INSIDER - National Council elects new leadership Communication the best medicine against patient complaints - SAMA Insider
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INSIDER
SAMA
DECEMBER/JANUARY 2019
National Council
elects new leadership
Communication the best
medicine against patient
complaints
PUBLISHED AS A SERVICE TO ALL MEMBERS OF SOUTH AFRICAN
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CONTENTS
DECEMBER/JANUARY 2019
Source: Shutterstock: MaximP
3 EDITOR’S NOTE 13 As long as you breathe, you are at risk
A new year, new leadership MDR-TB: My story
Diane de Kock Dr Zolelwa Sifumba
4 FEATURES 15 HPCSA complaints process:
SAMA’s National Council What to expect
elects new leadership Hanneke Verwey
Yolande Lemmer
16 Malnutrition in 2018: An opinion
5 Introducing Hoosen Coovadia, Dr Freddy Kgongwana
SAMA president
SAMA Communications Department 17 2019 MDCM products
SAMA Private Practice Department
6 Attending the Presidential Health
Summit 18 LETTERS TO THE EDITOR
Selaelo Mametja Complaint against Resolution Health
medical scheme
7 Meet the SA Academy of Dr W R Bezwoda
Family Physicians
Prof. Bob Mash 18 SAMA response: Complaint against
Resolution Health medical scheme
8 Communication the best medicine Shelley McGee
against patient complaints – experts
SAMA Communications Department 20 MEDICINE AND THE LAW
9 S olving youth unemployment –
we can all play a role
Complications of long-term
nitrofurantoin
Medical Protection Society
Tiyani Armstrong
20 Obituary: Dr Timothy Ndaki
11 Obituary: Dr Ivan Berkowitz SAMA Communications Department
SAMA Communications Department
21 BRANCH NEWS
12 Collective bargaining –
the numbers game
Simon Madini
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Offers SAMA members a 20% discount on motor and household insurance
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Automobile Associa>on of South Africa (AA)
AA Customer Care Centre
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The AA offers a 12.5% discount to SAMA members on the
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APLS
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021 406 6733 | cindy.maree@uct.ac.za | www.apls.co.za
APLS offers SAMA members a 10% discount on the 2-day Advanced
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Barloworld Retail Digital Channels offers compeRRve pricing on New vehicles;
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BMW
Melissa van Wyk : Corporate Sales Manager
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SAMA members qualify for a minimum of 8% discount on selected
BMW & MINI models. All Members also receive compeRRve
pricing on Lifestyle items and accessories.
DLT Magazines
Tracey Hack : General Manager
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DLT Magazines offers medical pracRces current consumer magazines
for their paRents, to keep them relaxed and occupied while that wait
for their service. We work with premium consumer Rtles from all
major publishers in South Africa. SAMA members qualify for a 10%
discount off any of our current custom and or preselect magazine
packs. We also offer magazine racks at 50% discount for SAMA
Members.
Ford/Kia Centurion
Burger Genis : New Vehicle Sales Manager – Ford Centurion
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selected Ford and Kia vehicles sourced from Lazarus Ford / Kia Centurion.
SAMA members who own a Ford/Kia vehicle also qualify for preferenRal
servicing arrangements. We will structure a transacRon to suit your needs.
Hertz Rent a Car
Lorick Barlow
072 308 8516 | lorick@hertz.co.za
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range of value-add product and service opRons also available. No cost to
register as a Gold Plus Rewards member to enjoy a host of exclusive benefits.
18/11/19
EDITOR’S NOTE DEC/JAN 2019
A new year, new leadership
T
he end of a year often marks a time of reflection, and as we put to bed the last
issue of Insider for 2018, once again a year of change and huge challenges, SAMA
welcomes a new era of leadership to guide and unify the association in 2019.
On page 4, we report on the recent national council meeting held at the end
of October, where a new chairperson and vice-chairperson were elected, and
Dr Richard Tuft was voted president-elect for 2019 - 2020. New SAMA president,
Prof. Hoosen Coovadia, is briefly introduced to readers on page 5 – we look forward
to his presidential messages in 2019.
Selaelo Mametja and a delegation of doctors attended the Presidential Health
Summit in October (page 6), a meeting which “aimed to address the numerous
challenges facing the SA health system, and to work towards strengthening the health
Diane de Kock system, to provide universal access to quality health services”.
Editor: SAMA INSIDER We introduce the SA Academy of Family Physicians on page 7, a professional body
affiliated to SAMA, and officially represented by Prof. Shadrick Mazaza on the National
Council and the Specialist Private Practice Committee.
The Ethics for All conference is covered on pages 8 and 9, a flagship conference
for the Medical Protection Society (MPS) in SA, which protects and supports the
professional interests of more than 30 000 healthcare professionals. More than 2 000
people attended the conferences in Cape Town, Durban and Pretoria.
The realities of an internship in SA are highlighted in Dr Zolelwa Sifumba’s article
on page 13, who says: “I went from student to patient to survivor to activist, and there
was nothing easy about this journey.”
Hanneke Verwey’s article on page 15 will “assist practitioners in understanding
what to expect, procedurally, once a complaint has been lodged against them with
the HPCSA”.
The power of communication is illustrated on our letters page (page 18), where
the SAMA Knowledge Management and Research Department ably address a series
of letters from a reader.
One of the key ingredients of good leadership is communication – this is your
magazine; let’s communicate.
Editor: Diane de Kock Senior Designer: Clinton Griffin
Chief Operating Officer: Diane Smith
Copyeditor: Kirsten Morreira Published by the Health and Medical Publishing Group (Pty) Ltd
Block F, Castle Walk Corporate Park, Nossob Street
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Email: dianes@hmpg.co.za Printed by Tandym Print (Pty) Ltd
Opinions and statements, of whatever nature, are published in SAMA Insider under the authority of the submitting author, and should not be taken to present the official
policy of the South African Medical Association (SAMA) unless an express statement accompanies the item in question.
