SA needs Cuban medical model

In July, 1,000 more South African medical students who have spent five years studying medicine in Cuba will return to complete their sixth year, graduate and start practising as doctors.

If I had my way, I would send them all to the Eastern Cape, train them for their final year and employ them in the province once they graduate.

These are precisely the kinds of doctors needed throughout the province and country, because Cuba's excellent medical schools pursue a comprehensive approach that focuses equally on the four pillars of medicine - disease prevention, health promotion, treatment and rehabilitative medicine.

The Cuban system produces well-rounded specialist family physicians who are appropriately trained for South Africans' medical and health needs. They are trained to practise in diverse communities, from the cities to the deep rural areas.

The system also produces super-specialists, such as Dr Khanyisa Makamba, who was among the first cohort of South Africans to be trained in Cuba and subsequently went on to specialise in urology in SA. He is now head of urology at the Port Elizabeth Provincial Hospital. He could practise anywhere in the world but he has a strong social commitment and he chooses to use his skills in his home province to help the many public sector patients who cannot afford private medical care.

SA can and should learn from Cuba, where 80% of medical practitioners are comprehensive or specialist family physicians and only 20% are specialists in other areas of medicine or are super-specialists. In SA it is the reverse, with many in private practice or emigrating.

Cuba has eight medical practitioners per 1,000 population, while most westernised countries have two to three per 1,000. SA has 0.77 per 1,000, with 50% of the 0.77 practising in the private sector.

SA sent medical students to Cuba in the first instance because the country is simply not producing enough doctors. The Department of Health looked at the number of doctors produced by universities and realised that producing fewer than 2,000 doctors per year was not matching the rapid population growth and these numbers could never reach a ratio of two doctors per 1,000 population. The department therefore increased the number of doctors by sending many more students than in previous years to study in Cuba from 2012, as per the Nelson Mandela-Fidel Castro Medical Collaboration.

There was much resistance from us as medical academics regarding sending students to Cuba. One of the major reasons for this is that training in SA is mainly suited for practice in the West, hence graduates are able to work internationally. What is not adequately addressed is whether they are trained to meet the health needs of the majority in SA. And what does the majority require?

In developing the curriculum for the country's newest medical school, Nelson Mandela University has taken great pains to address this question. What has informed its curriculum, which also informed Health Minister Aaron Motsoaledi's decision to have our students trained in Cuba, is the need for medical students to be trained in a comprehensive manner. That is, not only with a curative or treatment emphasis, which is the main approach in SA, but with an equal emphasis on health promotion, disease prevention, treatment and rehabilitative medicine.

As a paediatric cardiologist and health sciences academic, I was sceptical about this approach until I visited Cuba in 2017 and the penny dropped regarding the appropriateness of comprehensive medical training to SA's needs. The efficiency and professionalism of their system speaks for itself in Cuba's health statistics: life expectancy in Cuba for the population is superb at about 80 years, while SA's is about 60 years; infant mortality is two per 1,000, while SA's is 30-40 per 1,000.

How did they get it right? Through their comprehensive healthcare system, based on the four levels of care, everyone in the health system focuses on advancing health rather than only on treating disease.

Home-based care and local clinics are efficiently aligned to polyclinics, or what are called community health centres in SA. Every polyclinic has a section of complementary medicine - including acupuncture, homeopathy and traditional medicine - and each patient is advised on the relative merits.

Every polyclinic has as a basic minimum a comprehensive or specialist family physician-nurse team and a range of health professionals, as well as necessary equipment, including X-ray machines, certain laboratory facilities and ultrasound.

These are efficiently matched with secondary hospitals (district, regional and tertiary hospitals in SA) and national institutes that specialise in specific diseases, such as neurological diseases and oncology.

There are similarities between the structure of the Cuban public health system and SA's system, but there are also stark differences, notably in Cuba's far superior level of efficiency, professionalism, staffing, equipment and national emphasis on the four levels of care.

To cover all four levels, the entire health team plays a key role, starting at the community level where it is the role of community health workers to visit every individual in their area and to ensure that every individual goes for a medical check-up at least once a year, and to identify any health issues and why, for example, they have not gone to the clinic for their regular check-up.

The Cuban community health workers know each individual personally; one community health worker looks after about 50 people in his or her community, and they know every person's health status, disease status, medication, the names of the pills, and whether they are running out of medication. They educate the patients about their health, their disease condition and the medication they are taking.

They work with a team of health professionals, from doctors and physiotherapists to psychologists and dieticians to focus on all four levels of care.

