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The Democratic Alliance intends to propose legislation that would allow healthcare professionals to do community service and internships in private hospitals. Such a legislative change risks exacerbating some of South Africa’s healthcare inequalities, argues Bulela Vava.

The unemployment crisis in South Africa has become increasingly untenable. It not only effects young people in general, but also graduates. This problem of graduate unemployment is sending a message that even education is no longer the safety net it used to be.

Among the casualties, unemployed healthcare workers are not spared. Time and time again, hundreds of early career healthcare workers find themselves helpless, either struggling to secure community service or internship placements or to join the healthcare workforce after they complete compulsory community service.

This has led to a crisis with far-ranging impacts, in particular for rural and township economies that often have the highest burden of healthcare needs but with a disproportionately low allocation of the required human resources.

Wrong solution

In a move to address this problem, Michéle Clark, DA member of parliament who also sits on the portfolio committee for health, intends to introduce an Amendment Bill to the Health Professions Act.

At its core, the draft bill aims to introduce measures allowing the private sector to employ community service and intern health professionals, a move aimed at tackling the rising unemployment rates among healthcare graduates. While this initiative appears progressive on the surface, a deeper dive into its implications reveals a complex scenario that may not yield the intended benefits, particularly for marginalised communities in rural and township areas.

Concerns with the draft bill

The draft bill deserves reserved support, but also raises some real concerns.

On the one hand, the idea of harnessing the private sector’s resources to create employment opportunities for community service and intern healthcare workers is commendable. The public health system, already burdened by budget constraints, would benefit from the additional workforce without bearing the full financial responsibility. Moreover, unemployed healthcare workers – many of whom are left disillusioned after years of rigorous training—would finally have a chance to gain much-needed experience and earn a livelihood.

On the other hand, the proposed bill’s implementation without a careful appreciation of both the context and complexity of the problem it seeks to solve raises some red flags.

The most pressing concern lies in its potential impact on healthcare equity. By allowing the private sector to employ these young professionals, there is a risk that the focus will skew towards profit-driven goals, leaving rural and under-resourced communities underserved. A significant majority of people living in rural and township communities cannot afford the often-exorbitant costs associated with accessing private healthcare, and this makes for a bad business investment case for the private sector.

Historically, the private healthcare sector in South Africa has been concentrated in urban and affluent areas where patient populations can afford care. The rural and township communities, where healthcare access is already severely limited, may continue to see little to no substantial investment from private entities. This geographical maldistribution of healthcare services only serves to widen the gap in health outcomes between the rich and the poor.

Moreover, the introduction of private employment for internship and community service professionals could lead to a two-tier system where the private sector attracts the best talent due to better working conditions and remuneration, leaving the public sector with fewer resources. This would widen the disparity between public and private healthcare services, which is already a major barrier to achieving equitable health outcomes in the country.

The way forward

Government is not without blame in this unfolding crisis, and its role cannot be overlooked. For years, there has been a failure to adequately plan and invest in the healthcare workforce, resulting in many newly qualified healthcare professionals being unemployed. The public sector’s inability to absorb these graduates has created a bottleneck that leaves many young professionals idle despite the country’s dire need for healthcare services. With its inability or lack of urgency to resolve the problem, the passing of this proposed amendment by the government could appear to be a move to outsource its responsibility to the private sector, a move that might provide short-term relief but does little to resolve the underlying problems.

To truly address the unemployment of healthcare workers and the access to healthcare crisis in South Africa, a more comprehensive approach is needed. One that looks beyond mere employment and instead focuses on equitable distribution of healthcare services. The amendment bill should include clear provisions and incentives for the private sector to deploy community service and intern professionals in underserved areas. It should also enforce legally binding accountability measures to ensure that private sector involvement does not come at the expense of the greater public good.

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Additionally, government must prioritise leadership and governance reforms in the public health sector in the interest of the public, focus on addressing push factors such as dilapidated infrastructure and poor working conditions and build on decentralised training for improved healthcare coverage. While this proposed amendment may not readily address this, a review of the current community service policy is needed, facilitated by an inclusive and comprehensive consultative process.

Ultimately, strengthening the public healthcare system is crucial to counterbalancing the influence of a profit-driven private sector and ensuring that marginalised communities receive the quality care they deserve.

*Vava is an Atlantic Fellow for Health Equity in South Africa and President of the Public Oral Health Forum, a network of oral health professionals committed to improving oral health outcomes in South Africa through strategic advocacy, education, research, and collaboration.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

The post Proposed Health Professions Act Amendment a double-edged sword appeared first on Vuka News.

Signed appointment letters and related documents reveal that the National Department of Health’s (NDoH) top official and his counterpart at the Independent Development Trust (IDT) played key roles in an allegedly unlawful project to install oxygen plants at state hospitals.

The NDoH has since written to the IDT to withdraw from the project, according to a statement issued by the IDT’s board of trustees. The board has directed the IDT’s management to accept the NDoH’s instruction. According to the statement, the IDT’s management maintained that “procurement processes were followed”.

The project, bankrolled by the Global Fund, one of the world’s largest health financiers, was initially set to cost R216-million, but the figure later ballooned to R836-million. The main contractor, Bulkeng, failed to adhere to several of the project’s original requisites yet somehow managed to secure a R428-million portion of the roll-out.

In this latest instalment in Daily Maverick and amaBhungane’s joint investigation we unpack seemingly irregular tender processes associated with the project. The IDT, a government infrastructure implementing agency, appointed Bulkeng to install pressure swing adsorption (PSA) oxygen plants at 45 government hospitals.

A joint venture (JV) between Maziya General Trading and On Site Gas Systems International clinched a R152-million contract to install plants at a further ten hospitals.

Our investigation shows that the IDT seemingly expanded the project’s scope after it took over as the NDoH’s implementing agent. By altering the quantities and the sizes of the required plants at many of the hospitals, the IDT paved the way for far costlier contracts.

An implementation plan for the project, adopted by the NDoH and the IDT in August 2022, set the budget at R216-million. This boils down to an average spend of roughly R3.61-million per hospital. The following year, however, the IDT altered the bill of quantities and the contractors were eventually appointed at an average cost of R10.5-million per site. The IDT and the NDoH have been at pains to explain how the project’s budget ballooned by nearly 300%.

We’ve established that Dr. Sandile Buthelezi, the health department’s beleaguered director-general, and the IDT’s CEO, Tebogo Malaka, played key roles in getting the contentious contracts over the finish line, despite concerns about the cost overruns.

Buthelezi reportedly already faces an investigation for allegedly soliciting a R500 000 bribe from an unrelated contractor in another IDT project. He was also suspended in 2021 over his role in the Digital Vibes scandal but later returned to work after an internal disciplinary hearing cleared him of wrongdoing.

Dr. Sandile Buthelezi, the National Department of Health’s director-general. (Photo: sourced)

We can also reveal that the IDT, ostensibly with Buthelezi’s consent, ran afoul of the 2022 implementation plan by omitting or circumventing key requirements, including those related to the bidders’ South African Health Products Regulatory Authority (SAPHRA) registration status and their gradings from the Construction Industry Development Board (CIDB).

We will also detail how the IDT apparently allowed Bulkeng to slip key documents into its bid bundle more than a year after the tender had closed.

Finally, we will highlight some of the statements the IDT and the NDoH made in relation to the project, illustrating how the IDT in particular has apparently been disseminating patently false or misleading claims.

We sent the IDT and the NDoH detailed queries regarding each matter unpacked in this piece. Both organisations vowed to respond but failed to do so before our deadline.

Instead, the IDT’s board of trustees on Monday afternoon issued its statement. The board said it “noted with serious concern” the allegations regarding the project.

“…anything that smells of malfeasance should be nipped in the bud and those found to be responsible of such, shall face consequences management”, the board’s chairperson, Adv. Kwazi Mshengu, was quoted as saying.

Vital bid requirement dropped

Documents in our possession, including Bulkeng’s company records and the IDT’s request for quotations (RFQ), point to a flawed procurement process, one that allegedly saw Bulkeng appointed at an inflated cost despite the fact that it wasn’t qualified for the project.

The procurement process, a two-pronged affair, was concluded in 2023.

First, the IDT advertised a tender to appoint contractors to a panel of would-be suppliers. More than sixty entities submitted bids, and in June last year the IDT appointed eight companies to the panel.

Next, in July 2023, the IDT issued RFQs to the panel members and eventually picked Bulkeng and the Maziya/On Site Gas JV for the roll-out.

Much of the controversy around Bulkeng’s appointment stems from its SAHPRA certification – or rather lack thereof.