The publication of advertisements promoting materials or services does not imply an endorsement by SAMA, unless such endorsement has been granted. SAMA does not
guarantee any claims made for products by their manufacturers. SAMA accepts no responsibility for any advertisement or inserts that are published and inserted into SAMA
Insider. All advertisements and inserts are published on behalf of and paid for by advertisers.
LEGAL ADVICE
The information contained in SAMA Insider is for informational purposes and does not constitute legal advice or give rise to any legal relationship between SAMA and the receiver
of the information, and should not be acted upon until confirmed by a legal specialist.
FEATURES
SAMA’s National Council elects new leadership
Yolande Lemmer, SAMA Governance and Legal Department
S
AMA’s elective National Council meeting
Board member Position
took place over a period of 3 days at the
Dr A Coetzee Chairperson: SAMA
Southern Sun OR Tambo Hotel, from 26
Dr M Mzukwa Vice-chairperson: SAMA
to 28 October 2018.
Dr M van der Schyff Chairperson: Specialist Private Practice Committee
The first day of the meeting (commencing
Dr M N Mabasa Chairperson: General Practitioner Private Practice Committee
at 13h00 on Friday) was dedicated to SAMA
Dr L M B Majake Chairperson: Audit and Risk Committee
branch matters. Branch chairpersons
Dr C S Sihlangu Chairperson: Constitutional Matters Committee
and representatives from branches each
Prof. M Naidoo Chairperson: Education, Science and Technology Committee
provided a report on their branch activities
Dr S Toni Chairperson: Health Policy Committee
since the branch chairpersons forum
Dr M C Human Chairperson: Human Rights, Law and Ethics Committee
in May 2017. SAMA’s general manager,
Dr T O Sadiki Chairperson: Social and Ethics Committee
Dr Manny Thandrayen, presented on relevant
Dr M Nodikida Chairperson: Finance Committee
topics that carried over from the previous
national council meeting in 2016, as well as
some items that the branches had forwarded
before the meeting for specific discussion
there. These included, among others,
“geomapping” (the possible changing of
branch borders to align with health districts,
and the effect that this would have on the
membership of certain branches), branch
finances and SAMA’s progress in its efforts
to have an independent Medical and Dental
Council established.
Dr Thandrayen reported that SAMA has
commissioned an in-depth study to ascertain
the exact role and function of clinical
associates within the healthcare sector, and
that the organisation is actively pursuing
inter ventions insofar as safe working
conditions for doctors were concerned.
On the second day of the meeting, a
new chairperson, vice-chairperson and Dynamic leader Dr Angelique Coetzee, from Gauteng, was elected as SAMA’s new chairperson
president-elect were elected. SAMA is
proud to announce that Dr Angelique
Coetzee, from Gauteng, was elected as
its new chairperson, and is confident that
SAMA will make positive strides to continue
its major role in the health environment
under her dynamic leadership.
Dr Mvuyisi Mzukwa, from KwaZulu-Natal,
was elected as vice-chairperson. SAMA
would like to congratulate these leaders on
their new positions, and is looking forward to
gaining from their experience, wisdom and
innovative thinking in future.
The last day of the meeting saw the
new chairpersons and members of SAMA’s
committees elected. Following the elections
of the chairpersons, the new SAMA board SAMA’s new leadership, from left to right: Dr R E Ngwenya (convenor of the task team constituted to
was officially announced. investigate and implement a fully functional trade union), Dr M C Human, Prof. M Naidoo, Dr M N
The board comprises the following Mabasa, Dr M van der Schyff, Dr M Nodikida, Dr L M B Majake, Dr C S Sihlangu, Dr M Mzukwa (vice-
members: chairperson), Dr A Coetzee (chairperson), Dr T O Sadiki, Dr S Toni.
4 DECEMBER/JANUARY 2019 SAMA INSIDER
FEATURES
The SAMA president and general manager
attend board meetings in an ex officio capacity.
On the evening of the second day, a
Presidential Dinner was held to officially
welcome the SAMA president for the
2018/2019 term, Prof. Hoosen Coovadia, and
to say farewell to the SAMA president for the
2017/2018 term, Dr Marina Xaba-Mokoena,
who was thanked for her special wisdom and
contributions during the latter term. SAMA is
honoured to welcome Prof. Coovadia, with his
wealth of expertise and experience, into our
midst. Dr Richard Tuft was nominated as the
president-elect for the 2019/2020 term, and
will take over the reins from Prof. Coovadia
once his term is over.
Dr Coetzee and Dr Mzukwa thank outgoing president Dr Marina Xaba-Mokoena. The SAMA board The last day of the National Council
of directors sincerely thanked Dr Marina Xaba-Mokoena for the exceptional manner in which she meeting was also used to discuss and resolve
provided guidance, leadership and oversight during her tenure as president of the association. We issues of importance to the association, and
wish her and her family well. Her leadership, wisdom, calm nature and sense of humour will always many resolutions focusing on the unity of the
be remembered. association were passed.
Introducing Hoosen Coovadia, SAMA president
SAMA Communications Department
P
rof. Coovadia has been elected as the
new president for 2018/2019. His main
contributions include critical research
into the most serious health problems of
children in Africa. He has published more than
350 research papers in leading international
and SA journals, on the basic science
and pathogenesis, clinical management,
epidemiology, prevention and contextual
factors for the major causes of morbidity,
disability and mortality among Africa’s
children. His key research has been in the
fields of malnutrition, kidney disorders and
infectious diseases, especially mother-to-child
transmission of HIV through breastfeeding.
