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Health in 2022 – a review of the year in under 1,000 words

An HIV prevention injection approved in South Africa, several promising developments on the tuberculosis front, the National Health Insurance Bill grinding its way through Parliament, no end in sight to healthcare worker shortages, another dire year for health in Gauteng – Spotlight wraps up 2022 in under 1,000 words.
This year, 2022, is perhaps most notable for what didn’t happen. While SARS-CoV-2 continued to mutate rapidly, we did not see another devastating wave of Covid-19 deaths, as some feared. To what extent we remain vulnerable to future mutations is hard to gauge. Most people in South Africa have either been infected with SARS-CoV-2, vaccinated against it, or both. The vaccination rate slowed to a trickle and by the end of the year only a little more than half of South Africa’s adult population had been fully vaccinated. Updated vaccines that provide greater protection against new variants have not yet been made available in the country.
With the threat from Covid-19 waning, much of the focus in 2022 was on recovering from Covid-19-related disruptions. In some areas, such as tuberculosis (TB) testing, the recovery has been impressive. But as is apparent from recent measles outbreaks predicted earlier in the year, significant gaps remain.
The big picture remains bleak when it comes to South Africa’s public healthcare system.
As noted in several reports this year from community healthcare monitoring group Ritshidze and confirmed in several government reports, healthcare facilities remain beset by staff shortages. There is little sign that the government has a grip on the situation as a promising strategy document on the issue appears to be gathering dust, while the nurse population is ageing and nurse training in the country has hit several snags.
Question marks also remain over the government’s commitment to support healthcare workers, especially after steps were taken against Dr Tim de Maayer at the Rahima Moosa Mother and Child Hospital when he spoke out about conditions there.
Read in Daily Maverick: “Rahima Moosa hospital problem ‘has metastasised throughout the healthcare system in South Africa’”
Apart from healthcare worker shortages, most provincial health departments also remain beset by mismanagement and corruption. The Gauteng health department dominated headlines this year for the botched rebuild of Charlotte Maxeke Johannesburg Academic Hospital following last year’s fire, the attack on De Maayer, Covid-19-related corruption, and a still-unfolding web of corruption first exposed by Babita Deokoran who was assassinated last year – News24’s coverage of this affair was one ...

Living with a stoma in SA — we deserve better than the indignity our public healthcare affords

Our public health system is creating a new type of disability — ostomates who, with access to the necessary care and medical consumables could live long and fulfilled lives, but who every day are subjected to the indignities of inadequate care, writes colorectal cancer survivor and ostomate, Faizel Jacobs.
In May 2016, I was diagnosed with colorectal cancer. I was lucky. Detecting the cancer early meant that I required no chemo or radiation therapy and just had surgery, which left me with a stoma and a permanent colostomy bag.
A stoma is an opening in the abdomen that can be connected to either your digestive or urinary system to allow waste (urine or faeces) to be diverted out of your body. It looks like a small, pinkish, circular piece of flesh that is sewn to your body. There are three main types of stomas – urostomy (urine), an ileostomy (from the small intestine), and a colostomy (from the large intestine). Reasons for getting a stoma range from cancer, Crohn’s disease or ulcerative colitis, congenital (birth) abnormalities, or traumatic events, to name but a few.
It is entirely possible to live a happy and fulfilled life as an ostomate (someone who has a stoma).
Since my own diagnosis, I have run my very first marathon in Chicago and followed this up with marathons in Knysna and Istanbul. I have completed 20 half marathons as well as a triathlon. Living with a stoma — in my case, a colostomy — does not have to be debilitating.
With some tweaks in lifestyle, your life can be as “normal” as you want it to be.
Unfortunately, living a dignified and healthy life for many ostomates also depends on the public health service and the quality of the care you receive.
Differing needs
People’s needs differ and qualified stoma therapists are needed to best meet those needs.
No two stomas are the same. For example, think of spectacles. The function of the spectacles is to help you see better. However, two people cannot really interchange spectacles with the hope of maintaining perfect eyesight. It won’t work for a variety of reasons — from the difference in the lens prescription to the frames not being suitable to the face shape and fit.
Exactly the same applies to the prescription of stoma pouching systems and the related supporting products. What works for one ileostomy will not necessarily work for another.
Keeping an ostomate’s lifestyle in mind, the dexterity ...

