Health South Africa

Health minister is clearly a minister in poor health

2007-02-17T09:44:00.000-08:00

February 16, 2007
I take no pleasure in seeing Health Minister Manto Tshabalala-Msimang ill. Outshone by colleagues who were brimming with good health at a cabinet cluster briefing in Cape Town yesterday, Tshabalala-Msimang became an object of pity and embarrassment.

This was not Dr Beetroot, or the Mad Hatter - to be ridiculed and sniggered at. This was a woman who was disorientated and who spoke with difficulty.

The briefing was bound to be a headache for government officials, who had always dreaded Tshabalala-Msimang's antics at press conferences, especially when asked questions about HIV and Aids nutrition, beetroot and the African potato.

Then there was her combative perfor-mance in Toronto in 2006, which also prompted her colleagues to insist on a change in communication strategy. But yesterday was different. It appeared things had got worse. Reading from a statement, she lost her place and, on one occasion, had to be assisted by Housing Minister Lindiwe Sisulu.

Questions had to be repeated, while others were totally misunderstood. As the chairman of the cluster, for example, an erratic Tshabalala-Msimang directed a question about Bok van Blerk's song De La Rey to her director-general, instead of Arts and Culture Minister Pallo Jordan.

Laughter quickly smothered embarrassment.

When asked a question about extreme drug re- sistant TB that her officials had anticipated, she rambled on at length from a prepared reply that did not directly answer the question asked.

And then there was the question of whether she would follow in the footsteps of her deputy and some health MECs, and take a public HIV test.

Tshabalala-Msimang, who completed her medical studies in the Soviet Union, decided to throw in a Russian phrase, as unintelligible to most of us in the audience as some of her replies.

Later, after the ordeal was over, she was spotted giving a brief jig, as if to say, "I'm fit and healthy", before leaving the venue.

Was it government policy on everyone's lips after yesterday's briefing? Nothing of the sort. "What is wrong with Manto?" was the phrase on many lips.

Tshabalala-Msimang has always been the subject of gossip in the corridors of power and she has her more vocal detractors who have called for her head because they disagree with her position on HIV/ Aids. There has been speculation about the reasons for her incoherence and, if these are correct, she is not alone in the executive.

I don't know whether any of it is true. What I do know is that President Thabo Mbeki is not the type to get rid of cabinet ministers who are ill, even if they are on their death beds.

I once sat next to transport minister Dullah Omar on a National Assembly front bench. I watched him collapse before me and thought he was dead. He was helped out of the chamber, a frail old man. Public works minister Stella Sigcau, too, was often more at hospital than at work, but the president remained loyal to his colleagues, ensuring they con- tinued to receive a salary for life. Both died in office.

Tshabalala-Msimang's health continues to be a source of speculation.Last week, the Sunday Times reported how she had to be assisted by two cabinet ministers at the state-of-the-nation address, and also reported that she had rambled on unintelligibly at a cabinet lekgotla, with Social Development Minister Zola Skweyiya finally stepping in to complete her presentation. Although this was denied by her office this week, the denials no longer ring true.

The minister herself told reporters yesterday that she was in good health.

But we all saw it for ourselves - the media, the diplomats, public servants and her cabinet colleagues - all of us witnesses to something bizarre.

Tshabalala-Msimang is clearly a minister in poor health. Given the president's loyalty and reluctance to dismiss those who are ill, perhaps those close to Tshabalala-Msimang should advise her to step down, with whatever dignity she has left.

Industry opposes smoking curbs

2007-01-31T10:48:00.001-08:00

29.01.2007
The tobacco industry is trying to convince Parliament not to adopt more smoking controls at hearings on the Tobacco Products Control Amendment Bill of 2006.

Tobacco kills almost 5-million people every year and this figure is set to double by 2030. Yet this week the tobacco industry will continue its attempts to convince Parliament not to support more stringent measures aimed at curbing smoking.

Bennett Asia of the Department of Health said there was overwhelming evidence that tobacco companies were targeting the developing world. “Already 60 percent of all admissions at Groote Schuur Hospital (in Cape Town) are tobacco-related,” revealed Asia.

He said there was a need to amend the Act as the tobacco industry had exploited several loopholes. “We also need to strengthen the measures available to enforce the Act,” he added.

Asia said the amendments were aimed at increasing fines for those breaking the law, further regulating smoking in public places, banning smoking at homes where there are crèches and other businesses, regulating smoking at entrances to buildings and offices, regulating smoking at outdoor events, barring under eighteens from places where smoking is permitted and regulating manufacturing standards.

Abednego Baker of the National Institute for Occupational Health called for all workplaces and restaurants to be declared 100 percent smoke-free. He quoted from several studies showing there were still high concentrations of nicotine in restaurants and work areas adjacent to smoking areas, despite ventilation systems.

“These (ventilation) systems basically distribute second-hand smoke through a building,” he said.

Baker added that studies in the United States had also shown that statistically there was no significant effect on bar and restaurant revenues once smoking was banned.

Dr Yussuf Saloojee, executive director of the National Council Against Smoking (NCAS), told Parliament’s Health portfolio committee that tobacco was a uniquely dangerous consumer product as it was the only legal product that killed the user when used exactly as the manufacturer intended.

He said that in South Africa tobacco killed one person every 20 minutes or about 30 000 people a year.

NCAS supported several proposed changes including:
· restricting smoking near entrances to public places;
· not allowing smoking in private homes used commercially for childcare or educational purposes;
· assisting employees to safely voice their concerns without fear of repercussions;
· regulating smoking at sports events.

Saloojee also called for the amendments to protect domestic workers in private homes and for smoking to be banned in cars with children.

Francois van der Merwe, Chairman of the Tobacco Institute of South Africa which represents more than 95% of the total legal tobacco industry in this country, said although industry supported regulation, it was concerned that it would be “over-regulated”.

He said over-regulation would allow the illegal trade in tobacco to boom.

Industry opposes smoking curbs

2007-01-31T10:48:00.000-08:00

Doctors, nurses nowhere to be found

2007-01-26T22:20:00.001-08:00

January 19 2007
The shortage of health professionals is back in the spotlight, with the South African Medical Association sounding a warning that even in the private health sector, doctors and nurses are hard to come by.

"(The association) is concerned about the increasing difficulty attracting healthcare professionals to work in the public health sector. There is even a lack of doctors and nurses in the private sector," said association head Dr Kgosi Letlape in a challenge to the health minister.

Dr Manto Tshabalala- Msimang has just returned to work after a long illness, and Letlape said yesterday he would get in touch soon with a view to tackling the healthcare challenges of 2007 and beyond.

His comments follow serious concerns raised last month in the SA Medical Journal which said that, without major intervention, rural healthcare delivery capacity would collapse from next year when a change to the rules governing medical student internship would dramatically cut the number of doctors coming into the field. In 2008 students will have to do a two-year internship for the first time.

The Journal estimates that this will mean a 78 percent reduction in the pool of available, sufficiently qualified community service conscripts for that year.

"Just as the situation rights itself the following year, the three-year contracts of hundreds of foreign doctors will come to an end, progressively depleting the 2 250-strong foreign doctor workforce each subsequent year, unless willing new English-competent recruits are found," it said.

Letlape pulled no punches when he said the emigration of doctors was "an old story", and could no longer be blamed entirely for the shortage.

One of the major problems, he said, was the absence of a medical school in four of the nine provinces, which would create career opportunities and increase research capacity, so beginning to tackle the crisis.

Letlape was highly critical of moves to "dismantle" Medunsa and turn it into a satellite campus of Limpopo University.

In the US, he said, there was a medical school for every two million people, and the country still had a shortfall of doctors.

"In Gauteng, we have three medical schools for seven million people and the Medunsa situation is one of the saddest because it's the institution that trains the highest number of black doctors in the country," Letlape said.

The Western Cape has two medical schools, and there are one each in the Free State, KwaZulu-Natal and the Eastern Cape.

According to the Journal, one respected audit five years ago had 23 407 South African-born workers practising a medical profession in Australia, Canada, New Zealand and the US, versus 11 332 doctors and 41 617 nurses working in the public health sector here.

But Letlape warned against perceptions that the crisis was limited to the public health sector: "We are not actually training enough doctors and that is starting to impact on the private sector, too.

"Our population has increased, along with demands for better healthcare, and that requires more doctors than we have.

"We can't keep blaming the fact that doctors leave the country. That's always been the case and what we should be doing is factoring attrition into our forecasts."

Letlape said that to rise to the challenges facing the delivery of healthcare in South Africa, "we need to pool our skills and resources to ensure that patients in both the public and private sector receive the best possible care".

Don't give Manto new tobacco powers

2007-01-26T22:16:00.000-08:00

24 January 2007
Health Minister Manto Tshabalala-Msimang should not be given the "sweeping" powers set out in proposed changes to the tobacco-control law, British American Tobacco (BAT) argued on Wednesday.

David Crow, managing director of BAT South Africa, was speaking on the second day of public hearings on the draft legislation by Parliament's health portfolio committee.

"We're concerned about the sweeping powers that have been [assigned] to the executive," he said. "They're giving the minister extensive powers in lots of areas.

"There are areas that are ill-defined, and what we'd like is more definition [and] a real debate with all the stakeholders."

He said he was hoping for "pragmatic solutions, so we don't get into the problems we've had with previous Acts that have gone through government".

Crow said the existing law was already working extremely well, as witnessed by a reduction in smoking in South Africa, though there was room for improvement.

"Really what we're saying is, let's be pragmatic, let's do it right, let's get all the people round the table, write the legislation properly ... so it can be enforced and workable."

In a written submission to the committee, BAT said the minister already had the power to make regulations regarding "any other matter required ... to achieve the objects of the Act".

Under the new Bill, however, she is to be given powers to make regulations on the location, content, size and format of any sign (such as a point-of-sale sign) required under the Act; on the standards with which a tobacco product should comply; on methods of testing compliance with prescribed standards; and on disclosure of companies' marketing expenditure.

"If the Bill is enacted, material changes to the system of tobacco control could be made without any debate in Parliament," BAT said.

Earlier, the committee heard that smoking should be banned completely in the workplace and all other public places.

An occupational hygienist at the National Institute for Occupational Health, Abednego Baker, told the committee: "I've only got one recommendation: all workplaces should be made 100% smoke free."

He said smoking areas in bars and restaurants were serviced by waiters who were often working there only part-time, and were young and financially vulnerable.

The Bill seeks to give legal protection to employees such as waiters who object to working in smoking areas.

Under the existing legislation, smoking may be allowed only in designated areas that make up only a portion of the total area of the workplace or public place.

Baker said there was "some kind of contradiction" between the tobacco legislation and the Occupational Health and Safety Act, which stipulated that employers had to protect employees from any health hazard in the workplace.

Tshabalala-Msimang denies being sidelined

2007-01-20T07:28:00.001-08:00

January 16, 2007, 17:30

Manto Tshabalala-Msimang, the health minister, has dismissed suggestions that she has been sidelined from government's Aids combating efforts in recent months. She has also challenged her critics to find and present proof that she has in any of her statements on HIV/Aids, said that nutrition must take precedence over treatment.

The minister said the role of nutrition must be understood within the context of the government's comprehensive plan on the pandemic. She said she is still involved in all decision-making.

Tshabalala-Msimang returned to her office today after a three month absence. She was hospitalised for a month last September after she fell ill with a lung infection. The minister said: "I was sick and was not concentrating on what people were saying and obviously people were not going to wait for somebody to get ill before they implement those decisions. Besides the department briefed me on a daily basis on what was happening."

TAC says its prepared to work with minister
Tshabalala-Msimang also denied reports that the Aids plan only gained momentum once she was gone, saying the decisions were taken long before then. The minister said she cannot be held accountable for people twisting her articulation of the comprehensive plan on HIV/Aids.

The Aids plan will be finalised before the South African National Aids Council's first meeting in March. In the past the Treatment Action Campaign (TAC) made no secret of how it felt about the minister's stance on Aids. The TAC said its prepared to work with her as its key objective is to finalise the national strategic plan and if the minister maintains the tone which was set by Phumzile Mlambo-Ngcuka, the deputy president, there should be progress.

Doctors, nurses nowhere to be found

2007-01-20T07:27:00.001-08:00

January 19 2007 at 03:05PM

The shortage of health professionals is back in the spotlight, with the South African Medical Association sounding a warning that even in the private health sector, doctors and nurses are hard to come by.

"(The association) is concerned about the increasing difficulty attracting healthcare professionals to work in the public health sector. There is even a lack of doctors and nurses in the private sector," said association head Dr Kgosi Letlape in a challenge to the health minister.

Dr Manto Tshabalala- Msimang has just returned to work after a long illness, and Letlape said yesterday he would get in touch soon with a view to tackling the healthcare challenges of 2007 and beyond.

His comments follow serious concerns raised last month in the SA Medical Journal which said that, without major intervention, rural healthcare delivery capacity would collapse from next year when a change to the rules governing medical student internship would dramatically cut the number of doctors coming into the field. In 2008 students will have to do a two-year internship for the first time.

The Journal estimates that this will mean a 78 percent reduction in the pool of available, sufficiently qualified community service conscripts for that year.

"Just as the situation rights itself the following year, the three-year contracts of hundreds of foreign doctors will come to an end, progressively depleting the 2 250-strong foreign doctor workforce each subsequent year, unless willing new English-competent recruits are found," it said.

Letlape pulled no punches when he said the emigration of doctors was "an old story", and could no longer be blamed entirely for the shortage.

One of the major problems, he said, was the absence of a medical school in four of the nine provinces, which would create career opportunities and increase research capacity, so beginning to tackle the crisis.

Letlape was highly critical of moves to "dismantle" Medunsa and turn it into a satellite campus of Limpopo University.

In the US, he said, there was a medical school for every two million people, and the country still had a shortfall of doctors.

"In Gauteng, we have three medical schools for seven million people and the Medunsa situation is one of the saddest because it's the institution that trains the highest number of black doctors in the country," Letlape said.

The Western Cape has two medical schools, and there are one each in the Free State, KwaZulu-Natal and the Eastern Cape.

According to the Journal, one respected audit five years ago had 23 407 South African-born workers practising a medical profession in Australia, Canada, New Zealand and the US, versus 11 332 doctors and 41 617 nurses working in the public health sector here.

But Letlape warned against perceptions that the crisis was limited to the public health sector: "We are not actually training enough doctors and that is starting to impact on the private sector, too.

"Our population has increased, along with demands for better healthcare, and that requires more doctors than we have.

"We can't keep blaming the fact that doctors leave the country. That's always been the case and what we should be doing is factoring attrition into our forecasts."

Letlape said that to rise to the challenges facing the delivery of healthcare in South Africa, "we need to pool our skills and resources to ensure that patients in both the public and private sector receive the best possible care".

Minister Is Sidestepping Teacher-Aids Programme

2007-01-12T11:36:00.000-08:00

Government appears to have sidestepped a recommendation to implement a specific HIV/AIDS prevention and treatment programme for teachers and is instead preparing a general "wellness" programme for teachers and pupils.

For years fears have been expressed that SA is losing teachers faster than they can be trained due to HIV/AIDS.

In 2004, the Human Sciences Research Council (HSRC) and the Medical Research Council (MRC) studied the incidence of HIV among teachers and came up with recommendations.

One of these was that the education department and donor agencies "should establish and manage a workplace programme specifically to provide a comprehensive HIV and AIDS prevention and treatment programme".

However, in a reply to a parliamentary question from Democratic Alliance (DA) MP Ryan Coetzee, Health Minister Manto Tshabalala-Msimang said her department was one of the many key stakeholders involved in an initiative which is "the development of a national framework on health and wellness programme for both educators and learners".

This framework is intended to guide the education sector at all levels in the implementation of a wellness programme that "focuses on all health aspects instead of focusing on HIV and AIDS only".

Tshabalala-Msimang did concede that money had been obtained from the US President's Emergency Plan for AIDS Relief for the provision of antiretroviral drugs, particularly for teachers.

DA health spokesman Gareth Morgan said that while the HSRC had highlighted many chronic diseases facing educators, the immediacy of the HIV/AIDS threat deserved an extraordinary response from Tshabalala- Msimang and the national education department.

SA was already facing a critical shortage of educators and had to act swiftly to mitigate the effects of HIV/AIDS on the teaching population, Morgan said.

Specific recommendations were provided in the 2004 survey on educator supply and demand, which the minister had not taken seriously, he said.

Morgan said the health and education ministers "must not hide behind a vague wellness plan for educators" which did not contain the urgency to deal with HIV/AIDS.

"It is clear that the relevant departments need to target educators in need of antiretroviral therapy," he said.

Tshabalala-Msimang said the HSRC/MRC study had found "on the issue of morbidity, that about 12,7% of educators are HIV- positive and 22% of those are in need of antiretroviral therapy".

However, the minister said, HIV/AIDS was not the only factor in teacher morbidity.

Other diseases played significant roles in the health of educators. The most frequently reported of these in the past five years were high blood pressure (15,6%), stomach ulcers (9,1%) and diabetes (4,5%).

Pressure growing for ousting of Doctor Beetroot

2006-12-27T11:43:00.000-08:00

South Africa’s Health Minister Manto Tshabalala-Msimang has had a rough year. In a country where more than 5.5mn people are infected with the Aids virus, any politician charged with managing the pandemic has their task cut out.

But some analysts believe, that 2006 may have been the controversial politician’s last in her post, given that many South Africans, including those with experience of nursing dying relatives, are tired of the saga surrounding her portfolio.

The latest swipe at the Russian-trained doctor came in a newspaper advertisement paid for by Blue Ribbon, a bread and maize manufacturer, and poking fun at her apparent fondness for potatoes, beetroot, garlic and olive oil as Aids cures.

"Tired of people constantly calling for your resignation?," read the advertisement in the Star newspaper which featured a sandwich stacked with the minister’s favourite vegetables and recommending Tshabalala-Msimang eat Blue Ribbon bread to cope with her demanding job.

In her years as health minister since 1999, HIV infection levels have failed to fall significantly and Tshabalala-Msimang has earned a reputation for being stubborn, unapologetic and incredibly uncooperative.

Internationally, the woman known as "Dr No" and "Dr Death" stands as a laughing stock over her penchant for promoting the benefits of vegetable and traditional remedies for those infected with the deadly disease.

Aids activists regularly condemn her actions, including an initial refusal to provide anti-retroviral drugs that prompted a drawn-out court battle. In the end, the minister forced two years ago to make the treatment available to Aids sufferers through the state health system.

International scientists, Aids activists and local opposition politicians - among others - have written her off as incompetent and irresponsible, with some even accusing her of "human rights violations" and "murder." Several months ago, South African Aids activists attending the International Aids Conference in Canada set out to humiliate her publicly by vandalising her health department’s exhibition stand that carried a display of the infamous vegetable cures.

The incident left the government severely embarassed and tongue- tied, but Tshabalala-Msimang has refused to give up her preoccupation with garlic, beetroot, lemon and olive oil concoctions for Aids patients waiting to tap into the health system’s Aids drug supply.

President Thabo Mbeki drew criticism for refusing to act against his minister and sparked debate about whether this meant the two had similar views or whether she was actually just carrying out orders.

Mbeki, who makes available money to fights Aids, is often criticised for rarely mentioning the disease and for questioning the link between the HIV virus and full-blown Aids in 2000.

Calls for her resignation reached their peak recently when Tshabalala-Msimang took ill unexpectedly. During her spell in hospital, two more pragmatic politicians - Deputy President Phumzile Mlambo-Ngcuka and Deputy Health Minister Nozizwe Madlala-Routledge - began talks with the Aids lobby and civil society groups.

The two spoke out against the government’s "denialist" approach to the disease and praised the Aids lobby for their unrelenting stance on treatment, marked a turning point.

Tshabalala-Msimang returned from her illness, guns blazing with denials that she had been sidelined, but the media and health professionals continue to focus what a future without the "Dr Beetroot" might mean for the health of the nation.

Failing health of public hospitals

2006-12-23T14:00:00.000-08:00

MOST of the doctors and nurses interviewed in eight South African public hospitals believe staff shortages and management failures compromise patient care. While professionals are reluctant to acknowledge that this entails avoidable patient deaths, clinicians at one hospital were more forthright: “Everything is done in a rush, and staff are left exhausted. The result is a low quality of care and ... mortality that could have been avoided.”

A nurse in a second hospital commented: “We do not give quality patient care. Now I am alone in the ward, it means I am unable to prevent certain things happening. The result is complications, wound sepsis, longer hospital stays.” This is one among many similar comments from nurses in these hospitals.

It seems clear, on the basis of the eight hospitals studied, that many patients at public hospitals in SA are receiving low-quality health care. Why is this the case? There are three main problems: staff shortages, a dysfunctional relationship between hospitals and provincial health departments, and dysfunctional internal management structures.

All the public hospitals we investigated suffer from acute shortages of staff, particularly nurses and other professionals such as pharmacists and radiographers. Nurses consistently complain of stress, exhaustion and low morale as a result of the heavy workload they have to bear: “We always have to rush: we wash, we medicate, we move on. We cannot have tea, we cannot eat. The pressure leads to absenteeism, as nurses we become demotivated and no longer have empathy. It affects the patients.”

The closure of nursing colleges by government in the mid-1990s is the primary cause of the shortage of skilled nurses. The dramatic reduction in training has not only reduced the supply of skilled nurses, but has also reduced the number of trainee nurses in the wards, so increasing the workload of the trained nurses.

But government has also made other policy decisions that have exacerbated the nursing shortage. It appears that health department authorities, under pressure from the fiscal austerity programme of the later 1990s, significantly reduced the posts for support workers like cleaners, porters, clerks and messengers.

However, the essential role that support staff play in most hospital activities means that this is a false saving, impacting adversely on the utilisation of scarce and expensive professionals such as nurses. For example, the shortage of nursing auxiliaries means that professional nurses have to do more routine tasks; the shortage of porters and messengers means nurses have to collect medicines from the pharmacy or move patients through the hospital; and the shortage of cleaners means that nurses have to clean wards instead of looking after patients. In the wards, managers have to cope with a daily crisis as staff shortages mean shuffling staff from ward to ward, or calling in agency staff, to ensure that at least a bare minimum of service can be rendered. This prevents them from devoting attention to the proper management of health care and resources.

Hospital managers are disempowered and frustrated by the centralised control that departmental officials exert over their everyday activities. Provincial head offices micromanage the hospitals and hedge the hospital managers about with endless regulations and tedious procedures. Hospital managers have little control over budgets, procurement, discipline, staffing levels and staff structures.

Head office officials have very little understanding of the operational complexities of running bigger hospitals, or of the problems faced by health workers in the wards. Head offices frequently make decisions that disrupt or impose failure on hospitals, or worse yet, simply fail to make decisions. The result is that hospital managers cannot be regarded as accountable for health-care failures in the hospitals, as they lack the necessary powers to change things.

Indeed, disempowerment and lack of accountability is rife within the health department bureaucracies, both in head offices and in hospitals. Within hospitals the key problem is dysfunctional management structures. Management is split up into segregated silos according to functions: nurses are managed by matrons and nursing managers, doctors are managed by senior doctors and clinical managers, and support workers are all managed within their own structures. The result is that there is no locus of accountability for the operations of a specific unit of the hospital, a ward, say, or a clinical department.

