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Western Cape one of few provinces refusing to make critical breast cancer drug available

A potentially life-saving or life-extending breast cancer medicine is available to public sector patients in several of South Africa’s provinces, but not in the Western Cape. Elri Voigt asks what is behind the Western Cape government’s decision.
The cancer drug, trastuzumab, has often been in the headlines over the past decade. For several years, activists campaigned to have the price reduced and the Competition Commission earlier this year announced that it is seeking to prosecute pharmaceutical company Roche for alleged excessive pricing of the drug.
Trastuzumab is used to treat a specific subset of breast cancers called HER2 positive (HER2+). It is given in addition to other treatments like chemotherapy and radiation and has been shown to significantly reduce the chance of the cancer recurring after treatment. It is administered either through an IV or subcutaneously.
The drug has been listed on the South African Essential Medicines List (EML) since 2017, according to this timeline compiled by the Cancer Alliance (a local advocacy group), and is currently only approved for early-stage HER2+ breast cancer.
After its listing on the EML, trastuzumab should have theoretically been made available in all the provinces that have treatment centres for cancer that are linked to South Africa’s academic hospitals.
Trastuzumab was listed on the World Health Organisation’s Essential Medicines List in 2015.
Access to the drug in the public sector in South Africa has been something of a lottery, depending on where you live.
Public sector oncologists in the Northern Cape had successfully motivated for the necessary budget to provide trastuzumab at Kimberley Hospital as early as 2011. The Cancer Alliance’s timeline states that the Department of Defence was using trastuzumab in military hospitals in 2013.
According to Dr Mathabo Mathebula, CEO of Steve Biko Academic Hospital in Gauteng, the drug has been provided in the province since 2017.
A doctor from the Free State told Spotlight the province started prescribing the drug to patients in November 2018.
History of trastuzumab in SA
Salomé Meyer, project manager for the Cancer Alliance’s Access to Medicine Campaign, tells Spotlight that trastuzumab has been made available in Gauteng, the Free State, KwaZulu-Natal, the Northern Cape and the Eastern Cape, although the Eastern Cape may be experiencing procurement problems.
According to Meyer, the Western Cape Department of Health has never procured the drug. This, she says, has forced some patients to pay for their own treatment or simply go without.
“Since 2017, the Western Cape has refused to provide trastuzumab treatment ...

Universal access to electricity is the critical development intervention that South Africa needs

In many households, a choice must be made each month between electricity or food. No matter which option the household chooses, the impact is negative, not just for that household, but for our collective ability to make meaningful progress in economic and social development.
It is generally understood that access to (reliable) electricity for mining, business and industry is a critical input for economic development. It is the main reason why government has put addressing electricity supply constraints as the number one goal of Operation Vulindlela — the plan to implement a number of priority structural reforms designed to reinvigorate the economy.
Less well recognised is the central role of access to electricity for poor households and small enterprises in supporting development. Universal access to electricity is positively correlated with a wide range of socioeconomic benefits:
Households that have access to electricity are much more likely to start a small business enterprise than those that do not;
Access to electricity allows existing small businesses to engage in a range of additional value-adding activities, increasing household income and expenditure;
Small agricultural enterprises (the most important potential source of employment and income for households in rural areas) require electricity to increase productivity;
Access to electricity supports improved household food security: households can store and cook food more efficiently, reducing its cost, when they have access to electricity;
Electricity is positively associated with better educational outcomes, supporting study at night and access to the internet;
The ability to use electricity for cooking reduces indoor air pollution, which currently kills more than 1,000 children under the age of five each year in South Africa; and
Each year, thousands of deaths and injuries result from fires caused by paraffin or candles.
In summary, universal access to electricity contributes directly — and significantly — to a wide range of South Africa’s most important development goals. Access to electricity is essential to leveraging and increasing the impact of existing state expenditure across a wide range of areas, from small enterprise development to household food security. Conversely, lack of access undermines these goals and makes them more difficult to achieve.
In this developmental role, electricity is analogous to education: it is generally understood that universal access to quality education is critical to supporting broad-based development. Although it is the individual who benefits directly from that education, there are many more benefits for the whole of society. This is the reason why the cost of education is subsidised by the ...

