Page 4 - Weekly Reflections

 

Weekly Reflections

Week 1

Week 2

I believe that the first week of this course has opened my eyes to aspects of health that I have never fully considered. To me, previously, I believed health to only include physical health and the adequate function of the body. In other words, the absence of disease. As I matured throughout my life, I started to include mental wellbeing in my definition of health. In our very first session, we discussed what health is and I realized that health includes not just the mind and body, but additionally has social aspects and economic aspects as well as religious aspects. This allowed me to consider health as everything a person might need to function as the best version of themselves. Health can therefore almost be considered the niches of humans as a species. As we learned in matric biology, the niche of a species is the environment that a species inhabits which allows it to refrain from extinction.

An important learning experience for me was seeing what a large impact accessible healthcare and health education can have on us as a society. I have long believed that we should allow women to breastfeed in public, for example, but in one of this week’s sessions, I started to see a way in which this could be achieved.

Whilst we were doing Activity 1.2.3.3, the case study on breastfeeding, one of the questions needed us to evaluate what we believe could be the reason why certain groups in society do not support breastfeeding. As I was doing this activity, I started to see a pattern emerge. Most of the problems regarding this issue was due to ignorance.

By allowing me to see this pattern, I was able to see a solution for the problem, which is healthcare education, accessible to everyone.

This allowed me to see a problem and come up with a solution, which helped me further understand how to improve our current healthcare system. As a second benefit, it allowed me to see an argument I could bring up in my course paper and research extensively.

Week 3

The tragic events of Life Esidimeni started when the department of health terminated their contract with the psychiatric facility, despite warning from numerous organizations. Thereafter the patients were relocated to families and NGOs, however the care that the patients received was subpar and consequently 94 patients died of causes such as starvation and uncontrolled fits. The department of health is however refusing to take responsibility for the tragedy, despite being warned that their premature termination of the contract with the hospital could lead to serious consequences (City Press, 2017).

There were major human rights violations committed during this scandal, the most obvious one is the right to healthcare. The perpetrators include the families and NGOs that were responsible for the care of the patients, however the main perpetrator would be the Gauteng Health Department who recklessly placed all of the patients of the Life Esidimeni Hospital in harm’s way, because of their mismanagement of the situation.

The situation could have been easily avoided in the following ways: Not jumping the gun with the termination of the contract; securing more adequate care for the patients, by placing them in facilities with caretakers with the necessary credentials to work with psychiatric patients; transporting the patients to a different psychiatric facility instead of simply placing them with unqualified caretakers in the families and NGOs.

References:

City Press, 2017. Timeline: Life Esidimeni tragedy. [Online] Available at: https://www.news24.com/citypress/News/timeline-life-esidimeni-tragedy-20170207 [Accessed 10 September 2022].

Week 4

As we have started this course, I initially did not see the point thereof. As a health sciences student, my focus was primarily on the hard sciences, such as Physics and Chemistry and the scientific aspects of health. Now I believe that I have realized how health sciences affect the public. I am more open to holistic aspects of health, and I acknowledge their importance.

The modules started small, by explaining what health can be defined as. A core domain, I now realize. We then moved on to how social constructs regarding health affect civilians and the treatment of their ailments. At first, I did not see the connection to the definition of health, but I soon realized that the very definition of health affects how professionals and patients perceive it and thereby affect the entirety of the health system. Furthermore, the case study that week on breast feeding, allowed me to engage with specific examples about how misconceptions surrounding health and health practices, can hinder people from living their lives in the healthiest way possible.

Hereby I was able to see that the sessions start with a core concept, and then build thereupon with a cross-cutting domain allowing me to see the impact of certain concepts and finally include a complementary session, which allows for a more in-depth way of viewing the concept, by including the history and origins thereof.

I learned that health is a very complex system that affects all aspects of society on a social, economic, physical, mental, humanitarian, emotional and financial level.

Personally, I was touched by the mention of sexism in the health system. As a woman in STEM, I am already familiar with challenges presented to female medical professionals due to systemic and social forms of sexism and discriminatory practices. However, this module made me aware of specific struggles faced by women as patients and I plan to one day use my position as a female medical professional to help perpetuate a more equal health system and thereby a more equal society.

Week 5

From personal experience, I knew that there were often different types of care that different health professionals are required to provide. I for example see both a psychologist and a psychiatrist. When I go to the psychologist, I can expect someone to listen to me carefully and try to get to know me as a person in order to provide me coping mechanisms for my problems. When I visit the psychiatrist, I rarely speak about my personal experiences and how they affected me, and I was only expected to speak about how my medication affected my ability to function. Weather or mot it might have had side effects or if it worked sufficiently well.