In the ward the senior nurse is ostensibly accountable for the running of the ward, but in reality she has little control over support staff or doctors. The same applies to a clinical department such as a surgical department: while the clinical head manages the doctors, the nurses, clerks, cleaners and porters are managed by separate supervisors, each in their own silo. This fragmented management structure results in a pervasive disempowerment, frustration and lack of responsibility.

Public hospitals are in a state of decline. All three problems identified here need to be addressed in a comprehensive fashion if decline is to be averted. The National Labour and Economic Development Institute (Naledi) has recommended: the reopening of nursing colleges; significantly increased employment of support workers so professionals, especially nurses, can concentrate on their core tasks; devolving full operational accountability for hospitals to hospital management, leaving head offices to concentrate on strategy, audits and monitoring; and replacing the fragmented silo structures in hospitals with integrated and accountable management structures.

The cabinet accepted these proposals in January this year. Some of them, such as the devolution of management authority, are actually longstanding government policy but have never been implemented. It remains to be seen whether this changes as a result of the cabinet decision.

Critically important, however, will be the allocation of realistic budgets, especially for the employment of additional staff. Finance Minister Trevor Manuel’s revenue overruns and frequent complaints that government is unable to spend its money seem to provide an ideal opportunity.

‖Von Holdt and Murphy are researchers at Naledi and co-contributors to the recently published State of the Nation: South Africa 2007 (HSRC Press). This is an edited version of their chapter. Naledi has been contracted by the Gauteng health department to assist with the implementation of a transformation strategy at Chris Hani Baragwanath Hospital.

Pharmacy dispensing fee faces another hurdle

2006-12-23T11:30:00.000-08:00

A serious disagreement between government and pharmacists over the controversial new dispensing fee legislation is far from over.

Spokesperson for the Pharmacy Stakeholders Forum (PSF) Lorraine Osman on Sunday confirmed they would lodge a court application for postponement of the dispensing fee's implementation later on Monday.

This follows National Health Minister Dr Manto Tshabalala-Msimang's refusal to defer implementation of the new dispensing fee for pharmacists which is scheduled to start next month.

"We're taking the matter to court because we are convinced the proposed new dispensing fee will have a negative impact and wreak havoc on pharmaceutical service delivery in SA," said Osman.

"Implementation of the dispensing fee will place some community pharmacies under crippling financial strain and as many as 75 percent of pharmacies may be at risk of closing."

She said PSF was convinced the fee's introduction would escalate the growing crisis in pharmacies and harm the health of the public as accessibility to medicines will be compromised.

"The minister indicated to the PSF that deferment was also discussed with the Pricing Committee. It seems the Pricing Committee has again failed to comprehend the realities of the present marketplace and the practicalities of providing a comprehensive, quality pharmaceutical service, especially in regard to human resources, return on investment, security and rental costs," she said.

While government is adamant that the new dispensing fee is viable, people in the industry argue it has the potential to ruin numerous small businesses.

No deal with Manto

2006-12-23T11:28:00.000-08:00

Health Minister Manto Tshabalala-Msimang has refused to postpone the date for next year’s implementation of reduced dispensing fees for pharmacists, the Pharmaceutical Stakeholders’ Forum said at the weekend.

“After the close of business on Friday, the Minister of Health informed the Pharmacy Stakeholders’ Forum (PSF) of her decision not to defer the implementation date of the new dispensing fee for pharmacists,” said spokesman Anita Heyl.

A new dispensing fee of R26 was published in the Government Gazette at the beginning of December.
“We met the Director-General of Health on December 5 to inform the department of the potentially negative impact the proposed new dispensing fee would wreak on service delivery in South Africa,” Heyl said.

She added that the fee would place some community pharmacies under crippling financial strain and as many as 75% of pharmacies could close down.

Heyl said that, based on extensive information and the practical experience of its members, the PSF was “convinced that the introduction of the fee will escalate the growing crisis in pharmacies and will harm the health of the public as accessibility to medicines will be compromised.

“The Minister indicated in her letter to the PSF that the matter of deferment was also discussed with the Pricing Committee,” Heyl said.

“It seems the Pricing Committee has again failed to comprehend the realities of the present marketplace and the practicalities of providing a comprehensive quality pharmaceutical service, especially with reference to human resources, return on investment, security and rental costs.”
The current situation has already resulted in closure of pharmacies, Heyl said. Some communities were unfortunately left without adequate pharmaceutical services.

Deputy seems unscathed after Aids speech

2006-12-23T11:27:00.000-08:00

The government's revitalised HIV and Aids message appears to be the real winner, while Deputy Health Minister Nozizwe Madlala-Routledge seems to have emerged unscathed - publicly at least - after outspoken criticism of her boss and the president.

With most of this week's media focus on her reported call for President Thabo Mbeki to take a public HIV test, the deputy minister was able to deflect attention from her other equally candid and arguably more damaging remarks in an interview with the London Sunday Telegraph.

These related to Health Minister Manto Tshabalala-Msimang and Mbeki himself, who, she said, should bear some responsibility for the confusion on the proper way to treat HIV and Aids.

If Madlala-Routledge received a private dressing-down for this and other outspoken views, nobody was saying on Tuesday.

Presidential spokesperson Mukoni Ratshitanga was not aware of any discussion between her and the president, nor was he aware of any intention to have one.

Mabel Dlamini, Madlala-Routledge's spokesperson, did not know of any talks between the deputy and Tshabalala-Msimang.

She also was not aware of any "dressing-down".

Government spokesperson Themba Maseko confirmed on Tuesday that Tshabalala-Msimang was still recuperating at home after being hospitalised in October for three weeks.

Tshabalala-Msimang's spokespersons did not respond to messages, but Maseko said the minister was expected to return to work in the new year.

He could not say whether the minister was in contact with her deputy, who admitted at the weekend that Tshabalala-Msimang had effectively gagged her from speaking on HIV and Aids.

Madlala-Routledge, who along with Deputy President Phumzile Mlambo-Ngcuka, has become the new, less combative face of the government's HIV and Aids policy, put out a statement on Tuesday clarifying the more sensational aspect of her interview, that she had urged Mbeki to take an HIV test.

She acknowledged that while she had not called on Mbeki personally to conduct a public test as claimed, she had replied "yes" to a question on whether people in leadership positions should be tested.

In an indication that she might have come under fire for breaking ranks, Madlala-Routledge said: "I wish to reiterate my commitment to the policy framework as agreed by the cabinet to ensure the whole of government communicate a single, clear and consistent message on HIV and Aids."

It was clear the government has trodden carefully on how to handle the issue, taking two days before a statement was issued.

If Mbeki was seen to publicly take action against Madlala-Routledge, his detractors would have accused him of victimising the deputy minister, who is regarded as a breath of fresh air with Aids activists and NGOs.

It also would have damaged the government's unified message on the pandemic.

However, questions remain on how a junior member of the executive could escape censure, having publicly criticised her superiors all the way to the highest office in the land.

African minister ends decade of denial on Aids

2006-12-23T11:25:00.000-08:00

For two years she laboured in the shadow of her boss, South Africa's notorious health minister, who declared garlic, lemon and beetroot a suitable treatment for the country's victims of Aids.

Now Nozizwe Madlala-Routledge, a plain-speaking 55-year-old Quaker, is being feted as a heroine by health campaigners, Aids sufferers and much of South Africa's media, for daring to end a decade of denial on the disease by the ruling African National Congress.

In the space of a few weeks the deputy health minister has helped turn government policy on its head.

She has publicly admitted for the first time that the government has been in "denial at the very highest level" over Aids.

She is also helping to draw up a five-year plan to triple the number of patients receiving life-saving anti-retroviral drugs and halve the rate of new infections.

Mrs Madlala-Routledge has broken new ground by taking her family with her for an HIV test — and has called on the president, Thabo Mbeki, to do the same.

Fainter-hearted politicians might doubt the wisdom of asking that of a leader who has himself questioned the link between HIV and Aids. But Mrs Madlala-Routledge is confident about calling on her colleagues to follow suit.

"To me it is logical that people in the leadership see the need to do this," she said.

What is more, in an interview with The Sunday Telegraph, she was prepared to criticise those who for years have promoted traditional medicines as an alternative to modern drug treatment, for a disease that claims the lives of 1,000 South Africans every day.

She made clear that her criticisms included both Mr Mbeki and the health minister, Manto Tshabalala-Msimang.

"What has happened in South Africa, which is tragic, is that people are confused about treatment," she said. "I think it was irresponsible of leaders to say people have a choice, because what traditional healers do we know, who know how to treat Aids? I don't know of any.

"In relation to the president himself, he has recently announced a task team on traditional medicine. For me there's nothing wrong with that as long as the task team understands its duty is to assist in research on traditional medicine. But if there is a misunderstanding and they are saying people can use traditional medicine, that is a problem."

Encouraged and aided by her old friend, Phumzile Mlambo-Ngcuka, the deputy president, Mrs Madlala-Routledge has thrown herself into the fray since her immediate boss was sidelined by a lung infection two months ago.

Before that, the health minister's views on Aids treatment had led to South Africa being ridiculed. Mrs Tshabalala-Msimang ensured that her bizarre theories about the benefits of beetroot and garlic were promoted at international conferences.

"It was seen as saying that garlic, beetroot and vegetables can be an alternative to treatment," said Mrs Madlala-Routledge. "It did not reflect government policy, and the government was very, very embarrassed."

She conceded the merits of a nutritionally rich and balanced diet, but added: "I haven't come across any scientific information that tells me particular food items have a special role [in the treatment of Aids]."

Not surprisingly, her uncompromising stance has ruffled feathers at the department of health. Until very recently, she admitted, she had been instructed not to speak on HIV/Aids at all.

"I've been sanctioned because I've spoken in parliament, and was told I may lose my job," she said. "I must only say what she [the health minister] says, and this is official. For me that is gagging. But I've not observed the gag."

Pharmacist attacks Manto on new fees

2006-12-23T11:24:00.000-08:00

A Rondebosch pharmacist, at the end of his tether over new dispensing fees that he says will leave pharmacists insolvent, faces the tough choice of quitting after 16 years.

Rustenburg Pharmacy's Waheed Abdurahman slates Health Minister Manto Tshabalala-Msimang for "demonising" his profession as "rip-off merchants" and "fat cats".

Sham Moodley and Ivan Kotze, co-ordinators of the Pharmacy Stakeholders Forum, met Health Director General Thami Mseleku and members of the Secretariat to the Pricing Committee on Friday, to discuss the potential impact on pharmacists of the new dispensing fee.

The new fee, after years of controversy, was published in the Government Gazette on December 1. They will come into effect in January 2007.

The forum is adamant that the new fees will "precipitate a crisis in pharmacies", impacting on the pharmacists and their employees and also compromise client's access to medicines because pharmacies will be forced to close.

Abdurahman is one pharmacist facing that threat.

Mseleku is expected to return to the Stakeholders Forum by Wednesday with a response to its request for the new fee implementation date to be put on hold.

At the meeting, said Kotze, the forum had pointed out the difference between the pricing committee's theoretical calculation of costs, and the actual costs incurred by pharmacists.

Mseleku has undertaken to present this to Tshabalala-Msimang, who he said would make a decision as soon as possible.

In an open letter to the cabinet, Abdurahman writes that Tshabalala-Msimang is "deliberately destroying the retail pharmacy sector".

He says the department should consult ministers Trevor Manuel and Alec Erwin to arrive at a pricing structure that would keep pharmacies viable.

Another new medical plan

2006-12-23T11:23:00.000-08:00

THE Eastern Cape’s public health system appears set for a major overhaul.

According to a discussion document, the Service Transformation Plan, the “ultimate aim is to reshape the health service delivery system in order to provide accessible quality care health services to all”.

The changes, due to be implemented in phases from March, come a mere six years after a process of rationalisation which saw hospitals across the province such as East London’s Cecilia Makiwane and Frere amalgamated into complexes at significant cost.

The cost of East London Hospital Complex was estimated at R35 million. And it saw its managers occupy rather plush headquarters at the city’s beachfront.

But, then, it was heralded as a move that would see “people-centred quality care to the public”.

Seemingly, though, the Eastern Cape’s health managers and officials have found the amalgamation process to have been undesirable and have now put a new transformation plan on the table.

The major thrust of the new process, according to the report, will be an emphasis on primary healthcare and community health centres, avoiding congestion and oversubscription of services at major hospitals.

This, the document says, is in line with national health policy.

On the face of it, the Health Department has a difficult task ahead in bringing quality care to its clients. It faces massive shortages of skilled personnel such as doctors and nurses.

Earlier this year, national Health Minister Manto Tshabalala-Msimang said, CMH, for example had a 58 percent vacancy rate for doctors. The situation worsens in areas such as the former Transkei.

It appears, though, that the transformation process, is set to become a political football. It has yet to be presented to the Bhisho Legislature and the Premier for approval. The unions have yet to be consulted about a move that will see many of its members relocated to new centres.

There have been efforts to suppress our publication of the proposed changes. Calls have been made to the Daily Dispatch to stop its publication. The Health MEC refused to comment, instead preferring to lash out at our reporters, ranting how she “hates” and “despises” the Dispatch.

The MEC’s feelings aside, it is imperative that one key question is answered: Is it in the interest of the citizens of the Eastern Cape?

If it is, then the plan must go ahead. If it is nothing but a desperate plan to attempt to deal with the hereto unsolved problems of delivery, then it must be scrutinised.

That is the responsibility that Bhisho carries when acting for the people of this province.

Aids confusion catches up to Manto and Mbeki

2006-12-23T11:21:00.000-08:00

Deputy Health Minister Nozizwe Madlala-Routledge has criticised the government's shortcomings in tackling HIV and Aids, saying both President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang must bear some responsibility for confusion over the correct treatment for the virus.

Interviewed for a British newspaper, Madlala-Routledge criticised those who promoted traditional medicines as an alternative to conventional drug treatment.

"What has happened in South Africa, which is sad and tragic... people are confused about treatment... and this has come about because of the confusing messages coming from the very top.

"If I use the example of traditional medicine, I think it was irresponsible of leaders to say people have a choice... because how do those people choose when they don't have the knowledge that is backed up by science?

"It is absolutely irresponsible to say to people who are desperate, who want to live, 'Oh, go to your traditional healer if you want', because what traditional healers do we know of who know how to treat Aids? I don't know of any in my country."

Asked if she included the president and the health minister in her comments, Madlala-Routledge replied "yes".

Expressing concern that high-level decisions were generating confusion, she noted that Mbeki's recent appointment of Professor Herbert Vilakazi as chairperson of a "task team" on traditional medicine might contribute to this, if its role was not clearly defined.

"You see, in relation to the president himself, he has recently announced a task team on traditional medicine and for me there's nothing wrong with that, as long the task team understands its duty is to research or to assist in research on traditional medicine.

"But if there is a (misunderstanding)... that the task team is saying people can use traditional medicine, that is a problem, because what brings about that concern for me is that Vilakazi is chairperson of the task team on traditional medicine and... Vilakazi... is marketing an untested product, Ubhejane, so that's a concern because once people see 'Oh, Professor Vilakazi has now been appointed by the president to be chairperson of this task team and Professor Vilakazi is saying take Ubhejane to cure Aids' - you know what I mean, it's very confusing to ordinary people."

Pressed on whether she was saying it had been a mistake to appoint him, she replied, "Yes, I think so."

The comments are potentially embarrassing for the president, although Madlala-Routledge has a reputation for being outspoken.

The 55-year-old mother of two has become something of a hero to critics of the government's Aids policy and a symbol of the government's new willingness to accept criticism and work with former enemies such as the Treatment Action Campaign through the newly restructured South African National Aids Council.

Along with her old friend, deputy president Phumzile Mlambo-Ngcuka, she has been at the forefront of what has been hailed as the most important shift in the government's approach to tackling the disease in 12 years, with a five-year strategy being drawn up in consultation with civil society organisations, and bold new targets such as the halving of new infections by 2011.

Significantly, it was she, not her boss, who stood alongside the deputy president when the new strategy was unveiled on World Aids Day.

Referring to South Africa's exhibition stand at the Toronto Aids conference in August which featured garlic, lemon, beetroot and African potatoes, but no anti-retroviral drugs - until journalists pointed out the omission - Madlala-Routledge said it had left the government "very, very embarrassed" and did not reflect official policy.

Until very recently she was gagged from speaking on HIV and Aids at all - something she confirmed for the first time in the interview.

"Now I've not been gagged formally. It's not like there's a letter telling me not to talk about HIV and Aids, but I've been sanctioned because I've spoken in parliament and been told I may lose my job.

"I must only say what she says and this is official. For me that is gagging but I've not observed the gag. I've just said what I think ought to be said and nobody has told me to shut up. So I think, I've taken this to mean, what the government has wanted done from the point of view... that there have to be clear and consistent messages. This is what I'm doing, contributing to that."

Madlala-Routledge also commented for the first time on Tshabalala-Msimang's recent outburst on the ANC website, in which she attacked those who portrayed her recent illness as "an opportunity to turn others into champions of a campaign to rid our government of the so-called HIV and Aids denial (sic) at the highest level".

Madlala-Routledge said, "Of course, the minister has indicated her displeasure by writing... a veiled criticism of me, but I haven't had anybody else supporting her from the top."

She said she had not discussed the issue with her boss.

"As you know after her admission to hospital she's been recovering and I've wanted her to concentrate on that. I've not had any discussion with her about it but (I) also felt (I've) not really needed to although I know what I said and I stand by it."

Health minister missed AIDS Day, but wasn't missed

2006-12-23T11:20:00.000-08:00

World AIDS Day has come and gone, but there is still no sign of South Africa's health minister, Dr. Manto Tshabalala-Msimang, who has questioned the link between HIV and AIDS, and suggested that a potion of garlic, beet root and potato can keep the disease at bay.

In August, the contrarian minister, lampooned at home as "Dr. Beet Root," was verbally abused at an AIDS conference in Toronto when she set out the South African booth with vegetables and gave no space to life-saving anti-retroviral drugs, or ARVs.

However, when she entered a hospital to be treated for a lung infection last month, her deputy, Nozizwe Madlala-Routledge -- who previously had been forbidden from making statements on AIDS -- signaled a change in policy, pressing the need for ARVs and describing the Canadian protest as "embarrassing."

Dr. Tshabalala-Msimang is now back at the ministry, but the nation appears to have moved on without her. Last Friday saw huge rallies around South Africa to mark World AIDS Day, but in a change from previous years, government officials participated alongside representatives of the Red Cross and the U.N. program on AIDS, both of which have criticized the slow rate at which ARVs have been made available in South Africa.

Dr. Tshabalala-Msimang's office issued a statement saying the minister played no role in the events because she was still recuperating from her illness. Deputy President Phumzile Mlambo-Ngcuka, who filled in as keynote speaker, announced in the eastern city of Nelspruit that the government planned to cut the rate of new infections in half and that ARVs would be made available to all who need them.

The shift appears to have come from the highest level of government. Sources close to the Cabinet say that after the Toronto conference, President Thabo Mbeki and other ministers were concerned that the matter had gotten "out of hand."

Senior members of the ruling African National Congress have been speaking openly about the damage done to South Africa's image abroad by Dr. Tshabalala-Msimang's backing for alternative medicine.

Global health organizations, including the Red Cross and human rights groups, have argued that, in a country where adult mortality has increased more than 80 percent in the past decade and nearly two-thirds of state-hospital deaths are HIV related, it is irresponsible to promote untested treatments.

Five years of bungled health policies have turned the epidemic into a crisis:

5.4 million South Africans are HIV positive.
950 die from the illness every day.
One-third of women giving birth in state hospitals test positive for HIV.

ARV targets fall short

2006-12-23T11:18:00.000-08:00

Global targets to reach universal access to antiretroviral treatment are vague and abstract and will result in the dealth of millions of people, a civil society report warned this week.

The report card is a five country snapshot on the progress of scaling up of treatment. Authored by the International Treatment Preparedness Coalition (ITPC), made up of 800 activists, it says that despite pockets of progress, treatment efforts as a whole is stagnating.

They have urged the World Health Organisation to set a similar target as the “3 by 5” campaign where the global effort was geared towards reaching 3 million people by 2005.

Although acknowledging the worldwide progress in providing treatment to 1.6 million people at the end of June 2006, the report said this success is dwarfed by the 5 million people who may face death if ARV-roll out is not substantially increased.

“A lot of work needs to be done if we are to have universal access. At the moment we don’t have the fastest roll-out and targets needs to be set in order to keep governments accountable,” said Fatima Hassan from the AIDS Law Project and South African representative on ITPC.

The report looks at South Africa, India, Russia, Dominican Republic and Kenya and makes recommendation at country and global levels. ” The Global Fund, PEPFAR and other agencies should put clear systems, lines of accountability and guidelines in place to avoid country-level failures to meet goals associated with their programs.”

Activists said, the report highlights the need for national targets to be informed by global targets. The South African National Strategic Plan on HIV/AIDS came under scrutiny in the report that was criticised for its low targets.

“Even though targets are missed; it creates the incentive for everyone to set up systems and monitor progress. We can hold government accountable when these targets are not reached,” said Hassan. She said the health department cannot use the excuse that high targets will mean lack of quality as the quality of care does not need to drop.

The South African case study found that in October 2006, three years after the South African government agreed to provide ART directly, a combined total of about 265,000 people were on treatment in the public and private sectors. About 165,000 to 175,000 people were accessing ART in the public sector, with some 100,000 to 110,000 receiving it in the private and not-for-profit sectors. But currently 31,000 people are on waiting lists.

“The bottom line is that although we have made progress, a lot of work needs to be done,” said Hassan.

Aids' Death Certificate Causes a Stir

2006-12-23T11:15:00.000-08:00

In the first case of its kind in the country, a South African pathologist has been brought before the Health Professions Council (HPCSA), a national health watchdog, for mentioning AIDS as the cause of death on a medical certificate.

Greer van Zyl, a spokesperson for the HPCSA, confirmed that the next-of-kin of a young woman who died in April 2005 had filed a complaint against former state pathologist Dr Leon Wagner, but said that so far only the formal complaint had been made and the hearing to decide the matter had been postponed.

"The family has charged Wagner with unprofessional conduct after he apparently recorded AIDS as the cause of death without proper evidence or examining the body, as well as for a breach of confidentiality. But, due to the complexity of the case, it has been handed to our Human Rights and Ethics Committee," Van Zyl told IRIN/PlusNews.

In South Africa, medical certificates issued to the family in the event of a death attribute the cause to diseases such as tuberculosis (TB) or pneumonia, without mentioning AIDS, even if AIDS was a contributing factor, to protect the confidentiality of the deceased's status, and the family from stigma.

Van Zyl said, "Objections to the charges have been overturned by the HPCSA disciplinary committee, and the charges against Wagner will remain when the hearing resumes at a date mutually agreed upon by the complainant and the defendant."

Fatima Hassan, of the AIDS Law Project (ALP), a nongovernmental organisation providing legal assistance, agreed that the case was a sensitive one, but was confident that the HPCSA would handle it with the level of attention it deserved.

