Pandemics, professionalism and the duty of care: Concerns from the coalface

It is likely that the SARS-CoV-2 pandemic will affect a large part of the world's population and will last for several years. Many critical ethical issues have arisen in the healthcare context. While response from healthcare professionals to participating in the care of patients in the era of COVID-19 has generally been positive, there have also been disturbing experiences on the ground. The practice of medicine is a social contract with humanity. Challenges have arisen because the patient is both a victim and a vector of the coronavirus. All humans should have a natural instinct to care for those in need. Ethically and legally, healthcare professionals cannot be expected to assume a significant and unreasonable risk of harm. While fear is understandable, altruism and interest in serving the sick exemplify the value of solidarity. Social harms like stigmatisation and discrimination can occur. Concerns have been raised regarding protection of privacy and respect for rights of infected individuals. In the era of COVID-19, fear, misinformation and a detachment from one's calling put professionalism strongly to the test

South Africa's COVID-19 Tracing Database: Risks and rewards of which doctors should be aware

In response to the COVID-19 pandemic, South Africa (SA) has established a Tracing Database, collecting both aggregated and individualised mobility and locational data on COVID-19 cases and their contacts. There are compelling public health reasons for this development, since the database has the potential to assist with policy formulation and with contact tracing. While potentially demonstrating the rapid facilitation through technology of an important public service, the Tracing Database does, however, infringe immediately upon constitutional rights to privacy and heightens the implications of ethical choices facing medical professionals. The medical community should be aware of this surveillance innovation and the risks and rewards it raises. To deal with some of these risks, including the potential for temporary rights- infringing measures to become permanent, there are significant safeguards designed into the Tracing Database, including a strict duration requirement and reporting to a designated judge. African states including SA should monitor this form of contact tracing closely, and also encourage knowledge-sharing among cross-sectoral interventions such as the Tracing Database in responding to the COVID-19 pandemic

Suture material use and procurement: an audit of a public hospital surgical system in Gauteng, South Africa

Introduction:Surgical systems are integral to successful, safe and cost effective clinical practice and must balance surgical demands on consumable items and their costs. Suture material is a key consumable resource, and was evaluated in an audit of consumable use and cost as well as the procurement systems within the South African Gauteng public health care sector.Aims: To determine suture use and cost in the four commonest general surgical procedures ­ abdominal wall closure, mastectomy, appendicectomy and inguinal hernia repair ­ in three academic Gauteng hospitals. Performance and availability were evaluated as a secondary aim in suture material use.Methods:A prospective observational study. Suture use was documented by the surgeon at the time of the procedure and qualitative investigation at relevant hospital departments determined suture material procurement and expenditure.Results:The surgeons in three facilities documented consistent material type and average number of units used; however, in some cases there was a lack of availability of appropriate material and breakage of generic material intraoperatively. There is no consistent and consolidated electronic record-keeping of suture stock and cost in all three hospitals, therefore cost of suture material used was not obtainable.Conclusion: Clinical deficiencies in availability and quality of material may have adverse implications for patient health, healthcare costs and budgets through procedure-related complications and should be investigated. There is a lack of communication between the financial management, procurement officers, hospital and theatre stores and theatre staff. It is suggested that clinical protocols and system-based strategies be put in place to manage surgical consumables

Surgeons and HIV: South African Attitudes

Objectives. The HIV status of surgeons; in the context of the informed consent obtained from their patients; is a contentious matter. We surveyed the views of practising surgeons in South Africa regarding aspects of HIV and its impact on surgeons. Design. A cross-sectional survey of surgeons who were members of the Association of Surgeons of South Africa; regarding their attitudes to the preceding issues. Results. The salient findings included the view that a patientcentred approach requiring HIV status disclosure to patients would be discriminatory to surgeons and provide no clear benefit to patients; and that HIV-positive surgeons should determine their own scope of practice. Conclu- sion. Patient-centred approaches and restrictive policies; related to this issue; do not accord with clinician sentiment. In the absence of comparable local or international data; this study provides clinicians' views with implications for the development of locally relevant policies and guidelines