de Bruin, G

Janeke, J B

South African Medical Journal (SAMJ)

August 2005, Vol. 95, No. 8  SAMJBRIEWE544patients, but the findings published in 2001 emphasised theimportance of professional accountability at all levels of anysystem that provides health care.2,3 As long as doctors, nursesand hospital managers are human (and long may they continueto be so), the eternal risk of human error will prevail, and thechallenge will be to constantly examine, modify and sometimeseven re-invent medical practice and behaviour, so as tocompensate for the inherent risks that threaten everyinteraction between provider and patient.  If we instead opt forscapegoats, we will never achieve true accountability.  If wehide our heads in the sand, the litigators and the HPCSA willboth draw a bead on our butts, and relish kicking them blackand blue.The SAMA chairman's words may well be what theAssociation's members want to hear.  But tough love in theform of accepting medical fallibility, and providing clear,meaningful guidance towards individual and collectiveaccountability, may be far more effective in the long term ifSAMA truly wishes to keep the medico-legal demons at bay.David BassMedical AdvisorDepartment of HealthProvincial Government, Western CapePO Box 2060Cape Town80001. Reason J.  Human error: models and management.  BMJ 2000; 320: 768-770. 2. Bristol Royal Infirmary Inquiry. Learning from Bristol: The Report of the Public Inquiry IntoChildren's Heart Surgery at the Bristol Royal Infirmary 1984 - 1995. London: HMSO, 2001.3. Coulter A.  After Bristol: putting patients at the centre.  BMJ 2002; 324: 648-651.Holy Communion – chalice orchallicles?To the Editor: Holy Communion is practised globally as asymbol of holy communication with one’s maker.  In manycongregations a communal chalice is used to servewine/water/juice to partipants.  In other congregations achoice exists between a chalice and a challicle (small individualglass).As we enter the age of immune-deficiency diseases we needto be aware that certain diseases may be transferred via lipsputum, with far-reaching consequences to immune-compromised patients such as those with diabetes, cancerpatients on chemotherapy, HIV patients or those who are illand debilitated. Transferable diseases include: (i) herpessimplex (winter sore); (ii) herpes zoster (shingles); (iii)diarrhoea (viral); (iv) cholera; (v) Salmonella (typhoiddiarrhoea); (vi) Shigella (dysentery); (vii) hepatitis A (infectivejaundice); (viii) flu and other respiratory (lung) viruses; (ix)viral encephalitis; (x) bacterial meningitis; (xi) Streptococcusgroup A (sore throat); (xii) Staphylococcus aureus (diarrhoea andfood poisoning); and (xiii) TB (sputum transfer – all organsmay be infected).A sputum-contaminated chalice requires medical sterilisationin an autoclave to eradicate the possibility of disease transfer.If individuals feel strongly that they should use the commonchalice, they should be made aware of the above possibilities.The church has a moral and ethical obligation to informparticipants of the potential risks involved in using thecommunal chalice.To be on the safe side, an individual challicle should be usedby each participant.J B JanekeG de BruinMulbarton Clinic JohannesburgErratumIn the Childhood Atopic Eczema Consensus Document (part 2,June SAMJ), there was an error on p. 439 (first line, right-handcolumn).  Trials have shown that pimecrolimus can be usedsafely in infants as young as 3 months of age (not 3 years asstated).The corresponding author has however pointed out thatpimecrolimus is only approved by the Medicines ControlCouncil for use from 2 years of age.539-544 pgs tib  7/27/05  12:01 PM  Page 544

Holy communion - chalice or challicles?

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Holy communion - chalice or challicles?

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