Eastern Cape health dept hunts whistleblower who exposed doctor shortage at Livingstone Hospital
Livingstone Hospital staff fear retaliation as the Eastern Cape health department probes a leaked letter about doctor shortages, which the department claims was penned by 'faceless individuals' to destabilise the facility.
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News24
18 hours ago
- News24
Missed, misunderstood, and deadly: A Cape Town family's heartbreak with hepatitis B
When Desmond Pedro discovered a strange hardness under his ribcage, he was just 30 and preparing for a fresh start on a government skills course. Little did he know that he would soon die of liver cancer caused by undetected hepatitis B. Spotlight spent time with his family and spoke to experts to uncover how this overlooked virus continues to claim lives. Desmond Pedro was getting ready to attend a course at a college in Bellville in Cape Town when he noticed a hardness under his ribcage. The 30-year-old unemployed father of two small children hoped to learn skills on the government-sponsored boiler-making course. The strange condition worried him. When Desmond first went to a clinic, nurses said it wasn't serious and gave him laxatives for constipation. He returned three times and got the same response. On his fourth visit, Desmond's wife went with him, and she insisted on a scan. Two weeks later, while on his way to college, he returned to receive the results. His older brother, Mario tells the story: 'When he arrived, the clinic staff wouldn't let him leave. An ambulance took him to Tygerberg Hospital. We visited him that night but were told nothing. We felt helpless.' About a week later, Desmond asked Mario to meet him at Tygerberg's oncology unit, where a doctor delivered the news of his diagnosis. 'When I arrived, he was in agony and couldn't stand up straight. This had all happened within two to three weeks. A porter brought a wheelchair, and we went into the doctor's office where the doctor told us hepatitis B had brought on Desmond's liver cancer.' Hepatitis means that the liver is swollen or irritated. This can happen for many reasons, such as infections from viruses or bacteria, parasites, injuries, or when the body's immune system mistakenly attacks the liver. Viral hepatitis is a type of liver inflammation caused by a virus. There are five main types: A, B, C, D and E. As Spotlight previously reported, new, highly effective cures for hepatitis C are slowly becoming more widely available in South Africa. Where did it come from? Until Desmond's cancer diagnosis, he had no idea that he was carrying the hepatitis B virus in his body, nor where he contracted it. The virus is transmitted from person to person through blood, semen or other body fluids. It can, for instance, be passed from pregnant women infected with the hepatitis B virus to their babies during childbirth, through sexual contact with an infected person, sharing of needles carrying traces of infected blood, and accidental needlestick injuries in health workers working with people who have the virus. After Desmond's diagnosis, his entire family were tested. Mario said: Both myself and my youngest brother, Johan tested positive for hepatitis B. To this day, we don't know where we got it or if we ever had the vaccine. 'At the time, I was 33. My mother was negative, as were our wives and all the children. For Desmond, it was too late.' Once infected, some people have strong enough immune systems to fight off the infection and usually clear it within six months. This is called acute or short-term infection. People who get infected as adults normally have acute infections. In long-term or chronic cases, it lasts more than six months and can lead to liver failure, liver cancer or cirrhosis - a condition where scar tissue has replaced healthy tissue to such an extent that the liver can no longer function. The younger a person is when they contract the virus, the higher their risk of the condition becoming chronic, particularly in the case of newborn babies or children under five. In most cases, people with chronic infection show no symptoms for years until they become seriously ill from liver disease. A silent killer One of the reasons that viral hepatitis can go undetected, as it did for Desmond, is that it is often asymptomatic. Symptoms, for those who do get them, can start as soon as two weeks after infection and include stomach pain, joint pain, fever, extreme fatigue, dark urine and jaundice - a yellowing of the skin and whites of the eyes. Professor Mark Sonderup, Associate Professor in the Department of Medicine and Division of Hepatology at the University of Cape Town, explains that with chronic inflammation in the liver, the body's attempt to heal the inflammation drives scarring, or fibrosis, of the liver. Over 10, 20 or 30 years, he says, there's a serious risk of cirrhosis. ALSO READ | Stem cell transplant recovery