In our previous reports, we detailed that Bulkeng had never been registered with SAHPRA, and that it had submitted another entity’s certificate to the IDT.

The IDT has since repeatedly claimed that a SAHPRA certificate was never a mandatory requirement for bidders, but we can now illustrate why this statement is disingenuous.

An infrastructure programme implementation plan, or IPIP, signed in August 2022 by various NDoH and IDT officials, forms the basis for the oxygen plants project.

The IPIP document very clearly states that SAHPRA certification needed to be factored into the IDT’s procurement process.

When the IDT issued its tender and RFQs, the SAHPRA requirement was somehow omitted, which would have opened the door to unqualified companies like Bulkeng.

A PSA oxygen plant (Image: Sourced)

Construction Industry Development Board

The 2022 implementation plan also called on the IDT to manage the procurement process in line with the CIDB’s requirements.

Unlike the SAHPRA specification, the CIDB requirement did make it into the IDT’s tender, although the threshold was quite low.

Companies with a mechanical engineering (ME) grading of five and higher were allowed to submit bids.

A grading of five limits companies to a project value of R10-million or less. Considering the project’s initial budget of R216-million, the grading requirement seems to have been far too generous.

Bulkeng has an ME grading of eight, so it easily cleared this minor hurdle. However, the company’s grading still only qualifies it to work on projects with a maximum value of R200-million.

It is therefore unclear how the IDT managed to appoint the company for a R428-million contract.

Bulkeng was appointed to install oxygen plants at the St. Andrews Hospital in Harding, KZN, at a cost of nearly400% the original budget. (Photo: sourced)

The IDT’s uneven application of the CIDB requirement raises another red flag.

According to a submission by the IDT’s Management Bid Adjudication Committee (MBAC) dated October 2023, at least one of Bulkeng’s rival bidders was disqualified from the bid because the contract value would have exceeded its CIDB limit. It is unclear why the IDT did not apply the same standard to Bulkeng.

Enter the DG and the CEO

In July 2023, Bulkeng, the Maziya/On Site Gas JV and three other companies submitted their quotations to the IDT. The bids were staggeringly high, with the lowest among the lot coming in at more than double the R216-million budget.

The Maziya/On Site Gas JV’s quote came to R862.6-million, while Bulkeng said it would do the job for an eye-watering R1.18-billion.

Word soon spread among NDoH and IDT officials that the project’s budget would be raised to accommodate the sky-high bids.

Naturally, the development sparked concern over the potential legal and auditing implications. The project already had a set budget. Any attempt to pour additional funds into the roll-out risked triggering an irregular expenditure finding.

The matter came to a head in early August 2023, at a meeting held by the project’s steering committee, a seven-person body that consisted of officials from the NDoH and the IDT, plus an external auditor.

The committee, in a formal resolution, decided that it would be best to restart the procurement process, citing the escalating budget and the SAHPRA requirement’s omission from the RFQ as the main reason for doing so. They also referenced the CIDB issue.

The committee sent a letter to the IDT’s CEO, Malaka, requesting that the process be restarted.

But Malaka never responded to the committee. Instead, it seems she chose to directly consult with Buthelezi, the health department’s DG. We know this because later that month, Buthelezi allegedly told the committee that he’d spoken to the IDT’s CEO. He allegedly told the committee’s members that he was happy for the IDT to continue with the bid process.

Tebogo Malaka, the IDT’s CEO. (Photo: sourced)

By all appearances, Malaka and Buthelezi had effectively brushed aside the committee’s concerns.

Their apparent disregard for the cost considerations is seemingly manifested in a “concurrence approval”, signed by both officials in October 2023. The document sought to raise the program’s budget to R987.4-million, a jaw-dropping R771-million more than the IPIP budget from the previous year.

According to our sources, this was a bridge too far for the Global Fund, which apparently instructed the IDT and the NDoH to formulate a more realistic figure.

A second “concurrence approval”, signed by Buthelezi in February 2024, introduced a budget of R580-million. Malaka’s signature also appears on this document, but it is not clear when she signed it.

The R580-million figure is exactly enough to cover the contracts awarded to the two winning bidders, but this was not the final project budget. The IDT and the NDoH have both confirmed that the budget had been set at R836-million. This means they had somehow released an additional R256-million. It is not clear when this figure was adopted by the two state bodies and whether it had been cleared by the Global Fund. It is also not clear which contractors, if any, were going to benefit from the additional spend, although the NDoH previously indicated that the R836-million budget included “professional fees, management fees and maintenance costs” for the oxygen plants.

The appointment of Bulkeng and the Maziya/On Site Gas JV, meanwhile, was finally concluded in June 2024. Malaka signed the letters of intent that reflect the “final allocation” of the two bidders’ respective sites.

After the fact 

The Bulkeng contract that Malaka and Buthelezi green-lighted seems dubious for yet another reason.

The RFQ called on bidders to submit letters of support from whichever Original Equipment Manufacturer (OEM) they’d chosen to work with. Where relevant, the bidders also had to furnish the IDT with signed JV agreements.

Our assessment of Bulkeng’s bid documents strongly points to a flawed and possibly unlawful bid process. All indications are that Bulkeng failed to comply with key mandatory requirements and that the IDT nevertheless allowed the company to clinch the lion’s share of the project’s roll-out.

As far as we could establish, Bulkeng’s original bid submission did not include a letter from its chosen OEM, nor one from Brutes Air Solutions, the company we previously identified as Bulkeng’s partner in the bid.

What we did discover, however, is a letter from Brutes Air’s CEO, Christo Bruwer, addressed to the IDT. According to the heading, the letter serves as “Official Confirmation of Collaborative Partnership with Bulkeng for PSA Oxygen Plants”. But the letter is dated 25 July 2024, so we have strong reason to suspect that the IDT entertained this crucial document a full year after the RFQ had closed.

Christo Bruwer, CEO of Brutes Air Solutions. (Photo: sourced)

Bruwer claimed there had been “a few versions” of the letter, including one that had been submitted in time for the 2023 RFQ. We asked him for a copy of the earlier version, but he said he couldn’t share it with us without the IDT and Bulkeng’s consent. Bruwer wouldn’t say why it had been necessary for him to draft a 2024 version.

Bulkeng’s letter from its OEM, or lack thereof, should also raise eyebrows.

The company’s bid included a letter that explained its relationship with Brutes Air and its OEM, Atlas Copco, dated 17 July 2023.

However, Atlas Copco only submitted a letter to the IDT on 10 October 2024, more than a year after the RFQ had closed.

What’s more, the letter doesn’t do much for Bulkeng’s cause as a bidder. It merely states that Brutes Air is an “authorised partner” of Atlas Copco. Bulkeng therefore failed to submit a letter that affirmed its own agreement with an OEM.

Under normal circumstances, Bulkeng’s failure to adhere to these bid requirements should have disqualified the company from the process.

Soaring costs 

The IDT has made several dubious claims regarding the oxygen project’s ballooning costs.

Following our first reports on the issue, the organisation went as far as claiming that the original R216-million budget was for fifteen hospitals, not sixty.

The IDT’s spokesperson, Phasha Makgalane, claimed in a live interview with Newzroom Africa that the R216-million budget was compiled as far back as 2017.

Elsewhere, the IDT has claimed that the budget was formulated in 2019 and therefore had to be adjusted to account for inflation. It has also claimed that the lower figure excluded VAT and maintenance costs, claims the NDoH has also repeated.

None of this is true.

The August 2022 IPIP clearly shows that the R216-million figure was less than a year old when the RFQ went out. What’s more, the budget covered the roll-out of oxygen plants at sixty hospitals, including VAT, installation costs and maintenance.

We compared the IPIP to the bill of quantities the IDT later issued with the RFQ. This exercise explained why the costs had risen so dramatically.

The Tshepong Hospital in North West, for instance, required only one small (10Nm³/h or 15Nm³/h) PSA plant at a cost of roughly R2.84-million, according to the 2022 IPIP. However, the IDT altered the bill of quantities so that bidders were required to submit quotes for two large (40Nm³/h) plants. This meant the eventual costs would be far higher.

The IDT appointed the Maziya/On Site Gas JV to install the plants at this hospital, which the JV would have done at a cost of R24.4-million – a hefty 757% increase from the original IPIP budget.

Bulkeng, meanwhile, was appointed to install a large plant at the St. Andrews Hospital in KwaZulu-Natal. It would have done so at a cost of R13.9-million. The 2022 budget, meanwhile, called for a small plant at a cost of only R2.84-million. A large plant, according to the IPIP, should in any case only have incurred a cost of roughly R8.5-million – still far less than what Bulkeng would have gotten.