South Africa to receive donation of new child-friendly drug-resistant TB medicines

The Department of Health is set to receive a donation of child-friendly formulations of several medicines used to treat drug-resistant tuberculosis. It is expected that over the next year the donation will spare roughly 200 children the substantial difficulties associated with taking DR-TB medicines meant for adults.
The donations form part of a multicountry initiative of the Stop TB Partnership’s Global Drug Facility (GDF). Children in several other countries have already been provided with child-friendly formulations of drug-resistant tuberculosis (DR-TB) medicines through the initiative.
According to documents seen by Spotlight, the formulations being donated include dispersible formulations of the drugs delamanid, levofloxacin, and linezolid, and low-dose tablets of clofazimine. They will be brought into the country in terms of section 21 licences granted by the South African Health Products Regulatory Authority (Sahpra) at the end of August. The company importing the medicines is Equity Pharma.
Dr Norbert Ndjeka, chief director of TB control and management at the department, confirmed to Spotlight yesterday that the donation had been approved by director-general of health Dr Sandile Buthelezi. Letters about the donation had been sent to the heads of health in the Eastern Cape, KwaZulu-Natal and the Western Cape, and a meeting would be called next week to “coordinate this activity”.
Frustration over delay
While DR-TB doctors Spotlight spoke to are thrilled about the donation, there is also a sense of frustration over how long it has taken to finalise.
“This donation was first offered to South Africa in April of 2022 and Sahpra approved the import in September,” says Dr Jennifer Furin, a steering committee member of the Sentinel Project on Pediatric Drug-Resistant Tuberculosis. “It is unclear why the process was delayed for so long since these medications are all recommended for the treatment of children by the World Health Organization and the South African National Department of Health. They are quality assured and provide a much more accurate and acceptable way to care for children sick with DR-TB. It is a pity that paperwork and bureaucracy seemed to take precedence over the needs of vulnerable children. And while we are thrilled that South Africa is finally able to accept the donation, we have to wonder where their priorities are.” (The Sentinel Project participates in the Stop TB Partnership/GDF initiative and Furin has been actively involved in facilitating the donation.)
Read in Daily Maverick: “TB drug resistance — New tests set to improve treatment efficacy among patients”
When Spotlight first ...

Ten ways to avoid falling victim to an antibiotic-resistant bacterial infection

It’s time to take notice of antibiotic resistance in bacteria. It is not someone else’s problem. It affects you, whether or not you are the one taking antibiotics.
The most common question I get from interviewers and the public when discussing the public health crisis around increasing rates of bacterial resistance to antibiotics, is: What can people do to protect themselves?. There are two parts to the answer; the first is what you can do for yourself, the second is what healthcare professionals (HCPs) and employers should be doing for you.
Why should you care about antibiotic resistance?
The past two years have made us painfully aware of the health and social consequences of a pandemic. Covid-19’s onset was abrupt, its spread rapid, and its toll overwhelming. With all eyes focused on preventing a future, similar catastrophe, we are ignoring the slower development of a pandemic of bacteria resistant to antibiotics that is happening in the here and now, undermining the ability to treat you for common infections and meet medical needs that you take for granted. If you haven’t heard about antibiotic resistance in bacteria, it’s time you did, and it’s time to take notice.
This is not someone else’s problem. It affects you, whether or not you are the one taking antibiotics. Here’s why: if I prescribe you medicine for high blood pressure, diabetes or headaches, that medicine affects you alone. With antibiotics, it’s different. If you take an antibiotic, bacteria that live in and on your body that are able by chance to resist the action of that antibiotic, will survive and replicate, and can become dominant, resulting in infection with that resistant bacterium in the future (reducing your chance of successful treatment) and/or transfer to other people, through your touch. Equally, you may be the recipient of a bacterium resistant to antibiotics through contact with others who have had an antibiotic. To reiterate, this problem affects us all.
A total of 1.27 million people died in 2019 because of a bacterial infection resistant to antibiotics but that figure is unlikely to move you, since quoting large numbers such as this tends to leave people detached and disenfranchised. But what should catch your attention is that the pandemic of bacterial resistance to antibiotics is threatening your chance of being treated for everyday medical and surgical problems. And it’s not something that you can just throw money at to solve.
To illustrate the problem, ...

