The sphinx

god

I separate and unite
I break and mend .
I mold and remold.
I evolve wings like Horus.

I am unseen but felt,
A drizzle of oil over fire.
I am a restoration for fearlessness
The me, who is me now is immortal.

Hold fast to those dreams
For if dreams die,
The phoenix will not rise from those ashes

Why is End of Block such a big deal?

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To all my non-medical friends, I think I need to clear this for the sake of our friendship.

1. I am still cool, seriously I am.
2. I know I have been ignoring you and accusing studying or sleeping for it.
3. I still know how to have fun, even though these days it involves spending a few rands and cents.

Anyway back to my point, I wanted to explain why end of block (EOB) is such a big thing in my life and by extension to your life now.

A block is a period, usually 4-6 weeks, we we learn about a certain topic,eg Pathology, it a period that involves going through everything there is to know about the pathologies of the body, other than that it can involve going through coffee and cigarettes like a pedophile going through a child underwear drawer.

Now this is probably important for our future engagement, please pay more attention, when we finish a block, we have to write a test on that particular topic we were doing in those 6 weeks. You literally go through the whole textbook,yes the WHOLE textbook.

To do well in your EOB you must also master every past paper they ever asked in the last decade. You must also have consumed more that a tank of black coffee.

Yesterday I wrote my first EOB in med school, I nailed it. But thats besides the point. My point is:

1. After writing EOB, the first 22 hours I want to sleep
2. I want to eat real warm food
3. I want to do the things that remind me I am still a real human, like walking to beach, going to the township
4. Doing those whole night prayers

I hope this explains why I have been acting funny the past 8 months. I now declare my schedule open to having fun, but only until Monday. Monday I am starting a new block in Pharmacology (Pharms), Yes that means I will be learning every drug ever invented by men and gods.

Your friend
Dr WannaBe

From my book: A beautiful mess

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CHAPTER 1

I told this kid he should stay away, I am too much of a mess to deal with a human being, especially a cute boy who says he likes me. I don`t even think I like boys for that matter. Honestly I never had to deal with person who says they love me. Love is a strange concept to unravel, It never makes sense, I hate things that do n`t make sense. I am very mathematical in my approach in life, sometimes I think I am too logical I miss out on important things in life.

Why did I even come back to this town? I truly hate home, I think I have leaved too much on my own and for far too long, as such I can not relate to my won family, I love them with a strange kind of love, even though I never told them, but I think they sort of know. I do n`t really know much about my family, I know we sort of share this house and my fathers money, but that`s basically it, that all I know about them.

My dad still believes the South African educational system is not to advance the black child, He says the apartheid government changed the good old British Education that came with the missionaries together with Christianity into Bantu Education. My father spent some time in Bulawayo, Zimbabwe during his days with the MK. He came back to South Africa at the dawn of democracy, with my mother to serve government officials. My mom is a simple farmer girl from Zimbabwe, she is simple in the true meaning of the word. Her family were tobacco farmers, who were later killed by the Mugabe `s land expropriation regime.

I can`t tell you jerk about my sister and brother, I just know they are my siblings. As soon as my front milk tooth fell off I was sent back to Harare to start my alimentary education, who does that? who sends a mixed race child to a foreign racist, anti-white land? My father always says it was for my own good, but that`s rubbish, I think he was too shameful of having to raise a bipolar schizophrenic child. I still hate my mom for not having stopped him, I hate her submissiveness to everything my father says, it hurts me.

I can swear they are glad I will be moving to Cape Town to study medicine. These people really hate my presence in this family. They forced me to study medicine so I can be as far as I can from them and for as long as possible.
I can`t catch feeling now, I can barely bare with the madness of my own mind and now imagine having to learn to love a homo sapien?
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Is it time for politics to be a regulated market?

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I do not usually blog on politics, but then again we do not usually have the kind of messy and exciting political scenes both regionally and globally as we do today. Whether we talk Zille, Zuma, Zimbambwe or Ztrump. History has shown us the enormous significance politics has on people`s lives  around the world.

However, this is not simply a political blog in many respects I see it as a marketing or ethical exploration of political marketing. And indeed politics has much to do with marketing.

If we view politics as a market where promises and manifestos are sold in exchange of profits, is it not about time for politics to be a regulated market?, I  wear not only the hats of a concerned  citizen but also that of an objective outside observer.

As an observer I see a world that is heavily regulated. You cannot sell pharmaceuticals, electrical goods, electronics, children’s goods, food (& tobacco of course!), cars and automobiles, insurance, banking and other financial services, houses to buy or rent, and others, without meeting specific safety and other regulations. And the entire marketplace is covered by regulations on advertising and unfair trade descriptions.