At the Jubilee District Hospital in Gauteng, where one large plant would have sufficed, Bulkeng was set to install two large plants at a cost of nearly R28-million, a far cry from the R8.5-million budget envisioned in the implementation plan.

We looked at all 45 sites assigned to Bulkeng. Nearly every hospital that required only a small plant, as per the 2022 IPIP, was upgraded to a medium or a large one. The sites awarded to the Maziya/On Site Gas JV were given the same treatment.

Maziya’s CEO, Chris Delport, strongly denied that his company was trying to fleece the IDT through excessive pricing.

Chris Delport, CEO of Maziya General Services. (Photo: sourced)

He emphasised that the bidders had no say in the drafting of the bill of quantities, and that Maziya and its JV partner merely submitted their quotes in accordance with the RFQ.

Delport said there were several factors that contributed to the quoted fees, including the cost of installing and maintaining the plants. He said his company had factored in a mark-up of no more than fifteen percent.

“Some of the sites are in rural, far-flung places, so it costs more to go out there and install the plants. And none of these machines are manufactured in South Africa, remember, so there are import costs to consider too,” explained Delport.

We showed the project’s figures to an industry expert who told us that the numbers for the IDT project were “pure madness”.

This person, who has been involved in several PSA installations across the continent, reckoned that the roll-out could be done at a total cost of around R350-million.

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Photo: AI-generated image (Dall-E) representing fentanyl on a map of South Africa. Image edited using Photoshop by GroundUp staff.

Recent drug tests have found people at South African clinics testing positive for fentanyl. This is a highly potent opioid drug which has caused tens of thousands of deaths in the US.
It is the first direct evidence that South Africa could be headed for a fentanyl crisis of its own, though more data is needed.
Researchers say that to address the problem, naloxone will need to be distributed widely. This is a medication which can reverse opioid overdose.

People in the Eastern Cape and KwaZulu-Natal have tested positive for fentanyl, a lab-made painkiller that has been at the centre of the opioid crisis in the United States (US). In the US, fentanyl has caused tens of thousands of deaths each year, often among people in their 20s and 30s. While the drug can be prescribed as a legal pharmaceutical, the US crisis is primarily driven by illegally-made fentanyl, distributed by drug cartels.

Up until recently, South Africa appeared to be insulated from the illicit fentanyl crisis. But preliminary research suggests the drug has made its way onto our streets. The study is still ongoing, but lead researcher Dr Alanna Bergman provided GroundUp with information about the findings so far.

Bergman is an American nursing scientist who received funding from Johns Hopkins University to import highly precise urine drug tests. In February, she began using them to test people at clinics in East London, Port Elizabeth and Durban.

The patients who were tested were people who had drug-resistant TB, and were being monitored as part of a separate study. Nurses suspected that many people in the group may have been using substances.

There are a few possible reasons that this may have been the case. One is that HIV rates are high among South Africans who inject drugs, due to the sharing of needles. In turn, HIV can compromise the immune system, making active TB more likely.

Bergman was asked to step in to conduct voluntary drug testing at the clinics. In line with the expectations of nurses, Bergman’s tests found that 60 out of 100 patients tested positive for illicit drugs of some kind and 32 tested positive for fentanyl specifically.

Medical records suggest that none of these patients had been prescribed legal fentanyl. Surprised by the findings, Bergman imported more tests, which she has been rolling out since October.

“I believe we now have 320 people that we’ve tested,” says Bergman, “The fentanyl rate remains high. Each day, a few more people are added to the sample. When I check in on it, it’s anywhere between 25 and 33 percent who are positive for fentanyl at any given time”.

Bergman’s research is some of the first direct testing showing fentanyl use in South Africa. But there have already been signs of a brewing problem. One is a largely overlooked 2021 study, which tested wastewater at several treatment plants in Gauteng. It found biological markers for fentanyl in the sewage at each plant.

A second is a recent string of police reports related to fentanyl (which Daily Maverick summarised here).

What is fentanyl?

Fentanyl is an opioid medication (in the same category as codeine and heroin). It was developed as a strong painkiller, and can be taken as a pill, patch, lozenge or via injection.

In South Africa, it is sometimes used for medical procedures, for instance, as an epidural during childbirth. It can also be prescribed for chronic pain that hasn’t been cured by weaker medications. This is similar to how it’s used elsewhere.

People can also use the drug to get high; it produces a feeling of euphoria and relaxation. Like other opioids, people who use it for long enough can become physically dependent. At 30 to 50 times the potency of heroin, it can be deadly. There is a fairly narrow difference between a dose that can get you high, and an amount that could kill you.

In the US, the crisis is primarily driven by illegally made fentanyl, which the US Drug Enforcement Agency alleges is made in China. These include pills (often referred to as Blues) as well as powders, which are snorted or injected. Canada has also faced an illicit fentanyl crisis.

People using fentanyl by mistake?

In North America, people who use drugs sometimes end up taking fentanyl unintentionally. In a study conducted in Canada, roughly three-quarters of people who tested positive for fentanyl were unaware that they had ever taken the drug. This is because fentanyl is often added to other substances, like heroin. One study says that this is presumably to “reduce the amount of heroin needed for each dose” (since fentanyl is so much more potent).

Researchers suspect that something similar may have happened in South Africa, though the extent is unclear.

Shaun Shelly, a South African drug policy researcher, told GroundUp: “I don’t think anyone in South Africa is going out to get fentanyl intentionally; who here knows what that is?” Instead, it is more likely that people who tested positive for fentanyl had been buying what they thought was heroin, says Shelly.

Bergman noted that some people who tested positive for fentanyl also had morphine in their system (heroin turns into morphine in the body). But she says that “most are positive for fentanyl only”. Bergman says that this could mean that in some cases, fentanyl has replaced the heroin supply, rather than being used as an adulterant. She emphasizes that more data will be needed to confirm this.

If fentanyl adulteration or replacement is taking place, it could be difficult to reverse. “Fentanyl is a subjectively different experience to heroin,” says Shelly. “People get used to fentanyl, and then that’s all that can get them to the state they want.”

Shelly says that when fentanyl is cut into heroin it often “clumps”, meaning that it isn’t evenly distributed across a batch. As a result, “somebody can take a dose of one supply and they’re ok with it, but the next dose could potentially kill them, because the fentanyl is much more concentrated in that second dose.”

Government needs to act fast

To prevent widespread overdosing, the government will need to act fast, according to researchers. Bergman says one basic step would be to distribute naloxone more widely. This is a drug which is used to reverse opioid overdose. It has no potential for abuse.

The World Health Organisation recommends distributing naloxone to anyone who is likely to witness an opioid overdose. This includes emergency workers as well as close family members or peers of people who use drugs.

“There’s also going to need to be a lot of public health safety education,” says Bergman. For example: “Don’t use [substances] alone. You need to use with a partner so that someone can reverse an overdose.”

“These are the most basic low hanging fruit,” she says.

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the post Community Members Now Fed Up with Half-Decade-Long Makhanda Water Crisis appeared first on Karibu – A Working Class News.

By Nolusindiso Baliti 

For over five years, the community of Makhanda has been struggling with a severe water crisis.

Despite numerous complaints, protests, and community meetings, the local municipality has failed to act in the community’s interest.

In the past, the Gift of the Givers organisation provided some form of relief to the communities by delivering water to households, schools, and health facilities. However, their support has stopped, leaving many areas without water for weeks.
Community members are suffering a lot. Mr Lubabalo Bovuka (34), a father of two, explained that the lack of water affects his family’s daily life. “We can’t flush our toilets, and when the water truck arrives, the lines are long, and we often don’t get any water,” he said. “Our children get sick from drinking water from the tanks, suffering from vomiting, diarrhoea, and rash,” explained Bavuka.

The residents who don’t have access to water tanks are forced to rely on wells for water supply. However, the cleanliness and safety of well water are not guaranteed, sometimes it causes a serious risk of cholera which is a big health risk to those who use the water from the wells.

Nwabisa Mhlahla (31), a Makhanda resident, is also concerned about the ongoing water crises. “The situation is getting worse by the day, we need the municipality to find a solution to this water problem, our community deserves access to clean and safe water,” said Mhlahla.

It’s heartbreaking that women, children, and the elderly are suffering the most from the water crisis. Women spend all day queuing with buckets, waiting for water. The community in Makanda urgently needs help to solve this water problem.

This article was submitted on 27 November 2024. You may republish this article, so long as you credit the authors and Karibu! Online (www.Karibu.org.za), and do not change the text. Please include a link back to the original article.