In SA, with National Health Insurance in the wings, the country has to look at new health system models, such as Cuba's. While SA is well recognised for training world-class healthcare practitioners and it is important to maintain the country's high standards, it should also introduce new populationwide approaches to health. This includes increasing taxes on substances that can undermine health, such as tobacco, alcohol and sugar.

Cuba's health system model is working. The death rate in that country is seven per 1,000. Brazil implemented the Cuban system in the early 2000s and its death rate dropped from 9.5 per 1,000 to six per 1,000 in one year (from 2002 to 2003). It now has a better life rate than the UK and the US (nine deaths per 1,000). SA's death rate is 17 per 1,000, except for the 16% of its population on private medical aids, whose life expectancy is comparable to the West.

Cuba is spending about $500 per capita per year on health, while SA spends $1,000 per capita per year. The US spend is 3,000 per capita and other First World countries are spending $1,000-3,000.

In terms of GDP, most countries spend 10%-15% on health, with the US at 15%. SA spends 8% and only half of this is spent on the 84% of the population that is without private medical aid.

The private medical aid industry has a R160bn turnover per year in SA, and this is spent on only 16% of the population.

As a nation SA has to start looking after the health of the 84% of the population in far more comprehensive, holistic ways and the four pillar system is the best population-wide and budget spend approach.

SA should therefore embrace the medical students when they return from Cuba and ensure they get the best possible reintegration assistance into medical schools throughout SA.

There is so much more SA can do to improve population health, quality of life and length of life, and these students can help the country to achieve it.

  • Published in Cuba

South African Communists Award Cuban Doctors’ Internationalism

The brigade has been recognized often and has even earned a nomination for the Nobel Peace Prize in 2015.

Cuba’s Henry Reeve International Contingent of Doctors Specializing in Disasters and Serious Epidemics are being recognized once again: this time they have been honored by the South African Communist Party, SACP.

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The award was presented by Blade Nzimande, the Secretary General of the party, to Jorge Cuevas, a member of the Secretariat of the Central Committee of the Communist Party of Cuba, at the 14th SACP Congress in Johannesburg.

Cuevas said “In the name of the people of Cuba, we express our deep gratitude for this Special Recognition to Cuban doctors, particularly in the fight against Ebola in West Africa,” and added that the prize signifies a greater commitment by the Cuban people to global unity.

“Today we can say that Cuba's commitment to international solidarity is a fundamental part of the principles that have kept our Revolution and our socialism alive,” he continued.

“I am also convinced that the person who deserves this award is the principal doctor of the whole Cuban Revolution, Commander in Chief Fidel Castro,” he concluded.

The Henry Reeve Brigade was first created by the late revolutionary leader on Sept. 19, 2005.

Its first missions were in Guatemala and Pakistan, countries that faced the consequences of a devastating hurricane and earthquake, respectively.

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In May, the group was given the Dr. Lee Jong-wook Memorial Prize for Public Health from the World Health Organization, recognized particularly for its work in combatting the Ebola virus in Sierra Leone, Liberia and Guinea, where Cuba sent more than 250 workers when the crisis peaked in 2015.

For their work in the west African nations, the medics were also nominated for the Nobel Peace Prize in 2015.

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Allies Call for Zuma to Step Down

Former high commissioners, ministers and many respected anti-apartheid activists also told the media that the ANC should do "the honorable thing and recall the president."

Congress of South African Trade Unions' (Cosatu) Secretary General Bheki Ntshalintshali is calling for South African President Jacob Zuma to step down. The trades union executive member said Zuma is no longer the "right person" to lead the country.

RELATED: South Africa's Zuma Considers Stepping Down Early

The Cosatu is reportedly made up of 1.8 million members and is a key part of the governing alliance. It forms part of what is called the Tripartite Alliance along with the African National Congress (ANC) and the South African Communist Party (SACP). Ntshalintshali has managed to elicit the support of the anti-apartheid struggle veterans, who are urging the ANC to recall the president.

Pressure has been mounting against Zuma since his major cabinet reshuffle, which included the dismissal of highly respected Finance Minister Pravin Gordhan. Deputy President Cyril Ramaphosa chimed in, calling the sacking of Gordhan "totally unacceptable." The changes made to the cabinet has put a strain on the economy, leading to the country's credit rating being cut to junk status by S&P Global. Former South African President Kgalema Motlanthe also added that it is difficult for Zuma to command respect after the constitutional court found him in breach of the law.

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Ntshalintshali told a media briefing that the union's decision was triggered by Zuma's failure to consult it before making changes to his cabinet. He termed the president's leadership as "inattentive, negligent... and disruptive." He added that the organization was not concerned about Gordhan's sacking because he was, like his predecessors, "not a friend of the workers." Ntshalintshali also criticized the ratings agency S&P's decision to downgrade South Africa to junk status, saying the union views it as political interference.