I do however remember the first time I went to the psychiatrist. Despite the fact that my psychiatrist is very well educated and very accomplished in his field, I still did not feel like I was satisfied with my level of care, which is why my mother suggested going to see a psychologist, in order to fulfill the level of care I needed.

During this week I learned that one can expect different levels of care from different establishments. My psychologist falls under a community clinic and is the fist level of contact. The care I expect here can therefore be expected to be more personal and more community oriented. This explains how I can maintain a personal relationship with my psychologist.

My psychiatrist would fall under the regional hospital, and therefore be a secondary level of care. The level of care provided here is less personal and more universal, in the sense that it treats illnesses without specifically having knowledge of the community or upbringing of the patient.

Through both my personal experiences and what I had learned from the model of the health system, I realized that both levels of care are equally important and that they just happen to target different areas of a similar problem. The psychiatrist understands the mechanics of the disease and is therefore in a position to prescribe medications that have been proven to alleviate the condition. The psychologist understands the affects of the disease and how it might disrupt my personal life. The sessions also include getting to know my social and economic environment in order to give me habits and mechanisms that will help alleviate my condition alongside the medication I am given.

This realization gave me the idea of a more integrated healthcare system wherein there is better communication between the different levels of care. For example, my general physician has a better knowledge of my medical history whereas my specialist physician would know more about a specific condition I am affected with, however both levels of knowledge would be necessary to provide the optimal level of care. For this reason, I would propose the idea that the South African health system would be aided in providing a national database, wherein every patient’s files are stored (confidentially of course) This could potentially limit risks such as using two medications that could potentially be harmful together.

I really enjoyed this week’s work because I feel like I understand the health system a lot better and on top of that I have gathered new ideas on how I think it could be improved, which will come in handy when I write my course paper to include unique ideas.

Week 6

Before I did this week’s work, I thought that Human Resources was not necessarily an important part of any company, and I was mainly under the impression that it was mostly conflict resolution. I asked myself what I would need to deliver good quality work in a professional environment. I would need a positive environment wherein I could have platform to voice complaints if needed.

I then realized that HR was essential to maintaining a well-functioning work force. The quality of work delivered by professionals is greatly impacted by the environment in which they work. HR is basically the support structure needed for professionals. In my current environment of study, we as students have the OSS. The OSS helps us navigate anything that we could find troubling, whether it would be time management, mental health or even extra tutoring sessions for subjects we might struggle to navigate successfully. As I studied the work, I realized that an HR department would be needed to provide the exact same support structures in a working environment.

The work environment can either improve or worsen morale, avoid or instigate conflict between colleagues and better or worsen the level of work provided by professionals. HR would help people in a working environment to have access to platform where they may voice their concerns in a constructive manner

 With my newfound knowledge, I now know how important maintaining a positive work environment can be, which is a point of conversation that I will certainly reference in my course paper when I explain what I believe Universal Healthcare should include. I now understand that Universal Healthcare should not only benefit the patients, but also benefit the professionals in the Healthcare System.

Week 7

When learning about health financing, we first discussed the functions of health financing and thereafter the models on which it can be built. The South African public health system is built on a model of Public for Public, meaning that the health system is funded by the government through taxation and thereby delivers “free” healthcare.

This is a model that could work in theory, but in practice, the public health system is grossly underfunded. This is very unfortunate seeing as according to the functions of health financing, service delivery is very important. An underfunded health system would therefore not provide adequate services and whilst doing research for my course paper, I discovered to what extent service delivery was impacted. In fact, I learned this when I discovered during the course that only 43% of all health financing in South Africa goes towards the public health sector.

The NHI is a government plan that is supposed to fulfil the function of pooling funds and make the health system more efficient, accountable, and responsible. Once again, the plan sounds promising in theory. In reality, when taking the government’s history of corruption into account, one can easily see how this plan may not deliver all that is promised.

I was already aware that South Africa had struggles when it comes to funding, which would make UHC more difficult to achieve, but I was not sure how to research and structure this argument before I finished this week’s work. The work we did this week gave me a better insight about how health financing works and would allow me to make much more nuanced arguments regarding the functioning thereof.

I learned that health financing impacts service delivery because it impacts resources available, which in turn affects human resources and work environment as well as health information. If there is no funding to provide resources, workers may become frustrated seeing as they cannot perform their job to the best of their abilities. A lack of resources also makes health information more difficult to acquire, seeing as it might hinder diagnoses.

I plan to use what I learned this week in my course paper to better round out my argument and link it to other aspects of health systems, which would have otherwise gone unaddressed.

Week 8

In the way I understood the content, health information is the gathering of data surrounding the general health and health concerns about the public and compiling it for different functions. Data is collected from patients at a primary level, and then compiled into the database of the facility. The database of the facility is then used to compile an understanding of public health in different regions. Data is analysed to better understand the needs of the public and then used in a multitude of ways to run the healthcare system more efficiently.

