Mr Jason Marcus

CLICK HERE TO ACCESS:  Presentation

Respectful maternity care (RMC) has been on the global agenda for more than a decade. Disrespect and abuse of women in labour particularly is still widespread in all settings. Awareness, defining it and training around it has been on the SA maternity landscape for close on 10 years, in response to reports and research on disrespect and abuse during labour. The implementation and operationalising of RMC appear to be a challenge, especially at the coalface of health care, despite national and local policies to support its use.

Historically, slow or no progress in labour were thought to be caused by “the 4P’s”, when using the partogram. These “P’s” referred to the passage, powers, passenger and patient needing to be assessed to determine the possible cause of the slowly progressing labour with a view to intervening if any of these were thought to contribute to the problem. Labour is a complex process with many factors contributing to its progress and the woman’s experience thereof, the mere mechanics cannot be viewed as the be-all and end-all of influencing how well or slowly labour progresses.

The traditional 4 P’s do not consider all reasons for a slowly progressing labour. Eight additional P’s to consider and address are: (1) Partner presence, (2) Psyche of the woman, (3) Personnel behaviour and attitudes, (4) Position of the mother during labour and birth, (5) Paraphernalia, (6) Pain relief, (7) Place and (8) Paedagogy. There is good evidence that these aspects, when considered and acted upon have a positive influence on the needs of a woman in labour. There is good evidence about beneficial care for the labouring woman, yet the available evidence has not been clearly assimilated into the practices of labour care in the South African public health context.

Dr Raksha Balbadhur

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Healthcare providers (HCPs) can optimise dignity conserving care to improve the quality of lives of patients living with serious illness with the awareness of the bio-psycho-socio-spiritual concerns and psycho-spiritual coping mechanisms that affect their total dignity experience. Whilst having a greater influence in extrinsic sources of dignity in advanced disease, HCPs can offer kindness, compassion and respect that acknowledges and honours the unconditional value/worth of patients beyond the labels placed on them by their body, bodily illness and challenging circumstances. Patients wish to be seen as living beings, not disease entities that need fixing, and to be supported to create meaning and purpose in their last days. It is not about what they have become but patients wish to be seen for who they are. This study to understand the dignity experience of SA patients from diverse socioeconomic and cultural backgrounds in KZN, highlighted the need to affirm intrinsic dignity in dying patients, to affirm their personal unique worth as nonphysical entities, irrespective of the failing bio-psycho-social-existential systems. We may never be able to correct these external systems fully, but we may be able to offer patients dignity with an experience of their intrinsic untouchable worth. In this study, a Guided Imagery focused on intrinsic dignity is shown to be a novel relevant, feasible, acceptable and beneficial, short psychotherapeutic intervention that can be conducted at the bedside that can augment Dignity Therapy, or be used on its own, to affirm and strengthen the experience of patients’ intrinsic dignity.

Mr Jason Marcus, Dr Raksha Balbadhur, Dr Michelle Visser and Prof Bernhard Gaede

CLICK HERE TO ACCESS Dr Raksha Balbadhur :  Presentation

CLICK HERE TO ACCESS Dr Michelle Visser:  Presentation

Dr Imtiaz Sooliman

In 1985 the Trustees of the Estate of the late Dr K M Seedat proposed the establishment of a memorial lecture which would commemorate Dr Seedat, would benefit the branch of medicine in which he worked [Family and General Practice] and would perpetuate his own great interest in the under and postgraduate medical studies of South African students.

Dr Asafika Mbangata, Dr Mabowa Makhomisane and Sr Buyelwa Majikela-Dlangamandla

CLICK HERE TO ACCESS Asafika Mbangata:  Presentation

CLICK HERE TO ACCESS Sr Buyelwa Majikela-Dlangamandla:  Presentation

Dr Robin Dyers, Dr Cyril Nkabinde, Darren Sweiden and Dr Abongile Qamata

CLICK HERE TO ACCESS Dr Cyril Nkabinde:  Presentation

Prof Andrew Ross

CLICK HERE TO ACCESS:  Presentation

Prof Klaus von Pressentin, and Dr Arun Nair

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Seminar Overview:

Primary healthcare research improves patient care and overall health outcomes. High-quality research relies on rigorous reporting standards to ensure transparency, reproducibility, and reliability. This seminar, facilitated by the editors of the South African Family Practice journal, will delve into the critical role of reporting guidelines from the perspectives of authors, reviewers, and readers/users of primary healthcare research.

Objectives:

• To highlight the importance of reporting guidelines in enhancing the quality and impact of primary healthcare research.
• To provide authors with practical guidance on adhering to reporting standards while preparing the manuscript.
• To equip reviewers with strategies to evaluate the submission reporting guidelines’ adherence.
• To empower readers and users of research to critically appraise the quality of published studies based on adherence to reporting standards.