He was the international vice-chair of
a National Institutes of Health network on
paediatric HIV, and has held editorial positions
on a number of key journals. He regularly
reviews papers for The Lancet, and often
assesses proposals from the Wellcome Trust
and other agencies. He has chaired some
major international HIV conferences, and was
the chair of the prestigious XIIIth International
AIDS Conference held in Durban, 2000. A Incoming president Prof. Hoosen Coovadia (above) was inaugurated at the presidential dinner.
recipient of numerous awards from universities, Prof. Coovadia is a stalwart of the medical profession. “He brings with him a wealth of knowledge
public institutions and science organisations, and experience to give guidance and direction to the new board. Prof. Coovadia is an exceptional
Prof. Coovadia is closely engaged within the leader who has a strategic outlook on the medical profession, and his inputs going forward will
democratic organisations working towards the benefit not only SAMA, but the entire medical community in SA,” said Dr Coetzee.
attainment of freedom after apartheid.
SAMA INSIDER DECEMBER/JANUARY 2019 5
FEATURES
Attending the Presidential Health Summit
Selaelo Mametja, SAMA Knowledge Management and Research Department
T
he 2-day Presidential Health Summit was policy on the remuneration of work outside including accruals for personnel expenditure,
convened on Friday 19 and Saturday 20 public service, to limit its impact on service such as overtime and rank promotions. The
October 2018, at the Birchwood Hotel in delivery, and providing surety that the statutory commission recommended that provincial
Boksburg, Gauteng. requirements for internship and community treasuries should be engaged to prioritise
It was not clear who from SAMA would service are met. There is a need to review the health.
be attending until the Presidency offered us distribution of resources between the public Commission 4: Infrastructure. The
seats at the last minute. Nevertheless, SAMA and private sectors, and a task team should be National DoH has a health infrastructure plan,
was able to send a delegation of doctors who established (in my opinion, this may be a better but to date, the country has had neither the
participated meaningfully in the debates. approach than implementing a certificate of expertise nor adequate funding to implement
The Presidential Health Summit aimed need, which may result in resistance). the plan. In some cases, health infrastructure
to address the numerous challenges facing Short-term goals: ensure that service plans construction that has been successfully
the SA health system, and to work towards are based on good data, using evidence- completed has either cost more than the initial
strengthening the health system, to provide based tools. Review the policy on foreign- budgeted amount, or the facilities have been
universal access to quality health services. To trained medical practitioners, to address skills constructed either fail to meet the need for the
achieve this aim, the summit recognised the shortages and provide support for human services required, or have not been provided
centrality of NHI, and the combined roles of the resources (HR). with adequate funding to fully operationalise
public and private health sectors in meeting Medium- and long-term goals: ensure that the new facilities. The commission found that
the overall aspirations and goals of SA’s national the policies on funding and staffing meet the infrastructure plan must be able to respond
health system in achieving universal health the needs of the health system. Validate and to changing population and clinical dynamics,
coverage (UHC). optimise the use of PERSAL [“integrated human and not remain static.
resource, personnel and salary system”] and Commission 5: Quality of health services.
Objectives the HR management information system, and Although society is generally more focused on
The objectives of the Presidential Health review the roles and responsibilities of each immediate structural improvements, for health
Summit were to strengthen the SA health sphere of government in relation to health practitioners, process measures may be more
system by: services. The education system should be relevant. Both structural and process measures
• advancing our collective efforts to promote revised to respond to population needs. are necessary for improved outcomes. To
good healthcare services, as an essential Leadership and governance: the leadership achieve quality healthcare, there is a need
foundation for health for all structure in the public sector is characterised by for all facilities to comply with OHSC [Office
• outlining the roadmap towards a unified political interference and patronage, and is top of Health Standards Compliance] standards.
healthcare system by committing to heavy, with duplication of roles. Management Medicines and services should be accessible,
rebuild the health system, to provide quality lacks the necessary skills. The structure and it is imperative to improve HR, medicines
healthcare to all should be revised with a view to eliminating supply and facilities. Healthcare services need
• identifying ac tions to strengthen duplications, separating the administration of to be patient-centric and based on need, and
co-ordination, monitoring and evaluation health from politics, and training managers. to prioritise primary healthcare.
• identifying ac tions to strengthen Commission 2: Supply-chain manage The commission also noted that the
co-ordination to deal with corruption, waste ment. SA is characterised by frequent stockouts reality of the existence of both the public and
and abuse, to improve accountability and and medicine shortages. To address these private sectors in SA must be recognised. A
transparency issues, the commission recommended, among harmonious working relationship is needed
• addressing solutions to end the health other measures, the following: addressing between these sectors that puts the needs of
system crisis. corruption, ring-fencing pharmaceutical the people of SA first, and the private sector
budgets, engaging the private sector to assist has a critical role to play in the realisation of
Outcomes with inventory management, establishing a NHI. To engage the private sector meaningfully,
The summit focused on challenges that pose a state-owned and competitive pharmaceutical the inclusive process and mechanism started
threat to the achievement of UHC, in both the company. through the Presidential Health Summit should
public and private health sectors. There were Commission 3: Public finance. Over be sustained, by providing collective leadership
five summit goals, which revolved around the last few years, health has received real- and stewardship to unify both sectors around
collective efforts by all players to identify term budgetary cuts. The discordance in common goals. The recommendations from
specific actions to solve system challenges. priorities between the national and provincial the health market inquiry report should be
The summit was organised into nine Departments of Health (DoHs) has resulted implemented.
commissions, the outcomes of which are in inefficient budget and grant allocations, Commission 6: Health service provision.
