Naked Prosthetics enables ‘life after amputation’ for 28-year-old Nelisiwe Nare
On the 18th of June 2020, a seemingly ordinary day at the office took a different turn for 28-year-old Nelisiwe Nare. At the time, Nare was based in the Northern Cape where she worked in the mining industry as a Process Engineer. That night, Nare’s hand got caught between a rotating drum and a lip plate of a magnetic separator. As a result of severe tissue damage, the ring and middle fingers on Nare’s right hand were amputated.
“When I awoke from surgery, the first thing I did was check my hand – only to realise that my fingers were no longer there,” says Nare. What followed was a long journey of healing, physical therapy and planning for the future.
Resilient and self-motivated, with a firm belief that anything is possible, Nare was determined to find a prosthetic that would enable her to return to as normal a life as possible. “My goal was to find a functional prosthetic. I was less concerned with hiding my injury or that my fingers had been amputated. My focus was on function, more than anything else.” This is why the usual aesthetic prosthetic hands that were on offer were not an option as they would not provide the functionality she was looking for.
At that time, there was nothing available on the local market that met Nare’s needs. After extensive research, she came across Naked Prosthetics – a provider of functional devices for partial hand and finger amputees. “Their devices were cool, functional, and unlike anything else I had seen. They aligned perfectly with the functional experience I was looking for.”
Nare was put in touch with her prosthetist who worked closely with Naked Prosthetics to understand the exact nature of Nare’s injury, type of amputation, her goals for the device and exactly how she hoped to use it. This included exact measurements and casting as well as being able to select her colour of choice.
“I remember the day I was able to collect my device,” continues Nare. That she was able to write on paper and type on a laptop on her very first use of the device was amazing and an experience in itself. “It’s a testament to how these devices are designed with movement, purpose and hand function in mind,” enthuses Nare.
“It allows me to do many of the things I used to do and is exactly what I had hoped for. As someone who spends a lot of time working on a laptop, the device has made a huge difference. Without it, my hand would very quickly tire, to the point where I’d feel like something was missing.”
Össur South Africa recently announced the availability of Naked Prosthetics to the local market. “The loss of a finger can be severely debilitating, impacting one’s ability to carry out seemingly ordinary yet essential everyday tasks – let alone the potential impact on one’s career and professional life,” says Dewald Grey, a Prosthetic Clinical Specialist with Össur South Africa. The resulting lack of mobility is also not limited to the area of amputation only, with many amputees experiencing a loss of mobility beyond the area of amputation. No fewer than 5% experience a resultant impairment of the entire body and as many as 75% of heavy manual labourers are unable to return to work.
“We aim to provide finger and partial-hand amputees with functional, high-quality solutions that seamlessly integrate into their lives and empower them to live a life without limitations – resuming employment and engaging in the activities they love,” says Grey.
“I believe prosthetics is one of the most evolving areas in the medical field,” Grey continues. “The use of 3D printing and precision engineering has led to highly advanced, functional prosthetic fingers. We also have different types of finger prosthetics for different needs – each one tailored precisely to the individual user’s amputation and specific hand structure.”
“I love my device. I’m grateful to have had the opportunity to access something that has shown me that amputation isn’t the end but, rather, a new beginning. Plus, I look super cool wearing it and it opens up opportunities for me to share my story and challenge stereotypes,” continues Nare. Her advice to anyone facing a similar injury, “no matter the extent of your amputation, it’s important to realise that life doesn’t stop when you lose your fingers.”
“Embrace what was and what’s to come, your amputation, scars, failures, stares and figuring it out! Embrace the ignorance, awkwardness and kindness. Most importantly of all, embrace the superhuman strength that comes with limb loss. My life before the amputation doesn’t compare to what it is now. I am more confident, I know there’s nothing I can’t do, and I am functional.”
Nare is currently exploring the land of the emirates while pursuing her Master of Management degree in Digital Business at Wits Business School.
Johannesburg’s first general hospital was built on the “brow of the hill” in 1890. The building is now abandoned and derelict. (Photo: Courtesy of WRHI)
Hillbrow started out as Johannesburg’s first health hub in the late 1880s. It’s also been a suburb associated with pimps and prostitution, a middle finger to the Nationalist Party, and a key site of the HIV crisis. Today, it’s the forgotten flatlands of inner city decay … but in small pockets it stays true to its heritage of bringing healthcare to the city’s most overlooked.
Putting some distance between people and disease can sometimes be a smart idea. It’s what early Johannesburg town planners had in mind when they decided that the city’s first hospital should rise on the “brow of the hill”, looking north away from the gold-flushed, but malady-stricken, mining centre.
Johannesburg’s first general hospital opened in 1890. It was four years after Johannesburg was proclaimed a city under the Transvaal government with Paul Kruger at its head. With the hospital as an anchor in the suburb, Hillbrow would grow to become the health node of the city as it rushed into the new century with heady intentions to become a modern metropolis.
The Johannesburg General Hospital would treat miners arriving with crushed limbs and broken bodies from mining accidents, which were frequent. Other patients were admitted with respiratory illnesses and ruined lungs from breathing in silica dust as the angled reef under the Witwatersrand was drilled and crudely blasted for its yellow treasure.
From the shanties and old mining camps came those burdened with diseases of absent hygiene and sanitation and overcrowding. Typhoid, tuberculosis (TB) and dysentery were common. There would be malaria and smallpox. In 1905, the Rand Plague Committee published a report detailing outbreaks of pneumonic plague and bubonic plague in those first years of the new century. There would be waves of influenza as the “Spanish Flu” of 1918 swept through the country.
Author of Johannesburg Then and Now Marc Latilla writes that the first Johannesburg hospital located in Hillbrow was described as “lofty with handsome fireplaces”. He writes that the hospital had 130 beds for black and white patients. More wards would come with expansion plans, but so would racially segregated healthcare. By 1895, a separate wing would be built for black patients.
Tumult and gold fever
The new city was being constructed against a backdrop of tumult and gold fever. Social tensions, divisions, and politics were also always in play. In 1896, there would be the abortive Jameson Raid, an insurgency meant to usurp Kruger’s government. The raid failed but it would ratchet up tensions between the Afrikaners and the British till the outbreak of the South African War in 1899. The war continued till 1902. By the end of the decade, in 1910, the country would become a union, uniting the four old colonies of South Africa. In another four years, World War I would break out.
Medical and health historian Professor Catherine Burns, of the University of Johannesburg’s Department of Historical Studies, says a more textured history reveals a story of whose health priorities ranked higher in the young city.
Joburg’s first medical officer of health, Dr Charles Porter, arrived from Scotland and he would have looked at Johannesburg framed against his Glaswegian childhood. “He would have encountered Johannesburg mining slums with Glasgow on his mind – seeing the conditions of crippled children and terrible miasmas; and an atmosphere of steam and filth as people staggered from the mines,” says Burn.