The issue has sparked debate about the extent to which families might cover up the real reason for the demise of HIV-positive relatives. The opposition Democratic Alliance (DA) party stressed that there was still a large degree of stigma attached to AIDS and the families of HIV-positive people, even though an estimated 5.5 million of South Africa's 45 million population are living with the disease.

According to DA health spokesman Gareth Morgan, "Current policies, which protect the confidentiality of patients at all costs, could actually be hurting the national AIDS awareness campaign. Perhaps by listing AIDS as the cause of death on the certificate we could better monitor the pandemic, as well as eradicate existing stigma and continued denial among both families of patients and the government."

South Africa's approach to the pandemic has often drawn international criticism, usually as a result of Health Minister Manto Tshabalala-Msimang's promotion of natural remedies rather than antiretroviral (ARV) drugs, and the slow pace of the government's ARV rollout.

The first page of a death certificate, which went to the family, only indicated whether someone had died of natural or unnatural causes, while the second page contained more details, such as whether HIV/AIDS or any other factor had contributed to the death, and was used for statistical purposes.

Hassan did not believe statistical reporting on AIDS would improve if doctors listed the disease as a cause of death on both pages. "As it stands, doctors are already required to submit two certificates, one to the family, and another to the government."

Manto's new dispensing policy slammed

2006-12-23T11:14:00.000-08:00

Opposition parties have strongly criticised Health Minister Manto Tshabalala-Msimang for her medicine dispensing fees policy, with the Democratic Alliance calling for the suspension of the new fees system.

"It may take another protracted and expensive legal battle over dispensing fees to convince the Minister of Health that she cannot simply act on her own whims," DA spokesperson Gareth Morgan said on Wednesday.

The Minister should as a matter of urgency suspend the implementation of the new fees she announced recently, and which were due for implementation in January, and meet with the relevant role-players in the pharmacy industry.

"To avoid a legal battle, the Minister at the very least needs to hold discussions directly with pharmacists about these new fees - something that, quite astoundingly, has not happened yet, though the livelihoods of around 2800 pharmacists, and their dependants, are directly affected by these fees," he said.

In September last year, she was ordered by the Constitutional Court to go back to the drawing board after the dispensing fees she had announced were found to be inappropriate.

Now, according to an actuarial study into the implications of the new fees, only around 22 percent of pharmacies were likely to survive, because the fees allowed for an average mark-up of R21.45 an item, whereas pharmacies needed to be able to charge around R28 to cover their overheads.

The implications were particularly dire for rural areas, where the closure of a pharmacy would make medicines inaccessible to many, and the consequences of the loss of thousands of jobs
attached to pharmacies also needed proper consideration.

"The process so far has been one-way communication. The pharmacists have not been able to hold a single meeting with the pricing committee, which is astonishing considering that the committee's mandate was effectively to determine the future of their profession," Morgan said.

Ruth Rabinowitz of the Inkatha Freedom Party said the problems with medicine pricing were entrenched in the White Paper [on health], which made the Minister and her Director General the "Big Sister and Big Brother of health care".

"They decide everything about anything to do with health care and take on the roll of financial techno wizards, although they have no expertise in finance."

They should rather set minimum standards for all health facilities, lay down reasonable minimum packages for medical schemes, set maximum prices only, allowing for bulk discounts in a transparent pricing structure, expose pharmacies to open
competition, and ensure that nobody disobeyed the law.

The virtually arbitrary manipulation of prices up or down for medicines, among other things, had given her the "sticky rope to ensnare health providers in a web of bureaucratic controls that
makes health care provision in our country irrational and uneven", Rabinowitz said.

Hospitals overwhelmed by dying AIDS patients

2006-12-23T10:58:00.000-08:00

Despite government’s introduction of antiretroviral drugs in 2004 to contain HIV in those already infected, thousands of people are still dying of AIDS-related illnesses, and hospitals from Cape Town to Mussina are struggling to deal with the increased load.

Last year, an estimated 320 000 people died of AIDS-related illnesses in South Africa.

Half-a-million people are estimated to be sick enough to need antiretroviral (ARV) drugs but slightly less than half this number is getting ARVs.

The impact of AIDS can be seen on the country’s mortality figures, with a 79% increase in all deaths over the past seven years (1997 to 2004) and a 161% increase in people aged 20 to 49, according to Statistics SA. More people aged between 30 and 34 are dying than in any other age group (58 000 in 2004, in comparison to almost 19 000 seven years before).

“The antiretroviral rollout is not yet at a level where it has significantly altered HIV-related admissions and fatalities at hospitals,”says Professor Helen Schneider of Wits University’s Centre for Health Policy.

In addition, say hospital doctors, people with HIV are only seeking help when they are already very sick and it is difficult to treat them.

“We are overwhelmed by medical patients. We used to admit between 10 and 15 medical patients on a daily basis. Now that number has gone up to 40 to 50 patients per day. And most of these patients have HIV-related complications,” says Dr George Abraham, acting senior clinical manager of Natalspruit Hospital.

The day before Health-e visited Natalspruit, seven people had died in the 734-bed hospital of AIDS-related illnesses.

Up to 60% of all patients in paediatric and adult medical wards countrywide have HIV-related conditions, according to researchers.

But hospitals in areas with high HIV rates are taking even more strain:

90% of children and 80% of adult medical patients at Stanger Hospital on KwaZulu-Natal’s north coast are HIV positive, and 30% of male medical patients die.
Three-quarters of the male patients and 70% of female patients who died in the medical ward of Mseleni Hospital in far northern KZN over the past three months suffered from AIDS-related illnesses.
About three-quarters of the patients in the 135 medical beds at Durban’s Addington Hospital have HIV-related illnesses.
Two-thirds of patients tested for HIV at Rustenburg Provincial Hospital in the heart of North West’s mining area, were positive.
Between three and four women die every day in GF Jooste’s medical ward in Mitchells Plain while almost 50 000 medical patients, mostly HIV-positive, were seen in the hospital’s casualty ward last year, almost 20 000 more than in 2003.

“It does overwhelm us because really, the AIDS patients are sick,” explains Nombulelo Mabhija, sister in charge of Natalspruit’s 38-bed male medical ward.

“They need to be cared for all the time. They are totally dependent upon us because most of them can hardly walk. They can hardly feed themselves. They can hardly wash themselves, so we have to wash them.”

The Hospice Palliative Care Association (HPCA) last year took care of 35 000 HIV positive people – a mere 12% of those who died.

“We talk about thousands of AIDS-related deaths, but what about the suffering that led up to those deaths? No one talks about that,” says Dr Liz Gwyther, chairperson of HPCA.

“When a person is dying, their physical and medical needs actually increase because of the increased pain management needed.”

A wide range of organisations, including the Treatment Action Campaign and the HIV Clinicians’ Society, have criticised government for not providing ARV treatment at a faster pace.

Meanwhile, UCT Economics Professor Nicoli Nattrass says that a shortage of health staff is a severe problem constraining ARV provision.

“Unless public sector recruitment can keep pace, human resources will constrain the rollout. Addressing the human resources crisis in the public health sector thus ought to be an important priority for the Health Minister,” says Natrass.

Uncertain threat

2006-11-27T12:57:00.000-08:00

In a country where HIV/Aids kills 900 people each day, full hospitals and beleaguered doctors are nothing new.

But at one hospital in rural KwaZulu-Natal province, what could be a new public health nightmare is taking its toll as doctors and nurses grapple with a new, highly drug-resistant form of tuberculosis.

At least 74 people, including staff, at the Church of Scotland Hospital in Tugela Ferry have died since January 2005 after catching the drug-resistant strain. Most were HIV-positive and their immune systems were already weakened.

The new strain is resistant to most if not all of the lines of defence against the highly infectious lung disease spread through coughing and sneezing. Left untreated, TB attacks the lungs and can travel to other organs, the brain and bones.

Last week, South Africa's health department said 263 cases of extremely drug-resistant TB, or XDR-TB, had been recorded in KwaZulu-Natal, with about 30 new cases being reported each month. Another 40 cases have been recorded in other regions.

XDR-TB is particularly deadly for those whose immune systems have already been weakened by HIV/AIDS -- terrible news in KwaZulu-Natal where almost 40% of the adult population is believed to be infected with the virus.

"Everything changed in 1990 with Aids. We had TB under control then, maybe 100 patients. Now we have 800," said the Christian-run hospital's chief medical officer Theo Van Der Merwe.

"With XDR-TB more people are dying. It's depressing because we can work longer hours but I don't see it slowing down."

The World Health Organisation said last month the new strain could become a major killer in Aids-hit parts of Africa where governments have been slow to roll out TB control programmes.

Experts say the best way to fight HIV/Aids and TB in Africa is to overlap strategies. But no new antibiotics have been developed for TB in 40 years and it will be at least 2020 before new treatments are widely available.

Poverty and lack of resources complicate the problem.

In KwaZulu-Natal, the well-kept modern Church of Scotland hospital is a stone's throw from dilapidated shacks where running water and reliable electricity are luxuries and bucket toilets are standard.

The poor residents settled in the lush hills nearby are a target for acute diseases. About 1,3-million of KwaZulu-Natal's 9,2-million people are HIV-positive.

The hospital waiting-room is packed with patients who eke out a living as subsistence farmers or sell small items like single cigarettes or fresh produce at roadside stalls.

Inside the TB ward, the windows are wide open -- fresh air makes it hard for TB germs to stay alive -- but the breeze offers little comfort to the bedridden and fatigued.

Dozens are kept in crowded rooms. There are no vacancies and a waiting list of around 50. Staff strap on surgical masks and patients cough into cloths to prevent spreading the illness.

Doctors and nurses are on call day and night, stretched to breaking-point because the hospital is short 20 medical staff and efforts to recruit are hampered by a lack of specialists.

"My neighbour stopped coming over to visit. Finally she yelled [across the yard] that she no longer wanted to sit with me because I work with XDRs," said Thobeka Majola (24) a nurse at the hospital. "I'm scared too."

In many ways, life has changed remarkably little on the streets of Tugela Ferry despite the arrival of the deadly TB strain. Friends greet each other with outstretched hands, huddle to chat and stroll arm-in-arm on the town's rutted roads.

But there are fears the disease might not be fully understood in an area which has lost many of its educated residents to urban centres.

"I am not 100% sure but I've heard that you can die from it," said Jaheni Majolo (36) who tested positive for the deadly strain and is being treated.

The mother-of-five, a widow, said she expects to survive.

Elena Jordaan, the hospital's chief nurse, said she cranks up the volume in the TB ward when Zulu-language television programmes talk about XDR-TB in an attempt to teach sufferers.

"In some ways I don't think patients understand the graveness, in other ways it could be denial," she said.

Doctors researching the outbreak theorise that the tuberculosis bug may have become virulent after TB patients skipped treatment -- a relatively common occurrence.

Medical experts say XDR-TB is present in other communities but the strain in KwaZulu-Natal is alarming because of the high number of deaths in an isolated region.

Critics say the government dragged its heels while the death toll mounted, but Van Der Merwe said authorities have now pledged R53-million ($7-million) in funds to fight the disease.

"We had hoped it would be something that we would get past but we didn't," said Van Der Merwe. "The fact is we don't know what caused it but we hope there is an answer."

Row over Aids death certificate

2006-11-26T09:19:00.000-08:00

A South African doctor should face a charge of unprofessional conduct for naming Aids on a death certificate against family wishes, officials say.

A complaint was filed with the national health watchdog against Dr Leon Wagner after the woman died in April 2005.

Dr Wagner has not yet entered a plea, saying it is unclear what rule he has broken. The hearing has been adjourned.

A BBC correspondent says the stigma attached to Aids means doctors do not commonly list it as the cause of death.

Deaths are attributed on death certificates to related diseases, such as tuberculosis or pneumonia, rather than Aids, the BBC's Peter Biles in Johannesburg says.

The charge of unprofessional conduct has sparked debate in South Africa about the extent to which Aids-related deaths are covered up, he says.

South Africa, where 5.5 million people are living with HIV, is one of several countries where the HIV epidemic is continuing to worsen, according to a UNAids report released this week.

Proceedings against Dr Wagner were triggered by a complaint by the family of a 30-year-old woman to the national health watchdog.

After a disciplinary hearing in Bloemfontein, the South African Heath Professions Council said Dr Wagner should face a charge of "unprofessional conduct".

The labour union to which Dr Wagner belongs, Solidarity, has said the case could be "a watershed for South Africa".

"If he is exonerated and it is found that doctors may in future indicate Aids as the real cause of death on certificates, it would have tremendous consequences for the statistical documentation of this pandemic," a Solidarity spokesman said.

The opposition Democratic Alliance has argued that current policies that protect the confidentiality of Aids patients at all costs may not be helping the national Aids awareness campaign.

The government approach to the HIV epidemic in South Africa has been controversial. Health Minister Manto Tshabalala-Msimang has promoted the use of natural remedies - such as telling people with HIV to eat garlic and beetroot - rather than the anti-retroviral drugs used in the West.

More than 60 international experts on HIV/Aids called for her resignation in September, saying people were "dying unnecessarily" because they were being denied Aids drugs.

The United Nations special envoy for Aids in Africa has also criticised the South African government for its "negligent" attitude to rolling out treatment.

However, hundreds of traditional healers demonstrated in support of Dr Tshabalala-Msimang on Thursday, carrying placards warning of the dangers of anti-retrovirals.

Extent of collapse too difficult to describe

2006-11-23T12:37:00.000-08:00

A spanking new hospital without laundry facilities and 884 000 condoms that had to be thrown away because they lay exposed in sun and rain. These were two of the problems that came to light during an audit of Limpopo department of health.

And as if it wasn't bad enough that Dilokong hospital in Sekhukhuneland did not have laundering facilities, the linen that was washed at another venue was conveyed to and fro on an open lorry, on a dirt road.

The qualified audit report came up for discussion when the Democratic Alliance (DA) quoted from it as part of their monitoring of provincial health departments.

The useless condoms were found during a visit to the emergency medical services in Polokwane.

The expiry date of the condoms was 2009.

At the new Nkhensani hospital, which should have been completed in March this year, only the recreation facilities were ready on time.

Not without problems though - a marula tree had started growing in the basketball court.

The auditors also found discarded medical refuse that had been dumped at several places in the province, either lying around or unsafely stored. This presented a serious health danger to the public.

Financial records were in a bad state.

The list of debtors was described as very unreliable, and there was no indication of R48 000 losses.

In addition, repayments by debtors were not reflected accurately and sometimes the highest rather the lowest tender was approved, for no apparent reason.

Debtors were over-billed after they had paid off their debts to the province, to the tune of R350 000.

Other flashpoints were:

The way donations from abroad were managed by the department
Mistakes in payments of employment benefits, to the tune of millions (and without any proper records)
No proper registry of fixed assets and
Serious questions about housing benefit payments (R30,9m)

The auditors found that the department was lax about collecting debts and personnel were often guilty of a clash of interests in transactions.

There was concern about people who lived in government houses on hospital property without rental agreements, out-patient debts amounting to R213,6m and over-generous overtime payments.

In spite of this chaotic state of affairs, all senior managers had received a 6% bonus, irrespective of merit.

Gareth Morgan, DP-MP who brought the auditor's report to parliament's attention, asked that the national department of health investigate the situation in Limpopo immediately.

Morgan said the financial and operational management of the department had collapsed.

"It is actually difficult to describe the extent of this collapse, and the situation must receive attention urgently," an apparently dumbstruck Morgan said.

An audit of the Limpopo health department has revealed how, amongst others, over 800 000 condoms had to be thrown away because they lay exposed in the sun.

Traditional healers back Manto

2006-11-23T12:28:00.000-08:00

South Africa's embattled health minister received a rare public boost on Wednesday when hundreds of traditional healers marched in Johannesburg to support her natural treatments for HIV/Aids.

Several hundred healers, many wrapped in red cloaks and headscarves, praised Health Minister Manto Tshabalala-Msimang and urged the government to give greater weight to traditional remedies as it battles one of the world's worst Aids pandemics.

Placards showed messages that were anti-Treatment Action Campaign, anti-Democratic Alliance and anti-gay, while speakers voiced harsh feelings that Western medicine was taking advantage of traditional knowledge for profit and greed.

The marchers handed over a memorandum, which was received by the Gauteng health department's Patrick Maduna on behalf of provincial minister Brian Hlongwa, and called for the fast-tracking of the Traditional Healers Practice Act.

"It is unacceptable that such important legislation is delayed by 18 months," it read.

The memorandum further demanded the establishment of a provincial directorate of traditional medicine.

It asked: "Can the department protect this noble profession from thugs that claim to be interested in our profession but only want to modernise us through research that is aimed at fulfilling their selfish financial interest and greed?"

During the march, the national coordinator of the Traditional Healers' Association, Phephsile Maseko, told the South African Press Association that Tshabalala-Msimang was the only person in high office to understand the disparities between Western and traditional medicine.

"She has been trying hard to narrow the gap."

Traffic came to a standstill in parts of central Johannesburg to make way for the protest, which saw healers singing, dancing and ululating. Some placards warned of the dangers of antiretroviral (ARV) drugs -- the only treatment known to slow the progress of Aids.

"People should be warned about the side effects of ARVs" one sign read, while another said "Manto Thumbs Up 4 Good Work".

Tshabalala-Msimang has been criticised by Aids-activist groups who blame her for what they say is South Africa's dangerously slow response to an HIV/Aids epidemic that infects more than five million of the country's 45-million people.

Tshabalala-Msimang has drawn particular heat for advocating natural remedies, including garlic, olive oil and beetroot and questioning the central role of ARVs in Aids programmes.

South Africa's Aids strategy was a focus of this year's global Aids conference in Toronto, where United Nations officials slammed the government for policies that one senior official described as "worthy of the lunatic fringe".

In September, President Thabo Mbeki effectively sidelined the controversial Tshabalala-Msimang by handing the management of government's Aids policy to Deputy President Phumzile Mlambo-Ngcuka.

But the feisty health minister recently retaliated, saying in a letter to members of the ruling African National Congress (ANC) she was not giving up the battle.

"Nutrition is critical in prolonging progression from HIV infection to [the] development of Aids-defining conditions ... others chose to interpret this simple and straightforward statement as suggesting that nutrition might be an alternative to treatment. It is not," she wrote.

Complete breakdown of Limpopo health care

2006-11-22T11:59:00.000-08:00

The Democratic Alliance on Tuesday urged Health Minister Manto Tshabalala-Msimang to establish a special task team to investigate the "complete breakdown" of financial and operational management in the Limpopo health department.

This was evidenced by the Auditor-General having issued the department with a 21-page qualified audit report for 2005/06, the party said in a statement.

It said the AG found significant problems with the control of assets. For example, none of the hospitals visited had proper asset registers, and none had conducted stock counts or could even say when last a stock count had been conducted.

Control over departmental vehicles was also chaotic. Petrol cards that had been reported lost or stolen were in use, and sensors in cars were malfunctioning, resulting in odometer readings sometimes moving backwards, and vehicle accidents were routinely unreported, the DA said.

"Many examples of suspicious processes in the purchase of goods and equipment had also been found, including bids to supply goods and services were only accepted from historically disadvantaged individuals, which led to 'extremely inflated' prices, because no attempt was made to establish whether prices tendered were market-related."

In some cases, goods and services were purchased from businesses belonging to departmental employees, but these vested interests were not mentioned anywhere and no approval had been obtained.

Some cases were found where the highest quotation was accepted for no good reason, and the department was unable to supply a list of all tenders awarded or of all tenders where the best-qualified applicant was not accepted.

The AG had also identified many problems with the HIV and Aids programme, and in particular enormous deviations from the approved business plan.

For example, no training on post-exposure prophylaxis had taken place, no research had been conducted into the low uptake of nevarapine, and the department distributed only 35 000 of the 400 000 tins of baby formula it should have distributed, the DA said.

Dispensing fees cause pharmacies to close

2006-11-22T11:55:00.000-08:00

South African pharmacies could face closure due to dispensing regulations coming into effect in January, the United South African Pharmacies (USAP) group said on Tuesday.

Speaking at a meeting held at the Glenhove Conference Centre, USAP chairperson Julian Solomon said the new regulations would lead to many pharmacies having to close down.

Director of Management Healthcare System, David Boyce, said the department of health's pricing committee did not make provision for inflation.

He said the implementation of the regulations would lead to pharmacies not being able to cover their expenses.

Under the tariffs announced on October 31, the dispensing fee for medicines with a single exit price (SEP) of R75 would be R4 plus 33 percent of the SEP, while 64 percent of medicines fell under this bracket, Boyce said.

The fee on medicines costing between R75 and R250 would be R25 plus six percent; between R250 and R1 000, R33 plus three percent; and R1 000 and more, R50 plus 1.5 percent.

Boyce said that of the 2 467 pharmacies polled, 63 percent would fail, 22 percent were "likely to survive", while 15 percent were at a significant risk of failing.

"A casualty rate whereby operating expenses exceeded operational income would occur," Boyce said.

Ivan Kotze, executive director of the Pharmaceutical Society of South Africa (PSSA), said the Pharmaceutical Stakeholders Forum held a meeting on Tuesday with the Pricing Committee to discuss resolutions to the regulations.

According to Kotze, a letter to Health Minister Manto Tshabalala-Msimang and director general of health, Thami Mseleku, had been written to "defer" the implementation of the regulations.

Solomon added that a minimum of six towns in South Africa were without pharmaceutical services, and that affordability and availability of medication was important. - Sapa

Manto bounces back

2006-11-18T14:06:00.000-08:00

HEALTH Minister Manto Tshabalala-Msimang, who is yet to return to her post six weeks after succumbing to an ill-defined lung infection, on Friday moved to reclaim her mantle as leader of government’s efforts to fight HIV/AIDS.

The minister was admitted to hospital a month after the cabinet announced it had formed an interdepartmental HIV/AIDS committee tasked with overseeing government’s response to the epidemic.

The move was widely seen as an attempt to sideline the controversy-prone minister after SA’s embarrassment at the 16th World AIDS Conference in Toronto in August.

In her absence, Deputy Health Minister Nozizwe Madlala-Routledge has praised AIDS activist Zackie Achmat, who repeatedly clashed with the minister, and has spoken out strongly on government’s failings on the HIV/AIDS front.

Writing in the internet publication ANC Today, Tshabalala-Msimang dismissed criticism at the Toronto conference as a conspiracy. “A group of fellow South Africans teamed up with their partners at the occasion of the AIDS Conference in Toronto … to portray us as uncaring and indifferent to the plight of its own electorate — the very people who reaffirmed their confidence in the ANC by giving a close to 70% majority in the general election.”

She praised health workers who “have not been distracted by those who continue to falsely accuse some of us in government of being HIV and AIDS denialists”.

Her remarks stand in sharp contrast to Madlala-Routledge’s comments earlier this month, when she said government had been “in denial at the very highest levels”.

Tshabalala-Msimang said she had often been misunderstood. “Nutrition is critical in prolonging progression from HIV infection to development of AIDS-defining conditions. It is also critical in enhancing the effectiveness of medical treatment. Unfortunately, others chose to interpret this simple and straightforward statement as suggesting that nutrition might be an alternative to treatment. It is not,” she said.