presented below. which has impacted on the ability of hospitals The commission noted that we need to
Commission 1: Human resources. The to fulfil their mandate of providing quality urgently address accruals through a clear
commission made several recommendations: healthcare. Significant budgetary pressures strategy and relevant mechanisms, stop
lifting the moratorium on posts, reviewing the exist, with over-expenditure and accruals, unfunded health-service provision mandates
6 DECEMBER/JANUARY 2019 SAMA INSIDER
FEATURES
being given to provincial health departments Commission 8: Community engagement. functional repository, which could be used to
without consideration of their budgetary The commission recommended the revision measure activity and outcomes in healthcare
impacts, revise the equitable share formula, of the concept of community participation (enabling, among other things, access to
which should take into consideration in health, to clarify roles and responsibilities. data and information on services availability,
internal migration, and address the burden Community structures should be included and monitoring of the burden of disease
of disease. in the budget planning cycle, and there and quality outcomes). The commission
Commission 7: Leadership and gover should be monitoring of budget spending recommended and supported a review of the
na nce. The commission recommended reports, and an approach that takes social current strategy, and appropriate investment.
establishing an anti-corruption forum in determinants of health into account, as a SA needs appropriate information technology
the healthcare system, clarifying the roles of prevention strategy. (IT) infrastructure, and this is based outside
hospital boards and committees, expanding Commission 9: Health information of the health sector. The education system
management training and focusing systems. A standard electronic health record should produce a workforce that can utilise IT
performance management around patient- is essential, to improve health information. developments without further training, while
centric outcomes. This would allow the establishment of a current employees need to be upskilled.
Meet the SA Academy of Family Physicians
Prof. Bob Mash, president, SA Academy of Family Physicians
the more difficult or complicated patients. emergencies and maternal and child care. A
Each team may include nurses, clinical recent policy brief outlines the initial evidence
nurse practitioners, clinical associates, junior for their strengthening effect on district health
doctors and community health workers. In services in more detail (http://www.saafp.
addition, family physicians build the team’s org/index.php/main-menu/policy-brief ). We
capacity to deliver high-quality care through believe that primary healthcare teams need a
mentoring, teaching, training and clinical combination of extended reach and coverage,
governance activities. Often they supervise through community health workers in ward-
and train interns, clinical associates (mid-level based outreach teams, as well as the inclusion
doctors) and registrars. Their training includes of higher-level competencies, such as family
acquiring the competencies required for physicians and doctors with postgraduate
district hospitals in areas such as anaesthetics, training in family medicine (we also offer a
obstetrics and surgery. It also includes gaining national 2-year Diploma in Family Medicine).
an understanding of community-orientated So, if these are the family physicians, what
primary care, and the ability to support the is the SA Academy of Family Physicians? The
I
t may surprise you to learn that the SA ward-based outreach teams. In the private academy is not only a professional body
Academy of Family Physicians (http:// sector, family physicians may also work for family physicians, but is also open to
www.saafp.org/) is one of the professional as general practitioners, and medical aids membership from other medical practitioners
bodies affiliated to SAMA. We are officially are beginning to recognise their specialist who work in family medicine and primary care
represented by Prof. Shadrick Mazaza on the status in terms of their scope of practice and settings. The guiding vision of the academy
National Council and the Specialist Private remuneration. Family physicians explain more is to “promote optimal health for the people
Practice Committee. about what they do in a recent video that can in SA through advocacy, support and the
As family medicine is a relatively new be watched on YouTube (https://youtu.be/ development of the primary healthcare
discipline in SA (officially recognised in 2007), f6ef7pLN2SU). team, and the establishment of an equitable,
many policy makers and health professionals A number of research projects have humane and integrated district healthcare
are unsure about the contribution of demonstrated that family physicians, although system”.
specialists in family medicine to the health few in number, are making an impact on the At a regional and global level, the academy
system. Family physicians undergo 4 years quality of clinical processes across the burden is SA’s official body in the World Organization
of postgraduate training, in the same way of disease, and on the performance of the of Family Doctors ( Wonca). Wonca was
as other specialists, to, in essence, become health system itself. They improve access to recently part of the Global Conference on
expert generalists. Family physicians are a more comprehensive service within each Primary Health Care in Astana, Kazakhstan
trained to work at district hospitals and district, and also improve the co-ordination (http://www.who.int/primar y-health/
primary care facilities. In the public sector, of care with referral hospitals. They improve conference-phc) that launched a new
they work as clinicians and consultants to the the quality of care for chronic communicable global intergovernmental commitment to
healthcare team, as they are the most highly (e.g. HIV and TB) and non-communicable primary healthcare (including SA). The Astana
trained clinicians within the teams, and see diseases (such as diabetes and hypertension), Declaration is a renewal of the historic Alma
SAMA INSIDER DECEMBER/JANUARY 2019 7
FEATURES
Ata Declaration that led to the “health for all” members? It advocates for the discipline of and will focus on the primary healthcare team,
movement. The declaration states that “we family medicine, and its contribution to the and their alignment with the ideals of NHI. The
are convinced that strengthening primary health system in both the public and private academy is also an approved accreditor for CPD
healthcare (PHC) is the most inclusive, effective sectors. In the public sector, we hope that activities with the HPCSA, and offers a variety
and efficient approach to enhance people’s provincial departments of health will commit of face-to-face and internet-based CPD. In
physical and mental health, as well as social to employing more family physicians at district addition, we offer the SA Family Practice Journal
wellbeing, and that PHC is a cornerstone of a hospitals and primary care facilities. We also (http://www.safpj.co.za/index.php/safpj),
sustainable health system for universal health hope that they will provide an increase in which also publishes CPD, as well as original
coverage (UHC) and health-related Sustainable the number of registrar posts, to enable the research articles.