How to feed your baby – starting solids need not be scary

Starting the journey from breastmilk or formula to solid foods can be intimidating for many parents, but there is much helpful information and advice out there, so it need not be.
The time when parents would begin to feed their babies solid foods (solids) has had a somewhat wobbly historical trajectory.
Over the past century, parents have been advised to start their children on solids as early as two weeks old and as late as one year. Since 2002, the World Health Organization (WHO) has recommended that infants be exclusively breast-fed for the first six months of life to optimise their growth, development and health, and the WHO further recommends that breastfeeding continue until at least the age of two. The South African Department of Health’s Infant and Young Child Feeding Policy recommends the same.
Globally, trends on introducing solids early vary. In the US, 40% of mothers introduce solids before four months, in Australia 50% of mothers have fed their babies solids by four months and 90% feed solids before six months, with comparable patterns in the UK and in Italy. South Africa’s last Demographic and Health Survey (DHS) (2016) showed that just 32% of infants under six months of age are exclusively breast-fed and that almost a fifth of infants (18%) have started eating some solid food before six months.
Research has shown that the early introduction of foods (notably maize porridge and commercial infant cereal) and liquids (water, tea, herbal mixtures) other than breastmilk is common in South Africa.
The weaning window – when to start your baby on solid food
But is this necessarily a bad thing?
Not necessarily, according to Meg Faure, occupational therapist and co-author of several parenting titles including Weaning Sense. “Every baby is different. Some babies are going to need solids earlier and others will be fine on breastmilk and formula. It’s a window between 17 and 24 weeks where babies can be introduced to solids. The line in the sand is that parents shouldn’t introduce solids before 17 weeks because the gut system isn’t ready.”
If there is such a window, why does the WHO recommend exclusively breastfeeding until six months? “The reason is that the WHO is informing populations that don’t have access to hygienic water, adequate formula milk, and who don’t have access to good, solid nutrition. So, the very best thing for those populations is to exclusively breastfeed, because the most common killer for infants is ...

Leigh Matthews’ killer is granted a second chance at parole

After 17 years in prison for the murder of 21-year-old student Leigh Matthews, Donovan Moodley has been granted a second chance to appear in front of the parole board.
Seventeen years after Donovan Moodley was sentenced to life for the kidnapping and murder of Leigh Matthews, as well as for the extortion of Leigh’s family, he is appealing the decision made at his first parole hearing.
Judge Stuart Wilson ruled in the Gauteng High Court on Friday, 16 December, that Moodley would be granted another opportunity to present to the parole board by 31 March 2023 as his previous parole hearing had not been handled correctly.
“Mr Moodley’s minimum detention period, after which he became eligible to be considered for release on parole, expired on 3 June 2018,” the recent judgment reads.
Read more in Daily Maverick: “Advice to a monster”
‘Unlawful administrative action’
Wilson said the manner in which Moodley’s first parole hearing had been dealt with “constitutes unlawful administrative action”.
Moodley’s request for parole was denied on 18 February 2022 as the board had instead “recommended that the issue of Mr Moodley’s eligibility for parole be referred for further examination by a psychologist and a social worker”, the judgment reads.
The parole board recommended that Moodley be subject to “further profile” — which meant Moodley needed to be examined by social workers and psychologists to address his “abnormal love of money” and what the board characterised as “his insensitivity to gender-based violence”, explained the judgment.
During his time in prison, Moodley had done “more than was required” to present that he had rehabilitated himself, said Stephan May, amicus curiae (friend of the court) on this matter. He had obtained a Bachelor of Laws degree and a Master of Laws degree while in prison, according to the judgment.
“The Parole Board’s contrary view does not appear to be based on the Case Management Committee’s report, or on the material on which that report was based, or on any other evidence discernible from the record,” Wilson said.
Visit Daily Maverick’s home page for more news, analysis and investigations
Leigh Matthews was a university student at Bond University in Sandton, Gauteng, when she was abducted in the university parking lot on 9 July 2004.
She was held captive by Moodley, who demanded ransom from her parents, Rob and Sharon Matthews.
Despite receiving the ransom from her family, Moodley killed Leigh. Her body was discovered in Walkerville, south of Johannesburg, on 21 July 2004.
Moodley was sentenced ...