But importing a system of healthcare would have its limitations. Burns points out that even as the Johannesburg General Hospital would count as modern advancement for medicine, the melting pot of people drawn to early Joburg brought with them vastly different beliefs on healing, on warding off sickness, and the meaning of wellness.
“Throughout the city – even today – we see the venerable men and women who seek out hilltops and high places to perform the rituals and prayers of healing and wellbeing. And of course many of these spots are in Hillbrow or Yeoville. It means we can’t flatten everything, ignoring the layers upon layers of health history in the city,” she says.
The melting pot was growing and “Hospital Hill” with it. The early part of the new century would see the establishment of facilities for nurses’ accommodation, a fever hospital, a children’s hospital, a mortuary, an operating theatre, nursing homes, maternity hospitals, medical research facility and a medical school. Most ominous was the establishment of the “non-European” hospital built to further entrench racially segregated healthcare.
Kathy Munro, emeritus professor and heritage expert with the Johannesburg Heritage Foundation, says of particular significance was that the first Johannesburg hospital was built on state owned land and with the intention of service. These were the nascent ideals of a public health service for the city. The hospital was run by the Catholic Church’s Holy Family Sisters until 1915.
The front and back view of Johannesburg’s first general hospital, featuring the prominent laundry chutes that spiralled down the building. (Photo: Ufrieda Ho/Spotlight)
Munro says: “You then had a clustering of private hospitals like the Florence Nightingale, the Colin Gordon and the Lady Dudley Gordon around the state hospital complex that ran from the top of the hill to the bottom. The South African Medical Research Institute, founded in 1912 and housed in a fine Herbert Baker building, also came up along Hospital Road.
“The health authorities would have had to deal with the fragmentation in society and the separated services for the Non-European hospital and a whites-only hospital,” she says.
By the time apartheid was written into the statute book with the Nationalist Party coming to power in 1948, Munro says segregation would further shape the distribution of medical services in the city in the way Wits University had to deploy its medical students across the city.
“One of the inadvertent consequences of the apartheid system was that the university’s medical faculty had to service many hospitals that were fragmented on the basis of race. But it also meant that more specialist professors in each discipline came to be stationed at these hospitals,” she says.
By the mid-1960s and the 1970s, Hillbrow as a health hub shifted. The new Johannesburg General Hospital – now Charlotte Maxeke Academic Hospital – would rise as a concrete hulk in Parktown in 1978 and the original Johannesburg Hospital was renamed the Hillbrow Hospital.
In these decades, Hillbrow also became the flatlands made up of residential highrises, distinct from the rest of suburbia. Its residents were mostly young European expat professionals, recruited to work in a South Africa that was in an era of economic boom. According to The Joburg Book, edited by Dr Nechama Brodie, the new arrivals from Europe boosted the white population in the country by 50% between 1963 and 1972.
Hillbrow was now a high density suburb with different pressures on health services. It was also a suburb, Brodie writes, that “acquired a cosmopolitan Bohemian character … and nurtured a subculture that incorporated elements of ‘swinging London’ and America’s hippie culture”.
Under the two iconic city landmarks of Ponte Towers and the Hillbrow Tower (Telkom Tower), Hillbrow was an unbounded playground, freer from the hang-ups of racial segregation and largely managing to evade the heavy hand of apartheid-era law enforcers and morality policing.
But by the mid-1980s, South Africa was in various States of Emergency and Hillbrow changed once again. White flight came on fast as more black people moved from the townships to Hillbrow, which was central, affordable and also anonymous. Hillbrow’s slide to urban decline came at the same time as the anxious steps towards democracy. Landlords absconded; the city council failed on upkeep, maintenance, and bylaw enforcement. Banks redlined the area, leaving Hillbrow to become an urban slum.
Professor Helen Rees, founder and executive director of the Wits Reproductive Health and HIV Institute (WRHI), picks up the story from the mid-1990s. She says: “I had set up the Institute in 1994 and it was at the same time when HIV was just exploding. We started out in Soweto but worked with a public clinic dedicated to treating sexually transmitted infections (STIs) on Esselen Street in Hillbrow.
“I remember one morning when I got to the clinic the queue stretched around the corner, with about 100 people waiting. Of course, what we hadn’t appreciated fully was that HIV was driving up the level of STIs hugely,” she says.
Hillbrow’s population included groups not easy to link to and retain on care. They were young people, migrants and sex workers. It was enlarging the HIV challenge, Rees says.
Rees didn’t baulk. She doubled down and decided that the WRHI should be located in Hillbrow, right next to the Esselen Street Clinic, one of the first clinics in the country to offer HIV testing.
Staying in Hillbrow means the WRHI has to invest in infrastructure, to have back-up for basics like water supply, generators, and security. These things are needed if the institute is to function as a global leader of science, innovation and research in fields like infectious and vaccine preventable diseases, sexual and reproductive health, antimicrobial resistance, and health in a time of climate change.
The Institute was involved in COVID-19 vaccine trials, studies of the CAB-LA HIV prevention injection, and now they are involved in research on Mpox vaccines and on trials of the experimental M72 tuberculosis vaccine.
WRHI sits at the heart of that which survives of the Hillbrow health precinct. The Shandukani Centre for Maternal and Child Health that opened to the public in 2012 is also here. Other WRHI facilities include a clinic for sex workers as well as a clinic for transgender people. Their neighbours are the Esselen Street Clinic, that endures in the distinctive Wilhelm B Pabst designed building from 1941, and the Hillbrow Clinic, that runs a 24-hour service. Along Hospital Street, the forensic pathology and national laboratory services still function.
Throbbing to a different pulse
But beyond the WRHI’s electric fencing and street corners monitored by private security, much of Hillbrow life throbs to a different pulse. Most noticeable is that one of the WRHI’s immediate neighbours is the condemned building of the one-time Florence Nightingale Maternity Hospital. The building is now a so-called dark building, simply not considered fit for life. The first Johannesburg Hospital stands derelict and abandoned, as does the chapel and the house the Catholic nursing sisters lived in when they tended to patients in the hospital.
And the Hillbrow streets live up to much of its bad reputation. It’s overcrowded with people and garbage. Drug users curl up slumped against urine-soaked concrete benches as hawkers are forced to retrieve water from the city’s smashed water pipes and it seems every bylaw is ignored.
Rees is clear though that WRHI, which marks its 30-year anniversary this year, is exactly where it needs to be. She says the coming needs for healthcare globally will focus on healthcare in slums and healthcare on society’s periphery because more people’s lives are precarious and more people will call slums home.
“The work we do is defined by the context and the needs of the population. But we have created a hugely professional context and run a state of the art institute,” she says. “You cannot do clinical research for the things that affect the majority of communities unless you’re actually working in those communities.”
It means some of WHRI’s budget does go into fixing things in their neighbours’ buildings – repairing pipes or cleaning up backyards turned to garbage dumps. It’s not technically their responsibility but it is a response that helps them remain a relevant and durable pillar. And in a place like Hillbrow, where so many people survive by transience and invisibility, something that holds firm a little longer can make a big difference.