Controversial prof resigns

2006-11-17T01:46:00.000-08:00

Controversial University of Cape Town (UCT) Professor Girish Kotwal has resigned following an investigation into his ties with an untested “anti-HIV” remedy.

Kotwal, who is chief of medical virology at UCT’s Institute of Infectious Diseases and Molecular Medicine, will leave his post at the end of the year, according to a joint statement by the university and Kotwal.

An investigation by the internationally renowned “Nature Medicine” magazine earlier this year exposed Kotwal’s role in a concoction called Secomet V, which its Stellenbosch-based manufacturer claimed lowered HIV positive patients’ viral loads.

However, Secomet V (marketed as “Ithemba Lesizwe” or hope of the nation) has never been tested in clinical trials, only in Kotwal’s university laboratory.

Professor David Dent, deputy dean of UCT’s Health Sciences faculty, confirmed earlier this month that while university laboratories were run according to strict protocols, in Kotwal’s case there were “breaches in those protocols”.

He said Kotwal’s laboratory had been closed and decontaminated. According the statement there had been an absence of certain appropriate procedures, records and laboratory disciplines.

In an earlier statement, which was later withdrawn, the university said that no researcher, student or staff had been exposed to “hazardous material”. The new statement omitted this and said that nobody was “actually harmed or injured in the laboratory”.

“He (Kotwal) was presented with the results of our findings in total and absolute detail and he chose to seek resignation,” Dent confirmed.

He added that Kotwal would have faced a full disciplinary committee involving “witnesses and lawyers” if he failed to resign.

Dent explained that the university had opted for a joint statement to avoid “future ding-dong statements”.

According to the withdrawn statement Kotwal had also had failed to disclose that an article on Secomet, which he published in the “Annals of the New York Academy of Sciences” last year, had been co-authored by a director of Secomet, Stephen Leivers.

The new statement released in the name of Kotwal and UCT registrar Hugh Amoore, did not reveal this detail, it only stated that the article “required corrections” and that this had been submitted.

It was also confirmed that the Secomet study had not been submitted for institutional ethical approval or for approval by the Medicines Control Council (MCC) Clinical Trials Division.

Dent said that Kotwal had been told by Secomet that they had submitted the application to the MCC, but had failed to tell him “that the MCC had not come back to them”.

“Professor Kotwal thought that the submission constituted approval to go ahead,” Dent said.

Kotwal denied in the statement that he had any financial interest in Secomet or that he had endorsed, championed or promoted any of the products.

Dent said the university had cancelled a royalty agreement it had entered into with Secomet whereby a percentage of the profits would have been ploughed back into laboratory.

In a separate statement UCT Vice-Chancellor Professor Njabulo Ndebele confirmed that Kotwal would remain on leave until the end of the year and that his laboratory remained closed.

He added that the university’s attention to safe laboratory practice had to be reinforced.

“The case has shown the need for us to ensure that ethical approvals are rigorous and equally that institutional ethical approvals are in place for any work carried out by members of the University in our laboratories,” said Ndebele.

Medication could be fatal

2006-11-17T01:37:00.000-08:00

South Africa's Ministry of Health has confirmed that close to 6,000 HIV-positive people had died while receiving antiretroviral (ARV) drugs since the government rollout began in 2004.
Health department spokesman Sibani Mngadi said the deaths were a concern, but constituted just below 3 percent of the number of HIV-positive people accessing treatment at government ARV sites during the same period.

"The number of people being treated with antiretroviral therapy through our [government's] 'Comprehensive Plan on HIV and AIDS' has increased [by] 60,000 in the past year to 235,378 by the end of September 2006," he told IRIN/PlusNews.

He said there might be a number of factors resulting in the death of patients on ARVs, but "they would all be just speculation" without the proper monitoring systems in place.

Doctor Henry Sunpath, of McCord Hospital in the eastern port city of Durban, disagreed with Mngadi and pointed out that the factors encouraging the deaths were all too real.

"These could be anything from fear of stigma and discrimination from both family and community to confusing information about the benefits of ARVs, as publicly expressed by the Health Minister Manto Tshabalala-Msimang herself," said Sunpath.

Tshabalala-Msimang has consistently drawn international criticism for supporting the views of well-known AIDS dissidents, and her controversial promotion of remedies including garlic, beetroot and the African potato as effective means of treating HIV/AIDS.

Sunpath's sentiments are shared by Dr Francois Venter, an HIV specialist at the University of Witwatersrand in Johannesburg, who charged that "it is conflicting views such as these which ... [motivate] scores of people who still turn down or prematurely quit ARV therapy because they are too afraid of the exaggerated side effects."

Some side effects of ARV medication could be fatal, he said, but these were easily avoided with the proper monitoring and care of patients, as were the rare cases of lactic acidosis (a condition caused by the buildup of lactic acid in the body) in patients using Stavudine (also known as Zerit or d4T), which is included in South Africa's free programme.

Venter also pointed out that some could be caused by patients reporting to treatment sites when they were already in the advanced stage of infection.

"This is why the government, together with civil society organisations, needs to share a common goal in the effective rollout of ARVs to the huge numbers in need, with no fatalities in the process," Venter added.

The government is to reveal its revised 'Strategic Plan' in December, which will guide the country's response to AIDS and ensure continuity of the current strategies, as well as introduce additional interventions.

800 people die every day of HIV/Aids

2006-11-17T01:34:00.000-08:00

The South African government says nearly a quarter of a million HIV positive people are now receiving anti-retroviral drugs.

The number rose by 57,000 between June and September and health officials say the country now has the fastest growing treatment programme in the world.

In the past, the government has been accused of not doing enough to fight the HIV/Aids pandemic.

More than 5m people in South Africa are infected with the virus.

This is part of a striking turnaround in the South African government's approach to the HIV/Aids crisis.

In the past, Health Minister Manto Tshabalala-Msimang had stressed the importance of good nutrition, including beetroot and garlic, rather than anti-retroviral drugs.

But more than 235,000 people are now benefiting from anti-retroviral programmes, and there's also been an increase in the number of health facilities where treatment is administered.

The Department of Health says it is in the process of finalising a five-year strategic HIV/Aids plan which will be unveiled on World Aids Day on 1 December.

Lobbyists from the Treatment Action Campaign and other civil society groups have been working more closely with the government since the health minister was - in effect - sidelined.

Deputy President Phumzile Mlambo Ngcuka is now leading the National Aids Council and playing a far more prominent role.

But there are still huge challenges to address.

An estimated 800 people die every day as a result of HIV/Aids.

There are approximately 1,400 daily new infections, and a critical shortage of health workers.

Hospital treated me like a dog

2006-11-17T01:26:00.000-08:00

A 20-year-old woman has vowed never to set foot in Coronation Hospital again after being subjected to “dog-like” treatment.

Buoyed by Minister of Health Manto Tshabalala-Msimang’s call to the public to use state hospitals, Mmapula Thoane went to Coronation for a check-up last Monday.

She said the nurses who attended to her were discourteous. “One of them was insolent and sarcastic – I was embarrassed because she humiliated me in front of others,” said Thoane.

“The nurses did not explain what I was supposed to do, they just left me sitting on a bench and I had to go after them,” she said.
When she went up to them, “they said they were busy but were merely chatting.”

She said that “patients, mostly black, desperate and poor, are treated like downtrodden dogs.”

“I spoke to some patients who said they were always treated badly. The staff are mostly coloured and racist – three coloured patients on that day all came out of the consultation room smiling.,” she said. The hospital says it is investigating.

Deadly TB on upward spiral

2006-11-14T06:46:00.000-08:00

An alarming 267 new cases of extreme drug-resistant TB (XDR TB) have been detected in KwaZulu-Natal.

Another shocking revelation is that the disease has been found in 10 of the province's 11 health districts, and is not confined to the Tugela Ferry area, as was previously thought.

Doctors say this could have dire consequences for those suffering from HIV and Aids.

The latest figures come on the heels of a World Health Organisation (WHO) recommendation to provincial health authorities, urging them to re-test sputum samples in their laboratories for indications of XDR TB.

Over the past few months, 68 people are said to have died from the disease in the province.

A prevalence survey last month on sputum kept since January last year revealed the deadly XDR TB was now found in 10 of the 11 health districts in KwaZulu-Natal.

Tugela Ferry's Church of Scotland Hospital accounted for 181 of these cases, while 10 other health districts had 86.

In September this year the WHO suggested that all health institutions in the Southern African Development Community conduct surveys of TB patient sputums stored in laboratories since the beginning of last year to establish the extent of the problem. The aim was to contain the deadly TB strain and find effective ways of treating it.

KwaZulu-Natal's chief technical adviser on TB, Bruce Margot, said the initial results of the survey noted that XDR TB was found in all nine provinces, but KwaZulu-Natal was the worst affected.

Margot said the increase was a consequence of the WHO's new definition of XDR TB.

"They have softened the definition of diagnosing XDR TB. Before we used a very strict diagnosis and a patient had to be resistant to all second-line TB drugs to be declared to have XDR TB," he said.

The Church of Scotland Hospital, with 181 cases, dwarfs other hospitals in terms of the number of people with the deadly strain. The hospital said 133 patients had died from the disease since last year. Last week alone, the sputum of nine new patients was found to have the drug-resistant tuberculosis. In October, 24 new cases were diagnosed.

The head of TB control at the hospital, Dr Kenny Moll, said he was not surprised at the figures.

"We had expected the increase since the new definition came into effect last month. Our hospital has been vigorous in diagnosing people who show the symptoms of drug-resistant TB."

Most XDR TB patients at the institution were HIV-positive and the death rate of those patients was 73 percent.

"This is because the patients come to the hospital when their CD4 count is very low. Once we had diagnosed them we often did not have the necessary drugs to treat them," he said.

Margot said the latest statistics brought new challenges.

"These patients will have to spend two years in hospital, getting drugs such as capreomycin, which is injected."

He said the department had recently received the three drugs used to treat XDR TB. The department would, from Monday, begin testing new patients for XDR TB, especially where the survey had found a high prevalence.

Beetroot gets the boot

2006-11-14T01:07:00.000-08:00

Over the past few weeks, government's more vigorous approach to HIV/AIDS has been hailed as a "sea change", with Deputy President Phumzile Mlambo-Ngcuka and Deputy Health Minister Nozizwe Madlala-Routledge as the new captains.

Madlala-Routledge acknowledges that there is a "new energy" in government to address HIV/AIDS and that the "catalyst" for this was the international AIDS conference in Toronto in August.

At the conference, South Africa was written off as the lunatic fringe by Stephen Lewis, the United Nations Special Envoy on AIDS. This was after the health ministry put up what resembled a vegetable stall, and the health minister punted beetroot and garlic as AIDS treatments.

"Toronto galvanised government to be on a new footing, particularly around streamlining of communication on our strategy and our plan and greater mobilisation of all partners," explains Madlala-Routledge.

"In particular, there was recognition of the fact that this atmosphere of perpetual conflict with civil society is not helping."

Government sources confirm that health minister Manto Tshabalala-Msimang kept her deputy out of HIV issues.

But after holding her tongue for almost three years, Madlala-Routledge has been speaking bluntly about the challenges and shortcomings of government's programme in the past few weeks.

Where has her new courage come from?

"I don't have officially new, defined role, but certainly I have seen spaces being created for me. I think I've been given the space to support the improvement of relationships," says Madlala-Routledge.

"As chairperson of the South African National AIDS Council (SANAC), the Deputy President has indicated that she is aware of my abilities and strengths and she's drawn on these."

The two deputies go back a long way, both having been leaders of the Natal Organisation of Women (NOW) in the 1980s.

Throughout her term of office, Madlala-Routledge has kept the door open to the Treatment Action Campaign (TAC) - even when insults were flying thick and fast between government and the TAC.

She has thus been able to mediate between the two, drawing the TAC into government efforts to revitalised SANAC and draw up a new strategic plan on HIV/AIDS for 2007-2011.

While Tshabalala-Msimang remains political head of the health department, which is the lead department dealing with HIV/AIDS programme, the Inter-Ministerial Committee (IMC) on AIDS with Mlambo-Ngcuka as chairperson, has been revived. This will co-ordinate government's overall responses to HIV.

A revived SANAC, also chaired by Mlambo-Ngcuka, will be launched on AIDS Day to guide the partnership between government and other organisations.

For the first time, SANAC will not simply be a talkshop but will also have its own programmes.

"The real work starts now. We must get the people off the [antiretroviral] waiting list. There are just too many people waiting. When people come forward under the present conditions of stigma it is most discouraging when they must then wait in a long queue. So that is the very immediate challenge."

The second burning issue is for more people to take HIV tests.

"The sooner a person knows their status, the sooner they seek help. The earlier they seek help, the more chance they will have of success."

Two of Madlala-Routledge's cousins, Thandeka and Phyllis, died recently of AIDS-related illnesses. Neither disclosed their HIV or started treatment until it was too late.

The deputy minister acknowledges that government has not done nearly enough to prevent new HIV infections, and that the old ABC - Abstain, Be Faithful, Condomise - is not always appropriate and that poverty and violence have to be addressed.

"Consider the high rate of sexual and gender-based violence in the country. ABC is clearly not relevant in a situation where a person is being violated."

Tainted blood on the market

2006-11-12T11:37:00.000-08:00

Almost a year after smashing a syndicate selling HIV-positive blood to people who then used it to access disability grants, investigators are still trying to reel in all those involved in the scam.

The blood trade, which apparently started in the Eastern Cape in 2003, is believed to have cost the province millions. Although authorities bust the syndicate last year, officials say that not all those who used the HIV status of others to make a quick buck have been arrested. The provincial spokesperson for the South African Social Security Agency, Bandile Maqetuka, said 10 members of the community were serving sentences ranging from two to three years.

One departmental official who had approved the fraudulent grants was jailed for 19 years.

He said various others, including a Nigerian doctor who wrote "motivating letters" for those who wanted to claim the grants, were still on trial.

This included two departmental officials who had been fired and various other health professionals.

A spokesperson for the Eastern Cape Social Development MEC, Phumlani Mdolomba, said they became suspicious when they noticed that 24 000 of the temporary disability grant beneficiaries were from Uitenhage and that most of them collected their money in Port Elizabeth. The beneficiaries claimed that because of HIV and Aids - and in other cases, TB - they were too sick to be employed.

He said a joint Scorpions and departmental investigation revealed that blood which was drawn from hospitalised HIV-positive patients had been used and submitted for analysis under other names. Once the results - which indicated that they were sick - were returned, those involved then applied for the temporary disability grants.

Mdolomba said the community members who were behind bars had worked with hospital officials and staff in the Department of Social Development.

He said those who were lured into the scam paid between R500 and R1 000 to their "organisers", but this was due only once they had received their first disability payout. He said this was possible because it took up to six months to get onto the system.

According to Mdolomba, the fraudulent grants cost the department about R200 000.

Maqetuka said: "In the 2005/6 financial year we were projecting a R1,2-billion deficit on social grants. After the partnership with the Scorpions, only R100-million was overspent."

Yesterday, the national Department of Social Development confirmed that it had requested a report from the province on the matter.

The Health Department's spokesperson, Sibani Mngadi, said earlier this year that Health Minister Manto Tshabalala-Msimang had heard the rumours of the blood trade while in Port Elizabeth and had called on the community to report any evidence they had.

He said: "The exchange of body fluids and trading in body parts is illegal."

Last year it was reported that Eastern Cape health officials had cracked down on a human saliva scam in which recipients apparently obtained saliva from people suffering from TB and then used it to get state grants.

It has also been reported that many women fall pregnant as a means of accessing child support grants.

It's not my fault

2006-11-10T01:28:00.000-08:00

Eastern Cape Health Department boss Lawrence Boya has been ordered to recover R46 million owed to his department by former employees.

The debt, which has been piling up since 2002, is a result of miscalculations, overpayment of salaries and excessive telephone bills.

When responsible employees resigned, the department failed to dock the money from their payouts.

Mike Basopu, the chairperson of the health oversight committee in the Legislature, threatened to hold Boya personally accountable for the debt if he failed to recoup the money.

The department’s three senior managers said steps had been taken to recover the debt, but some debtors did not even own property.

They blamed the problem on the late former boss of the department and another senior manager who had since left.

They said some of the amounts owed were very old and it would be necessary to write them off.

Boya told the committee the problem was due to “systemic weakness” in the department and said it was difficult to tell what had caused it.

He said the department would take legal action to recoup the debt, but was non-committal about getting all the money back.

“We will report to you on a regular basis on how we are doing. I can’t give a definitive answer that we will be able to recover the money,” Boya said.

But committee member Maxwell Mhlati said Boya should be held accountable, adding that the records about the debts had not been buried along with the former head of department.

A visibly annoyed Basopu expressed disappointment that the problem dated as far back as four years ago, noting that the department had not taken steps to sort it out.

“There’s no way we can write off (the money), that’s why members are vocal about it.”

The latest lunatic ruling

2006-11-09T02:07:00.000-08:00

South Africa's independent corner chemists say they will die fighting as they fear their survival is hugely threatened by the latest "lunatic ruling" on dispensing fees announced by Health Minister Manto Tshabalala-Msimang.

Pharmacists have also warned that poor communities in outlying areas are likely to be hardest hit as patients will have to incur travelling expenses to obtain medicine from large chain stores in town centres as more and more local chemists are forced to shut their doors.

However, the Department of Health has accused pharmacists of a lack of procedural co-operation with its research in setting the new dispensing fee, and argued that it was higher than last year's fee of 26 percent of the single exit price, or R26, and was comparable to prices pharmacists had negotiated with medical schemes.

Julian Solomon, national Director of United South African Pharmacies, which represents 1 200 of the country's 2 450 pharmacists, said the dispensing fee was a "lunatic ruling" that favoured big chain stores and would obliterate independently owned chemists.

This was already happening in at least six small towns such as Steynberg in the Free State and Stella in the Northern Cape which were without a chemist as a result of the regulations.

He said the department was exacerbating the brain drain as pharmacists were being actively recruited by American drug companies.

"We lose about 30 pharmacists every six months.

The only thing that stops people from going is that they are asking them to go to outlying districts and not to areas such as New York and Los Angeles. Others are going to Australia because of the frustration they are finding themselves in. It (the department) has embarked on a political position without any thought," Solomon said.

Anban Pillay, Director of Pharmaceutical Economic Evaluation in the department, said all pharmacists were charged the single exit price for medicine whether they had a wholesale licence, as was the case with national chains, or not.

Pillay said: "Our licensing unit reports that numbers of applications for new pharmacies continue to come in, so if business is so bad why are people wanting to open pharmacies?"

However, Solomon said the department had not mentioned that wholesalers were being paid an extra six to eight percent as a logistics fee which ran into millions of rands that was not available to smaller pharmacies.

"They are painting us the villain when we are the victim. We don't get any kickbacks. No pharmacy sets the price, only the manufacturers do and the department is putting a stranglehold on the industry.

"It is trying to look good in the eyes of the public by bringing prices down, but it will destroy the profession and we have given it proof of that. But if we are going to die we are going to die with our boots on we will die with a fight," Solomon said.

There was "a place in the sun" for national chains but these stores had the advantage of being able to carry losses of millions of rands, the result of selling discounted medicine, which would bankrupt small chemists.

Solomon said 50 percent of customers paid with a credit card, further eroding profits by up to four percent as commission was payable to banks. He said pharmacists levying a three percent fee on credit card purchases were breaking the law.

Pillay said hundreds of pharmacists had "not bothered" to help the department with its survey to ascertain the costs of running a pharmacy.

However, Solomon said the Pharmacy Stakeholders' Forum had submitted statements with data from 31 million scripts, 200 audited statements and 700 surveys completed by independent pharmacists, suggesting an acceptable dispensing fee. He said PriceWaterhouseCooper had approved of the methodology.

"They have approved the format of a tiered system but the rand and percentages they have got all wrong," Solomon said of the new dispensing fee.

Marianhill Pharmacy owner Sally Mudly-Padayachie said manufacturers held the trump card when it came to medicine prices.

"We are the wrong people to be attacked because we are not making huge profits on medicines. The price of our medicine is high compared to other countries and closing down pharmacies is not going to do our country any good," she said.

A Durban pharmacist who asked not to be named said legislation was "really squeezing" small pharmacists. He said consumers, who were being forced to self-fund medical expenses, would be the losers if the corner chemist disappeared.

He said the free diagnosis service pharmacists offered would be lost and consumers would be forced to visit a doctor and pay his fees over and above medicine costs.

He said the government was earning 14 percent VAT off medicines, which in some cases was more than a pharmacist made on medicines.

Pillay said the Treasury was investigating the possibility of removing VAT from medicines.

Ivan Kotze, the national Chairperson of the Pharmaceutical Society of South Africa, said the organisation had not yet finalised its analysis of the dispensing fee.

Violent hospital strike

2006-11-08T05:17:00.000-08:00

A major strike at the Rob Ferreira and other hospitals continued while union leaders and Health MEC Pogiso Pasha met to try to resolve staff grievances.

Police were forced to use rubber bullets to disperse an angry crowd, which had protested illegally. They were still picketing yesterday.

Five people were arrested when hundreds of members of Nehawu went on strike at all hospitals in the Ehlanzeni region.

Striking members of staff prevented all but emergency vehicles from entering the premises. They demanded immediate payment of overtime, the filling of all vacant posts and that they be given additional bridging courses.

They clearly expressed dissatisfaction with the head of the Department of Health and Social Services, Dr Esthrasi Moloko. “Thanks for the bodyguards but go and chase Moloko,” and “Away with Moloko”, were some of the signs being brandished.

A car was stoned and the driver assaulted. Pam Williams said her daughter Bianca needed urgent medical attention but she was not allowed in. “I was really scared. I started driving in when a man wrenched the door open and hit me in the face,” she explained.

Police acted when protesters completely blocked the entrance with huge pieces of concrete.
The Mpumalanga branch of Cosatu lashed out yesterday at the way police handled the situation, condemning it in “the strongest possible terms” .

“Nothing can justify such brutal force and over-reaction from the police of a democratic state against unarmed protesters,” provincial secretary Norman Mokoena said. Cosatu also demanded the release of those arrested.

Doctors fear for their lives

2006-11-08T05:10:00.000-08:00

Limpopo province needs another 6 000 state doctors. At the moment, the province has less than 500 state doctors who had to help about 17 million patients last year, including repeat visits, said provincial health and social development spokesman Phuthi Seloba.

"There's a huge skills shortage," he said. "Our doctors are forever working overtime."

Seloba said some patients were forced to return home without seeing a doctor because the shortage.

He said R49m would be spent the hospital revitalisation project this year in a bid to attract doctors to the region.

"Doctors can only be as good as the equipment and infrastructure at hand. That's why we will spend this money to make their lives a little bit easier," said Seloba.

The department also has a programme called the hostel service programme, which builds soccer grounds and small entertainment areas close to doctors' and nurses' quarters.

"Entertainment and lack of infrastructure in rural areas is one of the major challenges that are preventing doctors from working in the province," said Seloba.

He said communities didn't make it easier by threatening or abusing staff.

"This continued abuse is not helping the situation at all. Our doctors cannot work in environments where they fear for their lives," he said.

Last year a doctor from the Bohlabela district was struck on the head and had to be hospitalised for two days.

The suspect was never apprehended.