hinges on living conditions - transplant donor organisation 'The other risk of hepatitis B, which increases dramatically as the scarring worsens, is that because the virus is a DNA virus and inserts itself into the DNA of the liver cell, it dramatically increases the risk of liver cancer which is why hepatitis B accounts for most liver cancer in the world.' Sonderup says hepatitis B is endemic in South Africa and the region. He cites figures pegging the country's chronic infection rate at just below 5%, which suggests there are in the region of three million people living with the infection in South Africa. Most cases can be treated Chronic infection can usually be treated successfully with antiviral medicines if diagnosed in time. These medicines have to be taken for life since they suppress, but do not eliminate the virus. For acute infection there are much fewer treatment options. Those with serious liver damage often need a liver transplant. Since their diagnosis, Mario and Johan have been going to the Groote Schuur Liver Clinic where he says they are in good hands. 'They've been there for us from the start,' says Mario. The brothers are both on tenofovir, an anti-retroviral used to treat chronic hepatitis B infection. READ MORE | Why most people in South Africa can't get the shingles vaccine 'We take one tiny tablet a day, which suppresses our viral load and has no side effects. I take my tablet religiously at the same time every night.' Tenofovir is also part of standard HIV treatment in South Africa. As such, it is taken by more than five million people in the country, some of whom will happen to have undiagnosed hepatitis B infection. Sadly, Desmond's diagnosis came too late for antiviral treatment to save him. Mario recalls: I'll never forget the look on Desmond's face when the doctor said there was nothing they could do. 'The liver cancer was aggressive. He died at home about four weeks later. The time between getting his results and passing away was about two months.' It is for this reason that Mario has become such a passionate advocate for hepatitis B testing. 'All it takes is a simple blood test, and if it's caught in time, you take one small tablet daily. There are no side effects and you're good to go,' he says. Mario reckons nurses testing for HIV should be testing for hepatitis B at the same time. A highly effective vaccine One piece of good news is that many people in South Africa, especially those younger than 30 years of age, would have been vaccinated against the hepatitis B virus as babies. The South African government began rolling out the vaccine in 1995, starting with a three-dose schedule for babies, administered at 6, 10, and 14 weeks. 'It took a while to reach full coverage across the entire country. To date, our numbers lag a little behind, in that full three dose coverage is somewhere in the mid 80 percent in South Africa,' says Sonderup. 'This is pretty decent, except that we do have babies born to women who are inadvertently chronically infected, and there's a full six-week period before the first dose of vaccine is given.' READ MORE | The US funded 40% of SA's data capturers: Why losing them is so dangerous In other words, there's a six-week gap before babies receive their first hepatitis B vaccine, leaving them unprotected during that time. This is why Sonderup recommends giving a vaccine birth dose within the first 24 hours after birth alongside the standard polio and BCG vaccines all newborns receive. 'This would be followed by the second, third and fourth doses at 6,10 and 14 weeks. This has been shown to completely shut down that potential six-week period where a baby may be exposed,' he says. A phased approach Dr Kgomotso Vilakazi-Nhlapo, the top hepatitis official in the National Department of Health, agrees that a birth dose is important. However, she says that due to resource challenges, the department has opted for a phased approach. 'Instead of starting with the implementation of the universal hepatitis B birth dose vaccination, we test all pregnant women for the hepatitis B virus, treat those who are hepatitis B positive (and HIV negative) and offer the hepatitis B birth dose vaccine to newborn babies of pregnant women who tested positive for hepatitis B,' she says. According to Vilakazi-Nhlapo, this approach was implemented in April 2023 in all public health facilities but by the end of December 2024, they were only testing about 50% of pregnant women. READ MORE | Common weed shows potential to fight cancer, UJ researchers find 'This meant that women among the 50 percent who were not tested could be positive for hepatitis B and be transmitting the infection to their babies,' she says. 'Of course, it would be preferable to give a universal birth dose to all newborns, but, unfortunately, the budget and human resources remains an issue.' Vilakazi-Nhlapo estimates that with around a million births per year and hepatitis B prevalence of around 5%, every year in the region of 50 000 women living with the virus are giving birth in South Africa. What to do Sonderup says the solutions to South Africa's hepatitis B problem are neither complex nor overly expensive. 