Facing GBV, Part 6 — Recovering from systematic abuse within communities that turn a blind eye

Three women from Willowmore discuss how difficult it is to overcome the long-lasting trauma that is caused by gender-based violence. From marriages affected by rape to how their kids suffer, this film goes into detail about how abuse has impacted their relationships later in life.
Facing GBV – Part 6 is the 6th part of a 6-part series highlighting South Africa’s “second pandemic”: gender-based violence. In conjunction with the 16-days of Activism campaign, Street Talk TV strives to highlight the truths behind domestic violence and crimes against women. Special thanks to the Canada Fund for Local Initiatives.
This film was produced by Street Talk.
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Visit Daily Maverick’s home page for more news, analysis and investigations
Street Talk is a groundbreaking television series aired weekly on community television. From grassroots to the establishment, our engaging programmes expose the lived realities and uncensored views of ordinary South Africans.
Street Talk was launched in 2008 and is a non-profit organisation – visit us
Disclaimer: Street Talk encourages freedom of speech and the expression of diverse views. The views of participants who appear in the TV series – Street Talk, are therefore their own and do not necessarily represent the views of the producers. DM

Mutually accountable citizen and government partnership delivers services

A number of issues plague South African small towns, including a lack of water and a ‘brain drain’ of talented people moving to larger cities. Additionally, many small-town municipalities are stretched to their limits and unable to deliver even the most basic services. In response the Towns Action Network is actively cultivating joint problem solving and action towards small-town regeneration.
Lelethu Zono from Joza Location in Makhanda is part of a growing number of ordinary South Africans taking charge of the change they want to see in their communities by holding the government accountable for service delivery.
Zono is a citizen reformer with the Public Service Accountability Monitor’s (PSAM) Action for Accountability Project in Makhanda, which encourages citizen and government partnership to achieve accountability and consistent service delivery.
The PSAM is part of the Towns Action Network (TAN), a broad church of partners from small towns across the country promoting activities that build small-town regeneration. TAN was formed in response to the serious challenges that residents of small towns face.
Zono explains: “There is a water shortage where we live. We get water three times a week or sometimes we don’t get it and the refuse doesn’t get collected. We have to store water because there is a possibility that the next day you won’t have water. This is the second year of no water but only some people have JoJo tanks so that they have water. You need to wash, and you need to drink water and so there’s no coping mechanism for not having water.”
But Zono is undeterred by this and believes in getting her hands dirty, alongside the government, to turn things around. Trained by the PSAM, Zono collects information from residents about service delivery issues, which is mapped and fed back to the government in council meetings that citizen reformers attend in a bid to hold the council accountable for delivery.
Zono dismisses the common refrain that it is only the government’s job to deliver services, not citizens.
Read in Daily Maverick: “New Activist Exchange dares to forge new ways to advance ‘project South Africa’”
“People must start somewhere. The government is the people. It’s important to keep open the line of communication between us and government. There’s always something that we as citizens can do.”
Zono’s journey as an agent of transformation in her community has been empowering.
“If you don’t believe in anything then you can’t stand up for anything. Doing this has ...