Former high commissioners, ministers and many respected anti-apartheid activists also told the media that the ANC should do "the honorable thing and recall the president", especially after the party's integrity commission advised that he should resign.

Finance Minister Malusi Gigaba has been working to reassure South Africans about the state of the economy. He told the media that the downgrade to junk status was a setback, but that people should not be despondent. "I'm not saying it's easy to get out of a rating downgrade, yet I remain confident," he added. Gigaba said he plans to meet with ratings agencies Fitch and Moody's.

Zuma is due to step down in 2019 at the end of his second five-year term as president.

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South Africa's Zuma Considers Stepping Down Early

Zuma has the authority to hire and fire ministers such as Gordhan, but if senior party figures openly criticize him it would weaken his position.

Jacob Zuma is considering offering to step down next year, at least 12 months before his term as South African president ends, under a deal with opponents in his ruling party that would see Finance Minister Pravin Gordhan leave office now, two senior party sources said.

Zuma is due to be replaced as leader of the African National Congress at a party conference in December after serving his allocated two terms, but was expected to remain the country's president until elections in 2019.

The offer appears intended as a way out of an impasse over the country's leadership within the divided ANC, but may not be enough to satisfy opponents of Zuma, who want the president out early anyway and urgently want Gordhan to stay.

There is precedent for an ANC leader to leave the presidency early. Thabo Mbeki was removed by the ANC as South African president in 2008.

A split in the ANC deepened this week after Zuma ordered Gordhan to return from an investor roadshow in Britain, raising expectations of a cabinet reshuffle that markets fear will include Gordhan's removal.

"Zuma's early departure after December conference is on the table," one of the sources told Reuters. "He could be forcibly removed so it makes sense for him to go on his own terms."

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South African Anti-Apartheid Leader Ahmed Kathrada Dies

Ahmed Kathrada was sentenced to life imprisonment along with the Nelson Mandela; served 26 years and three months.

Ahmed "Uncle Kathy" Kathrada was hospitalised in Johannesburg earlier this month after surgery to relieve blood clotting in the brain. Earlier today, his foundation confirmed that the former colleague of late South African President Nelson Mandela had succumbed to post-surgical complications at the Donald Gordon Hospital in Johannesburg.

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Kathrada, who was a lifelong supporter of the African National Congress (ANC), Palestine and all things liberation-related, was sentenced to life imprisonment along with the Mandela. He was imprisoned for 26 years and three months – 18 of which were on the infamous Robben Island. He was then moved to Pollsmoor prison in 1982 before being released from jail on Oct. 15, 1989, at the age of 60.

The activist-turned-politician later served as parliamentary counselor in Mandela's first administration. "We are deeply saddened to learn this morning of the passing on of our dear friend and founding trustee, Ahmed Kathrada," wrote the Nelson Mandela Foundation on Twitter. "Hamba Kahle [farewell] Kathy."

Kathrada had dedicated his life to fighting the racial injustice of white-minority rule in South Africa. He was also one of the most senior ANC leaders to criticize President Jacob Zuma's presidency regarding allegations of government corruption and maladministration. “This is great loss to the ANC, the broader liberation movement and South Africa as a whole. Internationally, he was staunch in his support for the Palestinian struggle. "Kathy" was an inspiration to millions in different parts of the world,” Neeshan Balton director of the Ahmed Kathrada Foundation said.

RELATED: South Africa President Blasts Anti-Corruption Report as Unfair

Tourism minister and activist Derek Hanekom added that the passing of the “revolutionary mentor and dear friend” was a great lost. “Comrade Kathy was a gentle, humane and humble soul. He was a determined revolutionary, who gave his entire life to the liberation struggle in our country,” Hanekom shared.

Former Archbishop of Cape Town Reverend Desmond Tutu said in a short statement published on Facebook: "May Ahmed rest in peace and rise in glory. May he rejoice in many heavenly cups of hot chocolate with his old friends and comrades, Mandela, Sisulu, Mbeki, Motsoaledi and Mahlaba, among them."

Kathrada was born to immigrant Indian parents in the Schweizer-Reneke province of South Africa, just before the Great Depression, in 1929. He became involved in politics at the tender age of 12 when he distributed leaflets for the Young Communist League of South Africa.

He was married to fellow anti-apartheid activist Barbara Hogan, who served 10 years in jail for high treason against the apartheid government.

  • Published in World

Cuba, South Africa Ratify Excellent Level of Relations

Cuba and South Africa have reaffirmed here their strong ties of friendship and the excellent level of bilateral and multilateral cooperation, at the end of the official visit today by Council of State vice president, Salvador Valdes Mesa.