'Firstly,' he says, 'we need to fully implement the universal birth dose vaccination; secondly, we need to ensure children complete their vaccine schedule in total, thirdly we need to screen pregnant woman and link them to additional care.' He also says that in a country where almost 5% of people are living with the virus, everyone should be screened for hepatitis B at least once as we do with regular HIV testing. 'This can be done through a simple finger prick test and it's not expensive. People should at least know their status,' Sonderup says. South Africa's key hepatitis B policy document is the viral hepatitis treatment guidelines published in 2019. Sonderup, who was involved in the development of the guidelines, is concerned about its implementation. He blames 'policy inertia' and competition for limited resources for the country not having made greater progress against hepatitis B. 'But we can actually do a great deal with not very much, with significant impact, to eliminate a virus that continues to cause significant havoc,' he says. 'A shortage of resources, staff, and skills' For her part, Vilakazi-Nhlapo blames a lack of 'resources, staff, and skills' for there not being more progress. She says there is only one other person working with her on hepatitis at the national level, and no dedicated staff at provincial health departments. 'We work mainly with NGOs and civil society. Provincial physicians have helped us greatly to do our work but it's not enough,' Vilakazi-Nhlapo says. 'There is still insufficient knowledge both among healthcare workers and within communities about hepatitis B. For now, patients with hepatitis B are referred to hospitals … but the reality is that, if primary healthcare staff are managing HIV patients, they can manage hepatitis B patients,' she says. She adds that they are trying to integrate hepatitis into other health programmes, such as those for maternal and child health. 'Everyone should know their status' Back in Cape Town, Mario, now 45, says he feels healthy apart from the normal aches and pains associated with his age. He has become an advocate for more awareness about hepatitis B. 'We'd never have known we had it if this hadn't happened to my brother. It's a silent killer. Someone could be dying of it right now without knowing. Everyone should know their status,' he says.
News24
18 hours ago
- News24
Gauteng's food safety campaign faces uphill battle in Naledi where 10 children died
Supplied/Gauteng department of health Be among those who shape the future with knowledge. Uncover exclusive stories that captivate your mind and heart with our FREE 14-day subscription trial. Dive into a world of inspiration, learning, and empowerment. You can only trial once. Start your FREE trial now
News24
a day ago
- News24
It's the ‘Donald disease' that's making us sick
Our so-called HIV 'key populations' — men who have sex with men, transgender women, sex workers and people who inject drugs, and, in Africa also young women — have been hard-hit ever since the Trump administration stopped most of its HIV funding in February. Key populations have a much higher chance of getting HIV than general populations, which is why Pepfar, over the past decade, allocated most of its funds to programmes working with such groups. With the 12 specialised key population clinics in South Africa funded by the US government and now shuttered, getting treatment at government clinics has been difficult, if not impossible, for some. 'Hello, sis. How are you? I hope you're fine. I mean, I'm not.' A lot has been going on out there, he told Bhekisisa in the voicemail, one of the many we recently received. 'You know, I'm a gay guy. I have sex with other men, without wearing condoms now, because when I try to fetch them from my local clinic, I'm told I get judged and told I want too many. You know what's happening in our industry.' We will call him Nkosi. Because he has sex with men and because his industry is sex work and because no one in the small community where he lives knows that he is gay or what he does for work. He even has a 'girlfriend' so people will think he's straight. Sex work has always been a dangerous profession. But ever since the Trump administration stopped most of its HIV funding in February, it's become even more risky. The World Health Organisation says gay and bisexual men like Nkosi's chance of contracting HIV through sex is 26 higher than that of the general population. Male sex workers are even more likely to get infected with the virus. That is what makes sex workers, as well as gay and bisexual men, what researchers call a ' key population ' in the HIV world. Other key populations are gay and bisexual men, transgender