In April a community clinic in Mashashane had to reduce its working hours from 24 hours a day to just 12 hours a day due to continued vandalism.

"Drunk residents used to stone the clinic while on drinking sprees," said Seloba.

Only 80% of the province's clinics have 24 hour security.

Sick to the very core

2006-11-05T09:45:00.000-08:00

An Eastern Cape health official is fighting to keep his job because his department cannot account for some R6- billion in its 2005/06 budget.

Its R18.3-billion worth of transactions are littered with “deficiencies” — some of which have no source documents to back them up. And when they’re there, they’re dodgy — like this one: R895 000 was claimed, but the invoice shows only R895.

We’re talking billions here, not millions. And this department boss, Lawrence Boya, is fighting to keep his job? He should be fighting to stay out of jail, such is the Mampara’s appalling criminal neglect of his civic duties.

There have been dark mutterings of the possibility of fraud, collusion and corruption. But why mutter? Let’s have action. Throw Boya in prison at once.

Manto muscled out in palace coup

2006-11-05T09:41:00.000-08:00

There has been a palace coup in the Health ministry while Minister Manto Tshabalala-Msimang has been in hospital. Over the past three weeks, Tshabalala-Msimang’s deputy, Nozizwe Madlala-Routledge, and Deputy President Phumzile Mlambo-Ngcuka have seized control of the country’s HIV/Aids programme.

Mlambo-Ngcuka has been quietly consulting the Treatment Action Campaign and other civil society organisations over the past three months, in her role as chairman of the South African National Aids Council (Sanac), which is driving the development of a new HIV/Aids strategic plan for 2007 to 2011.

The old strategic plan expired last year but the Department of Health failed to draw up a new one.

Mlambo-Ngcuka and Madlala-Routledge have engaged with a range of Aids organisations and praised Treatment Action Campaign president Zackie Achmat, Tshabalala-Msimang’s arch enemy. Mlambo-Ngcuka has also committed the government to halving the rate of new HIV infections by 2011.

While Madlala-Routledge said that she had not officially been given a new role, she said: “I think I have been given the space to support the improvement of relationships.”

For almost three years, Madlala-Routledge was sidelined by Tshabalala-Msimang and excluded from HIV/Aids issues, according to department officials.

Yet in the past week, Madlala-Routledge stunned even her inner circle by speaking out bluntly about the government’s shortcomings on HIV/Aids.

She described South Africa’s stall at Toronto’s Aids conference — at which beetroot, garlic and lemon were promoted as Aids treatments — as “an embarrassment” to the government.

“Toronto was a catalyst and a turning point. It galvanised government to be on a new footing and to recognise that the atmosphere of perpetual conflict with civil society is not helping the fight against HIV,” she said.

Meanwhile, Tshabalala-Msimang is convalescing at her home in Tshwane where few people have been allowed to visit her.

Remove all the confusion

2006-11-02T03:42:00.000-08:00

The government has sent out the strongest signal yet that messages about nutrition from Health Minister Manto Tshabalala-Msimang are damaging, saying its duty now is to "remove all the confusion".

Speaking on the sidelines of a review workshop of the South African National Aids Council (Sanac), Deputy Health Minister Nosiviwe Madlala-Routledge said there had been a conscious decision by the cabinet, taken at a recent meeting, to make it clear that foods like garlic and beetroot, while good for health, are not alternatives to antiretrovirals.

"We need to do everything we can to remove all the confusion. We cannot afford a single death more and it is very important that we get that message across to people who have been misinformed that eating specific kinds of food is a replacement for ARVs," said Madlala-Routledge.

She said the country's comprehensive HIV and Aids strategy was undergoing a review which included senior officials analysing the shortcomings of the strategy.

These included crippling staff shortages in the Health Department and other obstacles to a wider rollout of lifesaving ARVs, she said. The cabinet was committed to ensuring that people living with the disease were in no doubt as to the efficacy of ARVs.

"We need, as government as a whole, to communicate a message of hope, a clear, consistent message," she said.

The deputy minister denied that Tshabalala-Msimang had been "sidelined" but that cabinet ministers were all "getting a better grasp of the disease".

"There is new energy for us to say 'Let's do whatever we can to save lives'," she said.

Worthy of the lunatic fringe

2006-11-01T07:11:00.000-08:00

South Africa's new coordinator on HIV/AIDS conceded on Tuesday the government had fallen short in fighting the epidemic and promised much better results using life-saving drugs.

Deputy President Phumzile Mlambo-Ngcuka now heads the South African National AIDS Council (SANAC) and is President Thabo Mbeki's top official on HIV/AIDS.

Controversial Health Minister Manto Tshabalala-Msimang has been sidelined after a disastrous showing by South Africa at the world AIDS conference in August in Toronto.

Mlambo-Ngcuka said she would oversee a strategy that sets targets to reduce HIV infection and supply patients with anti-retroviral drugs -- life-saving medication that Mbeki and Tshabalala-Msimang have questioned in the past.

"We are very optimistic that this new SANAC... will ensure we are able to come up with results that are much better," Mlambo-Ngcuka told reporters after meeting AIDS campaigners.

Activists hope Mlambo-Ngcuka's appointment signals a government turnaround after years of desultory action against a disease which has infected some 5 million people in South Africa and is blamed for at least 900 deaths per day.

Tshabalala-Msimang, who has promoted natural treatments such as garlic and olive oil, was not present at Tuesday's meeting. South Africa's policies were labelled "worthy of the lunatic fringe" by a senior U.N. official in Toronto.

Mlambo-Ngcuka said the government hoped to coordinate with AIDS activists on simple messages about how to stop the spread of HIV and dispel myths about the disease.

"We are not asking them to spin anything. We are just asking they help us communicate better," said Mlambo-Ngcuka.

Representatives of AIDS-affected industries including mining, agriculture and transportation will meet regularly and Mlambo-Ngcuka will chair a full SANAC meeting at least twice a year to chart progress.

The Treatment Action Campaign, one of the most vocal critics of South Africa's AIDS policies, said it backed the new drive and had helped with the official AIDS plan to be unveiled on World AIDS Day, Dec. 1.

"This is providing us a space to breathe and a release for all of us so that we can engage productively. It will mean more accountability for all of us," said Sipho Mthathi, the secretary general of TAC.

"But the litmus test is going to be on our ability to deliver."

A glimmer of hope?

2006-10-30T10:54:00.000-08:00

The South African government is reviewing its strategy for tackling the Aids epidemic.

President Thabo Mbeki did his country and its estimated 5.4 million HIV sufferers a great disservice in 2000 when he notoriously questioned the virus's link with Aids. No other issue has done as much to harm the international reputation of post-apartheid South Africa.

Manto Tshabalala-Msimang, the health minister, was rightly lambasted this summer for recommending using garlic, beetroots or African potatoes to stave off symptoms. The UN's top Aids envoy spoke for many when he condemned Pretoria's approach as "wrong, immoral and indefensible."

The minister nicknamed "Dr Beetroot" may be a laughing stock, but the issue isn't remotely funny - nor limited to her foolishness. Jacob Zuma, the former deputy president, caused outrage during his rape trial when he said he had taken a shower after unprotected sex to avoid catching the disease. Such crass comments are in embarrassing contrast to the candour of Nelson Mandela in talking publicly about the death of his son from Aids.

And this is in a country where more than 1,000 people die every day from the disease, where in some hospitals more than half the patients are HIV-positive and over 500,000 sufferers are not receiving the antiretroviral drugs (ARV) they need. Younger people are most affected: one in five South Africans between 15 and 49 has HIV; testing is neither routine nor automatic. Business, especially the mining industry, has performed far better than the government.

Signs of a significant shift have been evident for some weeks, but were given a welcome public airing when the deputy president, Phumzile Mlambo-Ngcuka, addressed Aids activists previously shunned by the government. Thus the warm welcome for her pledges of easier access to ARVs through the public health system, especially for the poor (and to prevent mother-to-child transmission), as well as better health education for young women - the key to prevention.

Delivery is the test, but from a very low base things can only get better. The bitter truth is that prevention efforts have so far largely failed in South Africa, sub-Saharan Africa's most powerful economy, while Zimbabwe and other East African countries have had success in curbing new infections. Fresh targets are to be set out in a five-year plan due out on December 1. This is all happening very late, but it could yet help save a new generation of South Africans from this terrible global scourge.

I was very ill

2006-10-27T09:15:00.000-07:00

South Africa's Minister of Health Manto Tshabalala-Msimang was discharged from the Johannesburg General Hospital.

The minister -- who received treatment for a lung infection -- said in the statement: "I am very glad that I have been discharged today [Friday] after being in the hospital for the past three weeks.

"I would like to express my appreciation to all the staff of the Johannesburg General Hospital for the high quality care that has been rendered to me.

"When I was admitted, I was very ill."

Killer TB is devastating

2006-10-26T08:54:00.000-07:00

A new study published casts light on perilous drug-resistant strains of tuberculosis that have erupted in South Africa, reaping a mortal harvest among people with the Aids virus.

The prevalence of these resistant strains is far wider than previously thought, according to the paper, published online by the British health journal The Lancet.

The team of investigators, from the United States and South Africa, tested patients with suspected tuberculosis in KwaZulu-Natal province for the multidrug resistant (MDR) strain of TB and for so-called extensively drug-resistant (XDR) strain.

MDR strains thwart the first line of antibiotics that are conventionally used to treat TB.

XDR strains are a newly discovered mutation of the TB germ that not only defeat the first line of drugs but the second line too, leaving doctors with a shrinking, preciously-hoarded arsenal of medications.

Of 1 539 people whose sputum was tested by culturing in a lab, 542 tested positive for the TB bacterium. Of these, 221 had MDR TB and 53 of these had XDR.

The study, lead-authored by Yale University's Neel Gandhi, ran from January 2005 to March 2006 in the Msinga sub-district of KwaZulu-Natal.

The rate of drug-resistant strains is far higher than previous estimates. In 2002, MDR TB among new patients in KwaZulu-Natal was put at only 1.7%, and another study which ran from 2003 to 2006 put it at nine percent.

All of the sick patients who were tested for HIV were co-infected with the virus, and all but one died. They survived on average just 16 days from the time the specimen was collected.

A genetic ID of the TB germs suggested that the patients had been infected recently, and that some of them had been infected while in hospital, the study added.

"The findings show the devastating effect of XDR tuberculosis on patients and health-care workers, its alarmingly high mortality rates in those co-infected with HIV and rapid nosocomial [hospital-borne] spread," said TB experts Annelies Van Rie and Donald Enarson in a commentary on the paper.

Around 450 000 new MDR TB cases are estimated to occur every year, according to estimates published in September by the World Health Organisation (WHO). The WHO believes that around nine million TB infections occur annually.

600 000 people still need ARVs

2006-10-26T08:22:00.000-07:00

About 600 000 people still need ARV treatment for HIV/Aids in SA. This is according to a discussion document to be tabled at the Civil Society Coalition’s HIV/Aids conference.

According to the paper government now provides ARVs to about 170 000 while the private sector treats about 110 000.

But “actuaries estimate only 20% of those who need treatment are getting it.”

It is apparently mostly women who are seeking ARV treatment, and mostly in urban centres.

The report said about 31 000 patients whose CD4 counts were below 200 were awaiting treatment.

A second paper on human rights and HIV/Aids is critical of the Health Minister, saying “The resistance of the Health Minister, supported by the government, to introducing ARV treatment has delayed both treatment and prevention strategies at enormous cost.”

The paper said “only lip-service” was paid to community consultation on HIV/Aids, and one of the greatest challenges faced in improving HIV/Aids prevention and treatment was “the unwillingness by the Ministry of Health to enforce the government’s own legislation”.

It cites a “refusal by senior politicians to recognise the scale of the crisis” as a big stumbling block in fighting the pandemic.

House of horror

2006-10-25T06:44:00.000-07:00

Faces eaten away by rats, feet caked in dead skin, toenails curling over toes ... and eight deaths in 10 years. This is the horrific picture painted in court papers before the Cape High Court in a case in which a curator's report outlines the lack of care of 50 physically disabled children.

The curator was appointed to investigate conditions at a home in Langa that gets R46 000 from the Western Cape health department every month.

The Golden Girls Home for Disabled Children has now been ordered by Judge Dennis Davis to immediately close its doors, in an application brought by the provincial department of health.

The children will be moved to Stikland Hospital.

The report said most of the children wore nappies, but there were few nappy changes and a strong smell of urine and faeces often pervaded the home.

"Children are still washed in a bucket of dirty cold water, and the facilities which have been built remain unused."

The report further stated that it was clear that the children, aged between five and 19, were not being given proper medical attention, with a "total lack of emphasis on proper or timeous medical care". The fact that eight children died in 10 years "is undoubtedly a cause for concern".

The manager of the home, Doreen Nabe, attributes the deaths to the fact that the life expectancy of the children is greatly reduced because of their mental disabilities.

But the curator said doctors at the hospitals to which the children were sent for medical attention, did not support this view.

Four-year-old Sibabawe died after her face was eaten away by rats while she lay in her cot.

"The child's death can almost certainly be attributed to her having been attacked by rodents," the report said. "So extreme was the nature and extent of the injuries that all medical practitioners interviewed expressed revulsion."

Nine-year-old Wendy suffered from occasional epileptic fits and was found dead in her bed after staff said she had been "fitting".

A post mortem revealed that the young girl's body had been scavenged by rats after she had died. "This would tend to suggest that the death was not discovered for quite some time ... "

Six-year-old Rachel did not die, but the report said doctors found her one of the most neglected cases. When admitted to New Somerset Hospital she "was in a state of severe neglect, suffered from sepsis, kwashiorkor, a urinary tract infection, dehydration and diarrhoea".

She became critically ill and was diagnosed with blood poisoning.

The report concluded that "this facility could not be retained in its current form in circumstances where the health and indeed lives of these children cannot be safeguarded".

But Nabe has expressed her anger at the ruling, saying the decision "is very unfair".

Junior doctors forced to work for free

2006-10-24T23:14:00.000-07:00

State hospitals face major upheavals if the health department does not pay junior doctors for their overtime.

The doctors say they will take industrial action if the department doesn't pay them for the hundreds of hours overtime they routinely work.

The health department says it is committed to working with the Junior Doctors' Association of South Africa (Judasa) "to establish the authenticity of these allegations".

It also wants details of when the doctors have been "forced to work for free".

The Cape Argus sounded the alarm over the working conditions of junior doctors in June last year, when the SA Medical Association's Dr Keith Bolton likened them to "lethal weapons".

These doctors, after their five years of study, must complete a two-year internship at a state hospital, followed by a year of community service.

Dr Duan Lemmer, chairman of Judasa, said young doctors around the country were routinely working up to 40 hours of extra overtime every month - on top of the 80 hours included in their contracts.

The junior doctors' action, communicated to the department by the South African Medical Association, says junior doctors will not work these excessive overtime hours without payment.

"We are committed to deliver a sustained level of quality healthcare, but we wish to put a stop to the continuous exploitation of interns, junior doctors and medical officers," said Lemmer.

Manto still in hospital after three weeks

2006-10-24T23:11:00.000-07:00

Ailing Health Minister Manto Tshabalala-Msimang would probably spend the rest of the week in hospital.

Although she had shown a remarkable improvement in the past few days, she would probably be discharged only at the end of the week, the Health Ministry told the national broadcaster.

Tshabalala-Msimang was taken to hospital on October 5 as she was not feeling well, but was admitted for tests and to assess her response to treatment for a severe lung infection.

While her doctor was confident of her probable discharge last week, she was still in Johannesburg's Hospital's Folateng Private Wing.

She would remain there for the time being to receive "physical therapy treatment."

Her spokesperson, Sibani Mngadi, said that Tshabalala-Msimang's doctor would advise her whether she should go straight back to work on her discharge or take some time off.

Nurses deserve better

2006-10-24T02:32:00.000-07:00

President Thabo Mbeki, speaking at the 10th annual Denosa conference, committed himself to making "urgent interventions" to ensure that the nursing profession "continues to occupy its rightful and respected place in our society".

This commitment is very welcome, but would be much more meaningful if it were not for a great deal of disrespect shown to the profession by his government over the past few years. Salaries are a part of the reason for the despondency among nurses. Although constrained by the budget, government must make a more sincere effort to pay nurses better.

More importantly, Mbeki needs to stop the minister of health from treating nurses like pawns to be shunted around at will, or delinquents needing constant supervision.

Some examples of this failure to recognise the needs and rights of nurses include:

The Nursing Act, passed last year, which took away nurses rights to elect the members of the board which represents their interests.

The minister's refusal to allow for a "freedom of conscience" clause in the Choice on Termination of Pregnancy Act, which means that some nurses are compelled to act against their religious convictions in performing abortions.

It is no surprise that nurses are leaving the profession in droves. The best thing that Mbeki could do is request that the minister of health relinquish her responsibilities in relation to nursing.

No word on Manto

2006-10-22T12:59:00.000-07:00

Health Minister Manto Tshabalala-Msimang has been a patient at the Johannesburg Hospital for more than 10 days now, but no-one will say why.

The minister's spin-doctors and those close to her remain mum about the cause of her illness, except to say that she is being treated for a lung infection and is "doing well".

All the director-general of health would say was: "She is fine. She is doing well. She is going to be discharged in a few days, I think."

The minister was admitted to hospital on October 6 after taking ill while attending to ministerial duties in Pretoria. She insisted on being taken to the government hospital as "she prefers to go to state hospitals" for her medical care. She is being treated in the Folateng ward - the state's version of a private ward.

While this is not the first time Tshabalala-Msimang has been treated at a state hospital, it is the first time that her condition is being kept secret.

Joburg Hospital: where nurses don't care

2006-10-20T12:14:00.000-07:00

Lefa Motaung and Health Minister Manto Tshabalala-Msimang for a moment shared a common experience - they walked into Johannesburg Hospital. And that was where it ended.

While Tshabalala- Msimang convalesced in a private ward, a seriously ill Motaung sat for hours in the Casualty and Emergency Admissions section waiting to see a doctor.

When he did finally see one, he had waited 11 hours - the same time it takes to fly from Joburg to London.

And his wait wasn't over.

Motaung was rushed to the hospital on Thursday morning after he had been seen by a private doctor. He had been sick for three weeks and as he appeared to be getting worse, his mother, Maggie, asked her employer for help.

"We took him to our GP, he told us that his one lung had collapsed. He wrote a referral letter and told us to take him to Johannesburg Hospital," said employer Mandy Williams.

Motaung arrived at the hospital at 10.30am. Hours later, in frustration, Mandy's husband Danny phoned The Star.

"They wouldn't accept the referral letter, he had to see one of their doctors," said Williams.

Motaung's condition had deteriorated. Motaung had seen a doctor and had been taken to have X-rays.

The Williams family, who had been trying through the day to get medical attention for Motaung, had been banned from the waiting room. It was in this same waiting room that we met "Ubaba Daddy".

That was the name the night male nurse gave to irate relatives and the sick when they demanded to know his name. He appeared to be in charge of the waiting room and seemed to rule through the use of threats and the muscle of two body guards.

The sick sat on plastic moulded chairs wrapped in blankets, each waiting their turn to see the doctor. The very sick lay on the floor. Most had been there in the same position for hours, many hadn't eaten in that time.

"I don't care that you have been here since the morning. I will throw you out," Ubaba Daddy said to one patient. No one dared leave their seat as they could miss their chance.

On entering the hospital, relatives said that the patients were given a blood-pressure examination then told to join the queue. There were no check ups that followed.

At one point in the evening, the decision was made that relatives and friends be moved from the waiting room. Security began herding them out. A person pointed out that one of the very sick patients needed someone by his side.

"I don't care," Ubaba Daddy retorted.

When we told Ubaba Daddy that we were in fact from the media, again he said he didn't care.

He also told one person that he had been working as a nurse for 14 years, earned R6 000 a month and that he didn't care.

The only apparent doctor on call also resorted to a couple of threats of her own.

"If you don't do what you are told, I will go sit in my room and do nothing," she said.

We found Motaung sitting outside a room, waiting to have his X-rays. His mother sat next to him, crying.

"I must help my son," she whispered. Motaung said he was feeling a lot better but still didn't know how long he'd have to wait before he could lie down on a bed.

Back down the corridor, in another waiting room that wasn't presided over by Ubaba Daddy, Johan van Tonder sat quietly. He had a bag with some to see him through the night.

He had come to the hospital for tests to be done on a growth in his throat, to find out if it was cancerous. His throat had been sore of late.

It was too far to catch a train home to the East Rand, instead he decided to wait through the night.

The hospital had refused his referral letter from another state hospital. He would have to see a doctor at Johannesburg Hospital.

If all went well, he could be out by morning.

Contacted for comment on these allegations, Clinical director Dr Mmamorena Mofokeng said she was still investigating.

MEC of Health Brian Hlongwa's office was also timeously made aware of these allegations but did not respond.

Director general's report card

2006-10-20T03:32:00.000-07:00

Thami Mseleku is fond of saying that he is a linguist who had to be redeployed to the health sector to help sort out its problems. But Mseleku's lack of health knowledge has been his biggest disadvantage. Many of his senior staff lack respect for him because of it and it may also be the reason he appears to shun health sector stakeholders.

Although Mseleku has been director general since January last year, many key sector players report that they have never met him. As one senior pharmacy boss said recently: "The [Health Department] ship appears to have no captain."

While Mseleku has shied away from involvement in health policy issues, he has plunged head first into the political controversies involving the department -- most notably those involving HIV/Aids.

He has taken a personal interest in controversial vitamin seller Dr Matthias Rath, exonerating him from any wrongdoing even before a Medicines Control Council investigation into Rath's activities was completed. He also ordered a consignment of Rath's pills being held at Cape Town's port as unlicensed medicines to be released to the Rath Foundation.

He was instrumental in getting the Treatment Action Campaign (TAC) and Aids Law Project (ALP) excluded from the UN General Assembly Special Session on Aids.

There is still no new five-year strategic plan for HIV/Aids, although the previous one expired last year, and Mseleku has suspended the country's only HIV/Aids communication campaign, Khomanani, pending an audit of its performance.

Hopes that Mseleku's previous position as education director general would have enabled him to tackle the poor working conditions of health workers -- who, like teachers, are overworked and underpaid -- have not materialised.

In addition, the Health Department received a qualified audit for the third time in a row this year. Morale in the Health Department is dismally low, with almost 40% of top posts vacant despite an extra R30-million having been allocated to beef up the national staff.

However, the one bright spot in Mseleku's tenure this year is that the government is finally paying serious attention to setting up health information-gathering systems throughout the country.

Violence is bad for your health

2006-10-19T23:21:00.000-07:00

The Free State government says violence is a growing public health concern that poses a great challenge to the country's already burdened health system.

This is in terms of the increasing number of people admitted at health facilities to receive treatment for injuries.

According to the World Health Organisation (WHO) approximately 57 000 homicides took place among children under the age of 15 years in 2000, in the same year over 1.6 million people lost their lives to violence world- wide.

In South Africa alone, alcohol and drug abuse continue to be a contributing factor towards the occurrence of some crimes.