Development Goals.” discipline to go to scale (every programme Last but not least, the academy co-ordinates
The academy also supports the ideals should ideally have 10 new registrars per year). training in family medicine across all nine
behind SA’s commitment to re-engineering Our short-term goal is to have a family physician SA medical schools, through its national
primary healthcare and implementing NHI. at each district hospital, community health Education and Training Committee. This
Improving the quality of primary healthcare centre and/or subdistrict in the country. In the committee strives to improve the quality of
and district health services is essential to private sector, we are negotiating with medical the training programmes. The academy has an
improve the social foundation of SA society. aids to properly recognise the specialty. active collaboration with the Royal College of
NHI is vital to improving equity and enabling The Academy also offers its members General Practitioners to train clinical instructors
universal health coverage for all South Africans. an annual National Family Practitioners in the workplace, and to improve the quality
Beyond these lofty social and policy goals, Conference. The next conference will be held assurance and formative assessment of these
what does the academy actually do for its in Johannesburg from 23 to 25 August 2019, trainers.
Communication the best medicine
against patient complaints – experts
SAMA Communications Department
M
edical and dental professionals
provide care, consultation and aid to
millions of patients every day. Their
skill and ability in solving sometimes complex
health matters is what they have spent years
learning, honing their talents to best serve
those who come to them for help.
But these professionals may be accused by
patients of not doing enough – or not doing
the right thing – to make them or their families
better. Situations such as these can escalate
quickly, with patients sometimes turning to
the HPCSA for remedy.
“Doctors often feel isolated in these situa
tions, and when this happens, it’s our duty to
as their medical defence organisation to assist
them in the best way we can, whether this
is assisting them in dealing with a complaint MPS assists medical professionals in SA of important legal and ethical issues in the
to the HPCSA, a clinical negligence claim, a through an annual Ethics for All conference, profession, and how to manage problems
disciplinary procedure or preparing for an which was most recently held in held in should they arise. Speakers from the legal and
inquest.” explains Ms Margi van Gogh, regional October 2018, and outlined the latest in legal medical fraternities are invited to present, as are,
director of the Medical Protection Society and ethical developments relating to them. importantly, those from legislative authorities and
(MPS). The conferences are held in various locations statutory bodies and boards.
MPS is the world’s leading protection around SA, including Cape Town, Durban At the recent conference in Pretoria in
organisation for doctors, dentists and health and Pretoria, with a similar programme and early October, Adv. Stephen Farrell, SC, spoke
care professionals, and protects and supports speakers at each location. on the processes of the HPCSA and the legal
the professional interests of more than 30 000 In this way, doctors, dentists and other obligations of practitioners. Throughout
healthcare professionals in SA. healthcare professionals are kept informed his presentation, Adv. Farrell noted that
8 DECEMBER/JANUARY 2019 SAMA INSIDERFEATURES
the biggest problem between healthcare
professionals and their patients is poor
communication.
“There is a perception that the HPCSA and
Health Professions Act [No. 56 of 1974] are
there to punish healthcare workers. What must
be understood, though, is that when a doctor
receives a letter from the HPCSA, a process
has been put into effect that is prescribed by
legislation,” explained Adv. Farrell.
He said the Health Professions Act envis
ages a fair procedure, where the doctor is given
a fair opportunity to state their case, and that in
all cases, the doctor’s version of events is asked for.
“It’s normal to be defensive when this
happens, but doctors must ask themselves
some key questions when these complaints of one person’s unprofessional attitude towards doing is what a reasonable doctor would also
arise. And, besides communication, I rate his patients, work and colleagues. do. If you apply this, then legal action might
proper notes that are contemporaneous and “Our research shows that certain clinicians be taken against you, but not successfully,” he
comprehensive as the second most important are error-generating machines, and that noted.
part of any defense by a medical practitioner,” unprofessional behaviour can increase risk. Also speaking at the seminar was Dr
he noted. Clinicians in these situations need to manage Munyadziwa Kwinda, ombudsman of the
Adv. Farrell explained that once the this risk. One way is to create an anonymous HPCSA, and a member of the medicolegal task
HPCSA’s processes are underway, they must portal for clinicians to share information among team of the Department of Health.
continue to a resolution, one way or another. themselves,” he explained.
“When you are in this situation, where
you have received a letter and a patient has
Speaking on issues of litigation from a
clinician’s perspective, Dr Graham Howarth "Constantly ask
complained, you must stop what you are doing
and apply your mind to the patient’s complaint
noted that doctors must be aware of the
elements of litigation, and not automatically
yourself if what you
immediately. You must get their files and
account files, and their hospital files if there
assume the worst. Dr Howarth is the head of
medical services for Southern Africa for MPS.
are doing is what a
are any; you must do everything you can, and He noted: “Be aware that the cards are not reasonable doctor
be thorough, to determine how you reached always stacked against you as a clinician; the
your clinical decisions,” he advised. burden of proof falls on the claimant.” would do"
Echoing his sentiments, Dr Mark O’Brien, He added that there are three hurdles a
international medical educational consultant to claimant has to jump if he wants corrective Dr Kwinda noted that part of the problem at
MPS, and medical director and cofounder of the action against a clinician. the HPCSA is that the body only has seven
Cognitive Institute, noted that communication “The complainant must establish where the healthcare professionals on staff, but that it
with patients is vital. doctor’s duty of care begins and ends, if there is looking at increasing this number in future.
“Unmet patient expectations are the most has been a breach in this duty of care and, “We have removed legal people from
significant predicators of patient dissatisfaction importantly, causation – the patient must show our investigations level, and are now only
with a clinician,” he noted, adding, “Though they the harm that is caused by the act or omission involving people with medical healthcare
may not have the technical knowledge, patients of the doctor,” he said. backgrounds. This is important because we
can discern quality of care by the follow- Dr Howarth said that these three factors need to have people who understand the
through on promises made by a clinician, and need to be uppermost in clinicians’ minds clinical encounter, and we need to proceed
the quality of communication by the clinician.” when faced with litigation, and that their notes with complaints with minimal support from a
Dr O’Brien said that while many studies have will play a central role in framing a defense. legal perspective,” he said.
focused on individual clinician performance, He said in cases involving clinicians, the test As part of making the processes of
little attention has been given to the impact of is to consider what a reasonably competent the HPCSA better, Dr Kwinda said various
individual performance on teams or on other practitioner would have foreseen the likelihood measures were being looked at as part of the
clinicians. of harm to have been, and what steps could council’s turnaround strategy.