people, people who inject drugs, and, in Africa, also young women between the ages of 15 and 24. Because so many new HIV infections happen in these groups, the US government's Aids fund, Pepfar, has, for the past decades, invested most of its funds in programmes working with these groups. But the 12 specialised clinics for key populations, supported by the US government's Aids fund, Pepfar, have now been shut down. Gone, too, are their health workers specially trained in how to work without discrimination. Gone is their tailor-made HIV treatment and testing services; their specialised mental health support; and the condoms and lubricants they handed out for protection against HIV and other sexually transmitted infections. Gone are the two-monthly anti-HIV jabs and that some of these clinics handed out as part of studies — and the daily anti-HIV pills, which they distributed without any judgement. Although government clinics also stock the daily anti-HIV pill, which, if used correctly, can reduce someone's chance of getting HIV through sex to close to 0, people like Nkosi, research shows, are often treated badly by health workers at state clinics, making them wary to return. Preventive medicines like the daily pill are called pre-exposure prophylaxis, or PrEP, because they stop infection by preventing a germ such as HIV from penetrating someone's cells. 'So sometimes I don't have PrEP,' says Nkosi. 'A partner can tell me he is on PrEP, but I don't trust that. Because where is he getting PrEP? Where am I going to get it? The black market? 'I don't know if it is even the real thing. Is it a counterfeit? Lube? That's another thing — you use everything, anything, as long as it's got jelly in it. The last time I did that I had an itchy penis for a week.' Nkosi calls the domino effect of the Trump administration's decision to pull funding 'the Donald disease because it is being caused by this guy, one man.' 'It's like crossing the freeway every day the way we're living now. One day, I know I'm gonna die.' What's with key populations? When Health Minister Aaron Motsoaledi called a press conference in May to present his '18 facts' about the crisis, eight of those points were about what government is doing to make sure the patients from those specialised clinics — over 63 300 patients — were taken care of and that their files have been transferred to the nearest government facility. But why is there so much focus on these communities? UNAids says more than half of all new infections in 2022, around the world, came from key populations — and infections don't stay within those groups. 'Even the most self-interested people should be heavily invested in treatment and prevention of these populations,' says Francois Venter, who heads up the health research organisation, Ezintsha, at Wits University. 'There's no clean, magical division between key populations and general populations. It's a Venn diagram of married men sleeping with sex workers, of drug-using populations interacting with your ostensibly innocent kids, gay men with your straight presenting son, all needing HIV prevention and treatment programmes.' Although we have medicines like PrEP to prevent people from getting infected with HIV and antiretroviral drugs (ARVs) for HIV-infected people, which, if taken correctly, reduce their chance of transmitting the virus to others to 0, having the medications available, is just a small part of the solution. What's more difficult is to get medication to people and to convince people to use it, and to use it correctly. Studies, for example, show that getting people to use the anti-HIV pill, also called oral PrEP, each day, has been a struggle — and those who do use it, often don't use it each day, the less often it's used, the less well it works. Moreover, United Nations targets that South Africa needs to reach by the end of 2025, show that we struggle with convincing people who know they're infected with HIV, to take treatment — and stay on it. Researchers estimate that of South Africa's 8-million people with HIV, 1.1-million people who have been diagnosed with HIV, are not on treatment. Some of the 1.1-million choose not to start treatment, but an even larger proportion, who do go on treatment, cycle in and out of it. READ | 'It erases the very existence of people like me': Activists tackle doctors' anti-trans stance Pepfar programmes funded thousands of 'foot soldiers', such as community health workers, adherence counsellors, data collectors and youth workers, who went into communities with mobile clinics to find people who stopped their treatment, or to make ARVs easier to get by making it possible for people to collect their medicine from community halls, shops or private pharmacies close to where they live. That's why having lost at least half of those workers — we're likely to lose the other half at the end of the US financial year in September — is such a tragedy. And why, if