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A man prepares a small dose of heroin. Archive photo: David Harrison

In Durban, heroin is known locally as whoonga. While it’s widely, but falsely, believed that whoonga is an altogether separate drug, the term emerged as street slang for heroin.
There are two commonly sold whoonga products: a capsule with powdered heroin which is typically smoked; and ‘stone heroin’ bought in plastic packets and often injected.
Because people previously relied on capsules, it was rare for them to inject, but the price of the caps has risen sharply in the past two years, leading many people to use stone heroin.
This has caused a steep rise in injection use and the associated disease risks from people sharing needles when they lack access to clean ones.

Beneath overlapping highway bridges in central Durban, homeless people congregate on a graveled strip of land, dubbed Ematsheni by locals (“place of stones” in isiZulu). The strip sits beside the sloping shoulder of a busy main road and is lined by heaps of rubbish and makeshift tents. Despite Durban’s oppressive daytime heat, several fires are lit, apparently to extract copper from scrap. Plumes of smoke whip about, carrying the heavy scent of burning rubber.

Ematsheni is a known “drug hotspot”. People can be seen injecting substances or preparing doses. Crack cocaine and crystal meth are present, but according to harm reduction staff, the most commonly used substance is heroin, known locally as whoonga.

It’s reflective of the broader drug crisis in KwaZulu-Natal, where heroin dependence remains a top reason for people to seek out rehabilitation centres – outstripped only by marijuana and alcohol dependence.

A man who used to sell heroin in Durban told GroundUp that when he began dealing in 2006, the opioid was fairly uncommon. But in the late 2000s, the customer base grew steadily. Many people who use heroin in Durban told GroundUp this was when they began their journey.

Dr Monique Marks, a sociologist who has conducted extensive research on heroin use in Durban, said the real uptick happened closer to 2013. She notes, however, that in certain predominantly Indian townships, like Chatsworth, heroin had been popular for much longer, where it was known locally as sugars.

But while it long dominated the streets of Durban, the way that heroin is consumed appears to be changing rapidly, leading to serious health concerns.

Amidst the smoke in Ematsheni, a woman sitting on the floor tells GroundUp that when she started using whoonga, she would “chase” the drug: heroin placed on a piece of foil. A flame held underneath produces fumes to inhale. But now, she gets her fix by injecting it.

Numerous people who use heroin in Durban told us that the use of needles has become far more popular. South African Medical Research Council data on rehabilitation centres in Kwazulu-Natal confirms the trend. It shows in 2021, only 3% of people that came to treatment centres for heroin use were injecting. By 2023, that figure had increased by more than five fold to 17%. And it is set to increase according to harm reduction staff. In Ematsheni, virtually everyone was injecting.

This has public health implications. When people inject drugs, there is a greater risk of disease spreading, because needles are sometimes shared when people don’t have access to new ones.

A recent survey funded by the United States President’s Emergency Plan for AIDS Relief (PEPFAR) found that roughly half of all people who inject drugs in eThekwini were HIV-positive. Three-quarters had hepatitis C, a viral disease that attacks the liver.

Clovis Dusabe, a professional nurse at the Bellhaven harm reduction centre, also noted that people who inject drugs sometimes miss veins, creating a wound that can become infected.

“In recent times, we haven’t seen a lot of abscesses,” says Dusabe. But because “there is now a high rate of injecting … I think we’re going to start seeing that kind of issue”.

“In recent times, we haven’t seen a lot of abscesses,” said Clovis Dusabe, a professional nurse at the Bellhaven harm reduction centre. Photo: Jesse Copelyn

Why are people turning to needles?

GroundUp had several group discussions with people who either use heroin or have recently stopped.

In Durban there are currently two common whoonga products. The first is called “stone heroin”, bought in small plastic packets twisted at the end. Stone heroin needs to be mixed with water and then melted down, for instance on a spoon or plate. After this it can either be drawn into a syringe and injected, or it can be crushed and left to cool down, before being sprinkled into a joint of marijuana. It can also be “chased” on tin foil.

The second product is a pharmaceutical-style capsule, specific to eThekwini. It contains powdered heroin mixed with bulking agents. People pull the capsule apart and empty its contents onto foil or smoke them in a joint. It’s rare for it to be injected as the powder often fails to dissolve in water.

A third product, which has now gone out of fashion, was a heat-sealed straw that contained powdered heroin. This was apparently similar to the capsule in that it was primarily smoked or chased.

Because many people who use heroin previously relied on capsules or straws, it was rare for them to inject. But the straws have largely been phased out, while the price of the capsules has increased sharply. A 2021 report found that in Durban, the caps cost just R15 a pop. Users told GroundUp that today it’s R40.

This means many people have switched to buying stone heroin, which they say has had a more stable price. The smallest quantity of stone heroin can be bought for R20, though R30 and R50 packets are also available, as are much larger quantities.

The amount of heroin in each packet or capsule isn’t clear. Marks says that the contents of the capsules vary as they’re manufactured by a variety of competing groups. But users generally agree that it’s cheaper to rely on stone heroin than caps.

Another reason for the switch appears to be driven by people’s views about the quality of different heroin products. The woman at Ematsheni said the caps have gotten weak. Others made similar claims. At one group discussion, someone told GroundUp: “The capsules are not pure … but when you get the other heroin – the stones that you inject – it’s a pure heroin.” Everyone burst into agreement.

How did the term whoonga emerge?

The term whoonga derives from the Swahili word Unga, which means flour. This has historically been a common slang term for heroin in parts of Tanzania, as the Global Initiative has highlighted. Likely influenced by Tanzanian dealers, locals in Durban began widely adopting (and mispronouncing) the term sometime in the 2000s.

Elsewhere in the country, the common name for heroin is nyaope, which has a similar backstory. It comes from the Swahili word for white – nyeupe, which is the colour of some heroin products in the country.

In part because of the new lingo, reporters and academics often assumed that nyaope and whoonga represented “novel” substances that were specific to South Africa’s townships. It was often suggested that nyaope or whoonga elicited a completely unique high and was unusually addictive (more so than heroin). This is not supported by the evidence.

A person who used heroin in Pretoria in the late 1990s and 2000s tells GroundUp that the terms emerged as useful street slang: “We used to call it that on the streets back in 1999 or 2000 as no one knew what we were talking about.”

The area near Ematsheni. Photo: Jesse Copelyn

The post From caps to needles: Durban’s whoonga drug culture is changing appeared first on Vuka News.

Residents of Phumla Mqashi informal settlement march through Lenasia South to the civic centre in in Johannesburg, demanding a permanent solution to their water woes. Photos: Silver Sibiya

Residents of Phumla Mqashi informal settlement say they’re not getting enough water from trucks

 By Silver Sibiya – this post first appeared on GroundUp

About 500 protesters from Phumla Mqashi informal settlement in Johannesburg marched through Lenasia South to the civic centre on Monday, demanding a permanent solution to their water woes.

Last month, Johannesburg Water officials disconnected scores of illegal water connections from the settlement, sparking several protests.

Johannesburg Water confirmed that about 17,000 people live in the informal settlement, and said there had previously been water tanks there, but “due to the ongoing land invasions … these tanks were vandalised”.

Following the protest, the utility sent water tanks to the settlement, which are filled by water trucks. But residents say there is not enough water for every household.

Before the march on Monday, protesters blocked busy routes in the community including the Golden Highway and Sheffield Road. At the civic centre, there was a heavy police presence.

Community leader Alfred Mcunywa said they want Mayor Dada Morero to commit to timeframes for a permanent solution to the water situation.

“We want the mayor to tell us how long the Jojo tanks will be in Phumla Mqashi,” he said.

Mcunywa said when Johannesburg Water officials heard about their planned march, they were told more water tanks would be delivered. “Why do we have to protest for the government to do the right thing?”

Mcunywa said they would approach the court to intervene if Johannesburg Water does not keep its promise.

In a statement, Johannesburg Water spokesperson Nombuso Shabalala said that 36 water tanks had been sent to the settlement, and said nine more would be added.

“Johannesburg Water remains committed to maintaining sustainable water management practices.”

Residents say they want the municipality to build proper water infrastructure.

The post Hundreds march in Joburg demanding water appeared first on Vuka News.

The post “It was such a relief to not have to go to the clinic every month” appeared first on TAC.

Millions across Africa are already getting a 6 month supply, so why not here in South Africa where we have the biggest HIV burden in the world? Below we hear from Lebohang Mokhele, TAC’s National Representative of People Living with HIV who lives in Gauteng. Lebo explains how South Africa has managed in the past to very quickly roll out changes to the HIV programme to make it easier for people living with HIV to stay on treatment. Yet it’s now December 2024 and while more people are getting a 3 month supply in Gauteng, there is no public implementation plan in place for getting people a 6 month supply. She calls on the department to prioritise giving all stable people living with HIV a 6 month supply now!

