Top 10 stories of the day: Hospitals at risk
In the news today, service delivery failures have left some of Gauteng's most vulnerable at risk, with Carletonville Hospital having to shut down its theatre and maternity ward.
It looks to be a bad start to the week for residents in Joburg and Pretoria too, as throttling and maintenance slow water supply.
Orlando Pirates are still dealing with a Nedbank Cup loss to Kaizer Chiefs, which coach Jose Riveiro called 'ugly,' with 'not much football from both sides'. While off the pitch, five people were arrested at the match for various offences.
Good news if you are a naturalised South Africans or permanent resident, as you can now apply for a smart ID from Monday.
And we take a look at Isuzu's equivalent of a brother in prison, whom you love but do not speak about.
Stay up to date with The Citizen – More News, Your Way.
Municipal water disruption affects services at Carletonville Hospital
Carletonville Hospital in the West Rand is suffering from severe water disruptions, which have made the hospital's theatre and maternity ward non-functional, the DA in Gauteng says.
The party's spokesperson on health and wellness, Madeleine Hicklin, said the hospital has been receiving low water supply because of Merafong local municipality's R1.6 billion debt to Rand Water.
The DA is concerned the situation is affecting the health of patients and staff. Picture: iStock
'Theatre and maternity units at Carletonville Hospital are non-operational due to the water crisis putting patients' lives in danger.
'This crisis stems from Merafong local municipality's water supply having been throttled by 20% over non-payment of a R1.6 billion bill to Rand Water,' she said.
CONTINUE READING: Municipal water disruption affects services at Carletonville Hospital
Bad start to the week: These areas in Joburg and Pretoria will be without water on Monday
Johannesburg Water has implemented strict water throttling measures across parts of the city in response to surging consumption levels and to safeguard the stability of its reservoirs.
The entity said the measures are meant to 'regulate demand and protect reservoir capacities,' while ensuring continuous water availability for all residents.
Image used for illustration. Picture: iStock
'This strategy aims to regulate demand and protect reservoir capacities, thereby stabilising the supply and ensuring a consistent water supply for all residents.'
CONTINUE READING: These areas in Joburg and Tshwane may be without water on Monday
Naturalised South Africans can now apply for Smart IDs – Schreibe
Naturalised South Africans and permanent residents can now obtain Smart ID cards from this week, Minister of Home Affairs Leon Schreiber says.
For years, IT failures forced South Africans born abroad and permanent residents to continue using only the insecure green bar-coded ID book.
A South African ID book and driver's licence. Picture: Gallo Images/Nicolene Olckers
Schreiber said these individuals were excluded from obtaining the more secure Smart ID.
It also prevented them from using the eHomeAffairs platform to make bookings.
CONTINUE READING: Naturalised South Africans can now apply for Smart IDs – Schreiber
Dodgy ticket sales and pitch invaders: 5 arrested at Pirates and Chiefs cup final
While Kaizer Chiefs fans are still celebrating their first trophy in 10 years, it was a bad night for five people arrested at the match on Saturday.
Chiefs beat their Soweto rival Orlando Pirates in the Nedbank Cup final at the Moses Mabhida Stadium in Durban, KwaZulu-Natal.
Members of the South African Police Service (Saps) at the Moses Mabhida Stadium in Durban on 28 October 2022. Picture: Gallo Images/Darren Stewart
The build-up to the match had been clouded with security concerns, as fans raced to snap up limited tickets. Others claimed to be heading to Durban and 'make a plan' when they got there.
Police and security came out in full force, making sure none of the feared chaos materialised.
CONTINUE READING: Dodgy ticket sales and pitch invaders: 5 arrested at Pirates and Chiefs cup final
Revealed: What was found in Kagiso Rabada's drugs test
Proteas fast bowler Kagiso Rabada served a one-month suspension for recreational drug use after traces of benzoylecgonine (BZE), a metabolite of cocaine, were reportedly found in his urine sample, according to Sunday publication Rapport.
Rabada, who has already served the suspension after returning to South Africa from India in early April, is back with his Indian Premier League team Gujarat Titans.
Kagiso Rabada in action for the Gujarat Titans in the IPL. Picture:Rabada was one of 16 cricketers tested during the SA20 in January. He provided a sample to the SA Institute for Drug-Free Sport (Saids) after the match between his team, MI Cape Town, and Durban's Super Giants in Durban, according to Khalid Galant, the CEO of Saids.
