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29 November 2024 | Story Prof Mpumelelo Ncube | Photo Supplied
Prof Mpumelelo Ncube
Prof Mpumelelo Ncube is an Associate Professor of Social Work at the University of the Free State.

Opinion article by Prof Mpumelelo Ncube, Head of the Department of Social Work, University of the Free State


As we approach the end of another year, many people take this time to reflect on the successes they have achieved, as well as to appreciate their resilience in overcoming life's challenges. For some, this season of reflection serves as an opportunity to reward themselves for their accomplishments. However, for many others, the festivities become a coping mechanism, masking deeper pain and unresolved trauma.

This year has been marked by several successes, including the simple fact that we are still alive, despite the staggering number of lives lost in the country, but more so, in conflict zones. Countries like Sudan, South Sudan, the Democratic Republic of Congo (DRC), Mozambique, Palestine, and Ukraine have endured severe violence, with countless innocent lives taken. In these instances, the human cost continues to mount, making survival a powerful testament to resilience and divine grace in the face of such overwhelming adversity. Life itself is an accomplishment, but for countless individuals, it also carries untold stories of sorrow, stories not just from this year but from previous years as well. Families continue to grieve the loss of loved ones to the COVID-19 pandemic, and many have lost their livelihoods due to the economic downturn that followed. The situation is further exacerbated by South Africa’s unemployment rate, which exceeds 40% (expanded definition), making it increasingly difficult for many individuals to secure new sources of income.

The violence

In addition, South Africa continues to grapple with violence. Families mourn the loss of loved ones to murder — a pain that never truly heals, though families learn to live with it. The country’s murder rate remains alarmingly high, with slight fluctuations in the past five years looking only at the months of April to June across the years. In 2020, COVID-19 restrictions temporarily reduced murders to 3 466, but once the lockdown lifted, the rate surged to 5 760 in 2021, continuing to rise to 6 424 in 2022. Though slightly declining in 2023 and 2024, the numbers are still far too high. This reflects an ongoing crisis that demands stronger interventions, law enforcement, and efforts to address the socio-economic disparities that fuel crime.

Further compounding the year’s challenges, 2024 saw tragic events such as children dying from poisoned food, mass killings in the Eastern Cape, a rise in extortion, and an alarming increase in teenage pregnancies, especially in underprivileged communities. As we close the year, these issues do not vanish. In fact, they may intensify, often hidden beneath the veneer of holiday festivities.

The impact of alcohol

For many, these festivities are synonymous with alcohol consumption. Despite the economic struggles faced by many, a budget for alcohol remains a priority. This may seem counterintuitive, but it highlights the reality of people using alcohol to escape their suffering. Alcohol, like many other substances, becomes a coping mechanism for the trauma that so many endure.

In its 54th conference, the ANC rightly observed a universal phenomenon of alcohol abuse where socially and economically unequal societies tend to have higher levels of substance abuse, particularly alcohol and drugs. The §National Drug Master Plan 2019/24 identifies alcohol as the primary substance abused across racial and class lines in South Africa, largely due to its easy accessibility, affordability, and cultural associations. South Africa ranks among the high alcohol-consuming countries, with an average of 9.3 litres per capita annually, far surpassing the global average of 6.4 litres.

The consumption of alcohol is particularly concerning among young people, who often gain access to alcohol earlier than legally permitted, especially during the festive season. When young people normalise alcohol consumption, it often leads to lifelong addiction, impaired development, and an inability to fully participate in society. Tragically, in some cases, it results in fatal outcomes.

For the broader population, alcohol is often a catalyst for violence, both in public spaces and within homes. It exacerbates gender-based violence (GBV), fuels broken families, perpetuates cycles of poverty and substance abuse, and undermines social cohesion. These issues have plagued South Africa for years, with little success in addressing them.

The festive season is also associated with a rise in road accidents and fatalities, often linked to alcohol consumption. While this is only the tip of the iceberg, it reflects the broader societal damage caused by alcohol. Yet, alcohol continues to be marketed as a symbol of success, sophistication, and enjoyment. While alcohol-facilitated festivities and social gatherings in general may offer fleeting escapism, they ultimately fail to address the profound psychological and emotional wounds that individuals carry. Beneath the veneer of revelry and glamour, these events often leave participants with unhealed scars, merely postponing the inevitable pursuit of the next escapism opportunity. In truth, the industry exploits vulnerable individuals for profit, often masking the harm it inflicts on communities.

Despite the alcohol industry's substantial contribution to South Africa's GDP, a comprehensive cost-benefit analysis reveals that the industry's socioeconomic costs, encompassing both direct and indirect expenditures, as well as intangible externalities, significantly exceed its economic benefits. In the past, studies have shown that alcohol-related harm costs between 10% and 12% of the country’s GDP, while the benefits, including taxes and employment, account for a less than 10%. This disparity calls for a re-evaluation of the country’s relationship with alcohol. It’s a substance that not only fuels violence and the resulting trauma but also undermines the nation’s aspirations for a more prosperous and equitable future for all. We must question whether alcohol is truly indispensable. Does its social, cultural, or economic significance justify the considerable harm it causes to human life?

16 Days campaign

This truly is the time for the country to reconsider its approach to alcohol regulation. There have been ongoing debates about tightening restrictions on alcohol advertising, with proponents arguing that these measures could mitigate the damage caused by the industry. Some have also called for raising the legal drinking age, suggesting that delaying access to alcohol could benefit both individuals and the economy. Additionally, increasing excise duties could make alcohol less accessible, reducing its harmful impact on society. These steps require leaders who prioritise the lives of the people they serve over the profit margins of corporations. Ultimately, this serves as a clarion call to collective action, urging all stakeholders in society including families, faith-based organisations, community groups, educational institutions, and beyond, to assume a shared responsibility for reversing this destructive trend. By doing so, we can break the cycle of harm, mitigate the pervasive psychological and emotional trauma that permeates our society. Afterall, Life should be treated as sacred and worthy of protection and improvement at every opportunity.

In light of all these issues, we are also reminded of the 16 Days of Activism for No Violence against Women and Children Campaign, a global campaign aimed at raising awareness about violence against women and girls. Let this not be a mere rhetorical exercise, but a call to action, one that demands meaningful decisions and interventions to protect vulnerable individuals and build a society free of violence and harm.

Mpumelelo Ncube is an Associate Professor of Social Work at the University of the Free State. He writes in his personal capacity.

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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