Prince Harry walks through minefield in Angola, continuing Diana's advocacy
The Duke of Sussex visited Angola in southern Africa with the HALO Trust organization, the same group his late mother worked with when she went to Angola in January 1997, seven months before she was killed in a car crash in Paris.
Diana's advocacy, along with images of her walking through a minefield, helped mobilize support for a land mine ban treaty that was ratified later that year.
Harry walked through a land mine field near a village in Cuito Cuanavale in southern Angola that has been cleared by HALO Trust. He had visited the same area in 2013 when mines were still active, the charity said.
It wasn't the first minefield in Angola Harry has walked through. He also donned the blue body armor of the HALO Trust in a field of land mines for an awareness campaign in 2019.
Harry spoke to families on Wednesday who live near the minefield.
"Children should never have to live in fear of playing outside or walking to school," he said. "Here in Angola, over three decades later, the remnants of war still threaten lives every day."
The land mines across Angola were left behind from its 27-year civil war from 1975 to 2002. The HALO Trust says at least 60,000 people have been killed or injured by land mines since 2008. It says it has located and destroyed over 120,000 land mines and 100,000 other explosive devices in Angola since it started work in the country in 1994, but 1,000 minefields still need to be cleared.
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Patients died cold and uncared for: Health Ombud exposes collapse of psychiatric care in Northern Cape
The Health Ombud report reveals that two psychiatric patients died and one was left permanently bedridden. The mental health hospital operated without electricity for year, leaving life-saving equipment useless. Leadership failures and staff shortages caused the systemic collapse of the patient care system. The Health Ombud found that two psychiatric patients died and one was left permanently bedridden due to neglect and poor care. Northern Cape Mental Health Hospital went without electricity for a year, leaving life-saving equipment unusable and patients exposed to extreme temperatures. These are some of the findings in a damning report by Health Ombud Professor Taole Mokoena, who investigated the treatment, complications and deaths of psychiatric patients at the Northern Cape Mental Health Hospital and the Robert Mangaliso Sobukwe Hospital. The report cites leadership failures, staff shortages and collapsing infrastructure as the main reasons for the breakdown in patient care. Emergency machines stood useless as they had not been charged. Calls for help could not go out as the phone lines were down. Some patients died. Others were sent out in critical condition. One will never walk again. The investigation followed a complaint made by Health Minister Aaron Motsoaledi in October last year. The report details how systemic neglect, infrastructure collapse, poor staffing and lack of leadership directly led to suffering, medical complications and death. Four psychiatric patients were closely examined in the report – two died, one suffered permanent disability and another experienced complications due to poor monitoring. In his report Mokoena states: The general care provided was substandard, and patients were not attended to in a manner consistent with the nature and severity of their health condition. Taole Mokoena The situation was made worse by a yearlong power outage at Northern Cape Mental Health Hospital, caused by cable theft and vandalism. While neighboring hospitals had their power restored within days, this one was left without electricity due to delays in the provincial department's supply chain processes. 'Because of the lack of electricity, resuscitation equipment could not be used, heating and cooling systems failed, and patients had to endure extreme weather conditions without proper clothing or bedding. The report What happened Cyprian Mohoto was transferred to Robert Mangaliso Sobukwe Hospital on 13 July last year after he experienced serious complications. A chest X-ray revealed that he had pneumonia, but this was never treated. For three days, his deteriorating condition was ignored by both nurses and doctors. He died on 16 July in the emergency unit. Tshepo Mdimbaza was found unresponsive in his bed at Northern Cape Mental Health Hospital on 3 August. When staff attempted to resuscitate him, they discovered that the equipment was not prepared or functional. His vital signs had not been properly monitored. A post-mortem found he had died from 'exposure to the elements'. John Louw, a patient at Northern Cape Mental Health Hospital, suffered a brain injury known as a subdural haemorrhage. After emergency surgery, including a craniotomy and craniectomy, was performed on 7 July and 23 July respectively, complications have left him permanently bedridden. Petrus de Bruin collapsed in ward M2 at Northern Cape Mental Health Hospital on 30 July and was transferred to Robert Mangaliso Sobukwe Hospital's Emergency Centre. He was stabilised and admitted for hypoglycaemia. While emergency care was appropriate, nursing monitoring was inadequate. The report highlighted a deep leadership crisis and operational failure at both facilities. At Northern Cape Mental Health Hospital, there was no emergency preparedness, collapsing infrastructure, poor medicine control, a shortage of staff and a lack of proper record keeping, the report revealed. The Ombud found that: The clinical manager had written to the acting head of the provincial department of health, warning about the harmful conditions patients were facing, but no action was taken. At Robert Mangaliso Sobukwe Hospital, the problems included overcrowding, missing patient files, poor supervision of nurses and staffing shortages across all departments. 'Leadership instability in the Northern Cape provincial department of health negatively affected service delivery, patient safety and the overall quality of care,' said Mokoena. Recommendations The Ombud called for urgent action to fix the broken system. This includes: 'This level of systemic collapse must never be allowed to happen again in our health system,' Mokoena added.