No comment or explanation for why judge has taken 19 months to rule in vital court matter

Judge Nomonde Mngqibisa-Thusi of the Gauteng high court reserved judgment in February 2021.
This week we ran an article on late judgments across South African courts. At the end of December 2021, nationally there were 156 court judgments outstanding for at least six months, and 830 reserved judgments outstanding in total.
One example of a late judgment from this list is a case involving a dispute between the Department of Military Veterans and a health services company. The company claims the department failed to pay it for providing medical care and counselling to military veterans in 2015.
The matter was heard at the Gauteng Division of the high court in Pretoria on 8 and 9 February 2021, and judgment was reserved by Judge Nomonde Mngqibisa-Thusi on 21 February 2021. Nineteen months later, she has still not delivered judgment on the matter.
The company, Zeal Health Innovations, took the department to court over non-payment for healthcare services it provided to military veterans from June to August 2015. More than R15-million is being disputed.
The department, in response, filed an application challenging the validity of the R200-million contract its officials signed with Zeal Health.
Visit Daily Maverick’s home page for more news, analysis and investigations
Although the judicial norms and standards state that judgments should be handed down within three months of being reserved, GroundUp has used a more lenient six-month benchmark and has been reporting late judgments since 2017.
According to the last available list on late judgments, published at the end of December 2021, the Pretoria high court had ten judgments more than six months late, of which the matter between Zeal Health and the Department is the second longest outstanding judgment. The longest outstanding judgment at this court was reserved just a month earlier on 26 January 2021 by Judge Natvarlal Ranchod — nearly two years ago.
According to a previous list, at the end of September 2021, the Pretoria high court only had three late judgments. This means the number of late judgments more than tripled within just three months.
We asked the Office of the Chief Justice for comment on why Judge Mngqibisa-Thusi has not yet delivered judgment in the matter involving Zeal Health Innovations and the Department of Military Veterans but, despite providing ample time, have not received a response.
Since the list was last updated on 31 December 2021 (and is based on an honour system in which judges are expected to report their reserved judgments), ...

Well-conceived sugar tax needs further strengthening to save lives of millions

Even over the short period that the sugar tax has been in effect, studies from South Africa have shown that the tax has led to South Africans, especially the youth, buying less sugary drinks, and has encouraged the sugary drinks manufacturers to reduce sugar content in these drinks. This means that there is an overall projected reduction in overweight and obesity rates.
On 18 September, Andrew Russell from the South African Canegrower’s Association wrote in Daily Maverick that South Africa should get rid of the Health Promotion Levy (also known as the sugar tax). Not only is he wrong but he has distorted and offered falsehoods. This response explains why.
Everybody agrees that excess sugar is bad
Even big producers like Coca-Cola and Nestlé have admitted this fact. The false argument provided by Mr Russell, that there is no evidence that sugar leads to increased rates of obesity and non-communicable diseases is very similar to previous industry distortions of scientific facts that are promulgated in the name of profit.
Sugar intake, particularly through drinking sugar-sweetened beverages, has been shown, repeatedly and consistently, to increase weight gain and obesity leading to significant growth in the numbers of patients with cancer, diabetes and cardiovascular disease, and ultimately premature death.
A potato is, in fact, not a soda
Unprocessed carbohydrates including vegetables and fruit, as opposed to products with processed foods are an essential part of the human diet. Replacing food items with sugary drinks with no nutritional value, contributes to malnutrition.
The tax is working
Even over the short period that the sugar tax has been in effect, studies from South Africa have shown that the tax has led to South Africans, especially the youth, buying less sugary drinks, and has encouraged the sugary drinks manufacturers to reduce sugar content in these drinks. This means that there is an overall projected reduction in rates of being overweight and obesity. Studies from multiple countries have also shown compelling evidence that sugar taxes work.
We have heard all of this before. from alcohol and tobacco
Nutrition researchers have long noted the similarities between tactics used by tobacco, alcohol and sugar companies. For example, quick, commissioned studies to “support” their own argument that job losses are caused by the tax in these industries.
The documented misuse of evidence around the South African sugar tax is reminiscent of tactics in the 1970 and 1980s to try and suppress the link between smoking and lung cancer.
Visit Daily Maverick’s ...

