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How South Africa rations dialysis

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

ProPublica’s Sheri Fink, M.D., went to South Africa, where panels in hospitals still decide which patients deserve the scarce dialysis treatments and which must be left with failing, untreated kidneys. Fink was in the room as the assembled physicians gave the final approval or denial, and when they expressed their bitterness that hospital executives required folks on the medical side to make what were, essentially, cost-control decisions. The costs, after all, are not negligible.

In South Africa, only the roughly one out of five patients who have a form of health insurance or the small proportion of patients who can afford pay are able to get dialysis at private clinics or hospitals based on medical need alone. The cost of paying out of pocket—about $20,000 per year— is nearly double the gross domestic product per capita.

Probably in the middle of the last decade we were turning away 50 percent of the patients,” said Dr. Rafique Moosa, a kidney specialist at Tygerberg Hospital and head of the Department of Medicine at the University of Stellenbosch. According to him, as of August they were turning away 80 percent, and in November, only two out of 20 patients were accepted. “We just don’t have the resources to deal with the patients,” Moosa said..

Until relatively recently, there weren’t any formal guidelines for rationing dialysis care, an omission which opened the door for broad racial disparities.

The new general guidelines were drawn up by medical ethicists and emphasize medical criteria, which Fink reports on. It’s a carefully chosen set of criteria, but the enormity of the medical shortage gets in the way of neat formulae like those, Fink writes.

The problem is, few actually are able to get transplants. There are far more good medical candidates than there are dialysis slots. Therefore, the committee falls back on subjective criteria—does the patient seem motivated? Does he or she have a good social support network?

Professor: Research, training can improve South African health journalism

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In discussing a large grant his university has received and the center for health journalism that it will fund, South African professor Guy Berger (bio) has unleashed a scathing critique of African health journalism, and of the profession as a whole.

rhodes
Rhodes University, Grahamstown, South Africa. Photo by Pierre Nel via Flickr

Berger says South African health journalists don’t look hard enough for real news, don’t know enough about health care, and aren’t even that good at telling the stories that they do uncover.

It’s a dire picture, of course, but Berger’s overall message is one of hope. He implies that there’s a lot of great work to be done on health and the health care industry in in South Africa and the new center, he says, could help make health journalism the “healthiest trend-setter for the whole family of journalism.”

The “Discovery Centre for Health Journalism” will be funded by a $2 million grant from South African insurer Discovery Health. It will offer an honors program, six annual scholarships and an “annual symposium for working health journalists and stakeholders.” Berger also writes that it will “enjoy full academic freedom.”

For more on the center and African health journalism, see Issa Sikiti da Silva’s related post on bizcommunity.com.