CONTINUE READING: Revealed: What was found in Kagiso Rabada's drugs test, according to report
Here are five more stories of the day:
Yesterday's News recap
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14 hours ago
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Three decades in, is the Cuba-SA doctor training programme still worth the expense?
The Nelson Mandela-Fidel Castro medical training programme has been controversial from the start. It's had high points, low points, and now many say it should have an end point. Almost 30 years since the Cuba-SA doctors' training programme was launched, it still divides opinion. This year only Gauteng and North West interviewed candidates for the bursary programme that sends students from South Africa to be trained in the island country. Critics say the dwindling interest shows the Nelson Mandela-Fidel Castro medical training programme has passed its sell-by date. But supporters remain committed to its ideals, and some beneficiaries of the programme still think of it as the opportunity of a lifetime. Between the differing views, what can be glimpsed is a chequered story of three decades of trying to transform South Africa's healthcare system. The programme has its origins in the ANC's political fraternity with Cuba and the laudable ideal of boosting doctors numbers in under-serviced rural areas. But it is also a tale of political inertia arguably blurring overtime into a blind spot as conditions changed. In the background is the stranglehold of corruption and maladministration in the health sector, shrinking provincial health budgets, the transformation of doctors' training, and changing curricula. One concern is that little is actually known about the programme's impact. There is a lack of clear data on the costs and the numbers of doctors produced. Shockingly, for such a long-running programme, no comprehensive evaluation reports have been published, as far as Spotlight has been able to establish. A comprehensive evaluation would weigh the benefits of the programme against its costs, compare it to other options for training medical doctors, and contextualise it within the current reality of very tight health budgets in provincial health departments — as it is, not all the doctors we are training are being employed. Given this context, it is not surprising that the national Department of Health recommended a scaling back of the programme a decade ago. While most provinces have taken this advice, the Gauteng and North West health departments have instead pushed ahead with the programme. Old histories and old allegiances The agreement that put in place the medical training programme was signed in 1996, with the first cohort of students leaving for Cuba a year later, in 1997. It was a mere two years into democracy and South Africa urgently needed to address the gaps in the provision of healthcare. Under apartheid, services prioritised a white minority mostly in urban settings and healthcare had a strong slant towards hospital or tertiary care. There was a shortage of doctors, and those with the least access to healthcare services were rural communities made up mostly of black South Africans. Medical schools mostly had curricula designed for the status quo, and there were few academic pathways for underprivileged students who had good marks at school but were not top achievers, leaving them overlooked for scholarships and bursaries. So the new government looked to Cuba. With its focus on primary healthcare, preventive medicine and community-based training, the Cuban approach to healthcare ticked many of the boxes for the South African government then led by Nelson Mandela. Since the communist revolution in Cuba in 1959, it has provided free healthcare to all its citizens. While there remains some scepticism over data collection and interpretation, the politicisation of medicine, and limited freedom to criticise the state, Cuba's healthcare system is also widely lauded. According to the Primary Health Care Performance Initiative, the country registers average life expectancy at 78 years (South Africa is at about 66), infant mortality dropped from 80 deaths per 1,000 live births in 1950 to just 5 deaths per 1,000 by 2013, and it has one of the world's highest doctor to patient ratios. In 2021, it was at 9.429 physicians per 1,000 people, according to World Bank Open Data. In the same year, South Africa tracked at 0.8 per 1,000. Since the 1960s, Cuba has established itself as a hub for training international fee-paying students and sending them back to their mostly lower-income countries as graduate doctors. One of its biggest universities, the Latin American School of Medicine, has graduated more than 30,000 students from 118 countries in the 21 years since it was established. Another tick was Cuba's staunch support for the ANC. SA History Online emphasises the depth of solidarity. It notes: 'Cuba was a state in alliance with provisional governments and independent states on the African continent. Cuba's military engagement in Angola kept the apartheid state in check, foiling its geopolitical strategies and forcing it to concede defeat at Cuito Cuanavale, and ultimately forcing both PW Botha and FW de Klerk to the negotiating table.' Costs and benefits The political and historical bonds sealed the doctors' training deal. But from the start, the bursary programme, funded by provincial budgets, came under fire. The estimated costs over nearly three decades are massive, but the details remain fuzzy. Spotlight's questions to the national health department were 'answered' in one paragraph by department spokesperson Foster Mohale. 