Target Audience:

This seminar is designed for health sciences students and professionals in the discipline of family medicine and primary care, particularly those involved in research and publication. It is especially beneficial for emerging research scholars and seasoned practitioners who want to enhance their understanding of research reporting standards.

Dr Jenny Nash

CLICK HERE TO ACCESS:  Presentation

The Department of Health: current challenges and future solutions

2024 has seen many significant events occurring nationally, including within the health sector. The NHI Bill was signed by President Ramaphosa on 15 May 2024, two weeks before the national election. The election resulted in a Government of National Unity (GNU), which has already demonstrated some teething problems. Dr Aaron Motsoaledi was appointed the Minister of Health, reshuffled from Minister of Home Affairs. Dr Motsoaledi is no stranger to the health ministry, nor to the NHI, having been Minister of Health from 2009-2019. He helped champion the NHI journey which started in 2011.

In July 2024 the courts found former Health Minister MEC Qedani Mahlangu and Dr Makgabo Manamela guilty of causing 9 Life Esidimeni deaths. This has again raised the issue of mental health services in the country, and the reality of corrupt officials. The need for improved health services, including mental health services is a challenge in the current tight fiscal environment. Provinces are facing increasing medicolegal costs further pressurising existing budgets.

The National Department of Health has suggested that for health services to improve, provinces need to concentrate on a number of domains: namely 1. Leadership, organisational development and human resources 2. Financial sustainability 3. Clinical and specialised services 4. Infrastructure and equipment 5. Digitization and litigations.

This seminar will examine some of the current challenges and provide an opportunity for participants to make suggestions on how to tackle some of these challenges.

Dr Liezel Rossouw

CLICK HERE TO ACCESS:  Presentation

Background

Heart failure is a major global health problem with 26 million patients worldwide affected. According to the INTERHF study, the African annual heart failure mortality is 34%. Many of our district level beds are occupied by acute cardiac failure patients and few patients can be referred to secondary or tertiary care for further evaluation and imaging. Health care system organization and resources vary greatly.  Patients are dependent on the primary care physician to diagnose, manage the cardiac failure and identify those that will benefit from referral and formal echocardiography. New guidelines are not aimed at bridging this gap.

A study done at Groote Schuur hospital looked at the adherence to treatment guidelines. Most referring clinicians did not adhere to treatment guidelines on adequate pharmacological treatment. This results in readmissions, high morbidity and mortality for these patients.

Aim of workshop

To present and discuss the relevance of new heart failure guidelines in South Africa primary care public setting. Relevant clinical cases and primary care management strategies would be discussed in an interactive format.  The group would explore reasons for primary care non-adherence to current guidelines. The way forward in terms of multidisciplinary health care promotion for heart failure patients would be explored.

Personal back note:  I worked as a family physician for 12 years in the district hospital setting.  I observed the high number of acute heart failure patients managed in the primary setting.  A lack of knowledge to identify causality, optimize medical therapy and advocate for those that would benefit from specialist referral, was evident.  I was fortunate enough to learn from Dr. Tony Lachman, a cardiologist reaching out to the District Hospital setting. I developed a passion for the management of these patients.

Dr Sheena Mathew

The integration of innovative approaches with traditional medicine is crucial for the evolution of Specialist Family Physician practices. This seminar aims to explore the intersection of innovation and tradition, emphasizing the indispensable skills necessary for the modern Specialist Family Physician. Whilst our specialist clinical training has well equipped us with a unique skillset to manage multiple disciplines, procedural techniques and patient profiles, it lacked the critical aspects of practice management, business management, financial management, and technology skills required for the private sector. These competencies are increasingly vital in ensuring the successful operation and sustainability of medical practices.
As healthcare continues to evolve, the ability to effectively manage a practice has become as important as providing quality patient care. Practice management skills help streamline operations, improve patient flow, and enhance overall efficiency. Business management knowledge enables physicians to navigate the complexities of the healthcare market, ensuring that their practices remain competitive and financially viable. Financial management skills are essential for budgeting, forecasting, and making informed decisions that impact the practice’s bottom line. Additionally, proficiency in technology, from electronic health records (EHRs) to telemedicine platforms, is crucial for modernizing patient interactions and improving care delivery.
This seminar will provide Specialist Family Physicians with a road map for the tools and knowledge needed to integrate these non-clinical skills into their practice. By bridging the gap between clinical excellence and operational expertise, we can enhance the quality of care provided to patients and be the new benchmark for modern medicine physicians with traditional values.

Dr Chantelle van der Bijl, Dr Arun Nair, Prof Klaus von Pressentin, and Prof Hoffie Conradie

CLICK HERE TO ACCESS:  Presentation

How Can We Be Better Leaders as Family Physicians?