Valdes Mesa, who is also a member of the Political Bureau of the Cuban Communist Party, arrived in the African nation on Tuesday, January 31st, in his first visit to South Africa, and held meetings at the highest level with leaders of the government, the African National Congress (ANC) and other political organizations that comprise the triple alliance.

Valdes Mesa and his peer and host, South African Vice President, Cyril Ramaphosa, held official talks yesterday. In a subsequent joint statement to the press, the Cuban vice president highlighted the appreciation for the warm welcome in this brother town and highlighted some aspects of the historical ties between both nations, as well as the course of cooperation, which is currently extended and expanded to several sectors.

South Africa and Cuba enjoy a very special relationship not only in the political, because of the contribution of the Caribbean country during the anti-apartheid phase, but also in the social sphere, especially in health, Ramaphosa stressed.

Prior to the meeting, the Cuban leader was received by President, Jacob Zuma, who wished him a fruitful stay.

Zuma testified Valdés Mesa's participation in the recently concluded 28th African Union Summit, held in Addis Ababa, Ethiopia, to which Cuba attended as a guest country.

Valdes Mesa's agenda -which ends today when traveling to Maputo, Mozambique- included a tour of the Beki Mlangeni Hospital, where he exchanged with workers and patients from that facility. This health institution was opened in April 2015 in the popular residential area of Soweto.

Upon his arrival to the hospital, accompanied by his delegation and ambassador to Pretoria, Carlos Fernandez de Cossio, the visitor was welcomed by Deputy Health Minister, Joe Phaahla, administrative staff, the Cuban Medical Mission leadership and some collaborators.

Phaahla expressed gratitude for the presence of physicians, whose work he described as 'excellent' and worthy of mention, because they go where they are most needed, 'where health services are deficient,' he said.

The Council of State vice president paid a tribute yesterday to late ANC leader, Oliver Tambo, in the context of his 100th death anniversary this year.

  • Published in Now

South African Girl, Africa's Youngest Writer

Pretoria, Oct 13 (Prensa Latina) A South African girl, Michelle Nkamankeng, at seven years old, has become Africa's youngest author and has been added to the list of the 10 best young writers in the world, after publishing her book ''Waiting for the Waves''.

Nkamankeng, a second grader at a school in Johannesburg, has generated media attention after the publication of the book based on 'her life experience'.

Interviewed by local media, she gave quick, communicative answers and confessed that her 'book tries to overcome the fear of something that really happened to me'.

Paul Nkamankeng, her father, recently told reporters that he had no idea that Michelle was writing a book. 'The only thing we noticed, when she was about four or five years, is that she loved to read.'

'When we took her to the beach for the first time she asked me why everyone was looking at the ocean, and then I told her they were waiting for the waves.'

Waiting for the waves is the first of a four part series, explained Paul, who added that he fears the effect fame may have on his daughter's studies or her life as a growing child.

He said that his daughter was dedicated to women's basketball, ballet, gymnastics, swimming and was true music lover. 'We do not want that part of her life to change,' he concluded.

  • Published in Culture

How Will the ANC Fare in Key Local Elections in South Africa?

As polls open the traditionally popular ANC is expected to be put to the test.

Polls opened Wednesday for South Africa's municipal elections, with the ruling African National Congress expected to come under pressure in a vote that is seen as a preview of the 2019 general elections.

There are still millions of people who have a strong loyalty to the ANC, which led the liberation struggle for decades before winning the fight against apartheid and leading the country to its first democratic elections in 1994, electing Nelson Mandela as its first Black president.

Twenty-two years later, South Africa continues to be haunted by economic and racial issues from its past white-minority rule. Many still demand justice and restitution for the years of Black exploitation and oppression.

The Democratic Alliance, the main opposition to the ANC, with a mostly white liberal base, is expected to win a number of important municipal seats.

The Economic Freedom Fighters party, that apeals to young Black militants, is expected to poll well under the leadership of Julius Malema, a former ally of Zuma and expelled leader of the ANC youth wing.

Around 55 percent of the working-age population in South Africa is made up of those between the ages of 15 and 34. However, similar to previous elections, one of the issues will be whether the youth turn out to vote.

Municipal elections are held every five years across 283 local municipal councils. Municipal councils govern services such as electricity, sanitation and water.

There have been continued concerns in South Africa regarding housing, inequality and education, with a number of protests taking place demanding changes in these areas. Many demand land and wealth redistribution to combat the fact that wealth in the country is still predominately controlled by the minority white population.

Along with corruption, the economy has been one of the main issues during the elections with economic growth expected to slow. Many are concerned about the lack of jobs, with a quarter of South Africans being unemployed.

  • Published in World
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