Editorial

The South African Academy of Family Physicians: new direction

Guest Editorial: SAAFP moving forward

No Abstrac

The effects of a language barrier in a South African district hospital

Background. Communication between health workers and patients at   Hottentots Holland Hospital (HHH) is hindered by staff and patients not  speaking the same language. HHH is a district hospital in the Cape Town  Metropolitan District of the Western Cape where staff mainly speak   Afrikaans or English and a large number of patients mainly Xhosa.Objectives. The study aimed to explore the effects of this language parrier on health workers and patients at HHH.Design. Three focus group interviews were held with 21 members of staff and 5 in-depth patient interviews were conducted.Results. The language barrier was found to interfere with working  efficiently, create uncertainty about the accuracy of interpretation, be  enhanced by a lack of education or training, cause significant ethical  dilemmas, negatively influence the attitudes of patients and staff towards each other, decrease the quality of and satisfaction with care, and cause cross-cultural misunderstandings.Conclusion. The effects of the language barrier were considerable and  persistent despite an official language policy in the province. The training and employment of professional interpreters as well as teaching of basic Xhosa to staff are recommended

Academy calls on South Africans to vaccinate

CITATION: Mash, R. 2021. Academy calls on South Africans to vaccinate. South African Family Practice, 63(1):a5396, doi:10.4102/safp.v63i1.5396.The original publication is available at https://safpj.co.zaCoronavirus disease 2019 (COVID-19) vaccine hesitancy in South Africa has been fuelled by conspiracy theories and misinformation. Unfortunately, some of this misinformation has come from health professionals, the most notable recent example being Dr Susan Vosloo, a cardiothoracic surgeon in Cape Town. However, family physicians have also been seen to promote unproven treatments such as ivermectin and even nebulised colloidal silver.https://safpj.co.za/index.php/safpj/article/view/5396Publisher's versio

Mastering your Fellowship

The series, “Mastering your Fellowship”, provides examples of the question format encountered in the written examination, Part A of the FCFP(SA) examination. The series aims to help Family Medicine registrars prepare for this examination. Model answers are available online.Keywords: FCFP(SA) examination, Family Medicine registrar

Peripheral arterial disease - high prevalence in rural black South Africans

Background. The prevalence of peripheral arterial disease (PAD) worldwide  has been estimated at between 4.5% and 29%. PAD has been associated  with male gender, advanced age, diabetes, hypertension,  hypercholesterolaemia and smoking. Clinical experience with amputations at Mthatha General Hospital, a district hospital in the Eastern Cape, suggests that PAD is common, but the actual prevalence has not been  determined. The Eastern Cape is a rural area and patients attending the hospital are mostly Xhosa-speakers.Objectives. To assess the prevalence of PAD and associated risk factors among patients attending the hospital.Methods. Five hundred and forty-two patients over 50 years of age  attending the outpatient department were systematically selected. Gender, body mass index (BMI), blood pressure, capillary blood glucose and smoking status were determined. The ankle-brachial pressure index (ABPI) was measured by Doppler ultrasound, and PAD was defined as a ratio less than 0.9. Results. Of 542 patients (315 females, 227 males), 159 (29.3%) had an ABPI of less than 0.9. The mean age was 62.4 years and the range 50 - 95 years. In a stepwise logistical regression analysis smoking had a significant adjusted odds ratio for PAD of 4.29 (2.68- 6.95), diabetes 1.72 (1.11-  2.69) and male sex 1.69 (1.06 - 2.68). Obesity as measured by BMI and hypertension were not associated with PAD.Conclusion and recommendations. Prevalence of PAD was relatively high in this sample of rural black patients when compared with findings from other countries. Preventive interventions should focus on control of diabetes and smoking cessation. Surprisingly, the prevalence was higher in those witha normal BMI and without hypertension, and risk factors in this community should be studied further. Physicians in this setting should be more aware of the possibility of undetected PAD

Evaluation of a project to reduce morbidity and mortality from traditional male circumcision in Umlamli, Eastern Cape, South Africa : outcome mapping

CITATION: Nwanze, O. & Mash, B. 2012. Evaluation of a project to reduce morbidity and mortality from traditional male circumcision in Umlamli, Eastern Cape, South Africa : outcome mapping. South African Family Practice, 54(3):237-243.The original publication is available at http://www.safpj.co.zaBackground: Traditional circumcision is common among the amaXhosa in Umlamli, Eastern Cape. Circumcision is associated with high morbidity and mortality. The need to reduce complications was identified as a priority by the local community. The aim was to design, implement and evaluate a project to improve the safety of traditional circumcision. Method: A safe circumcision team was established and comprised health workers, community leaders and traditional surgeons. Outcome mapping involved three stages: intentional design, outcome, and performance monitoring and evaluation. The eight boundary partners were the initiates, parents, community leaders, traditional surgeons, the District Health Services, the provincial Department of Health, the emergency services and the police. Outcomes, progress markers and strategies were designed for each boundary partner. The team kept an outcome and strategy journal and evaluated hospital admissions, genital amputations and mortality. Results: Ninety-two initiates were circumcised, with two admissions for minor complications, compared to 10 admissions, two amputations and two deaths previously. More than 70% of the outcome measures were achieved in all boundary partners, except emergency services and the Department of Health. The key aspects were: the use of outcome mapping, the participatory process, a lower age limit, closure of illegal schools, consolidation of accredited schools, training workshops for traditional surgeons, private treatment room for initiates, assistance with medical materials, pre-circumcision examination, certificates of fitness. Conclusion: This study has shown the value of community-orientated primary care initiatives to address local health problems. Key lessons were identified and the project could easily be replicated in communities facing similar challenges.http://www.safpj.co.za/index.php/safpj/article/view/1806Publisher's versio