For those of a certain age, Coneheads is an iconic 90s film. But for breakdancers, it seems, developing a cone-shaped head can be an occupational hazard.
According to a 2024 medical case report, a breakdancer who’d been performing for 19 years was treated for “headspin hole”, a condition also known as “breakdancer bulge” that’s unique to breakdancers. It entails a cone shaped mass developing on top of the scalp after repetitive head-spinning. Additional symptoms can include hair loss and sometimes pain around the lump.
Approximately 30% of breakdancers report hair loss and inflammation of their scalp from head-spinning. A headspin hole is caused by the body trying to protect itself. The repeated trauma from head-spinning causes the epicranial aponeurosis – a layer of connective tissue similar to a tendon, running from the back of your head to the front – to thicken along with the layer of fat under the skin on top of the head in an attempt to protect the bones of skull from injury.
The body causes a similar protective reaction to friction on the hands and feet, where callouses form to spread the pressure and protect the underlying tissues from damage. Everyday repetitive activities from holding smartphones or heavy weights through to poorly fitting shoes can result in callouses.
But a cone-shaped head isn’t the only injury to which breakdancers are prone, however. Common issues can include wrist, knee, hip, ankle, foot and elbow injuries, and moves such as the “windmill” and the “backspin” can cause bursitis – inflammation of the fluid filled sacs that protect the vertebrae of the spine. A headspin hole isn’t the worst injury you could sustain from breakdancing either. One dancer broke their neck but thankfully they were lucky enough not to have any major complications.
Others, such as Ukrainian breakdancer Anna Ponomarenko, have experienced pinched nerves that have left them paralysed. Ponomarenko recovered to represent her country in the Paris 2024 Olympics.
As with other sports, it’s unsurprising to hear that the use of protective equipment results in the reduction of injuries in breakdancing too.
But breakdancers aren’t the only ones to develop cone shaped heads.
Newborns
Some babies are born with a conical head after their pliable skull has been squeezed and squashed during the journey through the vaginal canal and the muscular contractions of mother’s uterus.
A misshapen head can also be caused by caput secundum, where fluid collects under the skin, above the skull bones. Usually, this condition resolves itself within a few days. Babies who’ve been delivered using a vacuum assisted cup (known as a Ventouse) – where the cup is applied to the top of the baby’s head to pull them out – can develop a similar fluid lump called a chignon.
Vacuum assisted delivery can also result in a more significant lump and bruising called a cephalohematoma, where blood vessels in the bones of the skull rupture. This is twice as common in boys than in girls and resolves within two weeks to six months.
If you’ve ever seen newborns wearing tiny hats in the first few hours of their life, then one of these conditions may be the reason.
Newborn skulls are made up of lots of small bony plates that aren’t fused together, which enables babies’ brains to grow without restriction. Usually, once the brain reaches a slower growth pace that the bones can keep up with, the plates fuse together. In craniosynostosis, the plates fuse together too early creating differently shaped heads. Surgery can prevent brain growth restriction but is usually unnecessary if the child hasn’t been identified as having an shaped head by six months of age.
I was diagnosed with breast cancer on an ordinary Thursday afternoon in February 2023. I was 34 years old. The December before, my GP had performed a breast exam as part of a general check-up and was concerned that with my dense breast tissue she might be missing something. She wanted me to have an ultrasound, but there was no rush. Her exact words to me were something like: “Don’t worry, it can wait until you have medical aid savings again in January.”
The ultrasound turned up a small shadow, just a centimetre in diameter – something that could be a cyst, but the radiologist thought we should do a mammogram “just in case”. Would I mind waiting? No, I wouldn’t mind. The mammogram was worrying enough that she got approval to do a biopsy the next day. “Just in case”. The results came in the following week.
I had none of the risk factors for breast cancer. I didn’t drink, didn’t smoke, didn’t have any family members with a history of breast cancer, was nowhere near the age of 50. A few months later, I would find out I had none of the genetic markers which can predict risk either – not only did I test negative for the genes associated with breast cancer called BRCA 1 and 2, I didn’t have any of the genes connected with any kind of cancer at all.
As I say, I was diagnosed on a Thursday afternoon. I had my first appointment with an oncologist that Friday morning. I had my first set of scans two days later on Monday and my initial surgery the following Friday. I started chemotherapy treatment within three weeks of first having the word “cancer” used in relation to my body. My doctors moved quickly because they had to. On a scale of 1 to 9 on something called the Bloom and Richardson classification, my cancer was a 9. So, even though I was only stage 1, I was also a grade 3. “Aggressive” doesn’t begin to cover it.
During this time, I held onto five facts. First, we had caught the tumour at exactly the right time. Had I gone in for screening any earlier, we might not have found the cancer yet. Had I gone any later, it likely would have grown and spread to my lymph nodes and other parts of my body and I might have needed more radical treatment and surgeries. Second, it was treatable. My particular kind of cancer ought to respond well to a combination of chemotherapy and radiation. Third, I was otherwise very healthy, aside from the cancer. Fourth, I had a medical aid which was covering almost everything I needed. And, most importantly, fifth, I had a wonderful support system of my partner and his family and our close friends to rely on.
From the beginning, I had an incredible standard of care. To the point where the doctors I saw had heated examination beds – they didn’t want their patients to experience any additional discomfort and distress during such a difficult time. And it was difficult. Chemotherapy and immunotherapy left me feeling battered and broken. Nausea, intense muscular pain, fatigue, vomiting, diarrhoea, constipation, weight gain, hair loss, brain fog, depression – some of the awful side effects it’s impossible to really prepare for. In fact, I had such a hard time mentally during treatment that at one point I had to be hospitalised.
The same day I received my diagnosis, I overheard a woman in my doctor’s office asking if it was possible to make a payment plan for her treatment. The administrators replied that treatment was likely to cost in excess of R300 000 at a minimum. I cannot even begin to imagine having to go into debt to fight off cancer. For treatment that makes you feel more than just sick, more like you’re dying. For treatment that may not necessarily work.
But this is the choice that faces most people with cancer in our country. With a relatively small number of people on comprehensive medical aids with screening benefits and prescribed minimum benefits, many face waiting for treatment in government facilities or running up huge bills at private clinics.
According to the most recent report by Statistics SA, breast cancer is the most commonly diagnosed cancer in women in South Africa, accounting for 23% of all cancers. It is also one of the most deadly, representing 17% of cancer deaths in women, just behind cervical cancer.
The Stats SA report lists “awareness of the symptoms and need for screening” as the main intervention to reduce the risk of death by breast cancer. The report also draws attention to the discrepancy in mortality rates in different population groups. For example, Coloured women have a relatively low incidence of breast cancer, but a high mortality rate – meaning that they are dying of breast cancer after being diagnosed too late. Stats SA points out that this is likely due to “poor access to cancer treatment facilities” as well as a lack of medical aid coverage. It is perhaps unsurprising that Black and Coloured women are the groups least likely to have medical aid in South Africa.
