Access to healthcare by undocumented Zimbabwean migrants in post-apartheid South Africa.

BACKGROUND:  Zimbabwean undocumented migrants rely on the South African public health care system for treatment of non-communicable and communicable diseases, surgery and medical emergency services. A gap remains to understand undocumented migrant experiences at a time when accessing public healthcare has been topical in South Africa. AIM:  This article aimed to describe and understand the experiences, challenges and health-seeking alternatives of undocumented Zimbabwean migrants in accessing healthcare services in Nellmapius in Pretoria. SETTING:  The study was conducted at Nellmapius in Pretoria. METHODS:  A qualitative descriptive research design was used. Structured interviews with 13 undocumented migrants were conducted by applying purposive and snowballing sampling techniques. The data were thematically analysed. RESULTS:  Migrants reported that the attitudes by healthcare officials suggest unwillingness to provide services to undocumented migrants, aggravating their vulnerability and perennial illness. Migrants faced challenges of discrimination, a lack of professional service delivery, a lack of financial capacity to pay for services and a lack of documentation evoking health-seeking alternatives. CONCLUSION:  Migrants continue to face challenges while accessing subsidised health care. This study confirms that medical xenophobia is generally present in the public health care centres, at least for the sampled undocumented Zimbabwean migrants. The majority of undocumented migrants cannot afford to pay for private healthcare.Contribution: The findings of this study inform national, provincial and local healthcare facilities to be ethical and provide dignified quality healthcare to undocumented migrants in line with international practices.

Race, Kidney Transplants, Immunosuppression Research, and White Supremacy under Apartheid, 1960-80.

This paper uses the history of kidney transplantation in South Africa as a lens through which to write a racialized, micro history that illustrates the politics of medical discoveries and medical research at one of South Africa's most prestigious medical research universities, the University of the Witwatersrand (Wits) in Johannesburg. Between 1966 and the 1980s, the Wits team became the most advanced and prolific kidney transplant unit in the country. Yet the racist, oppressive Apartheid system fundamentally shaped these developments. Transplantation, as this paper shows, became an elite medical procedure, performed by a select group of white doctors on mostly white patients. For these doctors, transplantation showed their medical prowess and displayed the technical advancements they were able to make in research and clinical practice as they strove to position South Africa as a significant international player in medical research, despite academic boycotts and increasing sanctions. Transplantation became a symbol of white supremacy in a country where the black majority were excluded from anything but the most basic health care.

Burden of disease in South Africa: Protracted transitions driven by social pathologies.

For several decades, researchers from the South African Medical Research Council have made invaluable contributions towards improving the health of the population through the analysis and interpretation of cause of death data. This article reflects the mortality trends in pre-and post-apartheid South Africa (SA), and describes efforts to improve vital statistics, innovations to fill data gaps, and studies to estimate the burden of disease after adjusting for data deficiencies. The profound impact of HIV/AIDS, particularly among black African children and young adults, is striking, within a protracted epidemiological transition and the current reversals of multiple epidemics. Over the next 20 years, it will be important to sustain and enhance the country's capacity to collect, analyse and utilise cause of death data. SA needs to support development in the region, harnessing new data platforms and approaches such as including verbal autopsy tools in the official system and improving data linkage.

The evolution of non-communicable diseases policies in post-apartheid South Africa.

BACKGROUND: Redressing structural inequality within the South African society in the post-apartheid era became the central focus of the democratic government. Policies on social and economic transformation were guided by the government's blueprint, the Reconstruction and Development Programme. The purpose of this paper is to trace the evolution of non-communicable disease (NCD) policies in South Africa and the extent to which the multi-sectoral approach was utilised, while explicating the underlying rationale for "best buy" interventions adopted to reduce and control NCDs in South Africa. The paper critically engages with the political and ideological factors that influenced design of particular NCD policies. METHODS: Through a case study design, policies targeting specific NCD risk factors (tobacco smoking, unhealthy diets, harmful use of alcohol and physical inactivity) were assessed. This involved reviewing documents and interviewing 44 key informants (2014-2016) from the health and non-health sectors. Thematic analysis was used to draw out the key themes that emerged from the key informant interviews and the documents reviewed. RESULTS: South Africa had comprehensive policies covering all the major NCD risk factors starting from the early 1990's, long before the global drive to tackle NCDs. The plethora of NCD policies is attributable to the political climate in post-apartheid South Africa that set a different trajectory for the state that was mandated to tackle entrenched inequalities. However, there has been an increase in prevalence of NCD risk factors within the general population. About 60% of women and 30% of men are overweight or obese. While a multi-sectoral approach is part of public policy discourse, its application in the implementation of NCD policies and programmes is a challenge. CONCLUSIONS: NCD prevalence remains high in South Africa. There is need to adopt the multi-sectoral approach in the implementation of NCD policies and programmes.