In the 10 years that Lebo has been on ART she says there have been a few key improvements in helping people stay on treatment. She says the time is right to make a 6 month supply of ARVs the next step forward.

Lebo who uses the Boitumelo Clinic in Sebokeng says for her the tilt points in the decade came with the introduction of fixed- dose treatment; then there was CCMDD – the introduction of external pick-up points freed people from having to do ARV pick-ups inside clinics, then dolutegravir, a better ARV medicine with few side effects. But, she says, a most important introduction came with multi-month supply of ARVs – 2 months supply and then recently 3 month supplies at a time.

Lebo is on a 3 month supply currently and collects from a pharmacy in a mall in Alberton.

“When multi-month started for me just after Covid-19, it was such a relief to not have to go to the clinic every month. Our clinic is so small we even call it “The Mkhukhu Clinic” (the shack clinic). The infrastructure is bad, and it’s overcrowded. People have to wait outside, rain or shine, because only four people can be inside the clinic at any time. We have more people coming from the new informal settlements around the area so there are too many people,” says Lebo.

Now she says it’s time for 3 month supply to be boosted to 6 month supply. As a TAC leader, she does advocacy and outreach at clinics, and she says unanimous feedback is that a 6 month supply should be given to people who are stable.

“I think that there are so many people who are tired of being in those clinic queues, waiting for so long and having to face the bad infrastructure and sometimes the bad attitudes of nurses. It will make sure they stick to their treatments if they get a 6 month supply of ART. I really don’t see that there will be problems,” she says. 

Lebo adds that along with 6 month supply there should also be additional pick-up points outside of malls. These include at community based organisations that are based closer to where people actually live in townships. These are more ways to make sure it’s easier for people to stay on treatment and to take charge of their health, Lebo says. 

* Name changed to protect identity

#MoreARVPillsNow

Follow us on social media (facebook, X, instagram) for regular updates.

The post “It was such a relief to not have to go to the clinic every month” appeared first on Vuka News.

The post Critics raise alarm over leadership issues at Gauteng health department appeared first on Spotlight.

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Mampondo Primary School learners pose in front of their new toilets with school principal Goodness Nokulunga Manci-Mvulana. To the right, some elders from the community look in on the celebration. Photo: Yamkela Nntshongwana

Mampondo Primary School received 12 new aerobic sanitation system toilets

 By Yamkela Ntshongwana – this post was first published on GroundUp

Children at Mampondo Primary School in Sicwenza outside Flagstaff need no longer fear falling into a pit toilet.

In October GroundUp reported that a six-year-old had to be rescued after falling into one of the old pit toilets in August, and how in June an eight-year-old had also fallen in.

Now the school has received a dozen low flush aerobic sanitation system toilets – five for girls, five for boys and two for teachers.

The toilets were donated and delivered by Save Our Schools Non-Profit Organization (SOSNOP) in partnership with Amalooloo and Concor infrastructure.

SOSNOP CEO Shelly Humphreys said that after reading the GroundUp article, she contacted the school principal and asked if they could help.

Inspectors were sent to check the condition of the old toilets and that’s when they knew that they definitely needed to help.

“We are so thankful that we were able to bring help before a learner dies from these toilets, though it must have been a terrible trauma for those who were rescued in these pits before,” said Humphreys.

At the handover ceremony, school principal Goodness Nokulunga Manci-Mvulana said, “We really appreciate the work that you have done for the community of Mampondo and bringing back the dignity of our school from the teachers to the learners.”

She said the conditions of the old toilets had disrupted teaching and learning as teachers had to supervise use of the toilets.

School governing body member Feziwe Boko said they will now sleep peacefully.

Boko said she hopes that now that they have new toilets, more parents will enrol their children at the school as this had been an issue in the past.

The post School pit toilet nightmare solved thanks to civil society appeared first on Vuka News.

BY Daniel Mkhwanazi

The community members of Snake Park are struggling with the issue of tailing dust blowing toward their households, and it is an everyday struggle.

On Monday, October 21st we saw a very dusty day from the early hours of the morning until the next day. Dry tailing deposits contain small particles that were picked up by the wind, transported, and deposited near the community of Snake Park. The tailing contains toxins such as arsenic, uranium, and lead chemicals that may cause serious health concerns. With that being said, the whole community was somehow filled with the tailing dust inside their households.

A 38-year-old, resident of Snake Park who goes by the name of Mr Bhebhe said the dust was somehow on his blankets and pillows, and he had to clean up even though his girlfriend had cleaned up in the early morning but it was dusty in the whole house. He went on to say that when he slept, he would get skin irritation then he started scratching his whole body until he noticed that the tailing dust had chemical reactions on his body.

A 17-year-old female who said she suffers from sinuses stated that when the dust was blowing towards the community households she had a problematic experience, due to that her nose would be itchy and her eyes also. Yet she struggled to breathe through late at night and this saddens her because every time the tailing dust is inside the house it causes her serious health concerns.

The air quality of Snake Park is very poor due to the tailing dust that keeps rapidly blowing up nearby the community and the inhalation of the airborne particles can lead to respiratory issues, such as asthma, bronchitis, and other respiratory diseases. The dust from the mine tailing can also hinder the plants and vegetation, which reduces plant growth. Accumulation of dust on leaves can also block sunlight and the ability to absorb carbon dioxide, implanting plant health.

So to mitigate the risk of the environmental impact of the tailing dust pollution to the community of Snake Park is that the mine has to implement several measures such as putting water sprays, chemical dust suppressants to control the release of dust into the air, planting native trees and vegetation could also help trapping dust particles and improving air quality.

Engaging with the community and residents of Snake Park can help raise awareness about the environmental impacts of mining and ensure their concerns are heard attentively.

The post Mine Tailing Dust Impacts The Snake Park Community appeared first on Vuka News.

the post Why the fuss about long-acting antiretrovirals for HIV? appeared first on Spotlight.

By Francois Venter

HIV prevention injections that can provide two, or even six, months of protection per shot have arguably been the biggest HIV story of the year. Ahead of World AIDS Day, Professor Francois Venter assesses the state of play and the critical next steps with these potentially game-changing new tools in the fight against HIV.

The post Why the fuss about long-acting antiretrovirals for HIV? appeared first on Vuka News.

BY Sicelo Sithole

Talings are very highly toxic and they compromise people’s lives, In Snake Park residents are exposed to the dangerous chemicals that come from the mine tailing dump. Inhaling is more dangerous. Many community residents have health issues like wheezing chests from young children and babies who are born with deformities, in most cases some never grow normally because of the toxic chemicals.

In Block 7 a mother whose name is Nomsa said her 16-year-old boy Sthembiso has cerebral palsy and looks like a three-year-old baby because of deformation that’s caused by the chemicals from the mine tailing. Nomsa spends more time at home to care for her son and struggles to get a job because she can’t leave her son alone since he is not even attending any school. In Snake Park, there is no center for people living with disabilities and South Africa is the most unequal country when it comes to providing free education to people who are living with disabilities.

Moketsi Mofokeng from block 3, the father of Sthembiso, also said he is very angry with the mine tailing because it has disabled his son and made him unable to do anything for himself. It is a challenge to the family and more difficult for him to understand why they don’t remove this mine tailing for good so that people can be healthy and live in a healthy environment.

Residents are now looking for the best way to eliminate the mine tailing as people want this toxic mine tailing to be removed for health reasons.

We must all have one common goal to tell the mine tailing owners to remove the mine tailing and everyone must be part of the movement to fight for what is good for the community.

The post Toxic dust blows at high speed into the community of Snake Park. appeared first on Vuka News.

BY Bongani Dladla

A child may develop a sense of mixed emotions and physical neglect as well as a fear of danger if they are exposed to drug use at an early age in their homes. Drugs and alcohol are destroying our communities due to unemployment and lack of opportunities especially for our youth. After matric, they don’t have anything to do. So some of our youth have started to use drugs and others are drinking alcohol every day.

Bongani Dladla explains to us the negative effects of drugs and alcohol which contribute to violent crimes as well as gender-based violence:

The mental and physical effects of addiction are devastating and the disease of addiction itself can cause permanent brain damage. When a person is struggling with a substance addiction disorder, he/she can be noticeable in their behavior. Drug addiction is more than simply a bad habit, it’s a disease that like any other chronic illness. Let us stop using drugs and alcohol.

Our purpose is to encourage young people not to allow peer pressure to get the better of them. Do not drink because your friends are drinking and remember you can still have fun without alcohol and drugs. We also call on liquor traders and members of our community not to sell alcohol to a person under the age of 18 years, our community policing forum is working with police to find out who is selling drugs to our community, especially our youth. Let us protect our youth and say NO to drugs and alcohol.