There are also some NGOs trying to step in to fill the gaps, like the aptly named I Love Boobies or the PinkDrive. These organisations make it their mission to give women a fighting chance to beat breast cancer. They provide free screenings to women around the country who would otherwise not be able to afford this necessary medical care.
I am one of the lucky ones. I officially went into remission on 30 August 2023 when I had a lumpectomy to remove the tumour in my right breast. Remission means that the cancer can no longer be detected in your body through scans and blood tests. It doesn’t mean you’re “cured”. There could still be cancerous cells in the body, which is why cancer is also often treated with radiation like mine was. Some people prefer not to use the term “survivor” until they have been in remission for over five years.
Five years is an important milestone for many people diagnosed with cancer. It’s often the period in which someone is most likely to suffer a relapse. I live with the possibility that my cancer will come back every day; I am reminded by my scars and by the fact that I am still recovering physically and mentally from a traumatic year. I still battle with periods of fatigue and depression and I will never be the same person I was before falling ill.
Still, remission is better than relapse. So far, so good. I continue to see my myriad of doctors every few months for scans and tests and examinations to check that nothing has come back yet and I feel like I’m getting stronger.
Almost a year to the day after I went into remission, my fiancé and I ran the Johannesburg Women’s Race in support of the PinkDrive. A mobile health unit was parked on the field in Mark’s Park offering free screenings all morning, which women were queuing up to access after the run. The festive atmosphere was bittersweet to me. Certainly, some of the women in that line would not know that they were starting on a long and painful journey, a journey which sometimes feels like it has no end. Hopefully, they would be starting early enough to be given a chance to become a survivor.
There’s another meaning of “remission” I wasn’t aware of until I looked it up. It can also be defined as “a cancellation of debt”. No-one with cancer should have to crowdfund in order to get treatment, but that is the reality we are faced with in our country. This October, I encourage everyone to contribute in whatever way they can to a cancer survivor’s remission. Join the Imagine Challenge, try a secret swim, pick up a pink bottle of milk or a scrunchie, support someone raising funds on GivenGain, get yourself examined. Every one of us can join the fight against breast cancer.
Professor Glenda Gray, internationally known for her research in HIV vaccines and interventions to prevent transmission of HIV from mother to child, received the country’s highest honour, the Order of Mapungubwe, in 2013. (Photo: Biénne Huisman/Spotlight)
By Biénne Huisman
After a decade at the helm of the country’s primary health research funder, Professor Glenda Gray will focus again on doing the science. She tells Spotlight’s Biénne Huisman about her childhood, her passion for research, administering multi-million dollar grants, and a heated argument in the bathroom with an ANC bigwig.
Professor Glenda Gray, the first woman president and chief executive of South Africa’s Medical Research Council (SAMRC), has among others been described as outspoken, credible and tenacious. After a decade at the helm of the SAMRC, Gray retains her reputation for fearlessly speaking truth to power.
“Heading the SAMRC was definitely the best job of my life,” says Gray. “But I am excited about my future, it’s time for another best job. After ten years of doing science administration, it’s time to get back and do the science.”
Perhaps Gray’s fierce spirit was honed in her childhood, growing up in Boksburg on the East Rand, “on the wrong side of the tracks”. She laughs, remembering how American cable news channel ABC sub-titled her first TV interview, due to her strong “East Rand accent”.
Investing in research
From a childhood of counting cents, these days Gray administers multi-million dollar grants and passionately makes the case for greater investment in scientific research.
She says that while South Africa’s health department has competing priorities, ideally it should double or triple its allocation to research.
“We spend a lot of time trying to show the Department of Health how important science is. And so while there is commitment from them, they’re so busy worrying about services; healthcare workers, doctors, hospitals falling down, no equipment, no cancer treatment. And so, sometimes science is seen as esoteric and a luxury.”
Speaking to Spotlight during her lunch break at an SAMRC event in Cape Town, Gray adds: “Science gives you evidence to reduce morbidity and mortality. All the things that change people’s lives; like covid vaccines, ARVs, mother to child transmission interventions, typically these stem from research. And so, you can only improve outcomes if you fund research. Currently, the SAMRC gets around R750 million from government a year; in my view, around R2 to 3 billion a year is needed to really make profound investments in research.”
Supplementing the funding from the government, the SAMRC has scores of international funders and collaborators, such as the United States National Institutes for Health. One concern with such international donor funding is that local research may end up pandering to agendas set abroad.
Gray rejects this suggestion. “We [the SAMRC] always fund the ten most common causes of mortality and morbidity in South Africa. So the funders who work with us have to agree on funding what we deem our priorities.”
One of these priorities is transformation. “So I spent ten years of my life changing who we funded, where we funded, how we funded; changing the demographics of the SAMRC, creating an executive management committee that was diverse, and being able to attract a great black scientist [Professor Ntobeko Ntusi] to take over from me,” says Gray.
While having passed the public mantle onto Ntusi in July, the paediatrician and renowned HIV vaccinologist, named one of Time magazine’s 100 most influential people in 2017, will continue her HIV vaccine research. Gray is heading a major USAID funded study aimed at “galvanising African scientists, mostly women, into discovering and making an HIV vaccine.” She also holds tenure as a distinguished professor at the University of the Witwatersrand’s Infectious Diseases and Oncology Research Institute.
Give and take
Speaking to Spotlight, Gray reflects on managing the political side of the SAMRC – the intersection between politics and science: “As the president of the MRC, you have to be very brave and you have to be able to speak truth to power. Sometimes it’s hard, and sometimes it’s easy.”
This, she says, is a dance of give and take: “The relationship has to be flexible. Because, sometimes scientists are wrong and politicians are right. Sometimes politicians are wrong and scientists are right. And sometimes both are wrong, and sometimes both are right. And our egos can get in the way. You know: ‘Oh, you took me off the MAC [Ministerial Advisory Committee], now I’m not going to help you’. That’s not the right attitude to have…”
COVID-19 lockdown ruckus
Gray served on the Department of Health’s COVID-19 MAC at the height of the pandemic. In May 2020, she caused a ruckus for breaking away from the committee’s more measured counsel, turning to the press to criticise government’s lockdown regulations as “unscientific”.
She said the hard lockdown was causing unemployment and unnecessary hardship and malnourishment in poor families. Later as the hard lockdown started to lift, she spoke out against government’s continuation of restrictions on school going, the sale of certain foods and clothes like open-toe footwear, and the limits on outdoor exercise. “It’s almost as if someone is sucking regulations out of their thumb and implementing rubbish, quite frankly,” she told journalists at the time.