Health information can firstly be used by doctors to gain a better understanding of a patient’s medical history. This is important when making diagnoses, since it allows for additional information that could benefit the medical professional, such as allergies to certain medications, chronic medications, potential misdiagnoses etc.

Health information, when compiled can show areas of concern. A certain region may have a large amount of a certain infection, which allows for better decisions to be made regarding health promotion. For example, if healthcare facilities in a specific area have a large amount of cholera patients, this could point to an issue with the water supply, perhaps water pollution. Thereafter, steps can be taken to ensure that civilians are aware of the health risks. Finally, this can be communicated to the government of that area, (provincial government or municipality) and the water can be cleaned and made safe for consumption once again.

Another, more large-scale example is that of the COVID-19 pandemic, wherein the large number of infections all around the country, prompted the government to install lockdown procedures. This efficient gathering and usage of health information led to very quick preventative measures which likely saved hundreds, if not thousands of lives.

Health information can also be used to see which healthcare facilities are not delivering adequate care, by looking at patient mortality and which doctors were treating them.

When I started this week’s work, I was under the impression that health information referred simply to patient files and I was unaware of the large role this plays on governance of not only the health system, but of the country in general. Through applying this knowledge, I realised that South Africa has made many good governmental decisions based on health information, such as the example mentioned above.

Subsequently, I realised that Health Information is not something that the South African Health System is incapable of doing and that the issues faced regarding health information was not because of a simple reason. I hypothesised that it must be a much more complex reason.

Whilst doing research for the course paper, I came across an article that was evaluating the challenges faced by the South African public health system and the reason it is difficult to establish reform (Winnie T. Maphumulo, 2019). This article mentioned how sometimes health information is lost and that it causes a significant delay in service delivery. In my paper I used this information to specifically address service delivery, however I would like to take this opportunity to explain the conclusion I was led to.

I believe that health information is an aspect of healthcare that is easily overlooked by ground level staff, seeing as is does not form part of the treatment of patients. Staff are generally overwhelmed due to the larger patient to nurse ratio experienced in countries that have a large burden of disease. To solve this problem, one might think the first steppingstone is lowering the burden of disease, but that is unfortunately not possible without adequate health information.

I used what I learned this week to uncover overlooked problems in the public health system and I believe that I came up with an artful solution. Instead of written files, I would propose an online, cloud-based database, wherein each medical practitioner would be required to enter the patient’s information and submit it to a single platform whereupon all patient information can be stored, compiled, and evaluated. Furthermore, it would be beneficial to have both the private and public sectors use this platform to ensure better communication between the sectors. Through this, health information would not easily be misplaced (such as written patient files), all healthcare professionals of a specific patient can communicate with one another to better coordinate diagnoses, a more reliable image of health in South Africa can be made so that problem areas can be targeted with more precision.

Sources:

Winnie T. Maphumulo, B. R. B., 2019. Challenges of quality improvement in the healthcare South Africa post-apartheid: A critical review. Curationis, 42(1), p. 1901.of

Week 9

Medicines and technology are the cornerstones of every health system. Without this, one cannot expect treatment to be acceptable and one cannot expect medicine to advance. This building block is largely based on human rights and the basic requirements for someone to be considered healthy.

Primary healthcare requires 8 basic components according to the Alma Ata. Education for Health, Promotion of food supply and proper nutrition, maternal and infant health, immunisation, prevention, appropriate treatment, water and sanitation and provision of essential drugs.

South Africa faces a large burden of disease, making service delivery tricky. The burden of disease can however be minimised. The fist step is primordial prevention.

This relates to education for health as proposed by the Alma Ata. When people are aware of health risks, they are less likely to be infected with a disease. Take the AIDS epidemic as an example. Misinformation often leads to both stigmatisation as well as unknowing exposure to the illness.

Stigmatisation worsens the burden of disease, because sufferers will be less likely to seek treatment for fear of being judged. Misinformation can also lead people to be unaware of how the disease spreads. In the case of AIDs, HIV is spread via sexual contact or direct contact with large amounts of bodily fluids. If a person is unaware of this, they could potentially contract HIV from activities such as unprotected sex.

Primordial prevention also relies on nutrition and sanitation. This is because nutrition will promote health and will make it less likely for an individual to contact an illness. Sanitation is important to prevent outbreaks of diseases due to pollution in air, water, and soil.

Primary prevention would concern immunisation and mother and infant healthcare. Immunisation will occur when a risk is recognised, but still being managed to avoid a full-scale outbreak. In the case of illnesses such as measles, immunisation is required to prevent infection and thereby infect the spread of this disease. This minimizes the risk for not only immunised individuals, but for everybody they encounter.

Mother and infant care is also important. New parents often require guidance as to what constitutes a risk for themselves and their children. Family planning is also important, seeing as it affects health in the way of preventing overpopulation, which is often the cause for fast spread of disease.

