Urban Health in South Africa

Transcription

1 Urban Health in South Africa David Richards, MD, FACEP Assistant Professor Department of Emergency Medicine Denver Health Medical Center Attending Physician University of Cape Town, South Africa

2 Urban Health Individual Health

3 Urban Health Specific Medical Problems Politics Individual Health Social aspects Community Health Violence

4 Urban Health Specific Medical Problems Politics Individual Health Social aspects Community Health Violence

5 Urban Health Specific Medical Problems Politics Individual Health Social aspects Community Health Violence

6 Urban Health Specific Medical Problems Politics Individual Health Social aspects Community Health Violence

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12 Medical Aspects of Urban Health Urban diseases HIV/AIDS TB Trauma Gastrointestinal Fires Healthcare systems

13 HIV/AIDS 24.9% prevalence in Khayelitsha 9,000 AIDS orphans annually 6% prevalence in South Peninsula Areas of Western Cape with 50% prevalence Incalculable impact workforce, family, violence, unemployment, education.

14 TB A result of crowding? Khayelitsha Density 3752/km 2 Mitchells Plain Density 9/km 2

15 TB A result of crowding? Khayelitsha Density 3752/km 2 HIV/AIDS 24.9% Mitchells Plain Density 9/km 2 HIV/AIDS 22%

16 TB A result of crowding? Khayelitsha Density 3752/km 2 HIV/AIDS 24.9% TB 22% Mitchells Plain Density 9/km 2 HIV/AIDS 22% TB 6%

17 Trauma United States 5.8 per 100,000 Honduras 58 per 100,000

18 Trauma Homicide is the leading cause of premature death in males of all ages Males aged at highest risk 147 operative trauma cases in 30 days at one hospital 144 penetrating 3 blunt 45 penetrating operative trauma cases in 72 hours last weekend of October 2007 Motor vehicle collisions, auto-pedestrians, and fires account for majority of rest

19 Gastrointestinal Illness

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21 Gastrointestinal Illness 46% of Cape Town dwellings do not have acceptable sanitation (1 toilet per 20 people) #1 cause of death in children under 5 years in Cape Town Tied with HIV/AIDS in 2006 HIV/AIDS was 2.5 times more in 2004 Under 5 mortality rate (2006) Khayelitsha: per South Peninsula: 75.3 per

22 Fires

23 Fires

24 Healthcare Systems Unique aspects of urban health Economic, not physical, distance is the issue

25 9 miles

26 Location of world s first heart transplant 9 miles

27 Location of world s first heart transplant 9 miles No electricity at night

28 Healthcare Systems Unique aspects of urban health Economic, not physical, distance is the issue Referral clinics can be successful

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30 Healthcare Systems Unique aspects of urban health Economic, not physical, distance is the issue Referral clinics can be successful Violence

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32 Urban Healthcare Systems Unique aspects of urban healthcare Economic, not physical, distance is the issue Referral clinics can be successful Violence Dual systems develop Research and education are much easier Politics and policies run rampant

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34 Political Aspects of Urban Health Urban settings generate a critical mass for political activity Clinics provide: Condoms HIV testing Treatment of opportunistic infections HAART for vertical transmission What about HIV treatment?

35 Political Aspects of Urban Health Urban settings generate a critical mass for political activity What about HIV treatment? Nutrition is the basis of good health and it can stop the progression of HIV to full-blown AIDS, and eating garlic, olive oil, beetroot, and the African potato boosts the immune system to ensure the body is able to defend itself against the virus and live with it. Manto Tshablala-Msimang Health Minister, 30 June 2005

36 Political Aspects of Urban Health Urban settings generate a critical mass for political activity A case in point Treatment Action Campaign (TAC)

37 Political Aspects of Urban Health Urban settings generate a critical mass for political activity "It should be stressed that a healthy lifestyle and good nutrition are not alternatives to treatment" -Phumzile Mlambo-Ngcuka Deputy President, 19 September 2006

38 Political Aspects of Urban Health Urban settings generate a critical mass for political activity It goes both ways

39 Social and Cultural Aspects of Urban Health South Africa death toll rises to 74 in deadly TB outbreak - Reuters 4 October 2006

40 Social and Cultural Aspects of Urban Health South Africa death toll rises to 74 in deadly TB outbreak - Reuters 4 October 2006 Sick refuse drugs to get state grants - Cape Times 2 October 2006

41 Social and Cultural Aspects of Urban Health Government programs back-firing What is the use of completing treatment when, once you get better the grant gets cancelled, and then you go hungry again and your family suffers too. There is no use in completing it. -Langa Tembe, a TB patient receiving R280 ($35) a month from a grant for patients with TB

42 Social and Cultural Aspects of Urban Health Government programs back-firing Desperation by millions of poor who have no safety net means they will go to great lengths to qualify for support -Beth Goldblatt, University of Witwatersrand

43 Social and Cultural Aspects of Urban Health Government programs back-firing Our department was unaware of the problem and is not allowed to ask people if they took their medication -Ntokozo Khulese, Social Welfare and Development Department

44 Social and Cultural Aspects of Urban Health Who seeks care and when? Urban setting allows multiple options for health care: Traditional healers Western medicine

45 Social and Cultural Aspects of Urban Health Who seeks care and when? The man Leaving your community for healthcare Exposes weakness

46 Violence and Urban Health Anonymity Community assault Economic and social gradient blatant

47 The bottom line

48 The bottom line

49 The bottom line

50 Thank you! or