Then health minister Dr Zweli Mkhize rebuked Gray’s claims and sidelined her in the MAC before excluding her from a newly constituted MAC in September. The acting Director-General of Health, Anban Pillay, wrote to the SAMRC board urging them to investigate Gray’s conduct. As the fray deepened, the SAMRC board failed to back Gray. The council’s boardwas was acting in a “sycophantic manner aimed at political appeasement”, lamented a guest editorial published in the South African Medical Journal.
Despite this public falling-out, the following year, in February 2021, Gray worked with Mkhize to bring vaccines to South Africa’s healthcare workers.
“So basically at that stage government didn’t have a vaccine programme, and I bailed them out,” she tells Spotlight.
In February 2021, results from a clinical trial showed that the Oxford AstraZeneca COVID-19 vaccine – then intended for rollout in South Africa – performed poorly in preventing mild to moderate illness caused by the Beta variant of SARS-CoV-2, which was dominant at the time.
Gray says she was approached by Mkhize about an alternative vaccine – to which she responded by facilitating the procurement of 500 000 doses of the Johnson & Johnson vaccine through personal connections. These were officially rolled out to healthcare workers on February 17, when President Cyril Ramaphosa received his jab at the Khayelitsha District Hospital. Spotlight previously reported in more detail on the procurement of those first 500 000 doses.
“The vaccines arrived in Johannesburg at about midnight,” Gray recalls. “Then the plane with the president’s vaccine touched down in Cape Town at 12:20pm; and we had to rush it to Khayelitsha to have him vaccinated at one o’clock”.
A bathroom row with a minister
Gray is no stranger to fighting for policies and treatments based on scientific evidence. She recalls an altercation with former health minister Nkosazana Dlamini-Zuma in a bathroom at the presidential residence in Pretoria (Mahlamba Ndlopfu) in the late 1990s – the era of AIDS-denialism under then President Thabo Mbeki.
“Thabo Mbeki had a national AIDS plan and they were about to publish it. So there was a meeting; we were presenting, and we had data that mother to child transmission interventions were affordable, or that it was actually cheaper to give ARVs to a pregnant woman, than to treat a child who is HIV positive. But they kept on saying it was unaffordable, and that they wouldn’t be doing it. And then, when I saw Dlamini-Zuma in the bathroom, I got into a fight with her and said: ‘but it is affordable!’”
Early years in Boksburg
One of six children born to a “maverick father”, whip-smart but taken to getting involved in crazy schemes, and a mother who later in life became a Baptist minister, Gray says they grew up poor.
“My parents would often run out of money in the middle of the month, having to scrounge for food, borrow milk or buy on the book (credit arrangements). So I know what it’s like to be on the other side of privilege.”
Gray relays how neighbours would drop by at her childhood home to borrow cups of sugar, to spy on their family – as, during apartheid, her father would entertain friends of colour.
Gray matriculated from Boksburg High School in 1980. The next year she enrolled for medical school at Wits, working part-time to pay her way: “I worked at an ABC shoe store, Joshua Door, selling furniture, making Irish coffees at Ster Kinekor, waitressing…”
In 1993, as HIV exploded across the country; pregnant with her first child, Gray watched her own stomach expand while treating HIV-positive expectant mothers at Chris Hani Baragwanath Hospital. “In those days, there were no ARVs for children,” she recalls. “And so women had to navigate this joy of a new life, with the fact that death was looming over them.”
Today, Gray has three children and lives in Kenilworth in Cape Town.
Commenting on her reputation for standing up to pressure, she smiles. “My tongue has gotten me into trouble. How do I feel about that? I just want to make sure that as scientists we let politicians and society know the data and the evidence. I feel passionate about translating science, I feel passionate about evidence. I feel passionate about science changing the world.”
Spinal cord injury survivor is a capable and helpful big brother
Kamogelo Sodi, who was injured in a car crash when he was just six years old, says he learned valuable skills on how to regain his independence at the Netcare Rehabilitation Hospital. The teenager enjoys cooking for himself, taking care of his three younger brothers, and playing basketball when he’s not studying hard to achieve his dream of being a medical practitioner one day.
5 September 2024: At 14 years old, Kamogelo Sodi of Alberton enjoys listening to music, chatting with his friends on social media and working hard at school towards his dream of becoming a neurosurgeon one day. He cooks for himself when he’s hungry and loves looking after his three little brothers. He also likes playing basketball. The difference between him and most other teenagers is that he does all this from his wheelchair.
“Since I’ve been in a wheelchair, I’ve become more confident,” says the vivacious teenager. “I was extremely shy, and I didn’t have a lot of friends, but now I have loads of friends.”
In 2016, when he was just six years old, Kamogelo’s life changed forever. He was in a devastating car crash, which left him with fractures in the lumbar region of his spine, resulting in complete paraplegia.
Once discharged from the hospital, where he had emergency surgery, Kamogelo was sent to the Netcare Rehabilitation Hospital to learn how to cope with, as his mother Reshoketswe Sodi calls it, his new normal. He was to stay there for almost six months.
Mrs Sodi, a radiation therapist, says the enduring care of the doctors, occupational therapists and physiotherapists there helped support Kamogelo and their family on their journey towards accepting and learning to cope with this difficult transition in his life. “It was important for me that he continued his schoolwork while there. When the social worker asked me what I wanted to happen, the first thing I said was that I didn’t want to break the routine of what he had been doing and that I wanted him to continue with school.
“It’s been a struggle, but with the help of the occupational therapists and physiotherapists, it has been an easier journey. We saw real progress when they taught Kamogelo something, and he grasped it, putting all his energy into it by thinking positively about it. It’s been hard, but with the support of the team from Netcare Rehabilitation Hospital, we managed it,” she says.
“After he was discharged, initially, we lived in a flat on the seventh floor. When the lifts weren’t working, like during load shedding, I’d have to carry him upstairs on my back – there was no other way to take him up. I’m so fortunate that I had a lot of support from my family and friends who’ve been pillars of strength for us.”
Kamogelo remembers his first visit to the Netcare Rehabilitation Hospital in Auckland Park. “When I first got to the hospital, I was lost. I didn’t know how to use a wheelchair. I was still so young. But they were so kind and taught me everything I needed to know.
“At first, I struggled to move around. I battled to transfer myself from place to place, but they showed me what to do, and over time, I started getting used to it. I managed to start moving myself around, and I began to enjoy it. From that day forward, I didn’t like people pushing me around. The staff also taught me how to transfer myself from my wheelchair to the car. It was a bit difficult at first, but I learned to push myself up properly so my bottom wouldn’t scrape on the wheelchair.
“It does help you become more independent, but you must be consistent. You don’t need to complain about things, you just need to listen to the people who want to help you learn to be independent.”
Later, in 2022, when he was 12 years old, Kamogelo returned to the Netcare Rehabilitation Hospital after he developed a severe pressure sore.