“The question should not be, ‘Do I make have been taken to guard against it. More than 2 000 medical and dental
mistakes?’ – it should rather be: ‘What is the He said that clinicians need to remember professionals attended the three-leg seminar
error rate for everyone in the room?’” he said. that a patient must prove that the harm they tour by MPS in Cape Town, Durban and
Dr O’Brien used the example of the doctor suffered is a result of the clinician’s negligence, Pretoria.
who is always late for a shift. He noted that or something the clinician did or did not do.
this behaviour may have a negative impact on “Our central message to clinicians, though, For more information on MPS visit https://www.
everyone else who works with that doctor, and is to steer clear of litigation. How do you do medicalprotection.org/southafrica/home or the
that their error rate might be increased because this? You constantly ask yourself if what you are HPCSA website, http://www.hpcsa.co.za.
SAMA INSIDER DECEMBER/JANUARY 2019 9FEATURES
Solving youth unemployment – we can all play a role
Tiyani Armstrong, head of learnerships, FPD SHIP Department
valuable on-the-job training and workplace
exposure.
Why would a medical practice be a good
host organisation for a learner? Learners
who are enrolled in a business administration
learnership or a generic management
learnership need to be exposed to a number
of managerial disciplines in a workplace
environment. Medical practices create an
ideal opportunity for learners to take part in
administrative as well as managerial activities.
What are the benefits of hosting a learner?
Learnerships are designed to benefit both the
participating parties:
T
here are an estimated 600 000 unem (theory) and the realities that students • Learners receive access to sponsored
ployed graduates in SA, contributing experience when entering the workplace education, as the relevant SETA covers
to the country having one of the (practice). This disconnect was seen as their tuition costs, and better access to
highest youth unemployment rates in the contributing to the high unemployment rate workplaces, for practical experience. While
world. However, if graduates undertake a among graduates. Taking into consideration enrolled in the learnership, learners also
1-year structured learnership or internship the benefits of work-based experience, such receive a monthly stipend to cover any
programme, this increase their chances as that acquired through a learnership, and in travel costs related to their workplace
of employment by 27% directly after the order to address employer concerns around immersion. Upon successful completion of
learnership. This percentage increases to the disconnect between theory and practice, the learnership, learners receive a nationally
about 39% a couple of months after the the Skills Development Act No. 97 and the Skills recognised qualification.
learnership, when the candidates are actively Development Levies Act No. 9 were passed by • The host organisation can benefit from
looking for employment. This increase parliament in 1998 and 1999, respectively, and learnerships by gaining access to the
in employability is due to the learners structures and processes to transform skills services of enthusiastic young learners for
having acquired a national qualification, development in SA were put in place. a 12-month period at no cost to itself, and
along with the skills needed by employers. Learnerships are overseen by the Sector by encountering possible future employees.
Learnerships are vocational education and Education and Training Authorities (SETAs).
training programmes designed to facilitate These entities were created to ensure that Is there a downside to hosting a learner?
the linkage between structured learning qualifications offered are related to a specific The major expectation of the host organi
and work experience, and are often a occupation or sector of the economy. There sation is that it provide some oversight and
requirement for obtaining certain registered are 21 SETAs, who jointly identify National mentoring for learners, to ensure that they
qualifications. Doctors are familiar with Qualification Framework (NQF)-aligned have opportunities to apply their learning, and
the internship programme that they had learnership programmes that help participants to benefit the organisation. A concern often
to complete as part of their own training, to gain formally recognised qualifications while raised by host organisations revolves around
and are ideally positioned to host interns in getting on-the-job experience. issues of employer-employee relationships. To
their practices. A well-run medical practice allay such fears, most interns are employed
offers several opportunities for non-clinical How are learnerships organised? SETA- by intermediary organisations such as the
internships, in such fields as human resources endorsed learnership participants are enrolled Foundation for Professional Development (FPD),
management, office administration, finance, in a 12-month programme. These candidates are and seconded to the host organisation. In this
management assistance, information systems placed within a participating organisation under model, FPD is responsible for all human resource
management and office management. As the supervision of a mentor, for the practical management aspects of their learnership.
interns receive stipends, there would be no training component of their learnership. FPD has for the last 15 years implemented
financial obligation on any medical practice Learners spend 80% of their learnership period robust learnership, internship and fellowship
that hosted a non-clinical intern. in the workplace, and only 20% of the time in programmes. Various programmes have
the classroom for their theoretical training. This been funded by both local and international
Why were learnerships created? Although translates into the learner reporting for duty on organisations, and have yielded excellent
well developed in areas of study such as a daily basis, as would an employee, while only results.
medicine, nursing and teaching, many being required to attend classroom training for Should you wish to host a learner in your
qualifications offered in SA had a disconnect 3 days per month. The learner forms part of the practice, please contact FPD on (012) 816
between what was taught in the classroom host organisation’s workforce, while receiving 9000/9136, or email tiyanet@foundation.co.za.
10 DECEMBER/JANUARY 2019 SAMA INSIDERFEATURES
Obituary: Dr Ivan Berkowitz
SAMA Communications Department
I
van was born in Cradock in the Eastern In Port Elizabeth, he became senior specialist
Cape on 21 July 1939. He attended in O&G at Livingstone Hospital from 1998.
