Rural Com Serve


An unstable economy, rife corruption and a failing health care system at the hands of irresponsible and corrupt officials on the ground are just the kind of troubles that South Africans face. The burden of disease, exacerbated by the high prevalence and incidence of HIV pokes holes at a bucket that is barely containing leaks of an equitable democratic country.

Both urban dwellers and rural are hard hit by the realities that disturb our health system, but it is the latter that find themselves in clinics where gloves run out, basic medicines are stocked out and  healthcare staff is demoralised and eventually seeks greener pastures elsewhere.

Rural Health is my passion. It is these marginalised of our society, predominantly illiterate and poorly educated that have to suffer the severest consequences of the ills that plague our system. It is these citizens, whose loud cries are but whispers that get lost in the political winds that blow over the rural landscape.

But there is hope, there is hope when young leaders and visionaries pick up they shovels and axes and head out to mend this system one person at a time.


Taking from warrior men and women who went before us we will invest in a legacy that will outlive us. A legacy that began with the conscious efforts of health practitioners who simply said “ENOUGH is ENOUGH” change needs to happen, even if it means sacrificing a portion of your life to the seclusion of service in a rural area for a while. What does one have to lose? A mall, cinema trips and occasional night outs with the girls or guys at Long street?

It is sound minds and hearts like ours to which these silenced voices call, you and I. Leaders and pioneers of rural health care to be.

Will you join us or will you turn the blind eye?


Clinicians of a divided society.


I had the pleasure of working in small middle class area within the Western Cape. This part of Cape Town presents a different social dynamic as it is situated in a place that is both accessible to the upper-class of the suburban Cape Town and the masses of the lower class in the Cape-flats. Because of these social dynamics I was treating both the rich and the poor.

I often had very interesting conversations with my patients while treating them and I was surprised to hear how much our people do not know and understand each others backgrounds. This is because South Africa is a very divided society, we do not care about the people who die in skwatta-camps (informal settlements) because we do not have to see them dying of malnutrition. We still have an unacceptable gap between the “haves” and the have-“not`s”

Unfortunately this gap is evident even when it comes to accessing good quality healthcare in public hospitals. Generally in South Africa the rich people have their own hospitals and clinics, and the poor people have their hospitals, the rich do not have to see the struggles of the poor and the poor do not have to see the luxuries of the rich.

This statement of a segregated healthcare system sounds rather crude and unacceptable in a democratic state, however when you look at the role that private hospitals seek to serve in our society it is exactly that of further dividing our society.The private healthcare sector in South Africa is solely here to serve the rich.

Poor people are dealt with in over-crowded hospitals that do not even have half the resources that the private sector has. Unfortunately the concept of the :”rich” and poor in South Africa still continues to trend along the racial lines.Why do we need to have two healthcare systems the private sector for the rich and the public sector for the poor?

The private sectors continues to suck the living day light out of the public sector, because it entices the fresh  graduates with money to slave for it. Professionals who serve the public hospitals either still the resources of the public sector to feed the private sector if its not resources that they still it “time” which they should be spending in public hospital.

I believe that South Africa can have one healthcare system that will be accessible and affordable  to every citizen of the country irregardless of their money they have, or do not have. So what are the alternatives to the privatization of healthcare? Where is the health “Rand” to fund an inclusive healthcare system going to come from?

To answer the above questions, I think by the virtue that we will be working together as one we stand a ood chance of running a sustainable healthcare system that serves everyone who is sick. Every healthcare professional that once served a small segment of society will be working together with others to ensure that people are served.

We will not only be getting the professionals we have lost in private healthcare, but we will be getting amazing skills in regards to the management of a healthcare system. The National Healthcare insurance will ensure that every citizen is taken care of.

Lastly my last solution in ensuring the sustainability of a more inclusive healthcare system, I because when one speaks of an inclusive healthcare system we might think that we are speaking of “free services” well that is not necessary the case, I suggest that people who can afford to pay for their healthcare services should be allowed to do so by means of paying a healthcare levy. Citizens will pay 5% of their salary towards their healthcare, and you might ask what about those who are not working, truth is we are already paying for them either way.

How is the 5% levy going to be different from the taxes we are already paying is that, when a person has accumulated enough money or a person never gets sick or find any reason to use his healthcare fund, then s/he  transfare it to a family member that really needs the money or even get some of it back as a

These are feasible ideas that can only work with good governance and create a more inclusive society where everyone can benefit from healthcare services that they so much need.




I was very skeptical whether online learning can offer  me with good quality education, especially when you are dealing with complex topics like professional ethics in health-care. before starting with this course, I have participated in a number of other online learning platforms like coursera and they did not go well.

During my PHT 402 classes  I learned the importance of reasoning. This course has taught , me how to reason well. I learned how to understand and assess arguments by other participants and how to construct a good argument of my own about controversial issues like euthanasia or equality.

