RuDASA AND JUDASA CALL FOR AN IMMEDIATE END TO THE PREDICTABLE AND AVOIDABLE ANNUAL INITIATION DEATHS AND MUTILATIONS.
15 July 2013
In 2010, Dr. John Lazarus wrote in the South African Medical Journal: Twenty years ago two Eastern Cape urological surgeons documented their experience with treating initiates (...), they followed up 45 consecutive patients and documented a mortality rate of 9%. The death toll for the 2010 winter initiation period stood at 40 at the time of writing. These statistics not only point to the fact that little has changed, but suggest that the situation may in fact be deteriorating.”
From 2008 until 2012, the Eastern Cape Province recorded 323 deaths, with 126 initiates suffering genital amputation. At the beginning of July 2013 the EC province recorded 30 deaths and 293 hospital admissions from dehydration, septic circumcision wounds, and gangrene of the penis. We view the apparent absence of improvement with great concern.
RuReSA (Rural Rehabilitation of South Africa) is a newly formed interest group for rehabilitiation professionals who have an interest in Rehabilitation in rural places. Members have the chance to input on policy, give and receive personal and professional support, work with universities to promote rural-friendly curricula and encourage students to go rural. "We believe that rural work can be inspiring and fun, and with a little support we can achieve great things". RuReSA provides support to rehabilitation therapists in rural are as through our resource website, an online discussion forum, and advocating for change through input on policy and service strategies as well as working with the National Department of Health, professional bodies and universities.
To join, or for more information about RuReSA, visit their website.
Dr Desmond Kegakilwe is the current RuDASA chairperson. Born in Tlakgameng Village in the far west of the North West province, Desmond matriculated from Mafikeng with dreams of being a law enforcement officer, or an engineer. His life changed when he was granted a scholarship to study medicine in Cuba, which became one of the most exciting and challenging moments of his life! He drew on inspiration from the elders in the village, especially his grandfather, and graduated with a medical degree in 2004. Desmond currently works for the Wits Reproductive Health and HIV Institute (WRHI) as a Clinical Quality Improvement Mentor for the Mafikeng Sub district, mentoring professional nurses, mostly on HIV/AIDS and TB clinical issues, in 29 clinics. He works in the hospital one day a week to keep his clinical skills sharpened. In 2012 he was given the honour of being nominated one of the Mail and Guardian’s “200 Young South Africans”. Find out a bit more about Desmond below.
What was it like studying medicine in Cuba?
Karl le Roux presented at the 2012 RuDASA/Phasa conference. The following article is one he wrote based on his presentation, which can be found originally on the PHASA website (www.phasa.org.za)
"My job today is to describe to you what it is like being at the rural coalface. Though I have loved working in a rural hospital for the past six years, it has also been one of the toughest periods in my life. Working in rural medicine is a bit like sitting on a rollercoaster: a combination of enormous challenge and reward, feeling exhausted and exasperated and then inspired and invigorated, seeing dignity and strength in patients, but also sadness and unnecessary suffering and death. One always feels stretched and one often feels as if one is hanging on by one’s fingertips. The rural idyll is something that might be experienced on weekends off, but the reality of the working week is that on the whole one is extremely busy and constantly rationing care and doing the best one can with the resources available. It therefore might come as no surprise to the reader that at the coalface “policies” are more often seen as a hindrance than a help to the delivery of health care. Policies or programmes are often imposed from above, with no consultation and with little understanding of realities on the ground. There is usually poor data collection and feedback, lots of time-consuming and unnecessary paperwork and a focus on irrelevant aspects of care with the neglect of critical aspects. I need to make clear that good, realistic and helpful policies are greatly appreciated by most clinicians working at primary care level, as they improve care and the health of our patients (for example the new antiretroviral treatment guidelines). But there are also many examples of policies and programmes that aim for an unrealistic gold standard (with its unnecessary and unhelpful complexity) and which, as a result, undermine the provision of good healthcare to as large a population as possible.
The first example of this is the new Road to Health Booklet. Although an extremely well-intentioned document, it is completely unrealistic to expect a busy primary care nurse to use this tool properly.