Emalahleni municipality woefully failing to provide clean drinking water to 500,000 residents

People in the Mpumalanga municipality have to use their social grants to buy electricity to boil dirty water.
Water supplied by the municipality is often brown, sometimes even black, in Klarinet township, Emalahleni (previously Witbank), says Lettie Mdluli.
Mdluli, 62, lives with her five daughters and eight grandchildren. No one is employed in her family. The entire household survives on child support grants and a little money they get from recycling.
They try to boil water before they drink it, but between Eskom blackouts and the price of electricity for the two-plate stove they use, sometimes they just drink what comes out of the tap.
“The water is not good at all. It causes a loose stomach,” she says.
“We spend over R300 on electricity alone, because we boil about five litres of water every two days for drinking,” says Poppie Maseko, who lives a block away. “But even then, my husband suffers from stomach pains and diarrhoea.”
Her family survives on two child support grants and a R350-a-month social relief of distress grant.
As an authorised water service provider, Emalahleni Local Municipality is responsible for four water treatment works which are supposed to supply drinking water that meets South African National Standards to approximately 500,000 residents.
There are six indicators for the quality of drinking water supplied, the most important of which are “acute microbiological compliance”, “acute chemical compliance”, and “chronic chemical compliance”. The other three are “non-health aesthetic”, “operational compliance”, and “disinfectant compliance”.
Results from water tests taken throughout the distribution system are supposed to be uploaded monthly to the national Department of Water and Sanitation Integrated Regulatory Information System (Iris), an online site that tracks the quality of drinking water and the quality of effluent released from wastewater treatment plants across the country.
The results are depicted as a percentage of compliance, calculated on a 12-month running average, and are made public.
Data analysed from the Iris site on 18 June showed Emalahleni had 0% compliance on all six indicators. This means that no results were being uploaded, despite it though it is a legal requirement. Questions on this and other matters sent by GroundUp to the Department of Water and Sanitation, which is the regulator, have gone unanswered.
Similarly, earlier data analysed on 14 March showed 0% compliance across all six indicators.
A search on the Iris site on 15 September showed Emalahleni had an overall acute microbiological compliance of 92%, which is listed as “bad”. For drinking water ...

Copyright Act victory in ConCourt for blind and visually impaired

The judgment by acting Judge David Unterhalter reads: ‘Those with print and visual disabilities suffer from a scarcity of access to literary works that persons without these impairments do not’, due to the Copyright Act.
The Constitutional Court on Wednesday handed down a landmark judgment declaring the 1978 Copyright Act unconstitutional because sections of the act deny blind and visually impaired people access to reading materials.
Last September, Blind SA, represented by SECTION27, took the matter to the Pretoria High Court and in December the high court found the act unconstitutional. The organisation then took the matter to the Constitutional Court for confirmation in May this year, arguing that urgent changes to the act were required.
The judgment by acting Judge David Unterhalter reads: “Those with print and visual disabilities suffer from a scarcity of access to literary works that persons without these impairments do not”, due to the Copyright Act, which, therefore, “constitutes unfair discrimination” on the basis of disability.
Reflecting on the urgency of the need for accessible-format books, the judgment stated: “Persons with print and visual disabilities should not have to wait further to secure a remedy.”
“We are ecstatic that we have a judgment that provides for the exceptions that we have been advocating for so long,” said Blind SA CEO Jace Nair after Justice Jody Kollapen read out the unanimous judgment.
“We would like to thank the Constitutional Court for recognising the impact this violation has had on the lives of blind and partially sighted persons for decades.”
The judgment also made key findings about how the act disproportionately affected poor people with disabilities, saying: “The obligation to secure the authorisation of the owners of the copyright in literary works to make published literary works available in accessible format copies (the requirement of authorisation) has led to a scarcity of such works.
Visit Daily Maverick’s home page for more news, analysis and investigations
“More often, and particularly for poor persons in this class, the scarcity is absolute, and few works are available at all.”
In a joint statement, Blind SA and SECTION27 said: “The court categorically determined that the Copyright Act had, until now, ‘plainly infringed’ the rights to equality, dignity, basic and further education, freedom of expression and the rights to language and to participate in the cultural life of one’s choice.
“The paragraphs of the judgment which relate to the impact of copyright on the rights to dignity and education are particularly noteworthy:
Para 71: ...