The role of family physicians extends far beyond clinical duties; we are integral leaders within our practices and communities. Hosted by the Next 5, an interest group of the South African Academy of Family Physicians, this seminar aims to support newly qualified physicians during this critical transition period in their careers.

The seminar will provide a platform for participants to share experiences and reflections on their leadership roles, as well as the challenges they have encountered. Through interactive discussions, attendees will engage with their peers, fostering a supportive environment for mutual learning and growth.

Participants will be paired up to discuss their personal leadership experiences and the obstacles they have faced. These pairings will allow for in-depth conversations, enabling attendees to gain diverse perspectives and insights. Following these discussions, pairs will provide feedback to the larger group, facilitating a comprehensive dialogue on leadership in family medicine.

Expert facilitators will guide these sessions, offering practical strategies and tools to enhance leadership skills. Topics will include effective communication, team collaboration, and decision-making in complex healthcare environments.

By the end of the seminar, participants will have a deeper understanding of their leadership potential and be equipped with actionable strategies to overcome challenges and excel as leaders. Join us for this dynamic and interactive seminar to become a more confident and effective leader in family medicine.

Prof O Omole and Deidre Pretorius

CLICK HERE TO ACCESS:  Presentation

Brief behavioural interviewing skills: Exploring the 5Rs approach to motivate patients who are not contemplating change

Unhealthy lifestyle behaviours such as smoking, unhealthy diets, physical inactivity, etc, are prevalent among patients in primary health care (PHC) and are significant risk factors for morbidity and premature mortality. Healthcare providers in PHC are therefore in a unique position to intervene by offering lifestyle behavioural counselling to patients as part of ongoing health promotion and prevention. While most are aware of the risks of these behaviours and are willing to embark on the change process, many are not, yet. The latter group requires a different approach from the conventional 5As used for those contemplating. The 5Rs approach finds its development in smoking cessation counselling and holds promise in motivating unwilling individuals to consider embarking on the journey of behavioural change. The 5Rs approach is not a stand-alone checklist of tasks implemented in isolation but embedded within theoretical behavioural change frameworks.

In this interactive and scenario-based seminar, we review the components of the 5Rs, situated within the context of the four commonly used health-related behavioural change theoretical frameworks and demonstrate how this approach could be implemented during the clinical encounter.

Dr Nicholas Davies, PhD

CLICK HERE TO ACCESS: Presentation

Abstract: Neurodevelopmental conditions like autism (ASD) and attention-deficit/hyperactivity disorder (ADHD) profoundly impact individuals’ cognitive, social, and emotional development. Early intervention has emerged as a crucial strategy in mitigating the long-term challenges associated with these conditions.
Despite its evident advantages, challenges persist in accessing appropriate interventions timeously. One of the barriers is the missing or misinterpreting of early signs of neurodevelopmental conditions. This presentation will highlight potential indicators of some neuro-developmental conditions.
Research indicates that timely intervention not only improves immediate developmental trajectories but also fosters long-term gains in adaptive functioning and independence. Early intervention at an eco-systemic level extends beyond the individual, encompassing primarily the home, but extending to the school environment and the broader community. Early intervention should equip caregivers not only with practical tools to support their children effectively, but an authentic understanding of their child’s presentation to the ends of reducing family stress, enhancing overall family functioning and thereby providing an environment in which nervous systems can “flow” rather than spike.
In conclusion, early intervention represents a pivotal opportunity to positively and significantly influence the developmental trajectories of children with ASD, in particular. By prioritizing early recognition, identification and intervention, the chances of a child actualising their potential is significantly increased.

Prof Hanneke Brits

The message: Time is not a training limitation – timing is

In our busy life, it is easy to say that I do not have time for training. However, you only need 30 seconds to convey a message. Make sure it is the message that you intended to convey.

In this session, we will focus on feedback as the training method.

Therefore, timing is important when you give feedback to your registrar/student. Refrain from giving feedback when you are Hungry, Angry, Late or Tired. The pneumonic HALT should be kept in mind.

We plan to introduce and use a few tools that can assist you when you have limited time for training and feedback.

• The 1-minute preceptor tool
• SNAPPS for presenting patients
• Teaching with time constraints – blog

It will be an interactive session with an icebreaker, practical assessment and feedback.

Time is not a training limitation – timing is

Prof Andre van Niekerk

New DNA-based technology has opened our eyes to a group of diseases that we encounter daily but were not aware of. The International Union of Immunological Societies (IUIS) renamed their Primary Immunodeficiency Diseases (PID) committee to Inborn Errors of Immunity (IEI) committee in 2017 to better reflect the nature of these conditions. There are now more than 500 well-documented IEIs, and patients typically present with a spectrum of immune system disorders involving problematic infections, allergy, autoimmunity, autoinflammation, and malignancies. IEIs result from variations in the genes that direct immune function.