News24
a day ago
- News24
SA's doctor deal with Cuba is out of touch and out of time, critics say
The Nelson Mandela-Fidel Castro medical training programme was launched in 1996, and the first group of South African students went to Cuba in 1997. The programme has been controversial from the start. It's had high points, low points and 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 the 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 (NMFC) 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 doctor numbers in under-serviced rural areas. But it is also a tale of political inertia arguably blurring over time 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, 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 number 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 NMFC 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 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. READ | Five students went to Cuba 28 years ago with a suitcase full of dreams. They came back as doctors With its focus on primary healthcare, preventative 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, 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 around 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, 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 in 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 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 been 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. Minister of Health at the time, Dr Joe Phaahla, said the preparatory year, including a stipend, cost US$4 400 per student, and each of the following five years cost US$7 400 per student. But a separate table from the health department listed higher figures - US$8 400 for the preparatory year and up to US$15 900 per student by the fifth year. Added to this, the department listed annual costs of US$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 is 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 to 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, government ramped up the number 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 around 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 – around 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 Gauteng High Court in Johannesburg ruled that the Gauteng health department 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 ensures there are doctors for 24-hour coverage at hospitals and makes up as much as a third of doctors' take-home pay. The situation in the North West is also bleak. It's health facilities are routinely facing medicine stock-outs and understaffing. Its health department is regularly struggling 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, we understand at a 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 tells Spotlight. '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,' says Green-Thompson. He says a proper evaluation of the programme needs to be done. There are also lessons to learn, he says, including a review of admissions programmes. How some students who enter a programme at 20% below the normally accepted marks, exit the programme as excellent doctors, he says, offers clues to rethink how great doctors can be made. Green-Thompson also suggests we need to ask why specialisation has become a measure of success for many doctors in South Africa, often at the expense of family medicine. This, he says, takes away from the impact doctors make at community healthcare level as expert generalists. But changing the perspectives of healthcare professionals requires early and sustained exposure to working in community healthcare settings, says Professor Richard Cooke, head of the department of family medicine and primary care at Wits. Cooke is also director of the Wits NMFC Collaboration since 2018 and serves on the NMFC Ministerial Task Team. He says, speaking in his Wits capacity: 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. '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,' says Cooke. And curricula at Wits is shifting, for instance, towards placing students at district hospitals for longer periods of time, rather than weeks-long rotations, he says. 'When students become part of the furniture at a hospital, they become better at facilitating, at critical thinking, problem solving, teamwork and collaboration,' Cooke says. But making this kind of transformation in local training takes government funding and commitment. Students and doctors need to be attracted to the programme and need reasons to stay. But the money and resources to make this happen are simply not there – even as the Cuba training programme continues. Cooke adds: 'There hasn't been definitive data on the NMFC 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 established partnership 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, dean of the faculty of health sciences at Wits, says the NMFC programme costs an estimated three times more than it costs to train a student in South Africa. This, he says, should be enough reason for a beleaguered health department like Gauteng's to stop sending students to Cuba. He also says: 'Government is aware that it simply can't absorb the number of medical graduates being produced.' Madhi says some trainee doctors are sitting at home while others trying to finish specialisations are being derailed. Broadly, he pins 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 says universities have worked hard to close the gaps identified by the NMFC programme 30 years ago, but now student doctors are being let down by the government not playing its role. He says: 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 says that when it comes to admissions, the majority of students entering medical schools across the country are now black South Africans, and additional changes have 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 socio-economic component, with 40% of the admissions coming from students in quintile 1, 2 and 3 schools [no-fee public schools],' he adds. South Africa has 11 medical schools, with the most recent addition of 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 is increasing. Madhi estimates the total number being trained is above 900 per year for Gauteng alone. The bottleneck of getting doctors into clinics and hospitals, he maintains, is not a shortage of doctors, but 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 cannot detract from the goal to get doctors into communities – including through the NMFC programme. Today, he's the health attaché at the Havana Mission for the NMFC 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,' says Madela who was part of the 2002 NMFC intake. The six years abroad, he says, exposed him to very different reasons for becoming a doctor. He says: 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. 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 NMFC programme, Madela says, still plays 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', he adds, responding to criticism over the programme's comparatively high costs. 'We are used to seeing the NMFC programme from the point of view of adding human resources, but it's also about the impact it makes for a community,' he says. It's the impact of a community finally getting their own doctor. His argument is that, thanks to the NMFC programme, he got to be that person for his community.