The post Drugs and alcohol abuse affects our communities, especially our youth. appeared first on Vuka News.

Nobulawo Sitshaluza

The mine dump constitutes a potential source of contamination to the environment, as heavy metals and acids are released in large numbers. Soil erosion is the natural process in which the topsoil of a field is carried away by physical sources such as wind and rainwater.

Snakepark community members are currently experiencing a lot of dust since there are several truck movements on top of the tailing. On the 20th of October 2024 it rained but the following day on the 21st it was dusty, later the same day it rained again. On the 22nd of October 2024, the following day it was dusty again.

Ms Tlalane aged 40 years stays at number 27, with her husband and one child. He moved to Snakepark 5 years ago from Lenasia reason being they couldn’t afford rent payments. They made a deal with the farm owner to look after his farm in exchange for staying rent-free on his farm.

“She says that she doesn’t know what is going on in the tailing, all she saw were trucks that were busy on top working and the other thing is that the level of dust coming from the tailing mine dump has increased since all of these trucks arrived there ”

Mr Donsa is a farm owner, a father of three, and a grandfather of two. We spoke briefly during the time I went to his farm to bring his pig’s leftover food as I sometimes do .” He said that he spoke to one of the workers that were near the tailing mine dump and asked him what exactly are you guys working on there on top of tailing. He says the guy responded that “they are leveling the mine to prevent another sludge from flooding the community again and also we will be removing the tailing completely. He also complains about the dust becoming even more. ”

I have realized that some of our community members know nothing about what is going on at the tailing. The counselors need to put more effort into informing the community members of what is going on at the tailing currently. The most she needs to do is to call a follow-up meeting with all the community members because mostly it is only the stakeholders who receive invitations to attend the important meetings but when it comes to some community meeting gatherings, on every street there will be a huge announcement about an up and coming meeting.

The post Soil erosion at tailing mine dump in Snakepark appeared first on Vuka News.

the post Joburg’s Water Crisis Getting Severe! appeared first on © Karibu – A Working Class News.

By Yonela Gebengu and Karibu Staff 

Residents of Johannesburg are struggling with ongoing water supply issues. This community is experiencing “throttling water” supply.

Department of Water and Sanitation (DWS) Minister Penny Majodina announced that Johannesburg’s water would be restricted from 14 November 2024, until further notice.

The minister says the restriction of water in 11 municipalities in Gauteng is caused by neglect of infrastructure, illegal water connections, and frequent pipe leaks.

Johannesburg community members say that Joburg Water and DWS should prioritise addressing the water issues before implementing drastic measures.

An after-care teacher from Zenith Pre-School in Pritchard said the centre is affected by the disrupted supply. She says they must let the children go home early because they can’t use the toilets. For them, water is needed to maintain hygiene in the classrooms. The principal of the day care centre said they had to tell parents to bring water in the morning as their children will need it during outages.

Eritha from Bubbles laundry on Mooi Street said, they forced to close when there’s a disruption in water supply. She said the laundry business is new.

Eritha says they don’t have the capacity to reserve tanks to keep their laundries business running, but it’s something they are considering for the future.

Johannesburg Central residents said they have been without water for up three months at times. This would be exacerbated by electricity outages. It becomes hard for them to even carry buckets of water and use the stairs all the way to the upper floors.

“I don’t even trust if the water is clean when its back, because it’s been gone for too long and that also bring questions, how clean is the water?”

The water crisis in Gauteng has reached an extreme point. As the communities struggle to cope, they demand meaningful solutions.

This article was submitted on 20 November 2024. You may republish this article, so long as you credit the authors and Karibu! Online (www.Karibu.org.za), and do not change the text. Please include a link back to the original article.

The post Joburg’s Water Crisis Getting Severe! appeared first on Vuka News.

the post PETITION!!! RECKLESS ENDANGERMENT: HOLD SOUTH AFRICAN GOVERNMENT AND CHEMICAL INDUSTRY TO ACCOUNT FOR DEATHS AND SERIOUS ILLNESSES FROM TOXIC PESTICIDES ON THE FARM AND IN FOOD appeared first on groundWork.

Vuka.news SUMMARY – SIGN PETITON here by 4 December 2024:

South Africa is dealing with a serious problem involving food poisoning and toxic pesticides, which has led to children tragically dying. Critics believe the government’s response blames the wrong people and fails to address the real issues. Here are the main points:

• Tragic Deaths: Children have died due to food contaminated with deadly pesticides like Terbufos, which is banned in other countries but still used in South Africa.
• Government Response: A national disaster has been declared, and spaza shops must re-register. Activists argue this unfairly shifts blame onto shop owners rather than addressing the root causes.
• Outdated Laws: Pesticide regulations in South Africa are 75 years old and fail to protect public health effectively.
• Industry Influence: Powerful chemical companies, like CropLife, are accused of blocking reforms and prioritizing profits over safety.
• Activists’ Demands:
  1. Ban highly hazardous pesticides (HHPs) like Terbufos immediately.
  2. Create stricter regulations and stop allowing the pesticide industry to self-regulate.
  3. Provide better healthcare for victims of poisoning and support for their families.
  4. Transition to safer, chemical-free methods of farming.
• Call for Action: Experts and activists are urging the government to take responsibility, fix weak regulations, and protect people’s health and the environment.

PETITION

RECKLESS ENDANGERMENT: HOLD SOUTH AFRICAN GOVERNMENT AND CHEMICAL INDUSTRY TO ACCOUNT FOR DEATHS AND SERIOUS ILLNESSES FROM TOXIC PESTICIDES ON THE FARM AND IN FOOD

Ban Terbufos with immediate effect, institute mechanisms for banning all highly hazardous pesticides (HHPs) within three months

Please click here to sign on.

Please spread the word by sharing this petition with others: https://t2m.io/PesticideTribunal_BanTerbufos 

Signatures open until 4 December 2024.

22 November 2024

To:

The President of the Republic of South Africa Cyril Ramaphosa
Portfolio Committees on Agriculture and Rural Development; Labour and Employment; Health; and Environment, Forestry and Fisheries
Minister of Agriculture, Forestry & Fisheries John Steenhuisen
Minister of Labour and Employment Nomakhosazana Meth
Minister of Health Aaron Motsoaledi
Minister of Environment Dion George
Minister of Land Reform and Rural Development Mzwanele Nyhontso

South Africans have been alarmed to learn of multiple instances of children rushed to emergency due to foodborne illnesses and poisoning, some with tragically fatal consequences. As a result, President Ramaphosa has declared a national disaster and decreed that all spaza shops must re-register within 21 days.

We note that these solutions do nothing to deal with the source of the issue: the unacceptable presence of HHPs on the South African market, and the failure of the relevant Departments to carry out their duty to effectively regulate agrotoxins.

We are alarmed that the chemical industry, CropLife, immediately created a narrative in the media to place the blame on spaza shops, the lifeblood of most communities in South Africa (SA), fanning xenophobic flames. All in a bid to deflect attention from their responsibility for these historic and continuing tragedies. We are alarmed that our government has supported them in this endeavour. This injustice must be remedied.

PETITION DEMANDS

We call on the government to cease conflating incidences of food poisoning by highly toxic pesticides and food contaminated by food-borne illness. This has led to the inappropriate solution of blaming spazas for the government’s failure.

We urge the government to release in an open and transparent matter, the exact cause of each food-related emergency, as was done with the Naledi tragedy.

We call on the Department of Agriculture, Land Reform and Rural Development (DALRRD) to ban Terbufos with immediate effect and to overhaul the entire pesticide registration system within 12 months.

We call on the government to ban aerial spraying of pesticides, as recommended by the United Nations Special Rapporteur on Toxics and Human Rights, Dr Marcus Orellana, following his visit to SA in 2023.

We call on the government to establish an open and transparent process towards the banning of the category of Highly Hazardous Pesticides within the next three months.

We urge the government to ensure adequate funding for government Poison Information Centres.

We call on the government to establish an independent inquiry into the structural causes and the role of industry in the cases of pesticide poisoning.

We call on the government to implement its 2010 pesticide policy and to integrate this with a food security plan that reduces reliance on chemicals for pest control.

We urge the government to establish a Compensation Fund within one year that will compensate pesticide poisoning victims fairly and equitably.

We urge the Department of Health to ensure access to quality health care for survivors of pesticide poisoning – particularly children – whose long-term development and health may be at risk from the poisoning.

“Everyone wants to assign blame for this tragedy but spaza shop owners are not the culprits. If we don’t tackle the upstream causes, we will almost certainly see more poisonings in the future.” 

