THROUGH the past 10 years, South Africa has battled with a health burden which combines communicable diseases such as HIV/Aids and tuberculosis, with lifestyle diseases such as Type 2 diabetes, obesity, heart disease and illnesses relating to drugs, alcohol and cigarettes.
Adding extra strain to this is excessive demand for trauma care due to interpersonal violence and motor vehicle collisions, and an ever-growing demand for mental health services.
The majority of residents seek health care in the overburdened and under-resourced state hospital system, while approximately 16% rely on an increasingly unaffordable and unreliable private health insurance industry.
As our country seeks to better care for its citizens, these are some of the biggest health stories which made the news in the past 10 years.
World’s first successful penis transplant
In December 2014, a team led by urologist Andre van der Merwe from Stellenbosch University achieved the world’s first successful penis transplant at Tygerberg Hospital.
The recipient was a 21-year-old man who had lost his penis after a botched traditional circumcision three years earlier. Thanks to the surgery, he regained his ability to urinate, have an erection, orgasm and ejaculate.
In an article published in the Lancet, Van der Merwe said:
“The recipient was discharged after one month and first reported satisfactory sexual intercourse one week later (despite advice to the contrary). The recipient reported regular sexual intercourse from three months after the operation.”
Within a year, he had conceived a child with his partner.
“Psychologically, we knew it would have a massive effect on the ego,” Van der Merwe told the BBC. “You may say it doesn’t save their life, but many of these young men when they have penile amputations are ostracised, stigmatised and take their own life.”
Van der Merwe and his team completed a second procedure in 2017, this time giving a 40-year-old man a penis after his was lost 17 years earlier, also due to a botched circumcision. South Africa has a high need for penis transplants due to the damage done by unsanitary traditional initiation practices. This season alone, 21 initiates have already died.
Life Esidimeni tragedy
In what has been called the biggest violation of human rights in democratic South Africa, 144 psychiatric patients lost their lives after being removed from their care facility by the government. The causes of death shocked the nation: starvation and neglect.
In October 2015, Gauteng Health MEC Qedani Mahlangu terminated her province’s contract with Life Healthcare’s facility at Life Esidimeni, where as many as 2000 people were receiving highly specialised psychiatric care. This was to save money and to deinstitutionalise the patients.
From March to June 2016, the patients were discharged to NGOs, their families and hospitals. This process happened despite massive opposition, including experts warning that NGOs would not be able to provide the care needed for these patients.
In the following months, 144 of the discharged patients died because they were not adequately cared for.
In the wake of the tragedy, retired Deputy Chief Justice Dikgang Moseneke chaired an arbitration which found the Gauteng government had violated the constitutional rights of the patients and their families.
“It is now undisputed that as a result of the move, 144 mental healthcare users died and 1408 were exposed to trauma and morbidity, among others, but survived,” Moseneke noted.
“The irrational and unconstitutional decision was the reason for the death that ensued Yet despite their obvious position of authority and power, each refused to take full responsibility.”
He ordered the Gauteng government to pay out R1.2million to the family of each patient who died. This comprised money to cover funeral expenses, shock and psychological trauma, and included R1m for constitutional damages. Mahlangu resigned from her position as health MEC, but has not faced criminal charges.
World’s largest recorded outbreak of listeriosis
This public health scare began in October 2017 when the National Institute for Communicable Diseases (NICD) noticed listeriosis cases had been increasing throughout SA.
Listeriosis is a bacterial infection caused by the food-borne pathogen listeria monocytogenes, which can result in serious illness and death.
Cases continued to mount in the following months, with the NICD working non-stop to locate the source of the outbreak. By the time the outbreak was under control, there were 978 laboratory-confirmed cases and 183 deaths. Genome sequencing revealed that 91% of the cases were caused by the same strain of listeria monocytogenes, which was traced back to the Enterprise Foods factory in Polokwane.
The breakthrough came in January when nine children from a crèche in Soweto were all taken to hospital with suspected listeriosis. Samples were taken of polony found at the crèche, which led inspectors on to the Enterprise Foods factory, which was subsequently shut down.
Then health minister Aaron Motsoaledi said that 5812 tons of processed meats were recalled, amounting to R12m. He announced in June last year that the outbreak was officially over, with no further cases being reported from that particular strain.
National Health Insurance bill is tabled before Parliament
The debate around a potential National Health Insurance (NHI) scheme has been building since the Advisory Committee on NHI was established in 2009. In August this year, exactly 10 years later, the NHI Bill was introduced to Parliament. It is currently under consideration by the National Assembly’s health committee.
According to the national Health Department: “The NHI is a financing system that will make sure that all citizens of South Africa (and legal long-term residents) are provided with essential health care, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.“Health care is a human right... This right should not depend on how rich we are or where we happen to live.”
The NHI is an ambitious project which in theory would be revolutionary for health care in South Africa - but there are valid doubts about our government’s capability to fund and implement it effectively.
Professor Leslie London from the School of Public Health and Family Medicine at UCT’s Faculty of Health Sciences summed up the major concerns.
“While the intention is compelling, it lacks a clear focus on strengthening the public health sector, which must be a basis for any future universal access,” he wrote.
“Secondly, it risks exacerbating inequities Thirdly, high levels of managerial competence will be needed to run such a complex system. Lastly, public and community participation is absent, or at best very limited.”