Releasing the annual crime statistics last month, Safety and Security Minister Charles Nqakula said drug-related crimes had increased by 13.2 percent while incidents of driving under the influence of alcohol or drugs rose by 9.9 percent.

However, government remained committed to further reducing all other forms of crime, by between 7 to 10 percent annually.

Opening a trauma unit at Pelonomi Hospital on Tuesday, Free State Health MEC Sakhiwo Belot said the Arrive Alive campaign had been initiated to reduce the number of road accidents in the country, by modifying the behaviour of road users, among others.

"Government is also working on regulations to introduce labelling of containers of alcoholic products with health warnings to raise awareness amongst our people about the harmful health and social effects of alcohol," he said.

HIV can speed up XDR-TB into uncontrollable epidemic

2006-10-17T23:04:00.000-07:00

The World Health Organisation (WHO) says the extremely drug resistant tuberculosis (XDR-TB) poses specific threats and challenges in the fight against HIV and AIDS.

Tuberculosis is the most common opportunistic infection accelerating HIV infection among those living with the virus.

Experts have said HIV has the potential to speed up XDR-TB infections into an uncontrollable epidemic unless infection control precautions are scaled up without delay.

According to a WHO TB expert, Dr Teguest Guerma, the lung disease also threatens the considerable progress many countries have made towards meeting the Millennium Development Goals (MDGs).

Dr Guerma was addressing the Department of Health's two-day workshop on the perspective of HIV and XDR-TB.

Health Minister Manto Tshabalala-Msimang had requested the meeting for the WHO experts to help review national and regional strategies and action plans to deal with the multi-drug-resistant TB (MDR-TB) and XDR-TB.

This after XDR-TB cases were reported in several provinces in the country. More than 60 patients have since died from the killer disease in Tugela Ferry in KwaZulu-Natal.

Dr Guerma warned that XDR-TB would not in most parts of the world be solved unless HIV was properly considered.

"HIV and TB programmes should have a close and a real collaboration," she said.

WHO Director for the Stop TB initiative, Mario Raviglione, said the lung disease had killed 1.6 million people in 2005, 98 percent of who were in developing countries.

In addition, 8.9 million new cases were detected last year. About 80 percent of those were detected in the 22 highly-burdened countries including South Africa, Mozambique, Tanzania and Zimbabwe.

Dr Raviglione said the main challenges in this regard were that the Directly Observed Therapy Strategy (DOTS) had not been fully expanded in high quality in some countries, with weak health systems and services impending proper control and care.

"Another challenge is that not all practitioners are engaged in dealing with this, and communities are unaware and uninvolved in activities and discussions around TB," he said.

He also urged pharmaceutical and diagnostic companies to do research that would produce new tools to deal with TB.

WHO AFRO regional advisor, Wilfred Nkhoma said the Southern African Development Community (SADC) was the most affected region by the MDR-TB but the extent of the burden was unknown.

Waiting list a fraction of those in need

2006-10-17T22:56:00.000-07:00

About 31255 HIV- positive patients were on waiting lists for antiretroviral drugs treatment in government clinics at the end of June, the health department said .

In a move to pre-empt Health Minister Manto Tshabalala Msimang's response to a parliamentary question from the Democratic Alliance, due to be tabled in Parliament today, the department emphasised that waiting-list figures were much smaller than the estimated number of people needing treatment.

Between 500000 and 800000 HIV -positive South Africans needed anti-retrovirals, the department said in a statement.

The figures are derived from the Actuarial Society's models, and assume that between 10%-15% of the 5,4-million South Africans infected with HIV had progressed to the point where they needed treatment.

"The model does not necessarily take into consideration the impact of healthy lifestyle interventions in delaying progression from HIV infection to development of AIDS-defining conditions," it said.

Nomonde Qundu, the department's head of HIV/AIDS, said many HIV-positive South Africans in need of treatment were unaware they were infected with the virus, and had yet to seek voluntary testing and counselling at accredited clinics.

As a result, the waiting lists represented only a fraction of those needing treatment, she said.

There was apparently confusion in the public mind over the difference between the figures, Qundu said.

By the end of June, 178635 HIV-positive patients had begun treatment, she said. About 10000 patients were being enrolled a month.

SA's shortage of skilled staff, particularly pharmacists, and delays in procuring equipment were the main causes of the delays in starting treatment, said Qundu.

No room for the mentally ill

2006-10-13T13:30:00.000-07:00

HUNDREDS of awaiting-trial prisoners in need of psychiatric assessment are languishing in prison as short-staffed state hospitals battle to determine if they are mentally capable of standing trial.

This was disclosed by Health Minister Manto Tshabalala-Msimang in written replies to parliamentary questions, indicating the challenges the ministry is facing with regard to both the lack of skills and infrastructure resources.

This means the mentally ill men and women among them are at risk of not getting appropriate medical treatment.

They should ideally be cared for in psychiatric facilities and not in the correctional services facilities, which hardly have sufficient staff with expertise to attend to their special needs.

The bottleneck also compounds delays within the already strained judicial system.

The delays were caused by shortages of nurses and doctors trained in forensic psychiatry, which limited the number of beds facilities could provide.

Opposition to health Bill

2006-10-12T08:00:00.000-07:00

Opposition parties initially opposed to the Health Professions Amendment Bill have not changed their stance and remained vocal about their disapproval, when it was debated in the National Assembly on Tuesday.

In particular the Democratic Alliance and the Inkatha Freedom Party have raised concerns about the Bill, which gives Health Minister Manto Tshabalala-Msimang the power to select the members of the Health Professions Council of South Africa and other professional boards.

The Bill also allows the minister to appoint the registrar of the council, and opposition parties say this is a clear indication of her attempts to centralise power.

ANC MP James Ngculu, who chairs the National Assembly's health committee, said the Bill aimed to ensure greater protection for the public and greater accountability from medical professionals.

The Health Professions Council was a statutory body and therefore the State had to play a role, he said.

One of the Bill's most ardent opponents, DA MP Gareth Morgan, said under the existing health professions legislation, representatives of the various professional boards were directly elected by the professionals themselves.

This meant that the council had "somewhat of a balance" between representatives appointed by the various arms of government and representatives from the health professions.

However, the current amendment Bill meant that the minister would now decide who would represent the health professionals.

"The supposed rationale for undermining the democratic right of health professionals, that being costly elections, is a red herring on the part of the Department of Health," said Morgan.

He also provided statistics to back his point that the ANC's argument that the boards were not "transformed enough" was incorrect.

By making the council an arm of the Health Department it would not become more accountable, he said.

TB programme a failure

2006-10-11T04:02:00.000-07:00

Government’s TB programme is failing because it has not bothered to educate patients about their treatment in the way that HIV patients have been educated.

In addition, R50 000 a month is being wasted in KwaZulu-Natal alone on processing TB sputum tests at Nkosi Albert Luthuli Hospital, the results of which were never claimed by the hospitals and clinics that sent them in.

This is according to Zinhle Thabethe, who works for iTeach, a TB and HIV implementation programme at Edendale Hospital in Pietermaritzburg.

“I have been on antiretroviral drugs for five years and, because I was trained about taking the medication, I have never missed my ARVs even for a day,” Thabethe told an international HIV/AIDS workshop in Durban over the weekend.

“But,” she added, “I have also had TB three times and have never been told about how the treatment works or even the consequences if I don’t finish my course of medication.”

Thabethe said that instead of educating TB patients, health workers referred them to Directly Observed Treatment Short-course (DOTS) volunteers who were supposed to monitor them taking their medication.

“DOTS doesn’t work. You must teach us patients how to take our TB drugs rather than DOTS-ing us,” she said..

Patients living in informal settlements have “no addresses and no DOTS volunteer is going to be able to follow them up if they don’t show up for their medication”, she added.

DOTS is the cornerstone of government’s TB programme. Yet less than half TB patients countrywide are cured at present, while in eThekwini and Msunduzi barely a third of TB patients are being cured.

Can't stay out of trouble, even in hospital

2006-10-11T03:29:00.000-07:00

A DEBATE is raging in the Gauteng legislature over the viability of private wards in public hospitals, with the health department insisting they are a success and the Democratic Alliance (DA) saying they run at a loss.

DA provincial health spokesman Jack Bloom said yesterday the wards were badly managed, and cost more to run than they brought in. “Unless the Gauteng health department is willing to conduct research into the viability of these wards, I will approach the public health services commission to conduct a countrywide survey,” he said.

Health Minister Manto Tshabalala-Msimang is being treated at Johannesburg Hospital’s private ward for a lung infection.

Bloom criticised the minister for using the ward, saying she was costing the taxpayer money as the ward billed less than it cost to treat patients.

The health department told the Gauteng legislature earlier this year it cost R5,5m to treat patients at Helen Joseph Hospital in the past year, and of this R5,4m was recovered from patients.

She should take her own medicine

2006-10-09T13:30:00.000-07:00

Health Minister Manto Tshabalala-Msimang should be in the ordinary section of the Johannesburg Hospital and not the private wing, the Democratic Alliance said.

“She could then experience first hand the dire effects of the staff shortages caused by her policies,” said DA health spokesman Jack Bloom. He said the private wards provide good care but failed to raise any revenue to upgrade the rest of the hospital. “They are so badly managed, in fact, that they lose about R1 million a year. This is a unique case of the poor subsidising the better off.”

Department of Health spokesman Sibane Mngadi said the minister was contributing to the improvement of the hospital by staying in the private ward. The private wards of state hospitals were established to attract people on medical aid in order to raise funds to improve the rest of the facility, he said.

“There is no reason why paying patients should not come to public hospitals. The level of care is the same as in the general section using the same team of doctors. There are only slight differences.”

Tshabalala-Msimang has been in hospital since Friday after being diagnosed with a lung infection.

Nurse exodus

2006-10-08T07:42:00.000-07:00

President Thabo Mbeki told nurses that he had agreed to institute a "chief directorate" that would focus on nurses' issues only.

He spoke at the 10th anniversary celebrations of the Democratic Nurses Organisation of SA (Denosa) in Durban.

"I have agreed," said Mbeki to loud cheers in Durban's International Convention Centre where the organisation is holding its 5th national congress and celebrating the 10th anniversary of its founding.

He said that the government was looking at further addressing the issues of remuneration and working conditions affecting nurses. He said that the government was also looking at ways of addressing the migration of nurses.

National health minister Manto Tshabalala-Msimang was due to attend the gala dinner with Mbeki, however she was admitted to Johannesburg Hospital on Thursday with a lung infection.

How to deal with a shortage of nurses

2006-10-05T02:05:00.000-07:00

Faced with a dire shortage of nurses, a Cape Town hospital resorted to dressing a cleaner as a nurse.

This shocking incident emerged as the Western Cape government revealed it had spent R62-million in 18 months employing "freelance" nurses.

A senior source at False Bay Hospital said a domestic worker from the nurses' home was roped in to work on the wards during a weekend shift about four weeks ago.

But the provincial health department says it is training "compassionate and caring" general assistants who work only with qualified nurses and never on their own.

Health Department spokesperson Faiza Steyn said on Monday night that since March 2005 they had spent over R62m on agency nurses, who worked freelance and earned top salaries.

At one hospital, a freelance casualty sister working one weekend shift commands R1 400. Her permanent equivalent, with more than 30 years' experience, clears just more than R4 000 for a month's work.

Groote Schuur Hospital alone, which its head of operations Dr Saadiq Kariem says is much better off than smaller hospitals in respect of nursing shortages, spends R2m a year on agency nurses.

The situation is the result of serious nursing shortages.

Provincial health MEC Pierre Uys said in his budget speech this year there was a 12 percent attrition rate among professional nurses, but that that figure spiralled to 26 percent in specialised areas like theatres and intensive care units.

Medi-Clinic's head of nursing, Estelle Jordaan, said the situation was driving up healthcare costs, with agency nurses in such demand that they could command double and even triple the standard pay in certain situations.

The False Bay Hospital source confirmed the crisis, and said the matron had sought out the domestic worker in the nurses' home to boost numbers on a weekend night shift.

"Three of our long-time nurses have left or are in the process of leaving for overseas now, so the concern is that things are only going to get worse," she said.

"We have already been forced to close our private ward, which was supposed to generate money for the hospital, because there are just no nurses available."

The health department's Steyn said 20 general assistants had undergone 10 weeks of training in basic nursing skills, and although they could wear a nurse's uniform, they were always assisting a qualified staff member.

At Red Cross Children's Hospital, the shortage of nurses routinely results in operations being delayed or cancelled. Head of surgery Professor Heinz Rode says the ICU is the Achilles' heel of the hospital, with only 12 of the 26 beds functioning.

Groote Schuur's Kariem said operations were routinely postponed and delayed because of nursing shortages.

"It is unfortunate and does create a lot of unhappiness among patients. We take a lot of irate calls from patients," he said.

Sidelining the minister

2006-10-04T04:18:00.000-07:00

Organisers of a forthcoming major AIDS conference in South Africa have bypassed controversial Health Minister Manto Tshabalala-Msimang by inviting her deputy and the country's vice-president instead.

The event is being held by church, union and non-governmental organisations including the Treatment Action Campaign (TAC) lobby which has demanded the minister be sacked for advocating a diet of vegetables and garlic to help combat AIDS.

The TAC said an invitation to the conference starting October 28 had instead been sent to Vice-President Phumzile Mlambo-Ngcuka, head of a ministerial team on HIV/AIDS, and deputy health minister, Nozizwe Madlala-Routledge.

The general-secretary of the Confederation of South African Trade Unions (COSATU), part of the tripartite governing alliance, said Tshabalala-Msimang had been left off the list to avoid her making controversial remarks.

"We do not want controversies at such an important conference where we need to be sending a message that this epidemic requires maximum unity from both the people and the government," Zwelinzima Vavi told South African public radio. To avoid such controversies, it is better to have the deputy president addressing the conference."

Tshabalala-Msimang -- dubbed Dr Beetroot -- is being gradually sidelined as a result of the negative publicity she has generated.

Tshabalala-Msimang and the government were recently ridiculed by the United Nations' top envoy for AIDS in Africa, Stephen Lewis, for harbouring "theories more worthy of a lunatic fringe than of a concerned and compassionate state."

African potato is bad for you

2006-10-03T02:16:00.000-07:00

There is no substitute for anti-retroviral drugs when dealing with HIV/Aids, a prominent South African doctor has said.

At the 21st biannual Nutrition Congress in Port Elizabeth yesterday, Dr Kas Kasongo said the African potato, which has been held up by Health Minister Manto Tshabalala-Msimang as of great nutritional value to those with HIV/Aids, was not without side-effects even if it did slow down the progress of the disease.

“While some extracts of the African potato in purified forms are helpful, some are harmful as it suppresses bone marrow.

“In some cases this traditional potato has the potential to interfere with certain types of anti-retrovirals, lowering the treatment’s effectiveness by up to 80%.

Dr Kasongo said that it was of the utmost importance that “we don’t have unqualified people making false claims”.

In trouble again

2006-10-03T02:10:00.000-07:00

South African Health Minister Manto Tshabalala-Msimang has again come under fire - this time for her department's third consecutive qualified audit report by auditor-general Shauket Fakie. Many of the problems identified by the A-G are not new and seem only to get worse.

It is now time that President Thabo Mbeki removed the minister and her equally bumptious director-general Thami Mseleku from office for the financial management crisis which had mounted at the department under their watch.

Fakie found the department's financial statements did not reflect the true financial position of the department in a number of respects.

He found a number of instances in which the department knowingly flouted the provisions in the Division of Revenue Act.

Among other things, the department paid out R1.3bn in grants before receiving the business plans stating how the money would be spent, and ended up paying out R110m more than the amounts required in the individual business plans when they had been received at last.

The national department also failed to properly monitor spending by the provincial departments.
The private sector would simply not tolerate such dismal performance from its employees.

Manto denies Aids gaffes

2006-10-02T02:41:00.000-07:00

A war of words has erupted between the Treatment Action Campaign (TAC) and South African Health Minister Manto Tshabalala-Msimang.

This came to light following the Health Minister’s social cluster media briefing, where she challenged South Africans to read her statements and to highlight where she ever said that a healthy lifestyle and good nutrition were an alternative for treating HIV/Aids.

Nathan Geffen, of the TAC said that until now, Msimang had not made a single statement clarifying that nutrition was not an alternative to anti-retrovirals (ARV).

The TAC yesterday provided statements contesting the minister’s stance towards alternative treatments.

On May 14, 2001 the Mail&Guardian quoted Msimang as saying: “Some are going to be disappointed that we are not going to give ARVs tomorrow, but it is the message which does not get through – that people are getting treatment even if there are no ARVs.”

In a written response by the Minister to a question in Parliament on 14 September 2005, she said, “Certain traditional medicines may help treat numerous symptoms of opportunistic infections that are a part of Aids”.

Six years ago Msimang was quoted by Sapa as saying there was an “impression that until governments provided ARVs, whatever else they did came to naught. I want to dispel this myth, because it is absolutely not true” she said.

Meanwhile, during the briefing, Msimang made it clear that a healthy lifestyle and good nutrition were not “a substitute for medical treatment, but helped in maintaining health”.

Geffen said nutrition was a critical component of disease management, but her comments on nutrition were “pseudo-scientific” with regard to specific vegetables as immune boosters for people with HIV and that this was not based on evidence.

Msimang said that the message should not be lost and implied that the media were responsible for producing conflicting reports regarding this issue.

Garlic is bad four your health

2006-10-01T03:03:00.000-07:00

Should people with HIV/Aids be eating loads of garlic, beetroot and African potato as recommended by South African Health Minister Manto Tshabalala- Msimang?

“No,” is the forthright answer of Stellenbosch University dietitian Roy Kennedy. In some cases garlic can even make treatment 50% less effective.

“Nutrition is vital for HIV/Aids patients but they should not concentrate on any particular food,” he told the 21st biennial nutrition congress in Port Elizabeth this week. “They should include five vegetables and fruits a day and a multivitamin and mineral supplement to a maximum of three times the recommended daily allowance”.

Blame it on the media

2006-10-01T02:59:00.000-07:00

Embattled South African Health Minister Manto Tshabalala-Msimang blamed the media for confusion in government messages on how to fight the HIV/AIDS epidemic.

The social cluster media briefing gave her the chance to defend herself since cabinet’s decision to sideline her as chief government communicator on its HIV/AIDS strategy.

The cabinet boosted the role of the interministerial committee and the South African National AIDS Council in liaising with stakeholders such as the Treatment Action Campaign (TAC).

The minister dismissed the “myth” that Deputy President Phumzile Mlambo-Ngcuka was “elevated” to chair the interministerial committee and the AIDS council, saying this was traditionally a position occupied by the deputy president of the country and was “nothing new”.

She could not understand criticism that government did not want to implement its comprehensive HIV/AIDS strategy. “This issue should not be an issue that divides us as a country,” she said

But the minister did not backtrack on her commitment to her garlic, beetroot, olive oil and lemon remedy as a way of boosting health. She insisted she could not compromise on her beliefs and that she had never suggested good nutrition was an alternative to antiretroviral treatment. This was “a figmentation of some people’s minds. I never said that.”

However, she also said the lives of some people who had taken antiretrovirals had not been prolonged, which showed this could not be the only pillar of government’s strategy. It was also government’s responsibility to highlight the harmful side effects of antiretrovirals.

Hospitals in crisis

2006-09-29T05:16:00.000-07:00

Patients are dying unnecessarily because South Africa’s public hospitals are over-burdened, under-staffed and poorly managed.

Over 80% of South Africans have no medical aid, and have no choice but to seek treatment at the government hospitals and clinics that many patients interviewed felt were uncaring institutions. Many desperately sick and injured people are not getting the care that they need because of a massive countrywide shortage of skilled nurses, who are the backbone of our health system.

A shortage of doctors and specialists is also undermining the quality of healthcare, particularly in rural areas. Ironically, a number of nursing colleges were closed down in the late 1990s as part of government’s cost-cutting measures while government has made it very difficult for foreign doctors to work in this country.

Approximately one-third of health posts countrywide are vacant, but some institutions are running with less than half the staff they need. Psychiatric hospitals have some of the highest vacancy rates in the country. This is delaying hundreds of court cases countrywide where suspects have been referred to these institutions for observation.

The public health service is essentially running on the commitment of nurses and doctors to serve their communities, despite pathetic pay packages, enormous workloads and horrible working conditions.

Hospitals in urban townships are bearing the brunt of increased patient loads, and are battling to cope with the demand. Two factors are mainly behind the massive increase in patients: the AIDS epidemic and rapid urbanisation, where a large number of people are now living in unhealthy conditions in informal settlements.

At every hospital AIDS is having a huge impact. AIDS patients tend to be very sick and need longer and more specialised care than other patients.

Nurses admit that they feel overwhelmed by the sheer number of very sick and dying AIDS patients they have to care for. In addition, a number of healthworkers themselves are HIV positive, while others live in fear of getting HIV from work-related accidents.

Dr George Abraham, acting senior clinical manager of Natalspruit on Gauteng’s East Rand, says the hospital used to admit between 10 and 15 medical patients a day a few years back. “Now, that number has gone up to 40 to 50 patients per day. And most of these patients have HIV-related complications,” says Abraham.

Matron A Chinniah from Durban’s Addington Hospital, says: “We have 135 medical beds and they are always full, three-quarters with HIV positive patients.”

At many hospitals, doctors and nurses have to make decisions about which patients to try to save and which to abandon based on time and available resources, rather than medical criteria. Chris Hani Baragwanath is the biggest hospital in Africa, yet it only has 18 intensive care beds to serve the entire population of Soweto of over two million.

Because of the pressure on beds, doctors admit that patients are sometimes discharged prematurely and thus face the danger of relapsing or their wounds becoming infected.

The referral system – in which patients are referred from clinics to district, regional or tertiary hospitals according to how serious their health problems are – has also broken down in many parts of the country, with even a well resourced province such as the Western Cape facing serious challenges.

This means that patients who need more specialised care often cannot get it either because they get stuck within a dysfunctional system or because there is no space for them at more specialised institutions.

A severely traumatised young man with 40% burns on his body spent 24 agonising hours at Khayelitsha Day Hospital before being transferred to GF Jooste Hospital in Cape Town. He then lay in a general ward for over a week, his chances of survival rapidly diminishing, because Tygerburg’s specialised burns unit said it had no room for him.

Conversely, many hospital emergency rooms are flooded with patients with relatively minor ailments because they don’t want to queue for hours at poorly managed local clinics where basic medicines are often out of stock.

A young doctor based at Kimberley Hospitals described how he often had to go and fetch medicine from the provincial depot before attending to patients at a local clinic because the district health officials failed to get these to be delivered.

Professor Martin Smith, head of the department of surgery, describes healthcare at Chris Hani Baragwanath as “a bit of a hit and miss”, ranging from top-class to life-threatening care – depending primarily on a range of issues, particularly the availability of skilled healthworkers and beds.

This description can be applied to virtually all hospitals in the country. Often the hospitals that are able to deliver adequate health services are run by determined rebels who have found creative ways to by-pass red tape and inspire their staff.

One such “rebel” is Dr Victor Fredlund. Frustrated with his arthritic patients having to wait months for hip-replacements when he referred them to the regional hospital, Fredlund learnt how to perform the operation himself on patients under local anaesthetic at rural Mseleni Hospital in northern KwaZulu-Natal.