What I really appreciated about this course was the fact that my arguments and moral stance were questioned and challenged by other participants in the course, this helped me to sometimes re-evaluate , re-consider and re-think my ethical stance on certain issues. This has happened through comments and on my blogposts or people challenging some of my statements in their own blog-posts, because of these comments I was able to re-evaluate my believes.

One of the major learning curves for me was learning that it`s Ok to be wrong. Most of the time we are taught how to be right, we get rewards for being right (whether by high marks,or a star in our exercise-book), but in this course I learned how to be wrong and how to accept it. Because of these reward system  we have created a people who want to be right at all costs, even when they are wrong. I learned that my opinion is not the holy word it is nothing but an opinion amongst many opinions,therefore  it can be argued,challenged, opposed and refuted and when that process happens I learned how to embrace it. The most important thing was not being right but the most  important thing was to learn from others.

The main issue I can see with this move to online learning is it made me more responsible for my learning in the sense that there were no strict due dates and compulsory readings to be read, I followed people I liked and commented on blog-posts I liked and this made me to feel more in control of my learning. Most of the time in a traditional classroom I did not feel  in control of my own learning, partly because only  the lectures did the learning and now they just hoped anad prayed that we can be able to memorize what they teach long enough to be able to regurgitate it in an examination room.

I did not have any expectations for this course because I expected anything that could come my way, as Kim said in her last blog that we never set any expectations because we never make them in the first place.

In this video http:// argues that online learning is the answer to having an accessible good quality education for the masses of citizens who can not afford university education.

It has been wonderful participating in these classes. I did not only learn about things people believed, but I learned about the people who believed. Thanks to everyone who has been part of the PHT 402 class, you really made my learning intriguing and worthwhile, I wish you all the best as you continue with this great art of physiotherapy.

There is room for voluntary-euthanasia in our societies

My name is Cecil Lwana, I am trained to preserve and hounour life by all means necessary. I believe in right and wrong good and evil. I really love life and all it has to offer us. Under no circumstances will I consciously and voluntary take a human life for no apparent reason. So help me God.

I fell like I needed to clear the air and publicly proclaim that I value human life, because what I am about to say here my no clearly reflect that, partly because I am rather taking a stance that seems cold and heartless when it comes to choosing life or the lack of thereof. Most of the time I feel like we never really chose which side of the spectrum we belong in, unlike Charde I am not undecided on this issue, I think there is still room for  euthanasia

Good Life Good Death

When a person carries out an act of euthanasia, he brings about the death of another person because he believes the  present existence is so bad that patient would be better off dead, or believes that unless he intervenes and ends the patients life, it will become so bad that the patient would be better off dead. The motive of the person who commits an act of euthanasia is to benefit the one whose death is brought about.

After some googling I noticed that there are two types of euthansia, voluntary and involutantary euthanasia, I will not even talk about involuntary euthanasia where a competent person’s life is brought to an end despite an explicit  opposition to euthanasia, beyond saying that, no matter how honourable the perpetrator’s motive, such a death is, and ought to be, unlawful.

My concern will be with voluntary euthanasia : when a clearly competent person makes a voluntary and enduring request to be helped to die. One of the greatest gifts that God gave us as humans is our Autonomy, as Tony swiftly argues that we can not decide when to exist life because we are not God, I feel that the ability to make our own choices and take our dicisions is the greatest gift God gave to mankind.

I feel that people have an interest in making important decisions about their lives in accordance with their own conception of how they want their lives to go. In exercising autonomy, people take responsibility for their lives; since dying is a part of life, choices about the manner of their dying and the timing of their death are, part of what is involved in taking responsibility for their lives.

Many people are concerned about what the last phase of their lives will be like, not merely because of fears that their dying might involve them in great suffering, but also because of the desire to retain their dignity and as much control over their lives as possible during this phase. I believe that there is nothing as importnant as respecting other peoples autonomy.

The central ethical argument for voluntary euthanasia — that respect for persons demands respect for their autonomous choices as long as those choices do not result in harm to others.

(same person) If I was in this ladies shoes I would chose euthanasia, and to think that other people should not be given that opportunity would be selfishness on my side. There is a time when life is not life, when death is more merciful that life its self, and it takes a clear head to realise when that time has came. In this video Terry is evaluating his options when his Alzheimers makes death better than life.

I think there question here is not whether or not voluntary euthanasia should be allowed, but rather who should be allowed to carry it out? how is qualified to take someone else`s life? I think for me that the question we as society can not answer.