Profs Leslie London & Andrea Rother, UCT School of Public Health

 THE LONG READ

 Tragic deaths in Naledi highlight the scourge of street pesticides

In October 2024, South Africa was shocked, outraged, and dismayed to learn that six children had died after eating snacks bought at a spaza shop in Naledi, Soweto. The families of these young children will never be the same. The Department of Health soon confirmed that the deaths were caused by an HHP called Terbufos.

Soon, the media machine was picking up scores of other instances of hospital emergencies related to children eating from school feeding schemes and spaza shops. The pesticide industry, under the auspices of CropLife, aided by the South African government, used this tragedy to conflate the incidences of food contaminated by deadly toxins with food-borne illnesses caused by expired or otherwise spoiled or rotten foods. These are separate occurrences that need discreet and systemic solutions.

In the panic to identify a culprit, attention has focused on spaza shop owners and they have been scapegoated for a much bigger and complex problem. This has firstly allowed industry to wash their hands of any responsibility for failing to ensure product stewardship of their toxic chemicals through the lifetime, as required by the National Environmental Management Act. Secondly, it has opened the door to the scourge of xenophobia, which must be stopped immediately.

We, the undersigned, know who the real culprits are in this avoidable tragedy, and we demand radical and expedited changes in the approval, use, and regulation of agricultural poisons

Terbufos – HHP that should have been banned ages ago

Terbufos is an HHP from the organophosphate family. It was listed as a “restricted agricultural remedy” in 2023, requiring specific labelling. Terbufos has been banned in the European Union since 2009 and there is no reason for it not to have been banned here – European bodies and African bodies react to poisons just the same. Further and given that it is banned elsewhere, there are alternatives available.

The South African government was warned about deaths from pesticides freely available on the street, in 2023 and 2024, by the UN Special Rapporteur on Toxics and Human Rights, Dr Marcus Orellana. He even mentioned Terbufos by name in his report on toxins in SA released in July 2024. He found that deaths are caused by lapses in regulations and enforcement. He also warned of the outsize power the chemical industry has in regulatory decision-making. Although the state responded to his report, they did not acknowledge his findings in this regard or show any urgency to remedy the regulatory problems he identified.

Scientists have persistently raised the alarm over decades about the deaths and impacts of street pesticides, as well as pesticides used in agricultural settings. Research at a large Cape Town mortuary, published in 2023, showed that Terbufos was confirmed as the causative agent for more than 50% of child deaths in a 10-year review of child fatalities in which pesticide poisoning was suspected.

The DALRRD is primarily responsible for failing to modernise its regulatory control over toxic pesticides and this failure is the underlying reason for these deaths. The DALRRD issued two discussion papers on pesticide legislation that indicates knowledge that the current legislation – which is 75 years old – must be replaced to be fit for purpose. However, nothing has been done to advance this legislative reform and, under this antiquated Act 36 of 1947, six preventable child deaths have occurred in a terrible tragedy. The Departments of Labour and Employment, Health, and Environment must also take responsibility where they have failed to act. These incidents of death are not new, not surprising.

Our government has been warned many times by experts and activists but has chosen to prioritise the corporate profits of the chemical industry over Constitutional rights to our health and the right to a clean and healthy environment. We reject their attempt to scapegoat spaza shops and foreigners on this matter.

Terbufos and thousands of other pesticides poison farm workers daily

Terbufos is registered for agricultural, not domestic use. It is one of over 9,000 toxic chemical compounds registered for use in SA, in varying categories of toxicity, used extensively on wine, maize and citrus farms. Farm workers are exposed to these daily. While men often do the spraying, women farmworkers are also vulnerable to pesticide exposure, which occurs in multiple ways, including when pesticides are applied while they are working without proper protective clothing and when they are forced to re-enter vineyards soon after pesticides have been sprayed.

Farm bosses often ignore regulations regarding training, access to information, protective gear, wash stations, etc., and no one is monitoring them. Local clinics lack knowledge of pesticides in use in their vicinity, how to diagnose and treat poisoning, or their obligations to report pesticide poisoning. Farm workers live under extremely vulnerable and precarious working conditions where they have little to no bargaining power. They receive the barest minimum wage, with little access to health services. No amount of traceability and labelling will make a substance designed to kill safe, and there is no ideal real-life situation where these toxins can be deployed safely.

Farm workers and their children, farm dwellers, and people living adjacent to farms are also exposed to these toxins regularly. Spraying season has just begun (November) and those living on and adjacent to farms are experiencing the familiar symptoms of exposure to cocktails of toxic pesticides drifting in the air – asthma, sinus, streaming eyes, mood swings, headaches – and many will know the long-term impacts in their bodies in years to come.

This toxic mode of food production is not inevitable. We reject the well-worn narrative that we cannot achieve food security if we do not spray our food with numerous cocktails of poisons from seed to production to storage. Minister Steenhuisen recently declared in the media that these toxins are beneficial to society. How long will we allow the chemical industry to sell us this bizarre notion? What will it take for our government to take a serious look into alternative, safe methods of food production if the death of children from Terbufos poisoning has been an opportunity to deflect blame and responsibility?

The fox is in charge of the hen house – CropLife regulates itself

The multi-billion-dollar industry that produces these highly hazardous chemicals has a hold over the South African government, as noted by the UN Special Rapporteur in his July 2024 report. This industry, spearheaded by CropLife, has hindered every attempt to reduce the use of agrotoxins and to properly regulate and ban HHPs. Government is complicit, as they have enabled the self-regulation by industry to continue and consistently make decisions in favour of industry over the people and environmental health and safety. Here are some examples of industry audacity and impunity:

In 2006, the draft pesticide management policy contained strong safety measures, but the industry successfully lobbied to remove these and restrict the scope of the policy.
Industry stopped plans to replace the Committee to Protect Man against Poisons with a new department structure because the new members included scientists who were too critical of industry interests.
In 2020, it was revealed that CropLife members pay ‘independent consultants’ embedded in the office of the Registrar to do their bidding.
CropLife lobbied to set up a committee of their members to act as an ‘independent certification body’ when the government introduced new regulations governing regulatory trials for pesticides.
In 2021, the Department of Environment withdrew regulations to implement SA’s obligations under the Rotterdam Convention, arguing that time for adjustment was needed –17 years after SA ratified the Convention. Terbufos was one of the agents imported by UPL at its Cornubia store that went up in flames in 2021, and would have been notifiable under these regulations.
The South African registrar of hazardous substances promised to phase out 116 HHPs by June 2024 (Terbufos is one of these). Ultimately, only 28 were identified for phasing out, but not Terbufos, and to add insult to injury, regulations were even passed to allow industry to apply for exemptions to continue to use these chemicals under certain circumstances.
There is no publicly available database of pesticide registrations. This responsibility was handed by the DALRRD to industry and access to information on what pesticides are registered for use in SA is under the control of CropLife.

We the undersigned demand an end to the self-regulation of this industry as being a clear case of gross conflict of interests. We demand that our government takes responsibility for pesticide poisoning on the farm and in the street, and holds Croplife and its members to account. The government is under a Constitutional duty to take up the regulatory reins to ensure our Constitutional rights to health and the right to a healthy environment.

Issued by the South African People’s Tribunal on AgroToxins (SAPToA).

SAPToA is a coalition of vulnerable and affected peoples, civil society organisations, trade unions, academics and individuals working together to expose the harmful reality of pesticides in South Africa and support those who work with agricultural toxins in their daily lives.

Our growing affiliates currently include:

Commercial Stevedoring, Agricultural and Allied Workers Union (CSAAWU); Women on Farms Project (WFP); African Centre for Biodiversity (ACB); groundWork, Friends of the Earth SA, South Durban Community Environmental Alliance; affected peoples of the Blackburn Community; Surplus People Project (SPP); Ubuntu Rural Women and Youth Movement; Trust for Community Outreach and Education (TCOE); UCT School of Public Health.

You can sign the petition here.

Spread the word by sharing this link: https://t2m.io/PesticideTribunal_BanTerbufos 

Signatures open until 4 December 2024.