Are free and fair elections possible in Zimbabwe in 2023?

Given the history of elections in Zimbabwe in the past two decades, there should be considerable misgivings that the 2023 election could be any different, especially in the light of the statements by Zanu-PF that they will not accept loss and feel entitled to rule forever. This cannot be seen as mere rhetoric.
For 22 years the only solution to the political crisis in Zimbabwe has been the resort to elections, and the forlorn hope that an internationally accepted election result would guarantee the legitimacy for the country to re-engage with the international community.
Unfortunately, it is also the solution advocated by the two major political parties in the country: both parties claim that the legitimacy that will flow from an internationally accepted election will prove to be the panacea that will end the crisis and resolve the deep-seated problems — political, economic, and social — that afflict Zimbabwe.
We reject this misguided optimism as we have since 2016.
The hope about elections has been fostered by the surprising result in the Zambian election and the re-emergence of a popular opposition, the Citizens Coalition for Change (CCC). Whilst it is heartening to see this, it is evident that this merely deepens the political polarisation in the country, and a country that is the most politically polarised in Africa. This polarisation is reflected in the total absence of political trust by the citizens in political parties, the government, and the state.
The hope is also given new energy by the results of the by-elections and the confirmation that, despite all the manoeuvring to destroy the Chamisa faction of the MDC, the new party, the Citizens Coalition for Change (CCC) restores the polarisation of two big parties in Zimbabwean politics. Zanu-PF will have to face the fact that no GNU or political settlement can take place without the CCC, and that buying time to resolve its internal chaos has not changed the political reality in Zimbabwe.
The low poll, which is usually the case, also demonstrates the total absence of political trust in the state, the government, and political parties.
Citizens in Zimbabwe trust only NGOs and religious leaders, and too often the vote for the opposition is a mixture of support as well as a rejection of Zanu-PF, with the opposition seen as the lesser of two evils. The Afrobarometer survey in 2021 found that nearly half (49.8%) of Zimbabweans would not vote, and didn’t know, or would ...

Agriculture department to ban certain hazardous pesticides by 2024

This comes nearly three years after Women on Farms Project raised the alarm over the use of pesticides which had already been banned in the EU.
Several pesticides found to cause cancer, genetic mutations and affect reproductive health, will be phased out and banned by 2024, according to the national Department of Agriculture.
This was announced on Tuesday at the Worcester Town Hall to over 150 mostly women who live and worker on farms and Women on Farms Project members. The event was centred on the farm workers’ demand for responsible and ethical pesticide practices on farms.
The workers also handed over a memorandum at Worcester Hospital to a representative from the Department of Health. The memo demanded an urgent meeting with the department heads of Health, Agriculture, Labour, and Environment. They also want hazardous pesticides to be banned, and for old pesticide regulations to be updated.
The workers marched in August 2019 and again in May this year against the use of 67 pesticides which include Roundup, Dursban and Paraquat, which had already been banned in the European Union (EU) since 2007.
Many of these pesticides have been banned because they pose a danger to farm workers, consumers, and the environment, GroundUp previously reported. Pesticides are regulated by the Fertilizers, Farm Feeds, Seeds and Remedies Act (FFFAR).
During the event on Tuesday, many workers shared their stories of how the use of certain pesticides has affected them. Representatives of the departments of health and agriculture also addressed the women.
Chrisma Juluus, who lives on a farm in De Doorns, said the smell of pesticides on her husband’s work clothes lingers in their house even after putting it in a bag.
“It takes a long time for ailments to show up . They need to get rid of the pesticides,” said Juluus, adding that their three-year-old has shown symptoms of respiratory problems.
Visit Daily Maverick’s home page for more news, analysis and investigations
Bettie Louw from De Doorns said her husband sprayed pesticides on a farm for over 40 years. She said he too used to “stink of pesticides” and would often get sick. “I wouldn’t know what to do because he was very sick,” she said.
Others raised issues about not being provided with protective clothing when working with pesticides, having to work in crops right after pesticides were sprayed, and developing respiratory symptoms such as asthma.
Women on Farm Project’s Carmen Louw said Tuesday’s event was the first time they ...