Dr Anrie Carstens, a doctor at the Netcare Rehabilitation Hospital, said Kamogelo was operated on at Netcare Milpark Hospital under the care of a plastic surgeon who did a flap to close the wound. “When the doctor was happy with his progress, Kamogelo came to us to help him because you get weak after surgery. The wound had healed, but the skin was delicate, so we had a graded seating approach for him to build up his strength and so that the areas of the skin didn’t break down. Another area of focus for Kamogelo was spasticity at the ankles. We worked on relaxing the ankles to get to a ninety-degree angle so he could sit better in his chair with his feet positioned well in the footrest.”
When homesickness inevitably struck, the staff comforted Kamogelo. “I began to miss home, and I cried and said I wanted to go home. They spoke nicely to me and said they first had to help me so I could go back home with no problems so my parents wouldn’t have to worry about me because of the pressure sore.”
Kamogelo said the staff also taught him valuable techniques to help him empty his bladder and bowels and assisted him in his journey to independence. “I was worried it would be painful and was a bit hesitant to try them out. But, doing it daily helped my routine and helped me become independent.”
Charne Cox, a physiotherapist at Netcare Rehabilitation Hospital, describes Kamogelo as bubbly, intelligent and with lovely manners. “He’s so motivated and tried so hard in therapy. He manages to go to school each day, not because of us, but because of his character.”
She says as children grow, their needs change. “The pressure sore developed because his seating in his wheelchair was not adequate because he had grown so much. We collaborated with the wheelchair manufacturer to re-evaluate and reassess the wheelchair seating, and they made him a new wheelchair. He was getting heavier, and his feet weren’t in alignment, so it was trickier for him to safely transfer from the wheelchair to the bed, for instance. It was good to re-educate him on pressure relief and pressure sores. It’s vital that adolescents are taught to take responsibility for themselves.”
Cox also helped Kamogelo work towards getting his feet in a better position.
“Children are so good about learning to use a wheelchair. Kamogelo was so motivated to move and be independent. He absorbed the information we gave him to enable him to go up ramps, turn and even do wheelies because he liked to explore.
“Children want to learn and have fun. They want to be independent. It’s amazing to help give them the tools to be the best new person they can be. Unfortunately, sometimes we can’t fix the injury, but we can give them the best opportunity to be as independent as possible. It’s so satisfying to know that Kamogelo is going to school and playing basketball.”
Kamogelo is determined to pursue a career as a neurosurgeon. “As long as I follow the path that I want to do and enjoy it, I will continue pursuing that path. Academically, I was the top achiever from grade four to grade six at my school.”
When he’s not at school, he loves going around the estate he lives in, getting fresh air, and being a good big brother to his three younger brothers. “They’re a handful, but what can I say – they’re my brothers, and I love them,” he says with a laugh.
Asked who his hero is, Kamogelo is quick to say his mother and father are both his heroes. His mom clearly thinks he’s a hero too. She’s smiling as she speaks about her son. “He’s playful and has a great sense of humour. He’s helpful in the house. Instead of wanting us to help him, thanks to the skills he learned at Netcare Rehabilitation Hospital, Kamogelo always says, ‘Let me give you a hand. Let me help you.’”
The image represents a statistical average of how different types of love light up different regions of the brain. Photo: Pärttyli Rinne et al 2024, Aalto University.
We use the word ‘love’ in a bewildering range of contexts, from sexual adoration to parental love or the love of nature. Now, more comprehensive imaging of the brain may shed light on why we use the same word for such a diverse collection of human experiences.
“You see your newborn child for the first time. The baby is soft, healthy and hearty – your life’s greatest wonder. You feel love for the little one.”
The above statement was one of many simple scenarios presented to 55 parents, self-described as being in a loving relationship. Researchers from Aalto University utilised functional magnetic resonance imaging (fMRI) to measure brain activity while subjects mulled brief stories related to six different types of love.
“We now provide a more comprehensive picture of the brain activity associated with different types of love than previous research,” says Pärttyli Rinne, the philosopher and researcher who coordinated the study. “The activation pattern of love is generated in social situations in the basal ganglia, the midline of the forehead, the precuneus and the temporoparietal junction at the sides of the back of the head.”
Love for one’s children generated the most intense brain activity, closely followed by romantic love.
“In parental love, there was activation deep in the brain’s reward system in the striatum area while imagining love, and this was not seen for any other kind of love,” says Rinne. Love for romantic partners, friends, strangers, pets and nature were also part of the study, which was published in the journal Cerebral Cortex.
According to the research, brain activity is influenced not only by the closeness of the object of love, but also by whether it is a human being, another species or nature.
Unsurprisingly, compassionate love for strangers was less rewarding and caused less brain activation than love in close relationships. Meanwhile, love of nature activated the reward system and visual areas of the brain, but not the social brain areas.
Pet-owners identifiable by brain activity
The biggest surprise for the researchers was that the brain areas associated with love between people ended up being very similar, with differences lying primarily in the intensity of activation. All types of interpersonal love activated areas of the brain associated with social cognition, in contrast to love for pets or nature – with one exception.
Subjects’ brain responses to a statement like the following, on average, revealed whether or not they shared their life with a furry friend:
“You are home lolling on the couch and your pet cat pads over to you. The cat curls up next to you and purrs sleepily. You love your pet.”
“When looking at love for pets and the brain activity associated with it, brain areas associated with sociality statistically reveal whether or not the person is a pet owner. When it comes to the pet owners, these areas are more activated than with non-pet owners,” says Rinne.
Love activations were controlled for in the study with neutral stories in which very little happened. For example, looking out the bus window or absent-mindedly brushing your teeth. After hearing a professional actor’s rendition of each ‘love story’, participants were asked to imagine each emotion for 10 seconds.
This is not the first effort at finding love for Rinne and his team, which includes researchers Juha Lahnakoski, Heini Saarimäki, Mikke Tavast, Mikko Sams and Linda Henriksson. They have undertaken several studies seeking to deepen our scientific knowledge of human emotions. The group released research mapping subjects’ bodily experiences of love a year ago, with the earlier study also linking the strongest physical experiences of love with close interpersonal relationships.
Not only can understanding the neural mechanisms of love help guide philosophical discussions about the nature of love, consciousness, and human connection, but also, the researchers hope that their work will enhance mental health interventions in conditions like attachment disorders, depression or relationship issues.
In South Africa’s ever-evolving healthcare landscape, women are not just participants—they are pioneers, breaking barriers and driving transformative change. With women making up approximately 51.1% of South Africa’s population and over 50% of the African continent’s population of more than 1.4 billion people, their contributions are integral to the region’s progress. In the healthcare sector, women form the backbone of the workforce, representing a significant majority in roles ranging from frontline patient care to high-level decision-making.
writes Ms Nokuzola Mtshiya, Head: Stakeholder Relations and Business Development, Board of Healthcare Funders
The Board of Healthcare Funders (BHF) celebrates the incredible women who are leading the charge, advocating for equity, fostering innovation, and ensuring inclusivity at every level of the system. As trailblazers, they are not only providing essential frontline care but are also shaping strategies that will influence the future of healthcare in South Africa and beyond. This moment calls for even more women to step into leadership roles, to amplify their impact and continue to reshape the future of healthcare across the continent. Among the many remarkable women making a difference, we celebrate a few who are setting the standard for excellence and progress in the sector.
