarded patients were transferred from Life Esidimeni facilities in Gauteng to Non Governmental Organisations (NGO’s) in what was known as the Marathon Project. Many of the NGO’s did not have the capacity or resources to manage patients of this nature and as a result at least 144 patients died of neglect and many more suffered inhuman and degrading conditions. This occurred less than a year after I had retired as Head…
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Age and Ageism … some further thoughts
The recent withdrawal of President Joe Biden as a candidate for the upcoming American presidential election and the various responses to that event set me thinking once again about the manner in which ageing is addressed in the world today. In a world that has become progressively more politically correct we are made aware of the need to be sensitive to discrimination in all its various manifestations. Ageism simply stated is the prejudice or discrimination against people on the grounds of their age. President Biden a man of 81 had been the presumptive Democratic Party candidate elected through the process of primaries across the various American states but in recent…
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Government of National Unity (GNU) … illusion or reality?
The May 29th 2024 election delivered a parliament for the first time in the 30 years since 1994 in which no single party had a majority. During the past 30 years the African National Congress (ANC) had a significant majority at both national and provincial level with the exception of the Western Cape province where since 2009 the opposition Democratic Alliance had a majority which was maintained in the 2024 election. Clearly after the 2024 election the ANC which was the largest party with just over 40% of the votes had to seek coalition partners. After tough negotiations a coalition was formed with the Democratic Alliance as the second largest…
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South African Public and Private Healthcare … there is good and bad in both
The recent high profile signing of the National Health Insurance Act set me thinking about the public perceptions of healthcare in South Africa. In a South African context one hears much about problems experienced in the public health sector but less about those in the private health sector. In the public health sector issues relate to the poor quality of healthcare while in the private sector the issue most frequently is the high cost of services. I have had the advantage of having worked for forty years in the South African public health sector and subsequent to my retirement being part of, or having undertaken, various investigations into public health…
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National Health Insurance NHI … the “final countdown” … or not!
In May 2023 I wrote a post titled “National Health Insurance … will logic prevail?” Now a year later, in May 2024, it appears to me that emotion and political necessity rather than logic has prevailed certainly amongst the ruling party. I do not intend to repeat an analysis of what is contained in the now NHI Act signed by President Ramaphosa but rather to consider the consequences of his doing so 15 days prior to a general election in which the political party which he heads faces for the first time possible, but probably unlikely, election defeat. The President has defended his actions with the argument that the delay…
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Some personal thoughts on age and ageing
Aging something that faces all of us but a reality that few think of when they are young. At the risk of stating the obvious it is an inevitable process that no-one escapes. Those of you who know me personally will know that I have had grey hair, a marker of advancing years, for a very long time starting in my thirties. My age, in addition to the grey hair, chronologically places me at the upper end of the spectrum of life expectancy for male South Africans. In January this year I needed readmission to hospital for the repair of an incisional hernia, a consequence of my previous admission to…
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The dilemma of unemployed doctors in South Africa
Currently there are according to reports several hundred unemployed young doctors in South Africa, a country that according to recommended doctor to population ratios requires more and not less doctors. It has been previously reported that some amongst other categories of health professionals are similarly finding it difficult to find employment in the South African public service leading to some even emigrating from this country to find work elsewhere. This situation has been attributed to the shortfall in funding for public health services. The current financial crisis in government departments largely results from a wage agreement with organised labour that increased the salaries of all public servants by 7%. These…
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Facing budget shortfalls in the South African public health sector
In 2023 in my health blog I described the budget shortfalls facing most South African government departments. From my perspective the most pressing consequences of these shortfalls are those affecting provincial health departments. Recent developments including an open letter addressed to the Minister of Finance from health professionals in the Western Cape have again highlighted this issue. Many provincial health departments in South Africa have a history of what are euphemistically termed “accruals”, which stated otherwise is an inability to settle outstanding accounts within either the required 30 days or even a financial year. These departments have in the past been unable to remain within their approved budgets. An implication of “accruals” is…
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2023 … some reflections on the year that was!
At this time last year I published a similar post reflecting on the happenings of 2022. It is interesting to reflect on what I said then in the light of what has transpired in 2023. In December of 2022, the echoes of COVID-19 still remained, something that has now almost vanished from the public consciousness despite reports of new variants, similar to the amnesia that may follow a very traumatic event. In Britain, however, the country continues to anguish over the consequences of what was and what was not done during the pandemic in the public hearings of a commission of inquiry into the actions of those in positions of…
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Cystic fibrosis … the conundrum of scientific progress
I recently read a review article on cystic fibrosis which highlighted for me the tremendous advances in the field of medicine since I left active clinical practice as a paediatrician in 1995. During my training as a paediatrician and subsequently as a senior research fellow I worked for various periods in a clinic at the Red Cross Children’s Hospital that managed children with cystic fibrosis. As a result of this experience when in 1983 I moved to Bloemfontein, I started a similar clinic to manage children with the condition in the Free State province. Over the 12 years that I spent in the Department of Paediatrics and Child Health at…