Overcoming historic trauma – all South Africa needs is love (and compassion)

Fostering sustainable development, quality democracies and relatively peaceful societies that emerged from violence, cannot happen without the former oppressed communities inculcating a mass culture of individual self-love, and consistently electing leaders who operate from love, who have compassion for others that stretches across ethnicity, colour or region, and is not based on self-interest.
Colonialism, apartheid and systemic racism, and of chronic poverty which continued under many African governments following independence, undermine the agency of victims, the capacity of individuals to appreciate their own power, the opportunities in their midst and the alternatives they have to fulfil their potential.
More broadly, agency is the ability to act on one’s own will, despite the constraints of belief systems one has grown up with, others’ perceptions of one and a limiting environment. Quality development, democracy and societal peace following past country trauma is not sustainable without large doses of agency at the individual and collective level.
Societies that have emerged from colonialism, apartheid, civil war, systemic racism and long-standing chronic poverty, experience trauma not only at the individual level, but also mass trauma at a collective level. The trauma undermines the agency of the victims – at the individual and collective level, and often their offspring for generations.
Restoring the agency of victims of oppression is one of the key conditions for sustainable development following terror regimes.
Traumas from terror regimes or meted out by violent groups to others deny the humanity of those they oppress, assault and terrorise, resulting in broken individuals, communities and societies. Mass trauma damages indigenous cultures, collective identities and individual self-worth. It undermines self-esteem, batters self-confidence and distorts emotional management. Many victims develop inferiority complexes.
Fundamentally, it undermines self-love, which often leads to self-hatred and victims often who seek invisibility, rather than expression of their full self. It disfigures the sense of self, undermines healthy familyhood and distorts interpersonal relationships.
All these ultimately batter the agency of victims.
Shattered assumptions, existential insecurity
In his theory of shattered assumptions, Ronnie Janoff-Bulman argues that people interpret the world based on a set of assumptions about themselves, others and the world. This provides a view of how the world operates and how to interpret what happens in the world and one’s role in it, a process which allows one to function as a healthy human being.
One would believe that one is a worthy human being, of value and deserving of fair treatment. These assumptions give meaning, self-esteem and centredness to ...

Choba shack dwellers in Centurion demand more toilets, access to water

But City of Tshwane says it has already provided what it can with its budget
The Choba informal settlement in Olievenhoutbosch, Centurion, settled by people hoping to benefit from the surrounding housing project, has grown and is home to about 500 people.
Before the Covid pandemic, residents shared one tap. They received three water tanks in late 2020 under the State of Disaster regulations, but residents now say this is not enough for the whole community.
In August, GroundUp reported on the community’s protest, where residents demanded that the City of Tshwane give them better services and housing.
When GroundUp visited the area we found piles of rubbish near one of the tanks with stagnant smelly water around it. Some residents use the water and space around the tanks to do their laundry. When there is water in the tanks, residents say, they stand in long lines.
Choba has about 15 communal mobile toilets, but these are locked by households who live near the toilets and clean them. The roads around Choba are riddled with potholes.
Visit Daily Maverick’s home page for more news, analysis and investigations
Elizabeth Kona has lived in Choba since the 1990s. She said she has been waiting for her RDP house for decades. Kona said three water tanks are not enough for the community. She said people walk up to 300 metres to a tank.
According to the City, Choba is already benefiting from its current services budget. The City’s head of Human Settlements, Sello Chipu, said about R2-million would be spent on the provision of toilets and tanks in the 2022-3 financial year.
He said the number of toilets was in line with what the City could afford. “We have reached the cap in terms of the expenditure,” Choba said.
He said the City would investigate the poor condition of the main road in Choba. DM
First published by GroundUp.

