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18 March 2022 | Story Dr Chantell Witten | Photo Supplied
Dr Chantell Witten is from the Division Health Science Education, Faculty of Health Sciences, at the University of the Free State

Opinion article by Dr Chantell Witten, Division Health Science Education, Faculty of Health Sciences, University of the Free State (UFS). 
As we count down to Human Rights Day commemorated annually on 21 March, we are acutely aware of the failures of the state to realise and satisfy the human rights enshrined in our Constitution and Bill of Rights, especially for children.
Since the dawn of democracy in South Africa in 1994 the country has struggled with a persistent high level of child malnutrition measured as stunting, when children are too short for their age.  This is not just shortness of height but it is a proxy for compromised health and a risk factor for lower cognitive development, lower education attainment and lower future productivity both in work output and in earning capabilities. Unhealthy children are likely to be our future unhealthy adults and compromised human development.

Protect children from hunger

It is for this reason that all efforts must be explored to protect children from hunger. Since the outbreak of the COVID-19 pandemic more than two years ago, there have been huge negative impacts on global health and development which are bearing down on the youngest members of the planet, our children. These impacts on children are costing their lives now and well into the future. South Africa has the largest social protection programme for children on the African continent with a child support grant that benefits more than 12 million children under the age of 18 years. On 23 February 2022, Finance Minister Enoch Godongwana announced that the child support grant would increase from R460 to R480 per month as from 1 April. A mere 4% increase, against a year-on-year food and non-alcoholic beverages inflation of 5.5%, rendering the already measly child support grant ineffective to keep hunger at bay, much less to address the nutrition that children need to grow and be healthy. In Section 28 of the Bill of Rights in our Constitution states that “every child has the right to basic nutrition, shelter, health care and social services, as well as the right to be protected from maltreatment, neglect, abuse or degradation”. But the high levels of child malnutrition, almost one in three children are stunted, while one in four households reported child hunger. This is a result of the failure to protect children.

One of South Africa’s leading civil society organisations, the Black Sash, undertook research with the South African Medical Research Council to explore how households receiving the child support grant managed with respect to food procurement and dietary patterns. I was approached to assist with child nutrition data interpretation and policy implications. It was not surprising to find that all 12 households included in this qualitative study were not able to cope or meet their food needs. These households’ food purchasing patterns were insufficient in quantity and in dietary quality. All household members were not able to eat regularly or sufficiently to keep hunger at bay. Even for children, hunger was a norm. Even for a household of a single mother and her five-year-old child, the child support grant was not enough to buy enough food, and other essentials like electricity, toiletries and cleaning materials. This was a huge cause for concern, given the context of COVID and the need to wash hands and surfaces regularly.

Trauma of  caregivers to provide food

The nutrition evaluation of the foods that were purchased was lacking in diversity, nutrient-density and low-quality foods, raising the issue of food safety as well. Poor households dependent on the child support grant, even with multiple grants, was not enough to buy enough food for all the household members. Many adults are forced to go without meals or reduce the amount of food they eat and to rely on food relief efforts like soup kitchens, food packs and food charity. The most heart-wrenching finding is the constant experience of trauma faced by caregivers to provide food for their hungry children. Caregivers expressed feelings of shame and guilt knowing that their children are hungry, for sending their children to ask for food from neighbours and community members. The constant cries for food would drive caregivers to ‘hit the children and send them to bed’. Sleeping is an escape from hunger and having to deal with hunger. These households are under severe psychological strain, re-emphasising that hungry people are angry people. This is not conducive for optimal child care and highlights hunger as a driver of child ‘maltreatment, neglect, abuse or degradation’ as listed in the Bill of Rights.

While caregivers are resourceful in trying to stretch the food budget by buying cheaper, smaller quantities of food products, giving small children many smaller snack foods and taking cash loans to buy foods, these efforts do not shield or protect children from the physical and psychological harm of hunger. A whole-of-society response is needed to create more provision efforts like community out-reach kitchens, food drives and donations, macro-policy initiatives to subsidise food for grant recipients, promotion and support of food gardens and to push government to institute a Basic Income Grant for unemployed persons 18-59 years of age. The child support grant is not enough to protect children from chronic hunger which itself is ‘maltreatment, neglect, abuse or degradation’ as enshrined in the South African Bill of Rights.

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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