EDITORIAL: Beyond the Millennium Development Goals deadline: what next?

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Ebola virus disease in West Africa: outbreak or epidemic?

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Editorial: Are there alternatives to the shortage of blood in South Africa?

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Editorial - Ebola in West Africa: a forgotten epidemic

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Perceptions of hospital managers regarding the impact of doctors' community service

Background In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service.Methods After ethical approval was obtained from the Research, Ethics and Publications Committee (REPC) of the Medical University of Southern Africa (now University of Limpopo – Medunsa Campus), three focus group interviews were conducted with hospital managers from three purposefully selected hospitals. The interviews were audio-visually taped and supplemented with field notes, transcribed verbatim, with themes identified using the ‘cut and paste' and ‘colour coding' methods. Combined themes were categorised and interpreted within the context of the study and the available literature.ResultsCS has improved health services delivery, alleviated work pressure, and improved the image of hospital managers. In addition, it has provided a constant supply of manpower, and increased the utilisation of health services by the community. The negative perceptions identified included a lack of experience and skills, poor relationships with the rural health team, lack of support structures for CS doctors, poor continuity of care and budgetary constraints. Conclusions Hospital managers perceive CS to have had a positive impact on the supply of needed manpower, health service delivery and patient care. As this was a qualitative study, further quantitative and community-oriented studies are required to validate the results.Keywords:Perceptions; hospital managers; impact; community service doctorsFor full text, click here:SA Fam Pract 2005;47(8):55-5

Cosmetic Surgery and the Practice of Medicine

In this post-modern world, there is a recognisable bent in the media to promote the idea of youth (read as synonymous with beauty and power) to the fullest. The result is that public perceptions of the normal bodily processes of aging are viewed as detrimental or unattractive. Since we are “social creatures”, as Aristotle put it, the mediasation, for example, in magazines, TV, film, fashion, music, etc. of youth as ideal is bound to impact upon our individual ideas of ‘what-is-good-for-me'. Since youth is viewed by society as a good, it is possible to understand an individual's desire to take advantage, when it is possible, of the cosmetic procedures that fortify this ideal. Moreover, since medical practitioners are part of the public, and no more or less swayed by such ideologies, it is also reasonable to assume that some will advantage themselves and take up the gauntlet of promoting youth, although perhaps in the more medical guise of ‘remedying the ills of aging' in other words, enter the practice of cosmetic surgery. South African Family Practice Vol. 50 (1) 2008: pp. 50-5

Measles elimination - Is it achievable? Lessons from an immunisation coverage survey

Objectives. To detennine routine measles coverage at district level and to explore reasons for immunisation failure in Mpumalanga Province, South Africa.Design. An adaptation of the World Health Organisation (WHO) Expanded Programme on Immunisation (EFl) cluster sampling method was used to make a random selection of 30 clusters in each of 21 health districts, 630 clusters in total. Seven individuals from the age group 12 - 23 months were randomly selected from each cluster and immunisation status and source were transcribed from their child health records. Where no immunisations were administered, reasons provided by parents or guardians were recorded.Setting. Mpumalanga Province, South Africa.Results. The weighted valid population coverage with measles vaccine for children aged 12 - 23 months in Mpumalanga Province was 71.1% (95% confidence interval 64.9 - 78.5%); this was the lowest of all EPI antigens. There was marked heterogeneity in measles coverage across the province, with a coefficientof variation of 22.2%. Districts with the lowest coverage shared borders with neighbouring provinces. District measles coverage was highly positively correlated with diphtheria, pertussis and tetanus (DPT3) coverage (r = 0.960, P = 0.000). There was a strong negative correlation between ranked measles campaign coverage and routine measles immunisation coverage. Obstacles to immunisation accounted· for nearly half (49%) of all reasons for immunisation failure, while lack of information and lack of motivation accounted for 30% and 22%, respectively.Conclusions. Survey results highlight the need for supplementary immunisation, including non-selective campaigns, if Mpumalanga is to achieve the South African goal of measles elimination by 2002. The value of determining district resolution coverage in order to identify areas with low measles coverage requiring supplementary intervention was also demonstrated. A strong negative correlation between routine and campaign coverage deserves further study in other settings

Rabies: an evidence-based approach to management

Human rabies in South Africa is largely due to infection with the classical rabies virus (genotype 1), with the yellow mongoose the commonest vector except in KwaZulu-Natal, Eastern Cape, Mpumalanga and now Limpopo provinces where the dog is predominantly responsible for most bites. Rabies is always fatal in humans but can be prevented by timeous administration of post exposure prophylaxis( PEP). This article discusses an evidence-based approach to rabies management in South Africa. South African Family Practice Vol. 49 (7) 2007: pp. 35-4

Eyes wide open: perceived exploitation and its consequences

Drawing on the array of literature on exploitation from several social science disciplines, we propose a new way of seeing employer-employee relationships by introducing the concept of perceived exploitative employee-organization relationships, distinguish it from related concepts, and conduct five studies to develop a scale and test our theoretical model of the effects of such employee perceptions. Contributing to the Employee-Organization Relationships and workplace emotions literatures, perceived exploitation is defined as employees’ perceptions that they have been purposefully taken advantage of in their relationship with the organization, to the benefit of the organization itself. We propose and find that such perceptions are associated with both outward-focused emotions of anger and hostility toward the organization and inward-focused ones of shame and guilt at remaining in an exploitative job. In two studies including construction workers and a time-lagged study of medical residents, we find that the emotions of anger and hostility partially mediate the effects of perceived exploitation on employee engagement, revenge against the organization, organizational commitment, and turnover intentions, whereas the emotions of shame and guilt partially mediate the effects of perceived exploitation on employee burnout, silence, and psychological withdrawal

Mastering your Fellowship, Vol 58, No 1 (2016)

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