Crisis point — Prasa’s disastrous state revealed in comprehensive data analysis

No trains, no hope? We show just how bad things are at the Passenger Rail Agency of South Africa.
Revenue from train fares has plummeted while the state subsidy has skyrocketed
Nothing quite conveys the disastrous state of Prasa like graph 1 below. What it shows is this: In 2008, Prasa collected R1.2-billion in fares (blue line). Thirteen years later, in 2021, it collected R178-million.
Yet over that period, Prasa’s government funding (green line) mushroomed. Its operating subsidy ballooned from R2.6-billion to R8.8-billion. Its capital subsidy grew from R282-million to R2.9-billion (with a high of R4.3-billion in 2019/2020).
In the graph, total revenue looks healthy. But Prasa includes the money that it receives from the government as a subsidy in its revenue calculations — first, its operational subsidy and then, in the 2020/21 annual report, also its capital subsidy.
The steady climb in the operational subsidy — the green line — is mirrored by the depressing trajectory of the fare revenue.
Interest on cash reserves exceeds income from fares
Commuter rail is by nature a subsidised mode of transport. Taxes are used to reduce the cost of a passenger’s journey. But in the next graph, we see how fares have formed a smaller and smaller share of Prasa’s total revenue.
By the end of the 2019/2020 financial year, interest earned on its cash reserves contributed more to Prasa’s revenue than income from fares or from its rental properties.
We could interpret this as showing a decision by the government to reduce fares and wholly fund train transport from taxes — like Spain recently decided to do. But this is not the case. What we see is what happens when passengers can’t take any trains.
The number of passenger trips has plummeted
The graph below shows the collapse in passenger trips.
The red dashed line shows the total passenger trips during 1998, which is GroundUp’s calculation using data from Prasa’s 2008/09 annual report. The blue line shows annual passenger trips for each year from 2008.
The decline in passengers is largely the result of there being not enough trains. According to Statistics South Africa’s National Household Travel Survey, 2020, the single biggest reason nationally why people are not using trains is that trains are simply not available to them.
Between 1998/99 and 2008/09, there were an average of 43-million rail passenger trips per month. Prasa recorded its peak ridership in 2008/09, reporting an average of 54-million passenger trips per month, according to its annual report.
Covid ...

Ekurhuleni family demands independent probe after baby exposed to police teargas

They claim police threw the container into the property while chasing protesters.
The family of 11-month-old Zachary Rogers, who was exposed to teargas in his home during a protest in Geluksdal, Brakpan in Gauteng on Monday, are demanding that the conduct of police be investigated.
Protesters had blocked the main road near the Rogers family home. Some ran into the house when police fired rubber bullets and the family say police then threw teargas into the house. At the centre of the protest is the community’s demand for free basic electricity, among other things.
Zachary’s mother Gabriella Rogers told GroundUp that her son was gasping for air and was red in the face after the teargas canister was thrown into the house. She says they rushed him to hospital where he was treated for respiratory problems and discharged the same day. The family intends to report the matter to the Independent Police Investigative Directorate (Ipid).
Police did not confirm that teargas had been used. SAPS Station Commander Goodall Khumbulani Mbatha in a statement following the protest said, “The community barricaded the roads around Geluksdal including the main road with burning tyres and big stones.” Three people had been arrested.
“We will be opening a case because my grandchild was in the house. How can police throw teargas inside a house?” said grandfather Shane Rogers. On Wednesday, the family said they were waiting for Zachary’s formal medical report to file the complaint against SAPS.
Visit Daily Maverick’s home page for more news, analysis and investigations
In August, Ekurhuleni was rocked by riots over electricity in Tembisa and Geluksdal in which four people died. Until May this year, all residents in Ekurhuleni used to get the first 100 kilowatt-hours (kWh) of electricity free. The municipality said that this was adjusted when it implemented a National Treasury directive for which only indigent households with an income of less than R3,500 per month can qualify.
Portia Brink, a community representative, said many households were struggling to pay debts and blocked from buying electricity. Others had had their water cut.
Last week the City said some households had tampered with electricity meters and this had resulted in arrears and penalties.
But resident Ferina Ali said someone else had tampered with her electricity box. Now, she said, she had been blocked from buying more units until they pay a reconnection fee of R13,000 owed to the municipality.
She said her father relies on electronic breathing aids so ...

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