'More than 4,000 [lower numbers are quoted by government in other instances] doctors have been produced through this medical programme since its inception. The programme is still relevant today and complements the local medical schools to produce more doctors. Qualified doctors have options of joining either public or private health sector,' he wrote. But discrepancies have shown up in the government's own figures. In November 2022, Haseena Ismail, the then DA member on the portfolio committee of health, raised concerns about the quality of government data. The Minister of Health at the time, Dr Joe Phaahla, said the preparatory year, including a stipend, cost $4,400 per student, and each of the following five years cost $7,400 per student. But a separate table from the health department listed higher figures — $8,400 for the preparatory year and up to $15,900 per student by the fifth year. Added to this, the department listed annual costs of $6,472 per student for food, accommodation, and medical insurance. There were also expenses for two return flights over six years, plus the cost of 18 months of tuition and accommodation for clinical training at a South African medical school. Phaahla said that as of November 2022, 3,369 students had been recruited into the programme, and 2,617 had graduated. However, he noted there was no information on what happened to these doctors or where they were employed. Each bursary student was required to work for the state for the same number of years for which they received funding. The programme also faced criticism over selection criteria for bursary candidates and for requiring two extra years of training compared with local medical programmes. Students spend one year learning Spanish, five years training in Cuba, and then return to South Africa for an additional 18 months of clinical training at a local medical school. Controversies have dogged the programme over the years. In 2013, the Afrikaans newspaper Beeld reported that by 2009, only half of the students enrolled in the programme during its first 12 years had completed their studies. In 2012, the government ramped up the numbers of students it sent abroad. In 2018, this backfired when about 700 fifth-year students returned home only to find they could not be accommodated at any of the then 10 medical schools in the country. It was at about this time that the national health department issued recommendations for the provinces to phase out the programme. Gauteng and North West Despite all of the above, the Gauteng Department of Health continues to fund students — about 20 last year and an expected 40 this year. Spotlight's questions on this to the Gauteng health department went unanswered. Compounding the administrative and planning blunders for returning students is the impact of deepening corruption and mismanagement in Gauteng's health department. It has been under routine Special Investigating Unit scrutiny as well as coming under fire for service delivery issues such as the ongoing backlog of cancer patients lingering on treatment waiting lists. In March, the South Gauteng Division of the High Court in Johannesburg ruled that the Gauteng health department had failed in its constitutional obligation to make oncology services available. In April, the department failed to pay its doctors their commuted overtime pay on time. These payments ensure there are doctors for 24-hour coverage at hospitals and make up as much as a third of doctors' take-home pay. The situation in the North West is also bleak. It's health facilities routinely face medicine stock-outs and understaffing. Its health department regularly struggles with accruals and paying suppliers on time. Given all these challenges, it is puzzling that these two provinces in particular are so committed to sending students to Cuba, at what we understand to be higher cost than for training doctors locally. 'Better investments' Professor Lionel Green-Thompson, now the dean of the faculty of health sciences at the University of Cape Town, was involved in managing returning students from the Cuba-SA programme between the mid-2000s and 2016. At the time, he was a medical educator and clinician at Wits University, where he oversaw the 18-month clinical training of more than 30 returning students. 'Some of these students were among the best doctors that I've trained, and I remain a stalwart supporter of the ideals of the programme. But at this point, there are better investments to be made, including directly funding university training programmes in South Africa,' he said. 'A programme that's rooted in our nostalgic connection with Cuba and its role in our change as a country is now out of step with many of the healthcare settings and realities we face in South Africa,' said Green-Thompson. He added that a proper evaluation of the programme needed to be conducted. There were also lessons to learn, he said, including a review of admissions programmes. How some students who entered a programme at 20% below the normally accepted marks and exited the programme as excellent doctors, offered clues on how great doctors could be made, he said. Green-Thompson also suggested that we needed to ask why specialisation had become a measure of success for many doctors in South Africa, often at the expense of family medicine. This, he said, took away from the impact doctors made at the community healthcare level as expert generalists. But changing the perspectives of healthcare professionals required early and sustained exposure to working in community healthcare settings, said Professor Richard Cooke, the head of the department of family medicine and primary care at Wits. Cooke is also the director of the Wits Nelson Mandela-Fidel Castro Collaboration since 2018 and serves on the Nelson Mandela-Fidel Castro Ministerial Task Team. 