There are no absolute wrongs when it comes to Torture

What is striking about this topic is how obvious questions can not be so obvious. When I was reading the topic I felt that this topic has no meat to sink my teeth on because to me torture was an absolute wrong.To me torture simply meant, electric shock treatment to the genitals, cutting out parts of the body, e.g. tongue, or genitals, severe beatings, suspending by the legs with arms tied behind his back, applying thumbscrews, inserting a needle under the fingernails, drilling through an unanesthetized tooth, making a person crouch for hours in the ‘Z’ position,and denying food, water or sleep for days or weeks on end.

But this video which shows a young man who is left to die in pain because of archaic restrictions on medicines. A woman who is sterilized without her consent because she has HIV. A teenager with a drug problem who is locked away in a “treatment” center where he is beaten and abused made me think if whether or not there is a difference between torture and an inhumane acts.

When I was having a conversation with my friend Emma on this issue a lot of things started to surface about this topic that were not so obvious. These provided some venues for discussion.We established that torture is any action that inflicts pain on others, and it is done intentionally. But it also goes further than just an infliction of pain. Torture is also witholding treatment or anything that can help alleviate pain on someone, if I am in a position of alleviating pain on someone whether with a massage of morphin, I am torturing that person if I am not doing it.We had a mental scenario of watching someone burn to death whilst you are holding a bucket of water and concluded that is also torture. I think with this scenario I have established that torture in not only just inflicting pain on others intentionally, but it goes as further as with with-holding any help that can alleviate pain on people.

Is the government guilty of torture for running out of pain killers for our patients suffering with cancer? even more interesting when you look at the physiotherapy techiniques we use to diagnose patients, you will notice that reproducing the patients pain is a good thing (at least for physiotherapists) because it means you have managed to find the injured structure.

This reproduction of pain is intentional no doubt. Pain causes patient to physically suffer, no doubt and a patient is a sick defenseless person. If you ask me this sounds like Torture. Well you might argue that its torture done with the patients consent, but how many times do we get in wards and ask the patients for consent of every little technique we are going to perform? Where do you draw a line between torture and an excruciatingly painful medical procedure?

Fair discrimination results in equality

the state may not *UNFAIRLY discriminate directly or indirectly against anyone.- South African Constitution-

You probably can never understand the detriments and the legacy “Apartheid” left in our society, and how it has shaped and influenced our lives. I perhaps do n`t expect you to understand it, but I do however want you to be aware why certain things are the way they are in this country and perhaps  shine a spot-light on  why is it probably OK to have a “fair discrimination”.

Personally I was raised by a generation of parents that was considered not worthy to receive quality education,the generation before me was only allowed access to skills that will only teach them how to be better domestic workers, better miners et al, and this system of education enforced the idea of learning the language of the master which was Afrikaans.

Bantu Education crippled our parents not only their dignity but also they humanity, because now they were trapped in this vicious circle of a sick and a dehumanizing society of having to go ask for work in a man who just removed you from your land. If your are not suffering from convenient amnesia you will remember the youth of 1976 retaliating against Bantu Education and saying rather we die by the bullet than we continue to be treated less of human beings. You are probably bored or ready and perhaps saying ” get over it Cecil, apartheid happened long time ago, or perhaps you are mumbling something about  Black Economic Empowerment (BEE), that fine as long as you remember that apartheid was a white men`s BEE,and how do you forget apartheid when the fruits of apartheid continue to stare you in your face everyday you wake up?I do not think there is a single white person who did not benefit from apartheid, unfortunately these advantages were at the detriment of a black person ( WARNING: you might want to stop reading now)

When one talks of equality, one should always ask what are we equalising, and why was it not equal in the first place? South Africa is in exciting times now both politically and economically and majority of South Africans are asking themselves uncomfortable questions about economic redistribution, about redressing the injustices of the past. I do not know whether we can ever fix the mess apartheid caused, but perhaps we can make it better.But how do we make it better, well my answer is what I call ” fair discrimination”. This is an idea that says as citizens of  a democratic South Africa we understand the struggles of  previously disadvantaged South Africans, we acknowledge the societal dynamics that disadvantages people and we want to make that better.

After 350 years of a sick and a dehumanizing system, apartheid was not merely a political system but also an economic system, because the men with political power had economic power. Today we need to know the reality of ordinary citizens like that child who has to travel miles to get to school ( usually an old unused bus, or under a tree) so he can get education,and perhaps that child should be judged based on his context than to be judged against a child who drove his car to get to an air conditioned class room, with a qualified teacher who actually passed standard 8.

I am saying if we understand the context of South Africa and the current state South Africa is in, we will understand why a bit of a fair advantage is needed to equalise the injustices of the past. We should also be aware not to repeat the same system we fought so long and hard to do away with. As a young South African i know how it is like to be unfairly discriminated against, in as much as I did not experience it directly but I felt and saw the legacy of an “unfair” discrimination daily, this is why as a South African I think no one should ever be discriminated against based on the color of their skin, the orientation of their sex. Our sick South African past has taught us to know better what happens when we treat people less of human beings.