Similarly, the directors of companies are liable for the acts of those companies when they affect safety and human well-being or the economic welfare of the organisation.

There is no equivalent governance and regulation over political advertising. Normally the counter urgument is Section 16, well lets deal with the bogeyman of freedom of speech out of the way. Freedom of speech is not the issue: it applies as much to the marketing of any of these markets as it does to politics. Freedom of speech is the right to an opinion, a point of view, and to express it. It does not give you the right to deceive. But in politics we have all got used to deception as business as usual.

Of course, the institutional rivalry of politics means that the different parties contest and challenge claims. The problem is that this is an unsatisfactory solution. Committed followers of party X do not pay much attention when the members of party Y tell them that party X is telling them porkies. If they read the wrong paper they may even not see it. This is basic social psychology. And some are clearly better rhetoricians than others.

Politicians, and journalists, can make claims and promises that turn out to be untrue. Should  not only get egg thrown in their faces, but  what they say must meet legally reinforced standards of evidence if they state something risky as fact or deliberately overlook evidence to the contrary of their position.

We have plenty of experience of dealing with uncertainty in claims. Financial markets are always making predictions and they know that they have to emphasise that uncertainty. Pharmaceutical companies also market their drugs with both medical claims and information about possible side effects and risks. What would have happened if the politicians, on both sides of the fance, would be required to be careful in presenting evidence, and the limits of reliability on that evidence, rather than being given a free hand to offer opinionated  aspirational claims and promises?

Some might say that it will make politics too complicated. I would say that we are making extraordinarily important decisions in ways that are way too simplistic.

Some will say that people already do not believe politicians. There is much cynicism, but we should be careful to differentiate between cynicism about the other party’s point of view and scepticism about your own party’s claims. The latter is very important for good democracy.

 

My visit to Zimbambwe, Harare in times of economic unrest

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A lot of the times when we travel through the region we always get caught up in snapping pictures and acting touristy. My recent trip showed me that one is never a tourist at home, as such my engagements with Zimbabwe shifted from posing and pouting for a camera into drawing insight about the social fabric that stitches Zimbabwe.

I did not know what it means to be in a country that is bankrupt until the ATMs spewed out air instead of dollars. My trip brought into surface a lot of unknowns and uncertainties about the future of the region. I did not only get know and hear about the struggles of the people of Zimbabwe but I experienced it, with them.

I was there when the government of Zimbabwe was taxing its people for buying mayonnaise and cremora in SA.
I was there when the Beitbridge boarder erupted into chaos as police inflicted pain on its people.

I was there in those cheap Japanies cars,listening to them thelling us this policies are for our our own good.

I was there when the youth of Epworth brought the economy into a stand still.

I was in Westridge mall when shops refused to generate anymore revenue for a system that did not serve them, but creepled them.

I was there with the old women who told me they did not want their hard earned savings turned into meaningless government bonds notes because they wanna see Cape Town.

I was there in Roadport sleeping on the floor with Malawians and Zambians, for the first time our region slept with one blanket.
I was in the botanical gardens as the military was being pumped into the city to maintain thins as they were.

Because I share in your lived experiences I am never a tourist in Afrika, I AM A SON.

 

Mantavanni and my father

One of my beautiful cherished moments with late father, was listening to Mantovanni (Annunzio Paolo Mantovanni) from an old grammmaphone record late at night when everyone was sleeping. We would make ourselves a huge teapot with milk, play ‘Mantavanni and His Orchestra’ on a very low volume. We used to keep the house lit up by the brightness of a paraffin lamp and a good aroma of a steaming teapot. We would sit in our sofa for hours until I fall asleep and he would carry me to my bed. As a young man, there is still a lot I do not know about a lot of things, but my dad left me a fairly good blueprint on fatherhood.

The laborious journey to Universal Health Coverage in South Africa

 

Achieving universal health coverage is the Holy Grail for any effective  government that is serious about improving the health of its people. For South Africa, currently in the stress of the pragmatics of its National Health Insurance (NHI) scheme, the potential rewards are enormous so is its risk of failure without the buy in of the private health care sector. This is a country that continues to suffer poor health outcomes despite it`s  large spending on healthcare, due to chronic inefficiencies and under performances within the system. Breaking this cycle of inefficiency and under performance represents a huge opportunity and challenges for South Africa. But there are no easy fixes and turning NHI from a concept into reality will represent one of the biggest policy challenges facing the government today.