Cradock Boys’ High and matriculated in Later, he became head of O&G for the whole
1956, before proceeding to UCT, obtaining of the PE hospital complex, a position he held
the MB ChB in 1964. While in Cape Town he from 1998 to 2010.
played first team rugby at UCT – he had the Ivan was a regular golfer and a member
height and weight! of Wedgewood Country golf club, and his
He served his internship at Livingstone hobbies were oil paintings and making
Hospital in Port Elizabeth in 1965, and was a “teddies”, which amazed his colleagues!
medical officer (registrar) until 1967. He practised O&G privately from 1972 until
His interest was in obstetrics and gynae 2012. During this time, he served on SAMA’s
cology (O&G). He obtained the MRCOG in Eastern Province branch from 1993 to 2017,
1971, and the FRCOG in 1984, from the Royal and was elected president in 2000, becoming
College of Obstetrics and Gynaecology. chairman of EP branch council from 2009 to 2013.
Ivan married Harriet on 9 July 1967; Ivan “Berkie” Berkowitz will be sorely mis
he had a son and daughter, and five sed by his colleagues, friends, patients and
grandchildren. family. He passed away on 27 July 2018.
Protecting the public and guiding the professions
• Upholding and maintaining ethical
and professional standards within
The Health Professions Council of South Africa (HPCSA) is a statutory body
the health professions.
established by the Health Professions Act, 56 of 1974 (as amended).
Values
The HPCSA is committed to protecting the public and guiding the professions. In
order to safeguard the public and indirectly the professions, registration in terms
In fulfilling its roles of regulator, guide
of the Act is a prerequisite for practising any of the health professions registerable
& advocate and administrator, the
with Council.
HPCSA holds the following values
central to its functioning.
The HPCSA has a mandate to regulate the healthcare professions in the country
is aspects pertaining to education, training and registration, professional conduct
and ethical behavior, ensuring Continuing Professional Development (CPD) and
fostering compliance with healthcare standards.
Vision
Quality and Equitable Healthcare for All.
Mission
Contact Details
To enhance the quality of healthcare for all by developing strategic policy
frameworks for effective and efficient co-ordination and guidance of the Physical Address:
professions through: 553 Madiba Street | Cnr. Hamilton and Madiba Street | Arcadia | 0001
• Setting contextually relevant healthcare training and practice standards for
registered professions
Postal Address
• Ensuring compliance with standards
PO Box 205 | Pretoria | 0001
• Fostering on-going professional development and competence
• Protecting the public in matters involving the rendering of health services
Tel: (+27) 12 338 9300 | (+27) 12 338 9301 Fax: (+27) 12 325 5120
• Public and stakeholder engagement
Email:SAMA INSIDER Website:
info@hpcsa.co.za www.hpcsa.co.za 2019 11
DECEMBER/JANUARYFEATURES
Collective bargaining – the numbers game
Simon Madini, organising and collective bargaining officer, SAMA Industrial Relations Department
A
plethora of definitions have been matters relating to workers’ interests are dealt
advanced in an attempt to explain with accordingly.
bargaining, especially collective
bargaining. Though they differ in their International standards
presentation, these ideas all subscribe to the on the right to freedom of
notion that bargaining is not an individual association
action but a collective effort, the purpose of The right to freedom of association
which is to come up with a mutual agreement is described as the judicial and moral
on an entire range of pressing issues that entitlement of workers to form trade unions,
affect the group as a whole. to join trade unions of their own choosing
While it may sound simple, collective and to see that such a trade union functions
bargaining can fool a number of people. The independently. The right to freedom of
adverse effect of numbers can drastically association is a fundamental right that is
reduce collective bargaining to collective protected in a number of international
begging. SA labour law, while promoting instruments. The International Labour
and encouraging freedom of association Organization (ILO)’s Declaration of Philadel The SA public service is a very complicated
and the right to organise, also allows wide phia (adopted on 10 May 1944) holds that and politicised sector, and this has the
room for determinations and collective freedom of expression and association are potential to complicate collective bargaining
agreements that pose a threat to those very essential to sustained progress. processes. It is very politically aligned in
same rights. structure, and favours the left in its political
Section 18(1) of the Labour Relations Act International standards principles. The best and only way to survive
No. 66 of 1995 (LRA) states: “An employer and on the right to collective is by having the numbers. Whether the
a registered trade union whose members are bargaining collective bargaining processes may lead
a majority of the employees employed by The right to collective bargaining is a to a strike or resolve matters amicably, it
that employer in a workplace, or the parties fundamental right that is confirmed by is key to always be on the safe side – the
to a bargaining council, may conclude a member states of the ILO by virtue of majority side.
collective agreement establishing a threshold their membership. This right is protected
of representatives required in respect of one in a number of international instruments. Conclusion
or more organisational rights referred to in Part of the 10-point plan adopted by the SAMA as an organisation occupies a critical
section 12, 13 and 15.” ILO in the Declaration of Philadelphia is space in the health sector, with more-
This section of the LRA is then translated the effective recognition of the right of than-capable personnel to drive processes
into collective agreements where the collective bargaining, and the co-operation on core issues for its members. While we
employer and the majority union(s) will set a of management and labour in the continued are a profession-specific organisation,
threshold in bargaining councils sometimes improvement of productive efficiency, and our influence goes beyond the scope of
so high that minority unions will be forced to collaboration of workers and employers in public health. We also influence policy
enter acting arrangements with the admitted the preparation and application of social and processes such as the review of the public
unions. economic measures. service salary structure, and our inputs are
An acting arrangement means that another recognised by other unions. While we have
union allows you a sit on the bargaining Union has to keep growing a responsibility to continue to grow our
council, so that you can raise the issues that its numbers membership numbers, it is necessary to note
affect your members, and engage on them. When establishing a union, either sectoral that SAMA is vibrant and strong, and will
As SAMA, it is imperative that we recruit profession specific or as an allied organisation, continue to exert its influence and drive the
every unorganised member, so as to increase it is key that its growth pattern is very well policy development process to the standard
our voice in the bargaining council. Collective articulated. This would include, among required by its members.