Every hospital, no matter how well run, is under stress. Each day, health workers face huge workloads and increased patient deaths. They also face daily exposure to deadly infectious diseases such as multi-drug resistant TB as infection control in many hospitals is poor.

At the 784-bed Natalspruit Hospital, there were seven deaths in one day in the medical wards alone. Nurses work 12-hour shifts and have to treat large numbers of patients in this time. Many patients in the trauma wards are drunk and abusive.

A shortage of support staff such as nursing assistants, cleaners and porters means that nurses often have to carry, wash and feed patients, which keeps them from nursing esponsibilities. Absenteeism among health workers is rife, even at well run institutions such Durban’s Addington Hospital. This is mostly due to stress, but nurses “moonlighting” in private hospitals to supplement their meagre salaries is also a factor.

At hospitals where management is weak, such as Cecilia Makiwane Hospital in East London or Prince Mshiyeni in Durban, nurses also turn up late, leave early and often neglect patient care such as regular monitoring of vital signs.

Hospital managers’ ability to take disciplinary action is severely limited by the centralised nature of provincial health bureaucracies. In many provinces, the provinicial head of health is the only person able to dismiss staff.

In addition, hospital CEOs and superintendents are unable to decide on staff numbers, draw up their own budgets or play any role in the procurement of goods and services.

President Thabo Mbeki recognised that hospital management needed more power in his ‘State of the Nation’ address to Parliament in February when he announced: “To improve service delivery in put hospitals, by September this year we will ensure that hospital managers are delegated authority and held accountable for the functioning of hospitals.”

Provincial health departments would retain control over “policy issues regarding training, job grading and accountability”, added Mbeki. However, so far only the CEO of Chris Hani Baragwanath, Arthur Manning, has been delegated the authority to run his hospital by the Gauteng health department.

An investigation of eight hospitals in Gauteng, KwaZulu-Natal and the North West commissioned in 2005 by the Department of Public Service and Administration describes nursing as “a function in crisis” due to staff shortages.

The investigation, conducted by Karl von Holdt and Mike Murphy for the National Labour and Economic Development Institute (Naledi), describes public hospitals as “highly stressed institutions due to staff shortages, unmanageable workloads and management failures”.

The investigators report that there is a dysfunctional relationship between hospitals and provincial head offices, which “have centralised control over strategic, operational and detailed processes but are unable to deliver on these”.

“Clinicians and nurses in all but one of the hospitals studied state that staff shortages and management failures compromise patient care and have an impact on clinical outcomes. In many cases the result is increased morbidity (illness) rates, higher costs of intervention and longer hospital stays. In others it affects mortality rates,” says the report.

Outbreaks of the hospital-acquired infection, klebsiella, have already killed 110 babies at Mahatma Gandhi Hospital in Durban over the past three years, according to the organisation “Voice” that is spearheading a class action case against the department of health.

In response to the hospitals crisis, government has developed a revitalisation programme, and is in the process of upgrading 48 hospitals. Health Minister Manto Tshabalala-Msimang said recently that the programme aimed to show that, “contrary to popular belief, public hospitals can offer quality healthcare”.

However, she conceded that the success of the programme “will not be judged on the number of hospitals we have constructed or refurbished, but on how well we maintain and manage our facilities”.

These are the key findings of a three-month investigation of government hospitals by a team of reporters from Health-e News Service and the Mail & Guardian who visited 26 hospitals countrywide.

The Naledi report recommends a radical reorganisation of hospital services, based on full authority for hospital managers and the establishment of clear operational units within hospitals to ensure that sections – such as surgery – are managed as a whole, rather than nurses, doctors and support staff being managed separately.

It also calls for “considerable investment” in management capacity, the employment of less skilled staff to free skilled staff to do what they are trained to do and the reopening of nurses training colleges.

The Naledi proposals were accepted by Cabinet’s January lekgotla, but it remains to be seen whether government has the will to implement the measures with urgency.

I deny everything

2006-09-28T03:13:00.000-07:00

Health Minister Manto Tshabalala-Msimang has denied ever claiming that the use of certain fruits and vegetables by HIV and Aids sufferers could be an alternative to medical treatment.

“I challenge you to read all my statements and show me where this minister ever said it was an alternative. It is not,” Tshabalala- Msimang told reporters at a media briefing on developments in government‘s social cluster.

Blaming reporters for confusing the public and not being informed enough, Tshabalala-Msimang said government‘s message was simple: “Accelerated prevention, prevention and prevention.”

She warned that if the prevention message was not spread the cost of dealing with HIV and Aids would get out of hand. “The cost is just going to be enormous because we could do nothing but spend money on this one condition,” she said.

At the same time she again stressed the use for garlic, olive oil, lemon and beetroot as part of a diet for those living with HIV.

“It is not a substitute for medical treatment, but it helps in maintaining optimal health.” She also highlighted the contra-indications of anti-retroviral medicines, saying it was her duty to speak about it.

Backing the president's fringe views on AIDS

2006-09-26T02:23:00.000-07:00

The U.N. special envoy for AIDS has likened her to the "lunatic fringe," while a well-known comedian derides her as the "Angel of Death." She is South Africa's top health official and one of the most important front-line fighters against AIDS in this country beset by an epidemic. But controversial Health Minister Manto Tshabalala-Msimang has been widely criticized for questioning the effectiveness of antiretroviral drugs to combat AIDS, advocating beets, lemon, garlic and sweet potatoes as treatment instead. Activists had to take legal action to force the government to provide the medication to pregnant women and prisoners.

Tshabalala-Msimang has been criticized in international forums and recently faced a call from dozens of international health experts that she be fired. Still, South African President Thabi Mbeki has remained steadfast. Some analysts suggest it is his stubborn loyalty to a longtime political ally, others that he is satisfied with her performance because her views are similar to his own.

In the late 1990s, Mbeki warned of the toxicity and harmful side effects of the antiretroviral treatments, and in 2000 he questioned the link between the human immunodeficiency virus and AIDS. He has never publicly disavowed those views, although government said earlier this month that the government does believe HIV causes AIDS.

"I don't think he understands how much it has damaged his presidency," said William Gumede, the author of a critical biography on Mbeki. "Even his closest allies, if you speak to them, don't see it."

Other observers believe that the more pressure from activists and international experts, the less likely Mbeki is to dismiss Tshabalala-Msimang because he finds it difficult to admit he was wrong on AIDS.

"I think there's a certain degree of vanity here," said political analyst Tom Lodge, formerly head of politics at Witwatersrand University in Johannesburg. "He's like a lot of politicians: He really finds it difficult to say, 'Look guys, I made a mistake.' "

This month, Mbeki ignored a call for Tshabalala-Msimang's dismissal from 81 international AIDS experts, including Nobel Prize laureate David Baltimore and Robert Gallo, who developed the first blood test for HIV and identified the virus as the cause of AIDS. In the letter to the president, they called for an end to South Africa's "disastrous, pseudoscientific policies," saying the minister was an embarrassment to South Africa who had no international respect.

The most damaging recent criticism came at the International AIDS Conference in Toronto last month from U.N. envoy Stephen Lewis, who described the South African government's approach as "wrong, immoral, indefensible."

"It is the only country in Africa," he said, "whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state." With 600 to 800 dying daily in South Africa of AIDS, Lewis said the government has much to atone for. But he said: "I'm of the opinion that they can never achieve redemption."

Biographer Gumede said Mbeki did not want to fire Tshabalala-Msimang under public pressure, but noted that her power had been curbed recently when the government set up a committee of ministers this month to oversee the AIDS treatment plan. "Mbeki is very sensitive," he said. "If he feels one of his loyal supporters or loyal allies is under siege, it's real unlikely that he will fire such a person."

Political analyst Lodge, now based at Limerick University in Ireland, said Tshabalala-Msimang held conventional views on HIV/AIDS before she was health minister but that she had since echoed Mbeki's opinions, adding her own spin about garlic, lemons and beets as treatments.

"It's in some ways all the more unforgivable in her case because, unlike the president, she has a conventional medical training," Lodge said. "She is going against the conventions and the professional protocols of her own background."

Trying to catch up with Africa

2006-09-26T02:18:00.000-07:00

Nearly a third of deaths during pregnancy in South Africa are preventable and caused by guidelines not being followed, and a lack of trained staff, facilities and transport between health institutions. Eight years after monitoring of maternal deaths was begun in South Africa, most of the problems identified in the first report, released in 1998, are still responsible for the preventable deaths of thousands of women.

According to the Confidential Inquiries into Maternal Deaths Report released by Health Minister Manto Tshabalala-Msimang this week, 1 208 of the 3 296 deaths investigated could have been prevented. Wrong diagnosis, delays in referring patients and substandard management of patients were some of the reasons for maternal deaths.

At the time of the first report, Tshabalala-Msimang said almost half of the maternal deaths could have been prevented. The National Committee for Confidential Inquiries into Maternal Death said then that it would be possible to reduce maternal mortality by half within five years. This had not been achieved.

Eight years on, the number of women who died during pregnancy had only slightly decreased and Aids had emerged as the number one killer of pregnant women. In 1998 Aids claimed 18 percent of pregnant women in the study compared with 20 percent in the current report.

The first investigation reported that 150 out of 100 000 pregnant women died in SOuth Africa. According to a United Nations report released this year, the maternal death rate on the African continent is 1 000 in 100 000. In the UK it found the mortality figure was 13 out of 100 000.

Sit down, comrade

2006-09-26T02:14:00.000-07:00

Stung by criticism in the National Assembly of her "performance" at the recent 16th International Aids Conference in Toronto, Health Minister Manto Tshabalala-Msimang attempted to defend herself on Wednesday by rising in the House of Parliament on a point of order.

"What is the performance in Toronto? It is going to have to be elaborated, because I don't know," she said.

However, this was ruled not a point of order by presiding Deputy Speaker Gwen Mahlangu-Nkabinde, and the minister, who appeared exasperated by the criticism, was forced to resume her seat.

Earlier, Inkatha Freedom Party MP Ruth Rabinowitz - in a question to Deputy President Phumzile Mlambo-Ngcuka - had referred to Tshabalala-Msimang's "unfortunate performance" at the event.

The health minister has endured a barrage of criticism after South Africa displayed beetroot, garlic and lemons along with anti-Aids medicines in its exhibition at the conference in Canada last month.

Tshabalala-Msimang has advocated a diet containing these items as a nutritional complement in fighting HIV.

Local and international Aids experts and activists are calling for her head, and insisting President Thabo Mbeki fire her.

In the House on Wednesday, Mlambo-Ngcuka endorsed government's support for the embattled minister, saying she would continue to represent South Africa at international conferences.

Business as usual

2006-09-26T02:12:00.000-07:00

A CONTROVERSIAL state hospital has again come under fire for sending home a seven-year-old boy with a rusted blade in a wound dressing.

Now his furious parents want Mahatma Gandhi Memorial Hospital to pay for blood tests to ensure he hasn't been infected.

Grade 2 pupil Keyashan Gounden injured his forehead while playing soccer with friends in a park near his Phoenix home two weeks ago.

Gounden's mother, Michelle, said she was horrified when she found a blade stuck under a plaster covering a stitch on her son's head.

Last year, 22 babies died at the hospital as a result of an outbreak of klebsiella bacteria in the neo-natal intensive care unit.

Health Minister Manto Tshabalala-Msimang set up a task team to investigate the causes of the outbreak. It was found that the deaths were linked to the failure of infection control measures.

Illegal medicines industry out of control

2006-09-26T02:04:00.000-07:00

An illegal medicines industry is rocketing out of control as unregistered products - many claiming to cure diseases such as cancer, TB and Aids - are sold across the counter or on the streets. As usual, everybody is waiting for a really big important document that is expected to be released anytime real soon.

The department of health, which, by law, has to ensure that all products purporting to be medicines are registered, is struggling to control the industry as it has become too large to shut down.

Many of the complementary medicines are believed to be manufactured locally. It is thought that there are more than 15 000 complementary medicines on the South African market and about 30 000 registered medicines.

The products, which can be found at local pharmacies, on the Internet and through various informal traders, and even at taxi ranks, are illegal because although many claim to cure diseases, they are not registered with the Medicines Control Council (MCC), which all medicines are required to be.

Certain individual products claim to cure everything from cancer and HIV and Aids to arthritis, rheumatism, high blood pressure, urinary tract infections, thrush, eczema and acne.

A source at the health department said that the illegal industry had grown out of control to such an extent that no one really knows how many illegal medicines were on the market.

"The belief is that they (the health department) can't close down the market because it's too large. So the department is not enforcing the Medicines and Related Substances Control Act," said the source, adding that to enforce the law, all the department had to do was lay a criminal charge against the manufacturers of the illegal products.

Dr Alan Tomlinson, chairperson of the Health Products Association of South Africa (HPASA), whose members are manufacturers of complementary medicines, said that while the industry was generally a responsible one, "there are some cowboys who manufacture in their back gardens, who are harming our industry".

Two diseases in particular had been exploited by the complementary medicines market: HIV-Aids and cancer.

The health department source explained that consumers put themselves at greater risk by taking such products, as they could become sicker and could even die.

"A medicine can be dangerous not only because of what it does, but also because of what it fails to do. If you take a wonderful tonic that claims to cure HIV and Aids and don't take your antiretrovirals, you could die quickly," the source said.

The source added there was no way to ensure that the unregistered products were manufactured according to industry specifications.

The products are being sold from R80 upwards to unsuspecting consumers, who are unaware that the products are not registered; whether they contain what they say they do; or are in the correct doses.

Tomlinson said the HPASA, which represents more than 100 members in the health products industry, and other stakeholders were in talks with the department of health to draft regulations to control the manufacture of complementary medicines.

The MCC started the process in 2002, but there is still no indication of when it will become law.

The department of health had not been able to reply to queries on the burgeoning illegal medicines market.

MCC chairperson Professor Peter Eagles, however, said that the MCC was developing regulations for the registration of complementary medicines, which would be submitted to the minister of health for consideration.

"This is an important stage of the process initiated by Minister Manto Tshabalala-Msimang to regulate these medicines in the interest of the public and stakeholders alike," Eagles said.

How the minister's quackery hurts South Africa

2006-09-23T08:03:00.000-07:00

The South African regime's contempt for the people who voted them into power is the stuff of legend. Nowhere is it more visible than in the medicine dished out by the Department of Health.

MANTO Tshabalala-Msimang’s failure to manage the treatment of AIDS is well known. She has promoted pseudoscientific remedies and undermined the antiretroviral (ARV) rollout. SA is not even in the top 10 in Africa for the proportion of people in need of ARVs who actually receive them — that is if we are to believe government’s treatment statistics. The programme is so poorly monitored that no one knows with any confidence how many people receive treatment.

Tshabalala-Msimang has also failed on other critical aspects of her job, including AIDS prevention, TB management and adequately resourcing the health system. She has even failed at the one campaign she claims to champion: nutrition. She has undermined the independence of both the Medicines Control Council and the Medical Research Council (MRC) as well as shown contempt for the courts and the constitution. During her term, many clinics and hospitals have moved to the brink of collapse. Life expectancy has plummeted; deaths among infants and young adults — especially women — have soared.

The cabinet has emphasised prevention as the cornerstone of government’s AIDS policy. Yet, the mother-to-child transmission prevention programme is implemented poorly. It has been inadequately monitored and evaluated, so we have little understanding of how effective it is. Except for Western Cape, all provinces continue to use the suboptimal single-dose nevirapine regimen. The paediatric HIV epidemic could be eliminated swiftly, but there is no political will to do so.

Accessing postexposure prophylaxis after rape is challenging. Even health workers complain that accessing this programme is difficult following occupational injuries.

Few schools implement adequate sex-education programmes. Government-funded condom promotion campaigns are practically invisible. The Khomanani AIDS awareness programme is in limbo. The health department’s plan to deal with HIV prevention expired at the end of 2005.

As a consequence of HIV, the TB epidemic has exploded in the past decade. TB is the biggest recorded cause of death in SA. The minister spurned efforts years ago to form a coalition against TB. That she discouraged officials from attending the MRC-organised meeting to deal with the XDR TB outbreak should alone be grounds for dismissal.

Many public health care workers in SA are doing a phenomenal job, against all odds, to give the best care they can to their patients. They are the seldom-recognised heroes of the HIV epidemic. Yet the minister’s dereliction of duty shows utter contempt for them.

A Human Sciences Research Council survey has shown the poor state of health worker morale, caused primarily by the increase in workload due to AIDS as well as high levels of HIV infection among nurses. The South African Health Review shows that the number of nurses per public sector users has declined during the minister’s term. So have other key medical personnel ratios. Many nurses and doctors have left the public sector either for the private sector or overseas. Many of our hospitals are in a dire mess. Patients have to queue in township clinics before sunrise and spend the whole day navigating the system. Yet the health department’s framework human resources plan is devoid of concrete measures to address this.

The minister has created the illusion that she is addressing nutrition. But telling people to eat garlic, lemons and African potatoes to ward off disease is pseudoscience, not nutrition. Food insecurity is indeed a serious problem. Ensuring that unemployed people have access to healthy food, either through social grants or food parcels, is far more important than prescribing the contents of their salads. A Joint Civil Society Monitoring Forum report from 2005 demonstrated the inadequacy of the health department’s nutrition interventions. Further, not a single scientifically accurate fact sheet on nutrition and HIV for the public has been issued by the department. Between the minister’s rhetoric and implementation there is a huge gulf.

Ultimately, President Thabo Mbeki has to take responsibility for Tshabalala-Msimang’s failures. But it is not too late to address the crises in our health system. Firing the minister will not fix the problems, but it would be an important start. The president can signify his commitment to resolving the decline in South African health care by dismissing Tshabalala-Msimang and replacing her with someone competent and less arrogant, who understands science and deals fairly with civil society.

Trying to win friends and influence people

2006-09-22T04:38:00.000-07:00

The famous South African minister of Health only has one friend left in the whole wide world. Fortunately for her, he happens to be the President.

South Africa's Inter-Ministerial Committee (IMC) on HIV/AIDS is seeking the cooperation of activists to improve ways of tackling the pandemic.

The IMC was recently reinforced after concerns were raised in cabinet that health minister Manto Tshabalala-Msimang was diverting focus from the government's anti-AIDS strategies with her controversial promotion of garlic, beetroot and the African potato as effective means of treating HIV.

The strengthened committee, chaired by Deputy President Phumzile Mlambo-Ngcuka, reportedly decided at its first meeting to reach a consensus with nongovernmental (NGO) and civic bodies, such as the Treatment Action Campaign (TAC), who have been critical of the government's anti-AIDS plan.

Although welcoming the informal invitation, TAC spokesman Nathan Geffen told PlusNews that this offer would in no way detract from his group's stance on Tshabalala-Msimang's role as health minister, and the demand that she step down. The TAC recently appealed for international support in presenting a mass petition of its demands to President Thabo Mbeki.

"The minister continues to undermine the efforts of both the government and civil society organisations against not just HIV/AIDS, but other aspects of health as well. She represents a leadership crisis that urgently needs to be resolved," said Geffen.

He charged that the minister's association with known AIDS dissidents, like vitamin salesman Matthias Rath, also sent out conflicting and dangerous messages to a nation grappling with one of the highest HIV prevalence rates in the world.

Sibani Mngadi, spokesperson for the department of health, warned in a statement that the prospect of success in the TAC's campaign to oust the minister was almost nil.

Of course DDT is safe, you can trust us

2006-09-21T08:11:00.000-07:00

From the department who brought you the beetroot/garlic cure for AIDS: the safe use of DDT.

South Africans should be confident of the work they are doing in the health area, said Health Minister Manto Tshabalala-Msimang on Tuesday after the World Health Organization endorsed using DDT in the fight against malaria.

"We have been the sole voice defending this intervention at an international level despite the strong opposition and pressure..." she told a press conference.

DDT was an organic pollutant which increased in concentration as it moved up the food chain. However, it is effective to control mosquitoes that carry and spread the often deadly disease.

"We welcome the new position taken by WHO and will continue to use this intervention in a controlled manner to support our efforts to eliminate malaria in our region," she added.

Health Ministry spokesman Sibani Mngadi said Monday that his ministry was concerned about the environmental impact of DDT, but was taking precautions.

Collecting money to get minister fired

2006-09-19T03:01:00.000-07:00

The department of health is angry about a R4 million plan by the Treatment Action Campaign to get rid of Manto Tshabalala-Msimang, the minister of health.

Sibani Mngadi, the spokesperson for the health department, claimed on Saturday the Treatment Action Campaign was raising the money to oust Tshabalala-Msimang. "While the prospect of success of this campaign is almost nil, the money being raised can save lives by procuring millions of condoms or providing anti-retroviral treatment to more than a thousand people," he said.

However, Mark Heywood, the TAC spokesperson, said the initiative was a public appeal for financial help to put pressure on the government to respond properly to issues around HIV and Aids. Included in the plan is the hosting of an emergency indaba around the pandemic and the dismissal of the minister.

Mngadi claimed the money would be used to finance the organisation's activities over the next three months to try to remove the minister from office, adding that the TAC had already received R100 000 in donations.

"It makes special arrangements for donors in United Kingdom and United States of America, which are the main countries where the organisation has intensified its campaign against Minister Tshabalala-Msimang," he said.

Heywood said the government was using cheap tricks to detract from the TAC initiative. "We could argue how many lives would have been saved had the minister and her delegation not gone to the Toronto conference, which cost taxpayers R700 000," he said.

"We consider this campaign necessary because of the ongoing crisis of HIV prevention and treatment, which is being exacerbated by political denial. Nine hundred deaths from Aids a day should be intolerable in any society and we will not tolerate it. This is why we have called on the president to convene a national crisis meeting and for the firing of the health minister," Heywood said.

Regarding the TAC call for the removal of Tshabalala-Msimang, Themba Maseko, the government spokesperson, said it was the president's prerogative and no organisation could tell him what to do.

Tshabalala-Msimang suffers from incompetence

2006-09-17T02:59:00.000-07:00

A diagnosis on the South African regime's AIDS problem.

The recent decision by parliament to appoint the deputy president to head the government's HIV/Aids programme is yet another example of the crisis in the thinking of decision- making bodies, when it comes to selecting the right people for a job.

Our decision-makers just don't seem to learn. Jacob Zuma, without the necessary credentials, was appointed as head of the government's HIV/Aids programme and look at the mess he has landed us in with his mindless statement about why he took a shower after having unprotected sex with an HIV-positive woman.

The least he could have done was to have corrected his mistake, but instead he arrogantly went on defending his action in front of the media, by comparing the prevention of HIV to the washing of hands after peeling onions. The two are just not the same but I do not think he understands the difference. Washing one's hand after peeling onions removes the odour; for Aids, you need ARVs. It is simple as that.

This kind of response by Zuma about a disease as complicated as Aids, can only come from someone who has no clue about HIV/Aids and who cannot perceive the consequences of reckless statements to a gullible public. We must not forget that we have a vast population that is illiterate, making it imperative that we convey the right message to the masses of this country.

There are 900 new HIV cases each day; more than 50% of the new cases are under 25 years and the majority are young women. This means we are heading for a decline in the working population and children born with Aids are heading for the over-filled graves in their tender adolescent years long before they become strong adults to contribute to our economy.