'I'm not in support of further students being sent to Cuba for the undergraduate programme, because these students are not being trained in our clinical settings,' he said, speaking in his Wits capacity. 'The Cuban system is far more primary healthcare based than South Africa's, but that doesn't necessarily translate into these students ending in primary healthcare,' said Cooke. And curricula at Wits were shifting, for instance, towards placing students at district hospitals for longer periods of time, rather than weeks-long rotations, he said. 'When students become part of the furniture at a hospital, they become better at facilitating, at critical thinking, problem solving, teamwork and collaboration,' Cooke said. But making this kind of transformation in local training took government funding and commitment. Students and doctors needed to be attracted to the programme and needed reasons to stay. But the money and resources to make this happen were simply not there — even as the Cuba training programme continued. Cooke added: 'There hasn't been definitive data on the Nelson Mandela-Fidel Castro programme. But even if the programme over 30 years has done well and met its targets, it's not been cost efficient. What's needed now is to leverage expertise and establish partnerships in different, more cost-effective ways like in research, health systems science and health science education.' Up to three times more expensive? Professor Shabir Madhi, the dean of the faculty of health sciences at Wits, said the Nelson Mandela-Fidel Castro programme costs an estimated three times more than it cost to train a student in South Africa. This, he said, should be enough reason for a beleaguered health department like Gauteng's to stop sending students to Cuba. He added: 'The government is aware that it simply can't absorb the number of medical graduates being produced.' Madhi says some trainee doctors were sitting at home while others trying to finish specialisations were being derailed. Broadly, he pinned the blame on the mismanagement of resources, including the department underspending R590-million on the National Tertiary Service Grant meant to subsidise specialised medical treatment at tertiary hospitals. Madhi said universities had worked hard to close the gaps identified by the Nelson Mandela-Fidel Castro programme 30 years ago, but now student doctors were being let down by the government not playing its part. 'Across the universities, there's been a complete overhaul of the curriculum to be focused on primary healthcare. Students are also getting community exposure as early as first-year training,' he said. He added that when it came to admissions, the majority of students entering medical schools across the country were now black South Africans, and additional changes had been made to the selection process. 'We used to have a race quota, but in further revisions we have introduced criteria that focus on the socioeconomic component, with 40% of the admissions coming from students in quintile 1, 2 and 3 schools [no-fee public schools],' he said. South Africa had 11 medical schools, with the most recent addition being North West University — specifically focused on rural health — and the University of Johannesburg in the pipeline to join the list. So the number of doctors being trained and graduating was increasing. Madhi estimated that the total number being trained was above 900 per year for Gauteng alone. The bottleneck of getting doctors into clinics and hospitals, he maintained, was not a shortage of doctors, but the government's inability to pay doctors' salaries or to create functioning, well-resourced workplace environments. 'You can't put a price on that' For Dr Sanele Madela, the ongoing challenges could not detract from the goal to get doctors into communities — including through the Nelson Mandela-Fidel Castro programme. Today, he is the health attaché at the Havana Mission for the Nelson Mandela-Fidel Castro training programme. Madela was also at one time a schoolboy with a dream of becoming a doctor. Growing up in Dundee in KwaZulu-Natal, he remembers almost never seeing a doctor in his community. 'Then when we did see a doctor, it was a white person or an Indian person and they never spoke our language — a nurse would have to translate,' said Madela, who was part of the 2002 Nelson Mandela-Fidel Castro intake. The six years abroad, he said, exposed him to very different reasons for becoming a doctor. 'When people finish medical school, they say thank God it's over, but in Cuba people say thank God for the knowledge and information so they can give back to their country,' he said. When Madela got back to South Africa, his journey eventually led him to work in Dundee district hospital. It was the same hospital where his mother had worked as a cleaner. The Nelson Mandela-Fidel Castro programme, Madela said, still played a vital role because of its objective to get more doctors into rural and township areas — 'and you can't put a price on that'. 'We are used to seeing the Nelson Mandela-Fidel Castro programme from the point of view of adding human resources, but it's also about the impact it makes for a community,' he said. It's the impact of a community finally getting their own doctor. His argument is that, thanks to the Nelson Mandela-Fidel Castro programme, he got to be that person for his community. DM
IOL News
15 hours ago
- IOL News
Outrage as vigilante group targets foreigners: Who decides who receives medical attention and who does not?