we do nothing to replace them, modelling studies show, there's a high chance that we see up to almost 300 000 extra HIV infections over the next four years and a 38% increase in Aids deaths. The difficulty with state clinics and key populations Government clinics are mostly not geared towards key populations, because they serve everyone. And because many health workers' own prejudices so often interfere with the way in which they treat patients such as sex workers, gay and bisexual men, or teens who ask for condoms or PrEP, such groups frequently feel uncomfortable to use state health services. Stigma and discrimination in public clinics — doled out by security guards, cleaners, health workers and patients in waiting rooms — keep people away from HIV treatment and prevention. Researchers who surveyed over 9 000 people in key populations found that less than half, and in some cases not even a quarter, said they were treated well; about one in five said they were blocked from getting services. Motsoaledi says he's trying to fix that by now training 1 012 clinicians and 2 377 non-clinician workers at government facilities in non-discriminatory healthcare. But despite similar trainings having been conducted for years already, discrimination remains rife. Because funding cuts mean already understaffed government health clinics now have even fewer staff, many people with HIV, or those wanting PrEP, have to travel further for treatment, or wait in long queues. As politicians, activists and researchers duke it out from labs and clinics and press conferences, many of those most at risk, like Nkosi, have been left to fend for themselves. Here are some of their stories — we collected the stories via voice notes with the help of health workers who worked for Pepfar programmes that have now been defunded. Female sex worker: 'My child is going to be infected' 'Yoh, life is very hard. Since all this happened, life has been very, very hard.' 'I have tried to go to the public clinic for my medication. But as sex workers, we are not being helped. We are scared to go to the government clinic to treat sexually transmitted infections because we are seen as dirty people who go and sleep around. We even struggle to get condoms. We are now forced to do business without protection because it is only our source of income and it's the way that we put food on the table. My worry now is that I am pregnant and my child is going to be infected because I'm not taking my ARVs, and I have defaulted for two months now.' READ | Elon Musk's estranged trans daughter, Vivian, makes bold modelling debut Transgender woman: 'The future is dark' 'I'm a transgender woman. My pronouns are she.' 'When the clinic closed, I was about to run out of medication so I went to the government clinic in my area. I introduced myself to the receptionist and the lady asked me what kind of treatment I was taking. I told her ARVs and that I'm virally suppressed [when people use their treatment correctly the virus can't replicate, leaving so little virus in their bodies that they can't infect others], so I can't transmit HIV to others. 'The lady told me that they can't help me, and I need to bring the transfer letter. I told her that the clinic is closed so I don't have the transfer letter. I asked to speak to the manager and the manager also refused to help me. The manager! How can she let someone who is HIV-positive go home without medication? 'I had to call one of my friends and she gave me one container. If you're not taking your medication consistently, you're going to get sick, you're gonna die. And the future? The future is dark.' Migrant farm worker: 'Lose my job? Or risk my health?' 'When we were told that the clinic was closed, I was actually in another town trying to get a seasonal job on the farms. But when I went to the nearest clinic, I was told that I needed to get a transfer letter. So, I ended up sharing medication with friends. But then their medication also ran out. 'Then I got a job on the farm. Before the mobile clinics came to the farms and we had our clinical sessions there. The nurse was there, the social worker was there. Now we went to the clinic and spent the whole day there because we had to follow the queues. And because our jobs were not permanent jobs, you know, you just get a job if you apply by the gate. So, if you are not there by the gate on that day, then the boss will automatically think that you are no longer interested in the job, so they employ someone else. 'I went to the government clinic and asked to get at least three months' supply. But the clinic said no because it was my first initiation, so I had to come back. So, I went back to the farm to see if I could still have my job. I found that I was no longer employed because they had to take up someone else. 'What am I going to do? If I go to the clinic, I stand a chance of losing my job. If I stay at my job I am at risk of getting sick.'