Western Cape women’s shelters face permanent closure unless they receive financial aid

The Western Cape Women’s Shelter Movement), which campaigns for survivors of gender-based violence, has made an urgent call for assistance as 14 of their 26 shelters are in danger of closing due to lack of funding.
Shelters cannot raise sufficient funds to cover the deficit in their budgets after the allocation of funding from the Department of Social Development (DSD), said Delene Roberts, Western Cape Women’s Shelter Movement (WSM) chairperson and director of Sisters Incorporated. The situation is exacerbated by the escalating economic crisis and rising costs of basic needs.
The WSM shelters offer services ranging from short and long-term shelter stays, legal support, and psychosocial and economic empowerment services to women and children who are survivors of gender-based violence
Imminent danger
Some shelters are facing imminent closure, while others have funds for two to three months. One shelter facing immediate closure is The Safe House, located in the southern suburbs of Cape Town.
Kathy Cronje, the vice-chair of the Western Cape WSM and director of The Safe House, explained that the situation is critical.
“To put it simply, many of us will not be able to continue offering services very shortly if we do not receive emergency funds.”
The Safe House is likely to run out of funds by the end of December. While The Safe House usually accommodates up to 15 individuals for about three or four months, there are exceptions, such as a matric student who needs to finish their academic year. “That is when the board starts paying for the people in the house,” Cronje explained.
She said the shelter runs at a deficit of R1.2-million per year.
“To get us to the end of the financial year, which is the end of March, we need R490,000,” she said.
The shelter receives roughly 40% of its funding from the DSD.
“We have received the same amount for the last three years, so salaries haven’t gone up, managers are still not paid by the government, and a few of the posts are not paid by the government,” she explained. The government only subsidises the social worker, the social auxiliary worker and the house mother.
The 11 staff at The Safe House have told Cronje that they would keep working even without a salary. Cronje herself has not received a salary in the past few months, because: “We just have not been able to afford it.”
Although the shelter will receive money from the DSD in mid-January, there are outstanding debts ...

Expert panel advocates ‘gradual phasing-in’ of basic income grant

‘We will fight, we will soldier on even to the extent that we will ensure that we bring upon the introduction of the basic income grant, we are close to it, we are making steady progress towards it.’ — Social Development Acting Director-General Linton Mchunu.
The Department of Social Development (DSD) and partners on Tuesday released a report into the appropriateness and feasibility of a system of basic income support for South Africa.
The Expert Panel on Basic Income Support Supplementary Modelling report was produced under the supervision of the International Labour Organization (ILO) for the DSD and the South African government. It is a supplementary report looking at possible models and building on the first one released in 2021, in which the BIS Expert Panel examined the social and economic implications of a basic income support (BIS) grant.
Acting Director-General of the DSD Linton Mchunu said the report answered some crucial questions on basic income support, such as where the money would come from, whether it would help or hinder the economy, and the feasibility of such support.
Mchunu also seemed to point a finger at the National Treasury for challenges in implementing the Social Relief of Distress (SRD) grant and ironing out bumps in its provision.
He said: “The reason why we’re having the difficulties we’re having now with the R350 grant. we’re currently paying about eight million people — yet in the first iteration we were paying about 11.5 million — because we introduced the means testing, and you know why? We were told that if we don’t introduce the means test, we will not receive the money.
“So, we grappled with finding a balancing act. it’s a difficult thing but, as the Department of Social Development, I want to say we will never deviate from this fight. We go into meetings and say we need a sense of certainty in the long term, can we extend the grant to the next three to five years while we sort out the policy side of this? And we’re told, no, you will only get one [year].”
Challenges in reaching the intended recipients
Mchunu said the DSD was restricted by red tape, which delayed processes and left millions in limbo.
Read more in Daily Maverick: “Universal basic income for SA trumps basic income grant — author Hein Marais”
Panel chair Professor Alex van den Heever said the report looked at the R350 SRD grant as a more permanent model ...

