Rising to the challenge: Training the next generation of clinician scientists for South Africa

Background. A shortage of clinician scientists globally, particularly in the developing world, including Africa and South Africa (SA), is well known and was recently highlighted in a consensus report by the Academy of Science of South Africa. There is a need to find innovative ways to develop and advance clinician scientists in SA. Objective. To provide opportunities for young clinicians to develop research skills through enrolling for a PhD. Method. To address this need in SA, we developed an innovative programme over 2 years in collaboration with the Carnegie Corporation of New York to support and train young specialist clinicians in research as the next generation of clinician scientists, through a full-time PhD programme. Results. Since initiation of the programme in March 2011, 16 such specialists have been enrolled at intervals in the Fellowship programme, 5 have qualified with PhDs, while a further 3 are expected to qualify shortly. Publications and presentations at congresses have been recorded as well as grant applications. Discussion. Although the programme is seen as an important initial step in addressing the shortage of clinician scientists, its dependence on donor funding and the lack of a secure career path for clinicians wishing to spend more of their career in research pose problems for the programme’s sustainability. It is hoped that the positive outcomes of this experience will initiate further programmes of this kind at academic institutions and attract the attention of funders and universities in order to sustain and enlarge this initiative

The public’s attitude towards strike action by healthcare workers and health services in South Africa

Objectives. To evaluate a representative group of South Africans for their views about healthcare worker strikes and related matters.Methods. A descriptive, cross-sectional, self-administered  questionnaire-based study of 600 participants over the age of 18 years and able to read English, from two representative shopping malls (300 from each mall) in Greater Johannesburg. Data were analysed using SAS software version 9.1.3 for Windows. Tests for significant relationships were carried out using Pearson’s χ2 test at the 0.05 confidence level. The strength of the associations was determined by Cramer’s V.Results. Results revealed strong opinions among the population regarding strikes, numerous misapprehensions when it comes to striking and rights, a poor awareness of other healthcare-related rights and the perception of poor treatment at public hospitals.Conclusions. A majority of South Africans are aware of the healthcare worker strikes and are dissatisfied with the manner in which these take place, with strong objections to the perceived neglect of the critically ill during strikes, compounded by poor treatment at public hospitals. Many South Africans lack awareness of human rights issues, a situation which requires urgent remedy

Decreased sexual risk behaviour after the diagnosis of HIV and initiation of antiretroviral treatment - a study of patients in Johannesburg

Objectives. An extended programme for free antiretroviral treatment (ART) of HIV was launched in South Africa in April 2004. It is essential to assess the effects on sexual risk behaviour. Design and setting. A questionnaire was distributed to patients on ART at Helen Joseph Hospital, Johannesburg, between 17 January and 22 February 2005. Results. The percentage of men who had sexual contacts outside their relationship decreased from 48% before HIV diagnosis to 11% after starting ART. Condom use with casual partners increased from 53% among the men and 46% among the women before the diagnosis of HIV to 87% and 81% respectively on ART. The majority of patients were tested for HIV because they presented with symptoms of illness. We noted no significant difference in disclosure rate after the start of ART. All participants were positive about the treatment and felt physically better. The majority of the patients experienced a better quality of life. Conclusions. The ART had an overall positive effect on health with no increase of sexual risk behaviour. Southern African Journal of HIV Medicine Vol. 7 (4) 2006: pp. 12-1

South African Hypertension Guideline 2006

Outcomes. Extensive data from many randomised controlled trials have shown the benefit of treating hypertension. The target blood pressure (BP) for antihypertensive management should be systolic BP < 140 mmHg, diastolic BP < 90 mmHg, with minimal or no drug side-effects. However, a lesser reduction will elicit benefit although this is not optimal. The reduction of BP in the elderly should generally be achieved gradually over 6 months. Stricter BP control is required for patients with end-organ damage, co-existing risk factors and co-morbidity, e.g. diabetes mellitus. Co-existent risk factors should also be controlled. Benefits. Reduction in risk of stroke, cardiac failure, renal insufficiency and coronary artery disease. The major precautions and contraindications to each antihypertensive drug recommended are listed. Recommendations. Correct BP measurement procedure is described. Evaluation of cardiovascular risk factors and recommendations for antihypertensive therapy are stipulated. The total cardiovascular disease risk profile should be determined for all patients and this should inform management strategies. Lifestyle modification and patient education are cornerstones in the management of every patient. Drug therapy for the patient with uncomplicated hypertension should be as follows: first line – low-dose thiazide or thiazide-like diuretics; second line – add either an angiotensin-converting enzyme inhibitor (ACE-I) or a calcium channel blocker (CCB); third line – add another second-line drug not already used. In resistant hypertension where a fourth drug is needed, use either a centrally acting drug, vasodilator, alpha-blocker, or beta-blocker. The order of drug choice may change in those with compelling indications for a particular drug class. The guideline includes management of specific situations including hypertensive emergency and urgency, severe hypertension with target-organ damage and hypertension in diabetes mellitus, etc. Validity. The guideline was developed by a joint Southern African Hypertension Society and National Department of Health Directorate: Chronic Diseases, Disabilities and Geriatrics working group. Input was also obtained from representatives of the various related professional societies

CPD Editorial: South African Hypertension Society Guidelines 2006

The SAHS guideline 2006, is the first joint effort between the Department of Health and the SAHS. This would ensure that there is an agreed upon, uniform, national approach in the treatment of hypertension. This will hopefully reduce the impact of hypertension and cardiovascular disease in Southern Africa. South African Family Practice Vol. 49 (2) 2007: pp. 18-1

Rising to the challenge: Training the next generation of clinician scientists for South Africa

Background. A shortage of clinician scientists globally, particularly in the developing world, including Africa and South Africa (SA), is well known and was recently highlighted in a consensus report by the Academy of Science of South Africa. There is a need to find innovative ways to develop and advance clinician scientists in SA. Objective. To provide opportunities for young clinicians to develop research skills through enrolling for a PhD. Method. To address this need in SA, we developed an innovative programme over 2 years in collaboration with the Carnegie Corporation of New York to support and train young specialist clinicians in research as the next generation of clinician scientists, through a full-time PhD programme. Results. Since initiation of the programme in March 2011, 16 such specialists have been enrolled at intervals in the Fellowship programme, 5 have qualified with PhDs, while a further 3 are expected to qualify shortly. Publications and presentations at congresses have been recorded as well as grant applications. Discussion. Although the programme is seen as an important initial step in addressing the shortage of clinician scientists, its dependence on donor funding and the lack of a secure career path for clinicians wishing to spend more of their career in research pose problems for the programme’s sustainability. It is hoped that the positive outcomes of this experience will initiate further programmes of this kind at academic institutions and attract the attention of funders and universities in order to sustain and enlarge this initiative

Malignant hypertension and its renal complications in black South Africans

Malignant hypertension is an important cause of morbidity and mortality among urban black South Africans. Hypertension accounts for 15,9% of all patients and for 34,6% of blacks receiving treatment for end-stage renal failure. Malignant hypertension is more commonly diagnosed than benign hypertension and two-thirds of patients present in the age group 30 - 49 years. Together they are the most common preventable cause of end-stage renal failure in this  country. Acute partially reversible renal failure occurs in 20% of patients with malignant hypertension who require dialysis. This is an important subgroup, who may be recognised by their younger age, female preponderance and fulminant presentation. Short-term peritoneal dialysis and effective control of blood pressure will result in satisfactory return of renal function. However, only adequate country-wide control of hypertension will prevent these costly renal complications.S Afr Med J 1989: 76: 164-16