News24
a day ago
- News24
Don't ignore the link between sleep and mental health
__________________________________________________________________ Your body is just like a car; it needs the rest and maintenance it deserves to perform at the best ability. Many can tell firsthand that when they don't get enough sleep it affects their mental state – after all, there's a reason why the saying 'you woke up on the wrong side of the bed' comes up when one is in a bad mood. South Africans are the earliest risers in the world, with local data shows that the average person wakes up at 06:24, with many waking up even earlier to catch public transport and make it to their jobs. According to Dr Alison Bentley, a medical doctor at the Restonic Ezintsha Sleep Clinic in Johannesburg, the relationship between sleep and mental health is quite complex but worth understanding to improve both. 'Poor sleep doesn't just make you tired; it affects your mood, memory, focus and self-confidence, and can increase your risk of developing depression and anxiety for years to come,' Dr Alison says. Sleep and mental health is often considered as a 'chicken and egg' situation, where anxiety and depression can cause sleep disruptions, while sleep disorders like insomnia and sleep apnoea can trigger or worsen mental health issues. Sleep and the winter blues There's a reason why you might feel a bit off when below zero temperatures, grey skies, rain and winter chills roll around. Seasonal Affective Disorder (SAD) is a clinically recognised form of depression linked to limited sun exposure which can disrupt your body's internal clock, affect serotonin and melatonin levels and throw off your sleep patterns. 'Mental health is a key component of your overall wellness, yet it's often neglected, especially during busy, high-pressure periods,' says Dr Themba Hadebe, clinical executive at Bonitas medical aid. 'Recognising the signs of SAD early is essential because the sooner you acknowledge it, the sooner you can take steps to manage it.' Sleep disorders and how to treat them Insomnia Dr Alison explains that insomnia, which is defined as getting too little sleep to function properly, is not a one-size-fits-all condition. While sleeping tablets may help in the short term, they don't solve the root of the problem. For long-term improvement, Dr Bentley recommends Cognitive Behavioural Therapy for Insomnia (CBTI) – a proven, non-medication-based programme that addresses unhelpful sleep habits, thoughts and behaviours. 'There are free CBTI apps available and seeing a trained professional can be life-changing,' she says. Sleep apnoea and restless legs Dr Alison highlights that restless legs syndrome and sleep apnoea – a condition where breathing is repeatedly interrupted during sleep – can rob the body of deep, restorative sleep and leave people exhausted, irritable and vulnerable to depression. 'In men, sleep apnoea is a common but often missed cause of midlife depression,' she says. 'If you're waking up tired despite getting a full night's sleep, it may be time to get checked. A simple questionnaire or overnight sleep study can make all the difference.' Low iron could be the issue There is a fundamental link between anxiety, depression and disruptive sleep patterns and low iron, explains anaemia-awareness advocate and head of the Cape Town Infusion Centre Sister Karin Davidson. Even very heavy menstrual cycles can affect your iron levels. Iron is an essential component in the production of serotonin – your brain's 'happy chemical', explains Sister Davidson. 'When iron levels are low, the body struggles to produce adequate serotonin, which directly impacts mood, sleep patterns and overall sense of wellbeing. Low iron and anaemia fundamentally alter how young women experience life – and when you're in the prime of your life, that's a travesty.' Don't be afraid to reach out to a doctor to get your iron levels checked and explore the benefits of iron supplements and infusions.