bargaining is a numbers game. other issues, the analysis of possible mass In light of the above, the best strategy to
Another important aspects of collective recruitment by employers, and the interest keep a member-driven organisation strong
bargaining is the need for association or of employees in joining that sector. Certain and relevant is its organising ability, and
alliance with like-minded organisations. This professions and skills are only needed by service delivery. Recruitment of new members
improves the chances of your issues being employers up to a limited and capped must be a priority for every SAMA member.
supported, and included in resolutions of number. This then dictates whether a union As our numbers grow, so does our influence.
the council. To make a meaningful impact in operating in that sector or profession has With the limited number of employed doctors
negotiations, an organisation needs a strong the potential to grow beyond the needs in the public service, SAMA cannot afford to
and vibrant collective bargaining component, of employers or the service rendered by its lose members, or to have public-service
with all the necessary resources to ensure that members. doctors who are not members.
12 DECEMBER/JANUARY 2019 SAMA INSIDERFEATURES
As long as you breathe, you are at risk
MDR-TB: My story
Dr Zolelwa Sifumba
incision into the node, commenting that this had never got sick, and that those who did
was definitely TB, and a he took a biopsy of must have other illnesses (as a codeword
the node. I was referred to the local clinic for HIV ). Stigma. Stigma from healthcare
to commence treatment, in the anticipation professionals. Denial.
that this was indeed TB. Again, I told myself
that this was not possible, but I went along
with it.
I went from student
That weekend I received a phone call that
would change my life. With a phone call from
to patient to
a lab technician, it was official. Somehow, I survivor to activist,
had managed to contract TB. Isoniazid and
rifampicin resistant. But I had no idea how. It and there was
nothing easy about
might have had something to do with the TB
patients in the wards I worked in, but was that
even possible? If it was, this was the first that
I had heard of it. Surely sicknesses were for
this journey
patients? Surely this was a mistake, as I was
M
y name is Zolelwa Sifumba. I sure that I was HIV-negative, and I definitely I went from student to patient to survivor to
am a medical doctor doing my did not live in a one-bedroom house with activist, and there was nothing easy about
internship in KwaZulu Natal. I am 10 people. I was a UCT student, well-off at this journey. It has been the hardest thing
an occupational multidrug-resistant-TB home, and my lifestyle wasn’t particularly that I have had to endure in my life, and it is
(MDR-TB) survivor, and this is my story. unhealthy. So why? How? The denial, anger, honestly a miracle that I’ve made it through.
I always wanted to be a medical doctor, to bargaining and depression happened all at Throughout treatment, I considered
follow in my father’s footsteps. So when the once. I tried to make sense of it all. suicide, because of the side-effects that I
time came to apply for university, I applied I honestly had no idea that my occupation faced on a daily basis, and fear of the possible
to study medicine. Fortunately for me, the put me at high risk of contracting this illness – side-effects that would follow. I would not
university of my choice accepted me, so it that in fact, healthcare workers and students be able to carry on living if the injectable
was off to UCT to chase my dream. are a high-risk group, being three times more stole my hearing, as it did another student,
Medical school was challenging from the likely than the general population to develop in Khayelitsha, who would later become my
beginning, and we were warned about the drug-sensitive TB, and six times more likely friend and fellow activist. I thought that she
tough work we had ahead of us, but told to develop drug-resistant TB. I found all of might be able to do it, but I definitely would
nothing, really, about the risks to our health this out during my treatment, when I joined not. I carefully read the package inserts of
that we would face in this career. a non-governmental organisation named each of the drugs, and quickly realised why I
I woke up one morning to find a painful TB Proof, in the Western Cape. Here, I met had not been warned.
lump on my neck, just above my right other healthcare professionals who had I will state now that the current treatment
clavicle. This was the first time I had noticed been diagnosed with TB, both sensitive for drug-resistant TB is inhumane. I congratulate
it, and already, it was 3 by 3 cm. This scared and resistant, as a result of occupational our Minister of Health, Dr Motsoaledi, for
me, so naturally my friends and I discussed exposure. I was later introduced to students calling for an injection-free treatment
a differential diagnosis. We had been taught in my faculty who had also had TB. This regimen in SA, and the WHO for endorsing
to put TB at the top of our list – but what was felt wrong. Why had we not been told? Or the call. When I speak about my experience,
realistically a possibility was pushed to the should we just have known? Should we just I always describe that injection as feeling
back of my mind, because, well, we didn’t have known that since we would work with like hot lava being injected into you,
get TB. Boy, was I wrong… people with all sorts of different illnesses, we causing intense pain that burns and stings,
The lump grew bigger and more painful, would sooner or later contract one? We had eventually shooting down your legs and up
and I decided that it was time to see a doctor. been told about needle sticks and HIV, but your back, pain that lasts until it is time to be
The doctor decided to do a fine needle this was bizarre. injected again the following day. It is torture,
aspiration of the lump, and told me that I continued to try make sense of it all in my opinion, and a major contributor to
in our setting, it was likely to be TB. Again, throughout treatment, which people around treatment interruption (I reject the word
I rejected the idea. That was not possible, me did too, resulting in my facing heavy “defaulter”).
right? stigmatisation. I read article after article by Just imagine for a second that you are
The lump continued to grow, so on healthcare workers saying that they had the breadwinner at home, and your ability
my second trip to the doctor, he made an worked in the public sector for years and to provide is taken away by the debilitating
SAMA INSIDER DECEMBER/JANUARY 2019 13You can also read