Secondary prevention requires appropriate treatment as well as health education to allow for fast detection. Tertiary prevention is essentially damage control and is the reason why essential drugs is one of the 8 basic components.

When covering this week’s content, I made a connection to the recent COVID-19 pandemic. In the case of the pandemic, primordial and primary intervention were initially neglected. Governments around the world were warned by epidemiologists about consumerism and the effect it could have on outbreaks of illnesses. By the time the pandemic had reached South Africa, it had already been classified a pandemic. Only thereafter did the government install the necessary procedures. For nearly a year, there was nothing else to do but adhere to the rather late response. Secondary and tertiary intervention was the only steps taken and people were diagnosed with the illness. Unfortunately, because of the nature of the disease, it was difficult to treat adequately and therefore the intervention was limited. Finally, when the vaccine was introduced, primary intervention took place.

This is an example of a case wherein the world’s medical technology was not prepared to combat the illness that had come forward. However, as soon as the vaccines were developed, we saw a steep decline in infections.

This example shows how necessary the advancement of medicine is, by showcasing what would happen without it, as well as showcasing the impact it makes on a global emergency.

I gained a deeper appreciation for the importance of medical research this week and I would like to explore this field when I consider my future career path, seeing as I discovered what a difference I could make in the world.

 Week 10

This week I learned how to use the law in the context of health sciences. I learned that the law was sectioned into different acts. The acts are made up of different sections, sections are made up of subsections. The reason for this is to make it easier to understand the nuances of the law and how to reference it when it is necessary. I also learned that new laws could be put in placed based on previous cases of injustice, to avoid this from occurring in the future. The content also mentioned the South African constitution which is the primary law that cannot be contested. The content also covered different kinds of arguments and how to evaluate their validity.

Being able to read the law is very important to me seeing as now, despite not having legal education, I can use my knowledge of the law to know when I, or somebody I know is being wronged and I thereby know when I am entitled to take legal action.

I learned how to evaluate arguments. This will not only aid me when critically reading research papers, but it also helped me to better form my own arguments in my course paper. When doing this work, I was also editing my paper for submission and this played and important role in how I decided to differently frame my arguments in comparison to my first draft. I critically analysed all of my arguments and tried to find their limitations so that I may strengthen them. 

In my future career as a healthcare professional, I hope to be able to use this knowledge to help patients who are struggling to get their treatment because of the bureaucratic system.

Week 11

This week we discussed health governance. The Department of Health is responsible for health policies on a national level, this includes laws that promote health and prevent outbreaks of illnesses. The Provincial government is responsible for service delivery of government health facilities. Finally, the municipal government is responsible for local measures of health maintenance, such as providing clean water and safely disposing of hazardous waste that could lead to sickness of those who encounter it. These governments are integrated under the department of health and are sectioned to ensure more efficiency in preventing healthcare concerns.

Health Governance influences all other aspects of the health system. In terms of Health Financing, South Africa’s public sector is funded by the Government. The distribution of funds can either aid the health system’s functioning or it can hinder it.

Health financing is required to ensure proper equipment in each facility. If there is no proper equipment, it can frustrate the healthcare professionals who do not have the resources to perform their duties. This leads to a negative impact on the work environment and thereby impacts human resources.

The inability of healthcare professionals to do their work, leads to a negative impact on service delivery, seeing as the patients will not be provided the necessary care. It also impacts health information, seeing as being unable to properly diagnose patients, will lead to an inability to acquire health information.

An inability to acquire health information, will in turn lead to governance being misinformed about the needs of the patients and will thereby once again hinder their ability to make decisions that will improve the functioning of the healthcare system.

The importance of health governance and how it relates to the law and service delivery is perfectly showcased in the case study done this week. In the case of Soobramoney v The Minister of Health of Kwazulu-Natal, the healthcare facility was unable to provide the appellant with his necessary dialysis treatment due to budget cuts that the department of health put in place. 27(3) of the constitution stated that the patient was entitled to the necessary treatment, within the boundaries of the resources available. The court ruled in favour of the minister of health, seeing as the available resources were limited and thereby reserved for emergencies. Unfortunately, this meant that the appellant would not receive treatment for his chronic disease.

The Provincial Government’s choice to put in place budget cuts, negatively impacted their service delivery, which is not illegal, but is arguably the most important function of any health system.

I believe this information was valuable to me because that will allow me to recognise problems in the health system and know who is supposed to be held accountable and what measures need to be taken to fix the problem.

In my career, I hope to be able to make a positive impact on the health system, by eliminating problems that will cause health risks. Having knowledge medicine is important to recognise health risks, but without knowing the structure of governance and who to contact in terms of solving the problem, one will be unable to call attention towards the problem.