South Africa and my Alma Mater

Is the NHS Healthcare Heaven? #MSBlog #MSResearch

"I have had to start my sabbatical with a trip to South Africa to visit my mother who has just had a total hip replacement. Her surgery was covered by her health insurance, with a personal top-up to cover the costs of the clinicians' time. It was all done in the private sector. There is no NHS in South Africa, although there appears to be the political will to create one."

"Whilst in South Africa I have taken the opportunity to visit three academic neurology units, including my Alma Mater, Wits University, and give update lectures on 'Treating MS in 2014'. It is clear that not only has the management of MS, but neurology in South Africa, has changed dramatically since I have left in 1993 to do a PhD in London. A staggering 70% of inpatient neurology at the Johannesburg Hospital is HIV-related and I am told that in Kwazulu and the Eastern Cape this figure is even higher. Every neurologist practicing in the state sector, has by necessity, become an expert in HIV medicine."

"It is clear that healthcare in South Africa is a two-track system. Those who have private insurance have access to excellent healthcare with some caveats in the private (fee-for-service) system. In comparison those who can't afford insurance have to rely on the state system that is at breaking point financially and is focused mainly on the challenges HIV, TB and many other poverty-related problems. MS is relatively rare in South Africa and is definitely not a priority, hence MSers have poor access to DMTs. For example, only a handful of MSers are on DMTs in the state sector; the state sector simply can't afford the costs of DMTs. I have been asked several times over the last week what I would do if I was still working in the South African state sector with regard to managing MS? A very difficult question. At a grand round in Pretoria earlier this week I was shown a young man with very active and aggressive MS; he has gone from being mobile to a wheelchair in 2-years. Although he started off with rapid progression he has gone on to have several devastating relapses with an MRI showing multiple, Balo-like, enhancing lesions and a heavy spinal cord lesion load. In short this man has rapidly-evolving severe MS and would be offered a choice of natalizumab or alemtuzumab in the UK. These choices are not available to them in South Africa due to cost constraints, although he might be treated with these agents in the private sector (not all medical insurance policies would cover DMTs). Therefore I advised my colleagues in Pretoria to treat him with mitoxantrone or rituximab, although access to the latter is unlikely due its high costs. Why rituximab? If you plot out this young man's clinical course he has progressive-relapsing MS and in the PPMS rituximab trial, the subgroup of subjects who were young (less than 50) and had active scans (Gd-enhancing lesions) responded well to treatment."

"What is clear to me that for anyone who believes in Socialist Healthcare, i.e. within your society access to healthcare is a basic human right, the NHS is healthcare nirvana. My current visit to South Africa is a reminder to myself that if I had a chronic disease, such as MS, my healthcare would be covered by the NHS with no questions asked. I would have no anxieties about whether or not I could afford the care and what would happen to me if I lost my job, etc. In short the NHS is 'healthcare heaven' and we must cherish and appreciate it." 

"I am about to go off and buy myself another copy of 'Cry, the Beloved Country' by Alan Paton. It was probably one the most influential books I read as a child and I have a strong urge to read it again. The following are some quotes from the book that are as relevant today as they were when I read the booked, aged 12."

'Who knows for what we live, and struggle, and die? Wise men write many books, in words too hard to understand. But this, the purpose of our lives, the end of all our struggle, is beyond all human wisdom.'

'You ask yourself not if this or that is expedient, but if it is right.'

'There is only one way in which one can endure man's inhumanity to man and that is to try, in one's own life, to exemplify man's humanity to man.'

'I envision someday a great, peaceful South Africa in which the world will take pride, a nation in which each of many different groups will be making its own creative contribution.'

'To give up the task of reforming society is to give up one's responsibility as a free man.'

'Cry, the beloved country, for the unborn child that is the inheritor of our fear. Let him not love the earth too deeply... For fear will rob him of all if he gives too much.'

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