A reflection on the polis for pigs - Socrates' true and healthy polis

Thesis (M.A. (Applied Ethics for Professionals))--University of the Witwatersrand, Faculty of Humanities, School of Social Sciences, 2015.Plato in his dialogue the Republic designs an ideal polis, the Kallipolis, seeking ‗justice, our good and the knowledge of the good required for understanding and bringing justice, happiness and good government into our lives and society‘ (Santas 2010, p.7). The first step in the Kallipolis‘ development is a polis without formal government whose citizens live a modest, stable, sustainable lifestyle. Disparaged by Glaucon as a polis for pigs, Socrates‘ incongruous rejoinder is ‗the true polis… is the one we‘ve described, the healthy one, as it were‘ (Rep. 372e). Contemporary commentators are critical of this polis, questioning its role in the Republic. In trying to understand the polis for pigs, and Socrates‘ praise thereof, I posit it is a village, and consider it has virtue, is good and its citizens are happy. However, despite being true and healthy, it is not the best or an ideal polis, but it is crucial to the development of the Kallipolis

Attaining human dignity for people with birth defects: A historical perspective

People with birth defects have been stigmatised, marginalised and discriminated against for millennia, diminishing their human dignity and abrogating their human rights. Beginning with the United Nations Universal Declaration of Human Rights, promulgated in 1947, the circumstances in which human dignity in healthcare for people with birth defects could be achieved arose, and this was accomplished over the next 65 years through the insight, hard work and dedication of a select group of people and organisations. In 2010 the World Health Organization prioritised services for the care and prevention of birth defects, particularly in middle- and low-income countries. Translating what has been achieved into human rights in healthcare for people with birth defects is the next objective.

Need for services for the care and prevention of congenital disorders in South Africa as the country’s epidemiological transition evolves

The lack of prioritisation of services for the care and prevention of congenital disorders is a global concern. Reducing child mortality (MDG4) can be achieved by middle- and some low-income nations, including South Africa (SA), by focusing on congenital disorders. We performed a situational analysis of epidemiological transition and services for congenital disorders in SA to highlight their renewed need, in the form of a review of epidemiological transition in SA from 1990 related to the HIV/AIDS epidemic and services for congenital disorders. In the early 1990s in SA decreasing infant and child mortality revealed the previously hidden burden of disease of congenital disorders. Approaches to confront this burden were developed and incorporated in national policy guidelines published in 2001. The emergent HIV epidemic buried the issue, and as services for HIV/AIDS developed, services for the care and prevention of congenital disorders were simultaneously neglected. They are now at a base lower than in 2001. Infant and child mortality rates are at a more advanced level than their previous best levels in the early 1990s, but they are stagnating. There is therefore a renewed need for services for the care and prevention of congenital disorders. The present limited state of these services must be rectified urgently. Services for the care and prevention of congenital disorders require prioritisation again in accordance with Resolution WHA63.17 of the World Health Organization, and to achieve the human dignity and constitutionally and legally enshrined rights of people affected by congenital disorders.

Delay and poor diagnosis of Down syndrome in KwaZulu-Natal, South Africa: A retrospective review of postnatal cytogenetic testing

Background. Down syndrome (DS) is the most common chromosomal disorder in newborns. Until 20 years ago DS was considered rare in black African children in South Africa (SA). Lack of awareness of DS on the part of medical staff in SA, and difficulty in diagnosing it, appear to persist.Objectives. To establish an epidemiological profile of DS and investigate the ability of clinicians in KwaZulu-Natal Province (KZN), SA, to make accurate clinical diagnoses of DS.Methods. Records at the South African National Blood Service cytogenetic laboratory in Pinetown, KZN, were examined for all tests for clinically suspected DS undertaken during January 2009 - December 2013 and all cytogenetically proven DS test results. Age at diagnosis, the hospital from where the test was sent and type of chromosomal pattern for each confirmed DS test result were recorded.Results. Of a total of 1 578 tests requested, 875 confirmed DS, indicating that clinicians correctly clinically diagnosed DS 55.4% of the time. The average age of cytogenetic diagnosis of DS was 1 year and 20 days. The minimum population prevalence of DS was 0.8/1 000.Conclusions. The diagnosis of DS is a challenge in KZN, potentiating missed opportunities for early intervention. The relatively low population prevalence of DS may be attributable to a lack of confirmatory cytogenetic tests or missed clinical diagnoses. It may also be attributable to a high mortality rate for children with DS in the province

Thyroid dysfunction in a cohort of South African children with Down syndrome

Background. While international studies show thyroid dysfunction occurs more commonly in individuals with Down syndrome (DS) than in the general population, there is a paucity of available data from sub-Saharan Africa.Objectives. To document the range of thyroid function in a cohort of South African children with DS, and to assess referral and treatment practices when thyroid dysfunction was present. Methods. A retrospective file-based study of 391 children with DS seen at the genetic clinics at three Johannesburg hospitals from 2003 to 2008. Thyroid function test (TFT) results (thyroid-stimulating hormone and free thyroxine) and demographic details were collected for each child. Endocrine clinic files from two of the hospitals were reviewed for additional referral and treatment information.Results. The majority (83.6%) of children had at least one TFT, in most cases performed between the ages of 2 and 12 months. The most common form of thyroid dysfunction was subclinical hypothyroidism (SCH) (28.7%). Up to one-third of the patients, including several neonates with abnormal results, were not referred for further evaluation and were therefore not receiving the necessary treatment. Inter- laboratory biochemical discrepancies and lack of population-specific reference ranges complicated the interpretation of results. The controversy surrounding whether, and how, to treat SCH influenced treatment practices. Conclusions. Thyroid dysfunction is prevalent in South African children with DS. There is an urgent need to address the laboratory biochemical discrepancies, and to establish guidelines for surveillance and treatment to prevent further irreversible neurological and physical impairment.