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…
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Nutrition … a marker of poverty or privilege
A recent headline in the Daily Maverick read as follows, “Child malnutrition in the Eastern Cape qualifies as a disaster” quoting from a South African Human Rights Commission report on child malnutrition in the Eastern Cape province. The article cited the fact that 25% of the provinces’s children have stunted growth and over the period of one year over 1000 children were diagnosed with severe malnutrition of whom 120 died. Juxtapose this with a more recent media headline in a Afrikaans National Sunday Newspaper which reads translated from the Afrikaans, “You cough up R24 000 per head so that Cyril’s (the State President) guests can feast while they fly”. The…
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Accountability … is it a reality or a myth?
Reading various media reports about the actions of individuals, politicians, state entity and government representatives, I am struck by how often the word “accountability” is so easily and even glibly used. How often do we hear that a particular person must be held accountable for their actions and how often in the end does it appear that they were not? Accountability is simply defined as an “obligation or willingness to accept responsibility or to account for one’s actions”. It is the state of being accountable, that is being subject to giving account which implies being able to “explain or to be answerable for one’s actions”. In a political sense government…
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Thoughts after recent travel outside of South Africa …
I recently had the privilege to travel to Scotland, Austria and Germany and while this post is not directly health related the connection to good governance and government on which effective healthcare delivery depends is clear. In Scotland my wife and I visited my daughter, son-in-law and two grandsons on the croft in the Scottish Highlands that they purchased shortly after their arrival in Scotland over three years ago. In the last 18 months the family have constructed a barn on the property without outside assistance, something that they would have been unlikely to undertake in South Africa. Crofts which are a feature of the Scottish Highlands established in the…
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South Africa … how long are the shadows of apartheid?
In recent days both President Ramaphosa and a cabinet minister have attributed current issues in South Africa to the legacy of apartheid. Without doubt legacies of apartheid remain in this country almost thirty years after the birth of a democratic and non-racial South Africa. Glaring examples of this are the spatial distribution of South Africans and the significant differential of income and employment amongst South Africans which in large measure remains defined by race. However, can the tragic events of a fire in a “hijacked” Johannesburg building be attributed to apartheid as was done by a cabinet minister? Is the poor state of many municipalities across the country due to the…
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Healthcare … a victim of a self-inflicted government funding malady?
Various questions trouble me when I hear that a public sector health department has a major shortfall in the budget allocation that will result in people being unable to receive the healthcare that they need. Who is accountable? Who is responsible for the consequences? Is it immoral that the cost of healthcare should limit access? Who should decide which treatment should not be provided? What is an acceptable package of healthcare? What can be done to alleviate the problem? I could go on … I have great empathy with a doctor who although the treatment plan is clear must inform the patient that due to affordability constraints that either a particular…
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J Robert Oppenheimer, decisions and consequences with which we live!
I was reminded recently of my connections with Princeton and indirectly The Institute for Advanced Study when watching the 2023 film Oppenheimer, a cinematographic biography of J Robert Oppenheimer. I was born in October 1948, by chance in the United States when my parents were living in Princeton New Jersey and where my father, a mathematician, was a fellow for two years at The Institute for Advanced Study. J Robert Oppenheimer was the theoretical physicist who headed the Los Alamos Laboratory of the Manhattan Project that culminated in the detonation of the first atom bomb in 1945 in New Mexico and subsequently the atomic bombs dropped on the cities of Hiroshima…
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Oversight and governance versus Management
Recently pronouncements by both the Minister responsible for electricity within the national cabinet and the chairperson on the Eskom Board drew to my attention the differences between oversight, governance and management. In both cases they appeared to make statements that in my initial thoughts belonged with management rather than a politician and a board chairperson. It is often a sensitive issue when management is faced with a managerial politician or a board that seeks to take management decisions. Eskom, in South Africa, is a State owned entity (SOE) (also defined in the the Public Finance Management Act as a Major Public entity) that provides almost exclusively the electricity that powers the national…
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Politicians, policies, plans and their promises
Recently the South African President has extolled the virtues and achievements of the political party that he leads. This is totally understandable since as the leader he faces an election in 2024 which according to analysts could be the closest since the first democratic election in 1994 when the ANC assumed power. There have undoubtedly been achievements and the President focused on these including the fact that many indigent South Africans now receive a social grant that eases the poverty with which they grapple daily. In the public health sector, of which I have first-hand experience, there have been significant achievements for example the introduction of a comprehensive national immunisation…
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Cholera in South Africa … is it a marker of government failure?
As a paediatrician I specialised in childhood diseases of the gastrointestinal tract. I obtained a doctorate for a study of infants presenting to the Red Cross Children’s Hospital in Cape Town with acute diarrhoea. In the introductory chapter of my thesis, I quoted the researchers Rohde and Northrup (1975) who stated that, “the incidence of diarrhoea is more closely related to socioeconomic conditions than to climate, to poverty rather than place.” At that time (1981-1982) diarrhoea in infants was an annual summer epidemic in Cape Town located largely amongst the black and coloured communities of the Cape Flats. In recent times the frequency of the disease amongst children from these…