A member of March on March checks the IDs of two people coming for treatment. Image: Screenshot What was meant to be a routine check-up for his infant babies at Durban's Addington Hospital turned into a scary ordeal for Christian Tchizungu Kwigomba. The father from the Congo was stopped at the entrance and even shoved while trying to enter the facility. He was not alone. All patients arriving for care are being stopped - not by security or hospital staff, but by a group of self-appointed gatekeepers demanding to see identification. The March and March Movement, a vigilante group with no legal authority, has taken it upon itself to screen anyone approaching the facility's doors, targeting undocumented immigrants and turning away those who can't produce South African IDs. Video Player is loading. Play Video Play Unmute Current Time 0:00 / Duration -:- Loaded : 0% Stream Type LIVE Seek to live, currently behind live LIVE Remaining Time - 0:00 This is a modal window. Beginning of dialog window. Escape will cancel and close the window. Text Color White Black Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Background Color Black White Red Green Blue Yellow Magenta Cyan Transparency Opaque Semi-Transparent Transparent Window Color Black White Red Green Blue Yellow Magenta Cyan Transparency Transparent Semi-Transparent Opaque Font Size 50% 75% 100% 125% 150% 175% 200% 300% 400% Text Edge Style None Raised Depressed Uniform Dropshadow Font Family Proportional Sans-Serif Monospace Sans-Serif Proportional Serif Monospace Serif Casual Script Small Caps Reset restore all settings to the default values Done Close Modal Dialog End of dialog window. Advertisement Next Stay Close ✕ Ad loading The group's message is blunt: public healthcare is for South Africans who can produce their ID. 'I faced something that no human being should experience,' Kwigomba said. 'Even pregnant women are being turned away. It's a matter of life or death.' Kwigomba, who is diabetic and relies on medication, says he cannot afford private care. 'We are just waiting to die,' he said. 'They should remember the spirit of Ubuntu and stop kicking people out.' Teresa Nortje, March on March chairperson, makes no apologies. 'We've had an influx of undocumented immigrants who falsify papers,' she told IOL. 'We're enforcing Section 17 of the Constitution and saying the country's hospitals are for South Africans who pay tax.' But while she cites constitutional rights to protest, the group's actions fly in the face of another part of the Constitution - Section 27, which guarantees healthcare access to everyone in South Africa, regardless of immigration status. Last week, the group was caught on camera shoving 77-year-old Crispin Hemson, 77, a former director of the Centre for Non-violence at the Durban University of Technology, after he refused to show them his ID. Growing condemnation KwaZulu-Natal Health MEC Nomagugu Simelane Mngadi and her department denounced the actions as 'unlawful acts of vigilantism' earlier this month, stressing that 'no member of the public or structure has the legal or moral authority to block others from accessing healthcare'. Nationally, the Department of Health has also condemned the movement's actions. Spokesperson Foster Mohale called on protesters to raise concerns 'within the confines of the law,' warning that the protests endanger lives and violate the Constitution and National Health Act. 'There's a difference between being concerned and taking the law into your own hands,' Mohale said. 'Everyone has the right to emergency and primary care.' Security plans are now in place to prevent further intimidation. Police and public order units have been deployed to protect health workers and patients. The government has emphasised a zero-tolerance policy toward any group or individual attempting to block access to public health facilities. The South African Human Rights Commission (SAHRC) further stated that Section 27(1) of the Constitution of the Republic of South Africa, 1996, provides for healthcare for everyone. "This constitutional provision means that all people in South Africa regardless of nationality, legal status, race, gender, age, income level, or geographic location are entitled to access basic healthcare services," it said. This includes: South African citizens Refugees and asylum seekers Documented and undocumented migrants\ Stateless persons Children, including separated, unaccompanied and stateless children. Persons in detention Vulnerable populations, such as persons with disabilities, the older persons, and persons living in poverty "The Constitution does not qualify or limit this right based on immigration status or citizenship. It further states that no one may be refused emergency medical treatment. This provision ensures that emergency healthcare must be provided unconditionally by both public and private health facilities," the commission said. Government intervention The South African Police Service in collaboration with the Department of Health is deploying Public Order Police to maintain law and order during the protests at the affected health facilities. "Law enforcement will continue to apply the zero tolerance approach for lawlessness, with decisive action taken against individuals taking the law into their own hands and intimidating patients at health facilities," said acting government spokesperson, Nomonde Mnukwa. She added that while the government understands the genuine frustrations of many citizens regarding the pressures on public services, including overburdened clinics and exhausted healthcare workers, members of the public are urged to raise such concerns through lawful and appropriate channels. "Taking the law into one's own hands is unacceptable and undermines the values enshrined in our democratic Constitution," Mnukwa said. IOL
