My love of the music of Leonard Cohen, a music muse of my earlier years, was reawakened after watching the 2022 movie Hallelujah: Leonard Cohen, a Journey, a Song. Leonard Cohen is best known for his 1984 song, Hallelujah, that has had a renaissance among many artists during the last two decades. As a write this, I have Cohen’s silky and evocative voice playing in the background. Leonard Cohen struggled for periods of his life with depression but described his last years as having had a weight lifted off his shoulders that lead to renewed artistic creativity and a successful return to performing in the decade before his death at 79.…
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Healthcare … how should the priorities be determined?
I read with interest a recent report of the proceedings from a recent conference held in Cape Town. The conference, it was reported, brought together healthcare workers, researchers and community activists from 11 African countries. The focus of the conference was the unequal provision of surgical procedures to those living in rural areas and those without a medical aid or medical insurance. At the conference it was stated that before the COVID-19 pandemic the lack of access to surgical procedures was a challenge for public health services but that this had been exacerbated by restrictions on surgical procedures during the pandemic with an estimated 175 000 people now waiting for…
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Health and Wellness go together but are very different challenges.
The World Health Organisation (WHO) defines Health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and defines Wellness as “the act of practicing healthy habits on a daily basis to attain better physical and mental health outcomes, so that instead of just surviving, you’re thriving”. Both without a doubt important concepts but result in different challenges for those responsible for their achievement. “A new name, a new direction?” is the title of a recent article published in Daily Maverick . The authors draw attention, as so many have done in the past, to the work of Sydney and Emily Kark…
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Is the state of South African public health a budgetary or a delivery problem?
I was struck recently when according to a news report the National Minister of Health had appealed to his cabinet colleague the Minister of Finance to “stop cutting health budgets” and in doing do “alleviate the pressure on frontline health services”. He indicated that he had requested that there be no budget cuts in the coming year as had been indicated previously, so there would be no further reduction in frontline services. As an illustration the Minister reported a large number of vacant posts in the Free State Health Department of which the province had indicated nearly 900 were termed as “critical frontline posts” which he attributed to a lack…
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Is a fixed retirement age a sensible option?
Much has been written about the age at which employees should retire and whether with increasing longevity, the retirement age should increase commensurately. In countries with ageing populations resulting in many living over two decades after retirement, an increasing burden on pension funds has increased the urgency of this debate. A survey from the United States indicated that while there are many factors supporting an increase in the age at which citizens become eligible for Social Security payments that a proposal of this nature is unpopular with voters. It must be stressed however that retirement is a luxury reserved for those with permanent employment and employment is a luxury which…
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Management decisions right or wrong must have consequences.
Recent experience with almost month-long power cuts in South Africa due to inadequate generation capacity have highlighted a State-owned entity has been unable to ensure a reliable source of electricity to the country for over a decade. When this first occurred in 2008, I was heading the Western Cape Department of Health and as management we had urgent meetings with officials from the power utility to decide how to manage what was envisaged then to be a short-term problem. At that time many health facilities had inadequate or no back-up generators and a decision was taken and actioned urgently to acquire and install generators at as many facilities as fast…
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A personal reflection …
I have not posted anything since July 2022. This is not because there has been nothing worthy of comment in the health sector but rather that I have felt a deep sense of despair with what has transpired in the preceding months and years. Since my retirement in 2015 I have been involved in various initiatives to address challenges in the South African public health service as a member of nationally appointed task teams and most recently as a consultant requested to address financial management in a South African provincial health service. Whilst I accept that as an outsider and consultant not directly responsible for the management of health services,…
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Gift of the Givers and a Vaccine Task Force … lessons to be learnt … revisited.
It is worth reading my post of December 2021 again and then watching the link below to a recent Twitter post featuring a short input from Dr Imitiaz Sooliman. Well said Dr Sooliman! What we need is action and deeds by capable people as the answer to the challenges faced in South Africa today! https://twitter.com/nosh15/status/1550421503489019906?s=20&t=9PBoHEZ7i_MO8KdrdlWVJw
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Refuse … a marker of government failure
In March 2021 I wrote a post entitled, “Piles of refuse are a public health problem”, and reflected on the causes and consequences of this phenomenon. 18th July 2022 was the annual Mandela Day, a commemoration that is intended to be a “global call to action that celebrates the idea that each individual has the ability to make an impact”. Using the fact that Nelson Mandela fought for social justice for 67 years, people were urged this year to spend 67 minutes according the Mandela Day 2022 slogan to “Do what you can, With what you have, Where you are.” A video was posted on Twitter by the South Africa…
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The end of life … assisted dying … a vexed question