While some IEIs may be individually rare, they collectively contribute significantly to the health burden. Most patients are only diagnosed late due to various reasons, including the common (and often trivial) nature of infections they present with, leading doctors to overlook the link between increased infection burden, allergy, and autoimmunity.

The general practitioner (GP) plays a critical role in identifying IEI patients. Most will present repeatedly to their GP and receive repeated courses of antibiotics and corticosteroids without addressing the underlying immune error. Simple everyday screening can flag patients, and many can be managed without specialist referral.

The goal of this presentation is to equip general practitioners to be alert, test, diagnose, and offer basic care. We will define the IEIs and introduce you to this exciting ‘new’ field in medicine. Failure to identify these patients, unfortunately, often results in irreversible organ injury.

Dr Shaun Shelly

Dr Takshita Sookan and Prof Mergan Naidoo

CLICK HERE TO ACCESS:  Presentation

There is overwhelming evidence in the literature that physical inactivity is a major public health concern with a extensive range of detrimental effects. Exercise is an important modality for improving function, activities of daily living, quality of life and health conditions. Exercise plays an important role in the prevention, treatment, and rehabilitation of diseases. The evidence is clear that patients who engage in an active lifestyle, live longer, healthier, and better lives. Physicians have an obligation to assess each patients exercise behaviours and inform them of the risks of being physically inactive. Such an approach is critical to help decrease the burden on health care systems due to noncommunicable diseases, which are so closely associated with aging and a sedentary lifestyle. In this workshop we will use evidence-based basis for prescribing exercise as medicine for conditions such as metabolic syndrome, cardiovascular disease, Musculo-skeletal disorders and pulmonary disorders.

Dr Roland Duys, Dr Simon le Roux and Dr Jo Park-Ross

Dr Reinhard Boehmer

ETHICAL CONSIDERATIONS OF 

HUMAN MICROBIOME RESEARCH

The microbiome is the genetic material of all microbes – bacteria, fungi, protozoa and viruses – that live on and inside the human body.

Ethics is knowing the difference between what you have a right to do and what is right to do. The ethical principles are based on the four cornerstones of respec;, non-maleficence and beneficence; autonomy and respect.

Over the past century, agriculture has become increasingly industrialised with a particular rise in the number of livestock raised and meat produced. In order to fulfil such market demands, livestock farmers and agricultural corporations have artificially selected for and bred their cash animals to be more and more metabolically efficient via genetic and human-driven means. However, by selecting for more metabolically efficient animals, we may have inadvertently been selecting for obesogenic gut microbiota.

Per the CDC’s National Center for Health Statistics 2015–2016 data, 71% of adults over 20 y old in the U.S. were living with overweight or obesity and 39.8% with obesity.

The harms of antibiotic use, including off-target effects on the human microbiome, and the lack of evidence guiding most antibiotic prescription decision are discussed.

Knowledge of microbiomes, their systemic role, interactions, and impact grows exponentially. When a research field of importance for planetary health evolves so rapidly, it is essential to consider it from an ethical holistic perspective.

However, to date, the topic of microbiome ethics has received relatively little attention considering its importance.

Dr Madeleine Muller

CLICK HERE TO ACCESS:  Presentation

The NDOH TB Guidelines in South Africa for adults and children are over ten years old. Since then, we have seen the introduction of GeneXpert as our primary testing modality, dramatic changes to our management of Rif-resistant TB, new WHO recommendations on managing children with TB, and a guideline on managing TB infection (latent TB). This workshop will give an overview of the changes and additions to the diagnosis and management of TB in South Africa and discuss possibilities for the future.

Prof. Mergan Naidoo

Background

Workplace-based assessment (WPBA) in health education is receiving global priority. The College of Family Physicians of South Africa (CFP) and the various family medicine (FM) departments has developed 22 EPAs and have rolled out these EPAs in all nine medical schools in South Africa since January 2024. Currently, monthly webinars allow engagement with academics and registrars, and the Train the Clinical Trainer (TCT) course has been specifically adapted for an EPA-based curriculum. This workshop hosted by the CFP will provide an update on the 2024 progress and explore some of the new tools available on the Scorion platform. Potential participants would include trainers and registrars and those interested in workplace-based assessment.

Workshop

The SAAFP workshop will provide an update on the various developments and progress of the rollout and will engage participants in using workplace-based assessment (WBA) tools and making entrustment decisions. The workshop will cover the following topics:

1. CFP update on the rollout of EPAs for FM training in RSA.
2. Use of new WBA tools- entrustment-based discussions using scenarios.
3. Use of new WBA tools- one minute preceptor.

Take-home messages

Rolling out EPAs is a new educational experience for family physicians in SA. Sharing our experiences may help us understand this process better and hopefully help others at similar points in the journey.