There are 363 journalists jailed globally – here are the worst countries

Iran, China, Myanmar, Turkey and Belarus have emerged as some of the worst offenders for journalists who have been detained in the line of duty globally.
This year, 363 journalists were detained by various governments globally, according to a new prison census released by the Committee to Protect Journalists (CPJ), an independent organisation that promotes press freedom worldwide. The report was released on Wednesday.
The worst offenders for detaining journalists include Iran, China, Myanmar, Turkey and Belarus, which are among the countries where protests have made headlines around the world.
In 2021, 302 journalists were jailed.
The CPJ said the list only includes journalists who were confirmed to have been imprisoned in relation to their work. The census only counted journalists in government custody, not those who had disappeared or been held captive by non-state actors. Such cases were classified as “missing” or “abducted”.
Breaking down some of the cases, the CPJ flagged Iran as the worst for jailing journalists.
In Iran, following the death in police custody of Mahsa Amini, a 22-year-old Kurdish woman arrested for allegedly breaking Iran’s hijab law, the country has seen mass protests calling for women’s rights, among other demands. Journalists were among the estimated 14,000 Iranians arrested during the crackdown. According to the CPJ, there have been 62 journalists in jail. The number would have been higher, since 21 were released on bail ahead of the census date. Twenty-four women journalists are listed in the census, 22 of whom were arrested after the protests started. The 62 detainees represent the highest number documented by the CPJ for Iran in 30 years.
“China’s tight censorship of the media and the fear of speaking out in a country that conducts such extensive surveillance on its people makes it especially difficult to research the exact number of journalists among its prison population,” said the CPJ, adding that 43 journalists detained in 2022 (compared with 2021’s revised total of 48) should not be interpreted as an easing of China’s intolerance for independent reporting. The committee added that the authorities tightened online censorship during the zero-Covid lockdown-related protests, with several journalists reportedly detained briefly while reporting on the demonstrations.
Myanmar appeared on the CPJ’s list in 2021, when a military coup ousted the elected government and cracked down on coverage of the regime. In 2022 42 journalists were jailed, compared with 26 in 2021. The CPJ said this was as the regime “doubled down on its efforts ...

Hawks swoop on Tembisa Hospital at same time investigation confirms the slain Babitha Deokaran was right

A Special Investigating Unit report has confirmed allegations of serious maladministration and possible fraud and corruption related to the supply chain management process at Tembisa Hospital. The findings of the report were revealed by the Gauteng premier on Tuesday, as the Hawks descended on the embattled health facility.
On Tuesday, Gauteng Premier Panyaza Lesufi released details of a Special Investigating Unit (SIU) report which reveals the extent of the rampant corruption and maladministration at Tembisa Hospital. The findings of the report are in line with a report compiled by the late Gauteng Department of Health whistle-blower Babita Deokaran, weeks before her murder.
Deokaran was assassinated outside her home in Johannesburg in August 2021. A News24 investigation revealed that in the weeks leading up to her death, she had flagged R850-million of dodgy payments out of Tembisa Hospital and was afraid for her safety. Deokaran had reported the irregular spending to suspended department chief financial officer Lerato Madyo and had called for a forensic investigation.
Nothing was done at the time, but following the News24 reports, the then Gauteng Premier David Makhura’s office instituted an independent forensic investigation to probe allegations related to the assassination.
On 14 September 2022, Lesufi’s office signed a secondment agreement with the SIU to investigate the allegations of maladministration, fraud and corruption related to supply chain management (SCM) processes at Tembisa Hospital, under the Gauteng Department of Health (GDoH), and relating to 217 service providers as identified in Deokaran’s August 2021 report.
The SIU report revealed details on Tuesday which confirmed the allegations of maladministration and possible fraud and corruption related to the SCM process at the hospital under the GDoH, as based on an analysis of the limited payments received in respect of 26 of the service providers as identified by Deokaran.
‘Babita’s legacy’
“We are doing this to honour Babita’s legacy. to fulfil our commitment that her death will not be in vain. She remains the symbol of whistle-blowing and a symbol of fighting corruption. We will leave no stone unturned in ensuring that those involved will suffer the consequences,” said Lesufi.
The SIU investigation revealed that fraudulent service providers and suppliers are conducting business with the GDoH at Tembisa Hospital, and that possible fraudulent payments were made.
“The SIU found numerous irregularities in respect of the bid documents provided to Tembisa Hospital by the successful and unsuccessful bidders, which should have led to the disqualification of the bidders. The SIU confirms the ...

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