Universal health access is a particularly difficult goal to achieve in South Africa for three multiplex reasons. First, the apartheid system that institutionalized inequalities between the races created economic and social distortions that two decades of democracy have not  been able to obliterate. South Africa remains one of the most unequal societies on earth with a Gini co-efficient of 0.7 (closer to 1 being the most unequal society) and the health system reflects this reality. A well-resourced private healthcare system offers first world care and treatment that is out of reach for most black South Africans. The per capita spending on the private health sector is almost 10 times that of the public sector. Human resource personnel allocations is no also reflective of this inequality. South African medical schools are not enough in supplying the country with properly qualified professionals to meet the demands of the healthcare system.With only a mere 1,200 medical students graduates each year. Of the 600 who decide to practice in South Africa, only 150 end up in the public sector, these bottlenecks create the illusion that Universal Healthcare access is unattainable.

Second, the overwhelming and growing weight of South Africa’s quadruple burden of disease is placing immense pressure on the health system. South Africa is struggling with four separate health burdens, a deadly mixture of developing and developed nation health problems. Infectious diseases are rampant, notably HIV/AIDS and tuberculosis; maternal and child mortality is on a par with some of the poorest African nations; non-communicable diseases are on the rise; and chronically high-rates of violence and injuries continue to scourge the lives of many South Africans.

Finally, there are humongous doubts surrounding  South Africa’s ability to finance NHI. Although South Africa is now a middle-income country, the national economy has been in the doldrums for several years and there’s little hope of a recovery any time soon. Corruption is driving our nations economy to remain bloodless, the mining sector is on life-support, and the country’s creaking infrastructure has led to power outages that have cut production and costed retails a lot of rands and cents.

These economic and structural challenges add urgency to the task of restructuring South Africa’s health care system so that it is financially sustainable and improves the quality of care it delivers.

South Africa has toyed with the idea of introducing some kind of national health insurance scheme since the 1920s. The current effort began in 2011 and has become the flagship  Dr Aaron Motsoaledi.

The government’s policy document was finally gazetted last December , the documents admits there’s a shortage of billions of rand if the NHI is to work efficiently,conveniently, that white paper doesn’t say exactly how much NHI will cost, or where the money is expected to come from. In the meantime, reforms are under way in the health system that are intended to lay the foundations for NHI. These improvements are targeted at creating a a unitary system, financed through a central fund, where patients can select from a package of care offered by accredited health facilities, whether public or private.

There is a long way to go. Many of South Africa’s public health facilities are in bad shape. The physical infrastructure is poor, drug supplies are unreliable, caring staff are in short supply. There is a huge  focus in the reform of primary health care system; clinics are the natural entry point to the health system but they are underutilized by patients who have little faith in the quality of care they receive there and prefer to enter at the hospital level, causing bottlenecks in the system.

Few details have been given about the all-important issue of financing NHI. The basic concept is that the government will set up an NHI fund that will be funded by employers and taxpayers’ contributions. The fund will cover a range of healthcare services that will be free at point of delivery and can be accessed through the public or private sector. The problem is that South Africa’s tax base is already small and burdening its taxpayers.

 

Countries that have free health care have bigger tax bases and less unemployment, while only 39% of South Africans have jobs, in Mexico this figure is 59%, in Norway 62%, Brazil 65% and South Korea 75%. This will be a  tough sell to tax payers and NHI critiques. Undoubtedly additional sources of funding will be required; one possibility is would be increasing ‘sin’ taxes on unhealthy products such as cigarettes and alcohol and re-introduce sugar tax, which is among some of the reasons we are in this problem in the first place.

The planning and piloting phase drags on and six years into the 14-year timetable for NHI implementation, the deadlines already looks overly ambitious. There has been tussles between the Departments of Health and National Treasury, which must cooperate if NHI is going to work but they appear to have different visions for the initiative. Meanwhile, the private sector has been on the sidelined in these processes. The government may be missing a trick by not engaging more closely with some of South Africa’s largest private companies, which have long experience in providing health care to their employees and could, play a role in funding and managing projects and improving hospital infrastructure.

One thing is clear, much is riding on the success of NHI and the political costs of failure are high for the ruling party.The ANC is under more pressure than ever before to start delivering meaningful improvements to the lives of poor South Africans, the majority of whom are too young to remember the liberation struggle.The NHI scheme has the potential to address some of this unease by offering affordable healthcare options to even the least well off. To get there, however, will require a monumental planning efforts, intellectual firepower, sustained political will, and a little bit of luck from our economic fortunes.