Professor Deborah Glencross: Revolutionising HIV diagnostic immunology
Professor Deborah Glencross’s journey from childhood, which was marked by frequent hospital visits, to becoming a leading expert in haematology and molecular medicine. is nothing short of extraordinary. Initially aspiring to be a paediatrician, her path changed due to health challenges. This shift led her to a groundbreaking career at the National Health Laboratory Service, where she has made a significant impact in the field of HIV care.
Prof Glencross’s development of the PanLeucogated (PLG) CD4 assay has been pivotal in improving the quality and affordability of CD4 testing, a crucial aspect of HIV care. Her innovation has saved South Africa approximately R12 billion, reflecting her ability to drive significant advancements despite resource limitations. This achievement underscores the potential for local insights and creativity to lead to profound healthcare improvements.
Throughout her career, Prof Glencross has been deeply involved in flow cytometry technology, which contributed to her pioneering work in HIV diagnostics. Her success is also attributed to the mentorship she received from influential figures such as Prof Barry Mendelow and Prof Ruben Sher. Their support helped shape her research focus and contributed to her international recognition.
Prof Glencross’s career highlights the importance of persistence and effective management of both professional and personal responsibilities. She advises young women in healthcare to seek support and let go of guilt, emphasising the need for better support systems such as on-site childcare and flexible work hours. Her vision for the future includes driving impactful solutions through local knowledge and creativity rather than relying solely on large grants.
This driven and caring healthcare professional’s legacy is testimony to the significant impact that dedicated individuals can have on transforming healthcare and improving lives.
Dr Gloria Tshukudu: Innovator in plasticand reconstructive surgery
Dr Gloria Tshukudu’s career in healthcare is a powerful example of dedication and resilience. From a young age, influenced by her mother’s career as a nurse, Dr Tshukudu knew she wanted to be a doctor. Despite facing numerous challenges, including struggles with specialisation and balancing professional demands with personal responsibilities, she remained steadfast in her commitment to medicine.
Dr Tshukudu has achieved notable milestones in her career, including becoming the first South African woman to qualify as a plastic surgeon in 2013, pioneering research on chemical peels for ethnic skin and making significant advancements in plastic surgery. Her contributions have not only advanced her field but have also helped address issues related to gender dynamics and representation within healthcare.
Navigating the complex interplay between work, family responsibilities and societal expectations has been a significant part of Dr Tshukudu’s career. She has advocated for improved support systems, including better maternity leave and access to childcare, to enhance the working conditions for women in healthcare. Her leadership style emphasises empathy, support, and perseverance, reflecting her belief in fostering an inclusive and supportive environment.
Dr Tshukudu’s efforts have significantly increased the representation of women and marginalised groups in healthcare. Through mentoring and supporting younger professionals, she has contributed to the evolution of the healthcare sector, ensuring that future generations benefit from the advancements and opportunities she has championed.
Melanie Da Costa: A visionary in healthcare strategy and policy
Melanie Da Costa is a trailblazer in healthcare strategy and policy. She combines her expertise as a Chartered Financial Analyst (CFA) and a Master of Commerce (MCom) to make a profound impact on the healthcare sector. Her career began in the investment world, where she distinguished herself as a healthcare investment analyst and fund manager. Notably, she served as the Head of Equity Research for HSBC’s South African office, showcasing her deep understanding of financial dynamics and strategic insight.
In May 2006, Da Costa transitioned to Netcare, where she has been instrumental in the organisation’s strategic evolution. Her role in founding the Health Policy Unit has been crucial in shaping national health policy. Her responsibilities at Netcare include overseeing health policy, funder contracting and strategic initiatives, with a focus on international opportunities until 2018.
Da Costa’s influence extends beyond South Africa. She has played a key role in global healthcare policy discussions, leading Netcare’s participation in the South African Competition Commission Healthcare Market Inquiry and serving as the Board lead in the UK’s Competition Markets Authority Healthcare Inquiry. Her strategic acumen was further demonstrated during her tenure on the Board of BMI Healthcare in the United Kingdom, where she contributed until the group’s change of control in 2018.
Currently serving as the Managing Director of Netcare Akeso, Da Costa continues to drive strategic growth and innovation. Her leadership during the government-led pandemic response, including the vaccine rollout, was recognised with a Lifetime Achievement Award in 2022 from the Hospital Association of South Africa (HASA), honouring her contributions to health policy and unwavering commitment to improving healthcare systems.
Dr Keo Tabane: Shaping the future of oncology care
Dr Keo Tabane’s journey into oncology bears witness to her unwavering commitment to service and excellence. Raised by an Anglican priest, her formative years instilled in her a profound sense of purpose, steering her toward a career where she could make a meaningful impact.
After completing her undergraduate training in 1999, Dr Tabane embarked on her medical career with an internship at Kalafong Hospital, followed by community service in Makopane.
A defining moment in Dr Tabane’s career came early on during her internship when she faced prejudices as a young black woman. Instead of being deterred, she used this challenge as fuel for her drive, leading to her success and subsequent invitation to return as a specialist.
Her dedication and expertise earned her the prestigious Charlotte MacLeachy Award for medical excellence in 2019. By 2002, she returned to Johannesburg, becoming a specialist in internal medicine and later a pioneering force in medical oncology.
Dr Tabane attributes much of her success to the mentorship of Dr Daniel Vorobyov, whose guidance profoundly influenced her patient-centred approach. Balancing the demands of a high-stakes career with personal life has not been without its challenges. She views work-life integration as a dynamic dance rather than a static balance, blending her professional and personal spheres to enhance both.
Her advice to aspiring women in healthcare emphasises the importance of self-care and respecting personal boundaries. Dr Tabane envisions her legacy as one defined by a focus on patient-centred care, advocating for initiatives to tackle burnout and promote value-based care that keeps pace with medical innovation. Her vision for the future of healthcare is one where progress and patient welfare are intertwined, ensuring that every advancement serves to enhance the quality of care.
These women exemplify leadership and innovation in South Africa’s healthcare sector, making significant contributions that drive progress and equity. From advancing diagnostics and pioneering new treatments to shaping policy and driving strategic growth, their diverse achievements highlight the transformative power of women in healthcare.
Their dedication and impact ensure that adequate healthcare reaches every corner of the nation, inspiring future generations to continue their legacy of excellence and service.
In a world where healthcare challenges are evolving at an unprecedented pace, innovative leadership has become the cornerstone of transformative progress.
Visionaries such as Aurélien Breton exemplify this dynamic approach, blending passion with strategic insight to drive meaningful change. By placing patient wellbeing at the heart of their mission, these leaders are not merely navigating the complexities of the healthcare landscape, but redefining it.