If Health Minister Manto Tshabalala-Msimang, with a medical degree, can spew the nonsense that she does with annoying regularity, then what hope can there be in appointing someone like the deputy president, who has no medical knowledge at all?

The minister of health does not engender any confidence in her leadership and her constant derision of people like Zackie Achmat and the HIV Clinicians' Society in the media is a sign that she has outrun her term of office.

It is the president's right to listen to the voice of reason and get rid of his non-performing ministers, but how does he get rid of his own rubber stamp?

I would like to ask our president to replace Manto.

With a minister like her, no diligent, caring health worker would want to taint their good names by working under her.

No wonder so many good people, with vast knowledge on the management of HIV/Aids, have left the department of health for other careers.

The only people benefiting from the drivel dished out by the minister of health must be farmers of beetroot, garlic and potatoes.

I could never understand why these items were becoming so expensive and scarce.

A new minister would sing the correct tune so I could find garlic for my cooking.

Dr EV Rapiti
Mitchell's Plain

Published on the web by Cape Times on September 12, 2006.

Maternal deaths caused by incompetence and negligence

2006-09-17T02:53:00.000-07:00

Half of all maternal deaths at district and regional hospitals between 2002 and 2004 could have been avoided - were it not for negligent healthcare workers.

So reads the latest Saving Mothers report by the National Committee for Confidential Enquiries into Maternal Deaths. The report has been sitting on Health Minister Manto Tshabalala-Msimang's desk since June but has not been released.

The shocking report adds that while HIV and Aids accounted for more than 36 percent of the 3 296 maternal deaths reported, pregnant women are dying in their droves because of unskilled health officials.

The committee found that 1 059 of the total number of deaths for the period under review were "directly" avoidable. These preventable deaths were linked mainly to hypertension (331), postpartum haemorrhage (261), pregnancy-related sepsis (158) and antepartum haemorrhage (100). A further 91 deaths were "anaesthetic related".

At district hospitals, 53,8 percent of deaths were attributed to negligent health officials, while the proportion at regional and provincial hospitals was 48,3 percent and 36,5 percent respectively. These statistics related to 3 079 of the total number of deaths that were assessed for administrative problems.

Unsuccessful resuscitation accounted for 22,3 percent of deaths, while HIV and Aids accounted for 36 percent, or 1 226, of all deaths. It is important to note, however, that the HIV status of more than 1 800 mothers was not known.

A third of all deaths was attributed to "administrative factors" such as a lack of ambulances to transport women between hospitals (9,7 percent), a lack of appropriately trained staff (12,8 percent), insufficient intensive care beds or emergency laboratory services (11,2 percent) and inadequate supplies of blood for transfusions (9,2 percent).

Non-pregnancy-related infections were the most common primary cause of maternal deaths, comprising 37,8 percent of all deaths, with the most common sub-category being Aids (20,1 percent).

The report noted that with regard to deaths due to obstetric haemorrhage, pregnancy-related infections, hypertension and anaesthesia, "the ways to prevent these deaths are known".

"Specific protocols have been developed and these have been included in the recommendations given in the previous report. Despite this, the most common avoidable factor is still the lack of adherence to standard protocols. Renewed efforts must be put into ensuring that the protocols are known and used," it urged.

The report noted that there had been increases in maternal deaths at district and regional hospitals and that this showed that urgent cases were not being referred timeously to larger, better equipped provincial hospitals.

This indicated that there was either a problem with diagnoses or a lack of transport, or that provincial hospitals were not accepting referrals.

Loveday Penn-Kekana, a medical anthropologist at the Centre for Health Policy at Wits University, said the biggest failure of the report was that its recommendations did not once mention Aids. "Aids is the leading killer of women - that is clear in the report - and yet none of the recommendations mention it. What they should say is that pregnant women who're HIV-positive should be put on ARVs if their CD4 count is below 200," she said.

The quacks stand together

2006-09-17T02:49:00.000-07:00

The used to be called witch doctors, but has been awarded the more politically correct title of traditional healer by the regime.

Traditional healers marched through the Durban City centre on Friday in support of Health Minister Manto Tshabalala-Msimang's HIV/Aids theories.

The crowd of nearly 200 carried posters bearing slogans like: "Viva Dr Rath" and "Viva Manto". At the bottom of all printed banners was: "Dr Rath health foundation Africa."

Matthias Rath is the director of the Rath Foundation which disseminates information about the primacy of nutrition for good health, and has been under fire for advocating vitamins and nutrients as an alternative to antiretrovirals in the fight against HIV/Aids.

To the tune of the trademark song of former deputy president Jacob Zuma, "Leth' umshini wami (Bring my machine gun)" the traditional healers sang the words: "Leth'iklabishi lami, Leth'ubeetroot wami (Bring my cabbage. Bring me my beetroot)".

The AIDS lottery

2006-09-15T02:31:00.000-07:00

Unlucky to get AIDS? In South Africa you need a whole lot of luck just to get treatment.

HIV positive and living in South Africa is to be part of a national lottery that puts your current chances of accessing antiretroviral (ARV) treatment at about 25 percent. If you cannot afford private healthcare, make that just under 20 percent. Aside from your income bracket, the next best indicator of whether you will get your hands on those vital drugs is the province and the district in which you live.

If you are lucky enough to be living in the Western Cape, the first province to defy national government and begin providing treatment, your odds improve considerably. Gauteng, the wealthiest province, is also not a bad bet. But if you are poor, HIV positive and residing in the largely rural province of Mpumalanga, your chances of being part of what the national government has called "the largest ARV treatment programme in the world" are not so good.

By June 2006, more than 175,000 people were receiving free medication in all 53 districts of the country, certainly putting the country's treatment programme among the world's most extensive. Activists believe this is nothing to brag about, as the pace of progress in rolling out free ARVs has been slow and riddled with problems.

According to Dr Nomonde Xundu, head of the health department's HIV/AIDS and TB unit, "Based on the figures, it is indeed the largest programme in the world. If you look at need as a proportionality of that figure, then there's a lot of work that still needs to be done."

Superlatives are nothing new when describing South Africa's pandemic. In 2005 the country had the dubious distinction of recording the world's highest number of HIV/AIDS deaths - 320,000 - and over five million HIV-positive people, the second highest total.

So far, the treatment programme has failed to reflect the urgency that the scale of the problem demands. Prof Nicoli Nattrass, director of the AIDS and Society Research Unit at the University of Cape Town, says that South Africa's performance is poor, "given its economic, institutional and epidemiological characteristics."

So why is South Africa underperforming? According to the UN Secretary General's Special Envoy for HIV/AIDS in Africa, Stephen Lewis, a major constraint is political leadership. At the international AIDS conference in August 2006 in Toronto, Canada, the South African government was "still obtuse, dilatory and negligent" about delivering HIV/AIDS treatment.

Mark Heywood, of the AIDS lobby group, Treatment Action Campaign, also told conference delegates that South Africa's response to HIV was chaotic. "There has been an absence of moral, political and strategic leadership from the [ruling] African National Congress [party] and the government."

Health minister Dr Manto Tshabalala-Msimang has been overly cautious - if not outright sceptical - about antiretrovirals ever since the state finally agreed to provide the life-prolonging medication in the public sector in October 2003. To this day, she continues to warn about the dangers of taking the drugs, emphasising nutrition as an "alternative" to ARVs.

Nattrass points out that in such a politically charged environment it is "probably unsurprising" the rollout has proceeded far more slowly than expected.

Living in South Africa is bad for your health

2006-09-12T12:42:00.000-07:00

South Africans are being ravaged by diseases that are actually treatable and should be under control.

A highly drug-resistant strain of tuberculosis that has killed 52 people in South Africa is spreading, opening a deadly chapter in the country's HIV/AIDS crisis, medical experts said Monday.

Tuberculosis is an airborne illness that is particularly deadly for those with immune systems weakened by HIV, a virus that affects an estimated 5 million South Africans or one in nine of the country's population.

South Africa already buries an estimated 900 AIDS patients every day -- many of them killed by tuberculosis.

Dr. Tony Moll, who detected the new TB strain at King George Hospital in Durban, said South Africa's government, already accused by critics of dragging its feet in the war against AIDS, appeared equally unprepared for the new tuberculosis threat.

"A lot more attention from South Africa is needed, and it needs to happen quite fast to keep this in check and contain it," Moll told Reuters in an interview.

South Africa's Health Department, which was roundly criticized at last month's global AIDS meeting in Toronto, Ontario, for its AIDS policies, skipped an emergency meeting of regional officials in Johannesburg last week that produced detailed action plans to stem a possible global health crisis.

Moll said South African officials were alerted 16 months ago to the deadly strain of TB, known as XDR-TB and resistant to most of the drugs now used to treat the disease, but had yet to draw up a national strategy to fight it.

The extent of the crisis emerged only last week when the U.N. World Health Organization and the U.S. Centers for Disease Control and Prevention voiced public fears over the TB outbreak.

"For a long time I felt I was crying on deaf ears. It has really taken people from the international community to say, 'Gee whiz this is really serious and of global significance,' " Moll said.

Officials said the TB strain could spread beyond the poor rural community in South Africa's eastern KwaZulu-Natal region, where 53 people have been diagnosed. Of those, 52 have died, and all those tested for HIV were positive.

"It's very clear that the country needs to carry out better surveillance. If it grows -- if there are more provinces that show signs -- then it becomes a much bigger concern," said Paul Nunn, coordinator of the Stop TB department of WHO.

Tuberculosis kills about 1.7 million people around the world every year and is usually cured with antibiotics, although this treatment is proving ineffective against the new superbug.

Moll said 10 more cases of XDR-TB recently cropped up in KwaZulu-Natal and it has been identified in many miners in the central Gauteng province. But without a national plan to find and diagnose the disease, no one can accurately gauge the number of cases.

The TB outbreak adds to the woes of Health Minister Manto Tshabalala-Msimang, who is already under international scrutiny for her controversial interpretation of HIV/AIDS policies.

Top scientists this month called for her dismissal for advocating traditional medicines rather than anti-retrovirals to fight HIV.

A WHO official told Reuters last week that the TB outbreak warrants a response on the scale of the international campaigns to combat SARS and bird flu -- with the danger that the new strain could spread to other AIDS-ravaged countries in Africa.

It's not just AIDS

2006-09-12T12:34:00.000-07:00

The South African Health department, already world-famous for AIDS quackery, is about to become even more famous for other diseases.

A MASSIVE anti-TB initiative involving private firms, civil society and the government was culled two years ago by Health Minister Manto Tshabalala-Msimang.

The Coalition Against TB (CAT), a network of mining firms, drug companies and TB watchdog groups, was formed amid huge fanfare, but never took off after the Health Department withdrew its support.

Two years later, specialists are dealing with yet another TB crisis, this time in KwaZulu-Natal where a new, untreatable and lethal strain of the disease has so far claimed scores of lives.

Although the reasons for scrapping the anti-TB initiative are unclear, senior health professionals believe the move was politically motivated -- and further evidence of Tshabalala-Msimang's disastrous approach to healthcare.

The most senior national health officials -- including the head of the national TB control programme, Lindiwe Mvusi -- did not attend a vital meeting in Johannesburg this week to discuss the potentially catastrophic new TB strain that experts believe is already widespread in South Africa. The national department was allegedly upset that the meeting was arranged in conjunction with "outsiders" -- the World Health Organisation and the US Centres for Disease Control and Prevention.

The emergence of the strain comes five months after the department launched its National TB Crisis Management Plan, in response to plunging cure rates and rising infections. Health figures put the annual infection rate at about 300000 a year. However, only a fraction of those with TB -- about 8000 -- are benefiting from the government's crisis plan, according to Department of Health figures. Experts say the CAT programme would have had a significantly larger outreach.

Instead, the department is now playing catch-up and, in response to the new strain, this week had to take urgent steps to order two new anti-TB drugs.

Members of the scuppered initiative said the Health minister had been particularly unhappy with the appointment of the former South African Medical Association (Sama) secretary-general, Dr Moji Mogari, as chairman of the nine-member CAT committee. The medical association had made itself unpopular by criticising departmental policies, mainly around HIV/Aids and the overhaul of the pharmaceutical industry.

This week Mogari declined to comment on reasons for the project's demise, but said he believed Tshabalala-Msimang had made a politically motivated decision. "It was a great pity," he said. "I'm not saying CAT would have solved all the problems, but it would have had a great impact."

Mary Edginton, an associate professor at the Wits School of Public Health and one of the government representatives on the CAT committee, said a concerted effort was made by all to establish the venture, which even saw rival TB drug companies Sandoz and Aventis pledging their support. She said numerous meetings and workshops were convened with all the participants, including the Health Department, and a gala dinner was held to launch CAT.

But the function left local organisers red-faced in the presence of overseas dignitaries when Tshabalala-Msimang, invited to deliver the keynote address, failed to arrive. From then on, Edginton said, "it all fizzled away".

Former fellow committee member David Nish, a representative of the South African National Tuberculosis Association, said the initiative would have been a promising antidote to the government's waning effort to eradicate the disease. "The coalition was going to unite all sectors in the fight against TB ... the [government] clinics just can't handle it."

You are fired, or will be, real soon, maybe, sort of

2006-09-09T14:46:00.000-07:00

The teflon coating of SOuth African Health Minister Manto Tshabalala-Msimang is finally wearing off. After years of bungling and bein untouchable, even the regime has now had enough of her. They are are still trying to put a positive spin on it, as always. There is no talk of firing her just yet.

A split in the cabinet over the "embarrassing" and combative Health Minister Manto Tshabalala-Msimang led to her gagging this week. Up until now, Tshabalala-Msimang has been allowed to be a public relations "loose cannon" because she enjoys the full support of President Thabo Mbeki. She also enjoys support from a number of ministers close to Mbeki.

But this week, after a number of other ministers voiced concern, deputy president Phumzile Mlambo-Ngcuka was brought in to do damage control. Mlambo-Ngcuka already heads the South African National Aids Council (Sanac) and will now be the sole communication voice on government's HIV and Aids policy. The decision to make her the public face of the government's programme on the pandemic came after the cabinet meetings at which a number of ministers voiced concern that Tshabalala-Msimang's outbursts were diverting focus from substantive government programmes.

Although Tshabalala-Msimang has been sidelined as the public face of the government's HIV and Aids campaign, the controversial minister won't be fired. A number of ministers, including Social Development Minister Zola Skweyiya, had expressed concern that Tshabalala-Msimang's abrasive personality was damaging government's image on HIV and Aids.

The sidelining of Tshabalala-Msimang was said to be "the least" government could do to save the minister and the country from more "embarrassment and attack" on HIV and Aids policy implementation.

The fuss and ructions caused by the minister's stress on nutrition as complementary to anti-retroviral drugs, saw the world zooming in on South Africa's hazy Aids policies, prodding the government to rethink its strategy. The cabinet, though, is divided on how to handle Tshabalala-Msimang's personality.

Although the government will continue to withstand pressure to dismiss her because she is doing well on other health fronts, they are feeling the heat of her communication and personality problems.

During cabinet meetings, some ministers were of the view that there was nothing wrong with government policy on HIV and Aids, but rather with how it was communicated. The ministers were not apportioning blame to Tshabalala-Msimang, but were more concerned about the affect of her personality and worldwide perceptions that nothing much was being done to curb the pandemic.

Tshabalala-Msimang's personality is said to be a cause of frustration and despondency among her communications officers. Former acting chief director of communications Solly Mabotha left to join, ironically, Pfizer laboratories - the ARV manufacturer - as PR manager.

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Pigs will fly yet

2006-09-07T13:59:00.000-07:00

In a first for the ANC it is back-tracking on what it has said previously. But Dr Beetroot keeps her job.

The SA government's programme to fight HIV/Aids "is based on the belief that HIV does cause Aids", government spokesperson Themba Maseko said at a post cabinet briefing on Thursday.

His statement follows years of what he described as "political bickering" over the Aids issue. He noted that government aimed to resolve communication problems over the implementation of the government's programme through the setting up of an inter-ministerial committee (IMC) to "improve co-ordination and communication" to ensure that the programme targets - including the rollout of antiretrovirals - were reached.

Maseko's comments follow years of controversy stemming from President Thabo Mbeki's unorthodox views on the link between HIV/Aids and his health minister Manto Tshabalala-Msimang's emphasis on nutrition as a means to fight the syndrome.

Cabinet announced steps on Thursday to drive the comprehensive plan to fight HIV/Aids, but remains adamant in its support for embattled the Tshabalala-Msimang.

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Waht will it take to get her fired?

2006-09-06T15:10:00.000-07:00

More than 60 HIV scientists, including a Nobel Peace Prize winner and leading academics, have called for the immediate removal of Health Minister Manto Tshabalala-Msimang, the Treatment Action Campaign said on Wednesday.

"We therefore call for the immediate removal of Dr Tshabalala-Msimang as Minister of Health, and for an end to the disastrous, pseudo-scientific policies that have characterised the South African government's response to HIV/Aids," said members of the global scientific community. According to the letter it was an embarrasment to the South African government to have a health minister who "now has no international respect".

The list of signatories included leading academics from institutions such as Harvard University, and others specialising in HIV/Aids research, microbiology, haemotology, immunology, molecular and cell biology.

Winner of the Nobel Prize for Peace, David Baltimore, as well as Robert Gallo -- the developer of the first HIV blood test and co-discoverer of HIV as the cause of Aids -- put their names to the letter. In the letter, dated September 4, the signatories state that anti-retrovirals are the only medication currently available that alleviate the consequences of HIV infection.

Tshabalala-Msimang came under fire at the International Aids Conference in Toronto last month for her controversial promotion of the use of garlic and beetroot in fighting HIV/Aids. The South African exhibition openly displaying these items was also a point of contention at the conference.

In the letter the academics echo the words of Stephen Lewis, United Nations envoy on Aids in Africa, that South Africa's response to Aids was "obtuse, dilatory and negligent".

To the view that good nutrition was an alternative treatment to HIV infection, the scientists said: "There is no scientific evidence to support such views. Good nutrition is important for all people, including people with HIV, but garlic, lemons and potatoes are not alternatives to effective medications to treat a specific viral infection and its consequences on the human immune system."

South Africa has over five million people infected with the HI virus and over 500 000 people needing ARV treatment who don't have access to the medicines. The letter expressed concern on the amount of unproven remedies being marketed in South Africa, some with the support of the health minister.

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06 September 2006

Jobs for (wives of) pals

2006-09-06T15:01:00.000-07:00

President Thabo Mbeki will keep Minister of Health Manto Tshabalala-Msimang in her post, despite mounting calls for her to resign. Mbeki has defied critics over the years by showing confidence in her and re-appointing her for a second term even when she had already antagonised stakeholders during her first term.

The Cabinet also defended her on Thursday, saying that false information about South Africa’s treatment programme was being spread around the world. The African National Congress has dismissed criticism directed towards her, saying no amount of pressure will force the president to review his opinions on his Cabinet.

Opposition parties, the Independent Democrats and the Democratic Alliance called for her sacking. Lobby group, the Treatment Action Campaign (TAC), also embarked on a campaign to push the president to either fire her or to explain to the nation why he was keeping her on.

Various explanations have been proffered in the absence of Mbeki openly explaining why he is keeping her on. A TAC activist said Mbeki might be keeping her to spite his critics on Aids. Mbeki was severely criticised for his comments that he personally does not know anyone who has died of Aids, when about five million South Africa are estimated to be HIV positive.

The comments fit in with his earlier dallying with Aids denialists and his questioning whether HIV causes Aids. The president has since been quiet on the subject and prefers to say South Africa has the most comprehensive prevention and treatment programme in the world.

UN Special Envoy on Aids in Africa, Stephen Lewis, told the recent international Aids conference in Toronto, Canada, that South Africa was the only country in Africa whose government is still obtuse, dilatory and negligent in rolling out treatment.

Speculation about why Tshabalala-Msimang has kept her position include that she is articulating the president’s views. Some believe that Mbeki’s closeness to Tshabalala-Msimang’s husband Mendi while they were in exile in London could be the explanation. Mendi Msimang is ANC treasurer.

A provincial health official and ANC activist said Mbeki showed reverence to senior ANC women, who dominated his Cabinet. “Manto will never be fired. If you look at Justice Minister Brigitte Mabandla, Communications Minister Ivy Matsepe-Casaburri and Tshabalala-Msimang you will see the pattern. Matsepe-Casaburri failed at the SABC and in the Free State where she was premier but was still given new responsibilities. Unless she retires, she could be moved to another portfolio.

“Right now Tshabalala-Msimang is in a hurry to enact the Traditional Medicines Act when she is yet to demonstrate which traditional medicine could cure what disease. In the absence of that, she should not make traditional medicine an alternative. The problem with promoting it is that many people waste time at sangomas and come to hospitals when they are too ill to be assisted.

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28 August 2006

We don't speak no evil

2006-09-06T12:51:00.000-07:00

Department of Health director general Thami Mseleku reportedly instructed top provincial health officials not to comment on HIV/Aids.

It means employees will have to refrain from any form of commentary or reasonable criticism of their own government for fear of being dismissed. This is surely not what a democracy is about.

Mseleku had ordered all provincial senior health officials not to speak to the media about HIV/Aids or about a proposed visit to South Africa by United Nations special envoy to Africa Stephen Lewis, who has been strongly critical of the government's HIV/Aids programme.

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Manto Tshabalala-Msimang's antics

2006-09-05T13:55:00.000-07:00

Reaching out to seize control of the health profession

8 August 2006

THE long arm of Health Minister Manto Tshabalala-Msimang is once again reaching out to seize control of the furthest reaches of the health profession.

The latest plan is to change the Health Professions Bill to give the minister greater power over the men and women appointed to the Health Professions Council, which is charged with overseeing the good practice of highly skilled medics ranging from heart surgeons to dentists. Instead of the 12 professional boards that fall under the council electing 25 of their number to the 52-member council in good democratic fashion, the bill proposes that the minister appoint 16 professionals to a smaller council, based on nominations received through an as-yet-undefined process. The explanation given? Spurious, to say the least. Elections, say the minister's officials, are simply too costly.

18/08/2006

A new luxury gold-coloured Mercedes Benz S500, with a special seat for short people, is waiting in the show room of a Gauteng car dealer for its new owner - Dr Manto Tshabalala-Msimang.

The car, at a cost of about R1m, is apparently the right medicine for the Health Minister, who regularly faces severe criticism about her Aids cures.

14/08/2006

A Gauteng paediatrician has caused an uproar at an international Aids conference in Canada by saying the inclusion of lemon, garlic and beetroot on the South African Aids exhibit is "despicable".

Dr Harry Moultrie of the paediatric Aids clinic at Chris Hani Baragwanath Hospital in Soweto made his view known shortly after Health Minister Manto Tshabalala-Msimang said during the opening of the exhibit that South Africans should have the choice to use either traditional medicine or antiretroviral medicine against HIV/Aids.

Moultrie challenged the organisers of the exhibit to provide scientific evidence that any of the items, including African potatoes, were clinically effective.

Deprtment of Health

2006-09-05T04:05:00.000-07:00

The South African department of health is world-famous for all the wrong reasons.