¿Existe el apartheid en la ciencia moderna? / Is there apartheid in modern science?

Hace dos años lancé una pregunta en la plataforma ResearchGate. ¿Existe el apartheid en la ciencia moderna? Curiosamente hubo solamente dos respuestas bastante ambiguas, aparte de un mensaje privado incriminándome que me enviaron y que me aguó una celebración de fin de año. Cada cual interpreta los hechos de manera diferente, y mi manera de interpretar la reacción a aquella pregunta es que, lejos de no interesarle a nadie, el tema es tan delicado que pocos se atreven a abordarlo. Lo que planteara en aquel momento como una pregunta, para mí aún no ha encontrado respuesta. Al parecer, en una amplia porción de la llamada comunidad científica sí existe el apartheid. Fuera de las revistas cubanas y un número muy limitado de publicaciones, si no se pagan cifras que oscilan entre 300 USD y 2000 USD, es imposible publicar un artículo en una revista de alto impacto. Con las demandas de calidad editorial actuales, los que pueden pagar, encontrarán un corrector editorial que hará el servicio por algo así como 100 USD. Por otra parte, no nos llamemos a engaño: las mejores publicaciones en cuanto a originalidad, calidad y capacidad para brindar nuevas ideas, enfoques y conocimientos, están precisamente en las llamadas revistas de alto impacto, salvo excepciones, por supuesto. Al mismo tiempo, en esas revistas no es infrecuente encontrar trabajos que no sé si serían aceptados en la más humilde de nuestras revistas. A modo de ejemplo, la revista prestigiosa New England Journal of Medicine publicó un trabajo en 2012 donde se analiza la correlación entre consumo de chocolate y la cantidad de premios Nobel de cada...(AU)

[«I stole with my eyes¼: Hamilton Naki, a pioneer in heart transplantation]. / «I stole with my eyes¼: Hamilton Naki, pionero en el trasplante de corazón.

On December 2, 1967, when Denise Darvall was hit by a car, a surgery that made medical history was unfold: Hamilton Naki, a black man, expertly removed her heart and gave it to Christian Barnard, who was preparing the receptor, Louis Washkansky, in an adjacent operating room. Naki's contribution was an outlaw act, a criminal offense under the laws of apartheid due to the difference of races; the law forbade him to cut white meat or touch white blood. Naki was perhaps the second most important man in the team that day. There were few photographs where he and Barnard appeared together, but because of the nature of society was Barnard who won the world's attention.

South Africa's universal health coverage reforms in the post-apartheid period.

In 2011, the South African government published a Green Paper outlining proposals for a single-payer National Health Insurance arrangement as a means to achieve universal health coverage (UHC), followed by a White Paper in 2015. This follows over two decades of health reform proposals and reforms aimed at deepening UHC. The most recent reform departure aims to address pooling and purchasing weaknesses in the health system by internalising both functions within a single scheme. This contrasts with the post-apartheid period from 1994 to 2008 where pooling weaknesses were to be addressed using pooling schemes, in the form of government subsidies and risk-equalisation arrangements, external to the public and private purchasers. This article reviews both reform paths and attempts to reconcile what may appear to be very different approaches. The scale of the more recent set of proposals requires a very long reform path because in the mid-term (the next 25 years) no single scheme will be able to raise sufficient revenue to provide a universal package for the entire population. In the interim, reforms that maintain and improve existing forms of coverage are required. The earlier reform framework (1994-2008) largely addressed this concern while leaving open the final form of the system. Both reform approaches are therefore compatible: the earlier reforms addressed medium- to long-term coverage concerns, while the more recent define the long-term institutional goal.