Their commitment to advancing patient access and optimising care underscores a powerful message: that true leadership in healthcare is about more than just responding to current needs, but anticipating future demands and crafting solutions that elevate the quality of life for patients around the globe.
For nearly five years, Aurélien has been a driving force within the Innovative Pharmaceutical Association of South Africa (IPASA), serving as a cornerstone of the Executive Committee and leading the Patient Access to Innovation (PAI) Working Group.
His journey with IPASA reflects a deep commitment to improving patient access to life-saving medicines, tackling the significant challenges within South Africa’s healthcare system, and advocating for those most in need.
“For me, being a part of IPASA means engaging in a collective effort that extends beyond personal or corporate interests to enhance the broader healthcare landscape in South Africa,” says Aurélien.
A native of France and current Managing Director of Southern and Eastern Africa at Servier, Aurélien’s passion for healthcare brought him to South Africa in 2019 driven by a desire to contribute to something greater than himself and to make a meaningful difference in the lives of all South African patients.
“I am a firm believer that a true leader is someone who wakes up every morning driven by a deep sense of purpose. For me, that purpose is ensuring access to innovative medicines for those who need them most. Our work in providing medicines transcends mere numbers; it profoundly impacts the lives of patients and their families, enhancing their quality of life and serving a greater purpose beyond business,” he adds.
While Aurélien’s role has evolved since joining IPASA, his mission has remained constant – to address barriers to patient access and help patients benefit from innovative medicines. Under his leadership, the PAI Working Group has engaged key stakeholders, including government bodies, medical schemes, and patient advocacy groups, to improve access to innovative treatments.
Aurélien admits that despite engaging with all relevant stakeholders, progress has been sluggish. He attributes this to the healthcare environment at large, where excessive processes and regulations dilute responsibilities and hinder effective action.
“Constructing a path to improvement is challenging due to unresponsiveness and barriers, including a lack of urgency from some stakeholders and uncertainty surrounding the National Health Insurance (NHI) scheme. This has slowed efforts to enhance patient access to life-saving medicines. We must focus on refining the existing system rather than waiting for a complete overhaul.”
Despite these challenges, including others such as infrastructure, access to innovative medicines and their associated high costs, Aurélien and the team have made significant strides. Most notably, the Group has been instrumental in fostering strong engagement between medical schemes, the Council for Medical Schemes, patient advocacy groups, and others; while several prominent medical schemes, such as Discovery Health and Medscheme have entered into agreements that could improve access to innovative medicines in the future.
Aurélien is quick to credit the collective efforts and dedication of the PAI Working Group for the progress achieved during his tenure, acknowledging their willingness to invest time and energy in something greater than themselves. He recognises the significant long-term commitment required, noting the burdensome and relentless nature of the work, which can lead to discouragement or frustration. Despite facing hurdles, the PAI Working Group has met these with resilience and determination to drive progress and effect meaningful change.
While Aurélien has helped achieve significant strides in improving patient access across the South African healthcare landscape, he is eager to broaden his impact by extending his expertise to other countries where he will continue his work in improving patient access.
“While I am sad to be moving from South Africa, I believe I have helped set the foundation for change in the country. Even though the registration of innovative medicines has improved, access to these potentially life-saving medicines and increasing the public visibility of patient voices remains a challenge. I implore everyone involved to continue working tirelessly to break down these barriers, ensuring that all patients can benefit from the innovations that have the power to transform their lives. The work is far from over, and we must maintain our commitment to improving healthcare access and outcomes for all,” concludes Aurélien.
Reflecting on Aurélien’s contributions, Bada Pharasi, CEO at IPASA, adds: “Aurélien’s commitment to improving patient access and healthcare innovation reflects a deep-seated passion for making a tangible difference. As he embarks on this new chapter, we, as IPASA, thank him for his commitment and drive to contribute positively to the healthcare landscape in South Africa. His influence will undoubtedly continue to inspire and impact many in the industry.”
Review of research suggests patients feel better when providers sit or crouch during bedside conversations
Photo by National Cancer Institute on Unsplash
Doctors and other healthcare workers, you may want to sit down for this news. A systematic review of studies suggests that getting at a patient’s eye level when talking with them about their diagnosis or care can really make a difference.
Their findings, published in the Journal of General Internal Medicine, revealed that sitting or crouching at a hospitalised patient’s bedside was associated with more trust, satisfaction and even better clinical outcomes than standing, according to the review of evidence.
The study’s authors, from the University of Michigan and VA Ann Arbor Healthcare System, note that most of the studies on this topic varied with their interventions and outcomes, and were found to have high risk of bias.
So, the researchers sat down and figured out how to study the issue as part of their own larger evaluation of how different nonverbal factors impact care, perceptions and outcomes.
Until their study ends, they say their systematic review should prompt clinicians and hospital administrators to encourage more sitting at the bedside.
Something as simple as making folding chairs and stools available in or near patient rooms could help – and in fact, the VA Ann Arbor has installed folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.
Nathan Houchens, MD, the U-M Medical School faculty member and VA hospitalist who worked with U-M medical students to review the evidence on this topic, says they focused on physician posture because of the power dynamics and hierarchy of hospital-based care.
We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it.”
-Nathan Houchens, M.D.
An attending or resident physician can shift that relationship with a patient by getting down to eye level instead of standing over them, he notes.
He credits the idea for the study to two former medical students, who have now graduated and gone on to further medical training elsewhere: Rita Palanjian, M.D., and Mariam Nasrallah, M.D.
“It turns out that only 14 studies met criteria for evaluation in our systematic review of the impacts of moving to eye level, and only two of them were rigorous experiments,” said Houchens.
“Also, the studies measured many different things, from length of the patient encounter and patient impressions of empathy and compassion, to hospitals’ overall patient evaluation scores as measured by standardised surveys like the federal HCAHPS survey.”
In general, he says, the data paint the picture that patients prefer clinicians who are sitting or at eye level, although this wasn’t universally true.
And many studies acknowledged that even when physicians were assigned to sit with their patients, they didn’t always do so – especially if dedicated seating was not available.
Houchens knows from supervising U-M medical students and residents at the VA that clinicians may be worried that sitting down will prolong the interaction when they have other patients and duties to get to.
But the evidence the team reviewed suggests this is not the case.
He notes that other factors, such as concerns about infection transmission, can also make it harder to consistently get to eye level.
“We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it,” said Houchens.
Making seating available, encouraging physicians to get at eye level, and senior physicians making a point to sit as role models for their students and residents, could help too.
A recently launched VA/U-M study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a bundle of interventions aimed at making hospital environments more conducive to healing and forming bonds between patient and provider.
In addition to encouraging providers to sit by their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patient rooms and posing questions to patients about their priorities and backgrounds during conversations.
The researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores, and other measures between the units where the bundle of interventions is being rolled out, and those where it is not yet.