Further reading

Visit to South Africa – Report of the Special Rapporteur on the implications for human rights of the environmentally sound management and disposal of hazardous substances and wastes, Marcos Orellana. July 2024. https://www.ohchr.org/en/documents/country-reports/ahrc5752add1-visit-south-africa-report-special-rapporteur-implications

Comments by the State: Report of the Special Rapporteur on the implications for human rights of the environmentally sound management and disposal of hazardous substances and wastes on his visit to South Africa. September 2024. https://documents.un.org/doc/undoc/gen/g24/149/14/pdf/g2414914.pdf 

Pesticide Action Network list of HHPs. https://pan-international.org/wp-content/uploads/PAN_HHP_List.pdf

Terbufos information sheet: https://echa.europa.eu/substance-information/-/substanceinfo/100.032.679

End notes

HHPs are pesticides that have been identified as posing a high and unacceptable risk to human health or the environment. They are typically characterised by:

acute toxicity,
potential to cause chronic health effects, or
persistence in the environment, and
commonly being highly restricted or banned in other regions for this reason.

192 HHPs are registered and legally in use in SA and of these over a third (57/192) are banned in the European Union (EU) because of unacceptable human health and environmental risks, and 36 belong to the most hazardous class known as the World Health Organisation (WHO) Group 1a and 1b. These are substances known to have carcinogenic potential for humans, based on human health evidence and, in acute poisonings, can cause death. Examples of HHPs in this class still legally registered and used in South Africa include:

Carbofuran: This pesticide used on many crops is toxic by inhalation or dermal absorption. Farmers and farmworkers are most at risk as it is an endocrine-disrupting chemical (EDC) and reproductive and developmental toxicant. It is also highly toxic to aquatic organisms.

Mevinphos: Exposure can result in long-term neurological effects. It is also a groundwater contaminant and farmworkers and farmers are at great exposure risk as it is also an EDC.

Terbufos: This agricultural insecticide with neurotoxic effects is often sold as a street pesticide in SA – a pesticide that is decanted and sold for use in informal markets without the correct label or warnings. Children and adolescents are the most vulnerable group and high incidences of poisonings are recorded every year.

The post PETITION!!! RECKLESS ENDANGERMENT: HOLD SOUTH AFRICAN GOVERNMENT AND CHEMICAL INDUSTRY TO ACCOUNT FOR DEATHS AND SERIOUS ILLNESSES FROM TOXIC PESTICIDES ON THE FARM AND IN FOOD appeared first on Vuka News.

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By Marcus Low – the post #InTheSpotlight | SA has started a TB revolution – can we see it through? appeared first on © Spotlight.

Summary by Vuka.news:

1. TB Rates in South Africa: TB cases have declined from 500,000 (2005) to 330,000 (2023), but the pace is too slow. South Africa remains a high TB burden country with 427 cases per 100,000 people.

2. HIV and TB Link: HIV compromises immune systems, making people more vulnerable to TB. Rising antiretroviral therapy use since 2008 has helped reduce TB cases by improving immunity. TB diagnoses are hindered by late detection, leading to widespread transmission before treatment. “Earlier identification of people in early stages of TB disease is really critical if we hope to control TB,” says Professor Thomas Scriba.

3. Advances in TB Understanding: TB is no longer just classified as latent or active; an intermediate stage, sub-clinical TB, exists. Sub-clinical TB patients can be infectious without symptoms, complicating control efforts. Early treatment of sub-clinical TB could prevent lung damage and reduce transmission.

4. TB Testing Revolution: Molecular tests now give results in hours versus weeks and are widely used in public healthcare. Portable X-ray machines enable community testing but need follow-up molecular tests. New saliva, stool, and blood-based tests are being developed.

5. Targeted Universal Testing (TUT): TUT tests high-risk groups, like those with HIV or recent TB exposure, even without symptoms. Early results show TUT increases TB detection significantly.

6. Challenges in Sustaining TB Control: TB programs depend heavily on international funding, posing sustainability risks. Political support and public awareness campaigns, akin to those for HIV, are vital.

7. Research and Local Innovation: South African universities are leaders in TB research, focusing on early detection and treatments. Investing in local TB solutions could reduce reliance on international donors. “The outcome is very much still in doubt…TB claimed 56,000 lives in the country last year.”

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Staff at TB HIV Care provide methadone at a drop-in centre in central Cape Town. Archive photo: David Harrison

Research shows that people are more successful at quitting heroin when they enrol in opioid agonist therapy (OAT) programs, which provide prescribed medicines to block withdrawal symptoms.
Government has largely failed to fund OAT. Instead, it has invested in abstinence or detox-based rehab programs that are usually unsuccessful.
The government appears to be changing tack. In July it advertised a pilot OAT program to begin next year at two government clinics – one in Mpumalanga and another in the North West.
Concerns have previously been raised that state-sponsored OAT could lead to an uptick in methadone overdoses, but some researchers say these risks can be managed by ensuring that users take their medication at clinics under the watchful eye of clinicians in the first weeks or months of their treatment.

The government is preparing to trial a medically-assisted treatment program to help heroin users who want to quit the drug. This is after long resisting this approach, in favour of drug-free rehab programs that have yielded low success rates.

In July the national health department requested bids to run a pilot program to provide opioid agonist therapy (OAT) to heroin users. OAT is a form of treatment in which people who are quitting heroin (or reducing their intake) are provided with medicines, called opioid agonists. These drugs block the painful withdrawal symptoms that occur after a person quits heroin.

The health department has until February 2025 to appoint a service provider to run the pilot, which will run for 20 months. It’s supposed to operate at two primary healthcare facilities – one in Emalahleni in Mpumalanga and another in Madibeng in the North West. These locations were chosen as they reportedly include a “high number of people” who use heroin.

The opioid agonist drug to be used in the pilot scheme is methadone, a syrup that is taken once a day. OAT programs usually offer it alongside other forms of assistance, such as counselling or therapy. The medicine is typically administered for a minimum of six months.

Clinical trials show that heroin users are more successful at kicking the habit when they’re provided with methadone than when they’re sent to drug-free rehabs. For the treatment to work, however, people need to take it for several months or even years. This allows them to establish a more stable social environment (for example, getting off the street, finding work, and re-establishing family relationships) before slowly tapering off the medicine.

Many countries, such as the US and UK, provide OAT free of charge. But South Africa has historically taken a more conservative approach. People who are suffering from heroin withdrawal at public hospitals can be provided with methadone, but only for up to ten days. This short-term option is called detox therapy, and research shows that it isn’t as effective as longer-term OAT programs.

Similarly, at government-funded rehabs, users are either expected to quit cold-turkey, or are provided with one to two weeks’ worth of methadone. There isn’t any national-level data on the success rates of these rehab programs but the available evidence isn’t promising.

One study looked at 300 heroin users who went to state-funded rehabs in Johannesburg. It found that three months after the program had ended, two-thirds of them had gone back to using heroin, and many of those that had stopped were simply on other substances. For instance, the number of people using crystal meth (commonly known as tik) had increased. The researchers partially attributed these disappointing results to the lack of OAT.

After getting new needles and syringes from a mobile program at a site in Wynberg, Cape Town, a man prepares a small dose of heroin nearby. Photo: David Harrison

The government has slowly been changing tack. In 2018 civil society groups and academics made a submission to the National Essential Medicines List Committee requesting methadone for long-term OAT at public clinics. The committee is an advisory body that helps select which drugs the government should buy for public sector patients.

This led to a period of consultation. In 2021, the committee published a review which stated that OAT is more effective at reducing heroin use than drug-free or detox-based programs. But it expressed “concerns that the current service delivery platform [South Africa’s system of primary health facilities] is not adequate to deliver [OAT] safely, considering the risk of respiratory depression in toxicity and the risk of diversion to illicit drug markets”.

The committee thus recommended that OAT be conducted from pilot sites first, in order to see whether government clinics have the capacity to run these programs safely. The health department states that this “will help to inform the rollout [of] OAT in the country in a safe, cost-effective and efficient way”.

Effects of methadone

For people who are dependent on heroin, withdrawal can come just a few hours after their last hit. The symptoms can include fever, body aches and intense fatigue. The American author, William Burroughs, who used heroin for years wrote that it “is a feeling as if the life energy has been shut off so that all the cells in the body are suffocating”.

Heroin users who live on the street are constantly hustling to buy enough heroin to stave off these looming withdrawal symptoms.

Users in Cape Town’s Joe Slovo township told GroundUp that they needed at least six quarter gram shots a day (though usually more), which cost R25 a pop. This comes to R150 a day. To support this they engage in a range of odd jobs that provide immediate cash, such as carting scrap metal to recyclers or assisting small informal businesses with cleaning up.

The hustle becomes all-consuming. It’s for this reason that OAT can be so powerful for those who are looking for a way out. By blocking withdrawal, people can exit the constant street hustle, and instead begin to make long-term planning decisions – applying for jobs, finding a steady shelter, and building relationships.

Risks shouldn’t be overstated

OAT is not without its criticisms.

According to a 2023 study, the hesitancy to roll out OAT at South African clinics has partially been motivated by the fear that patients may overdose on methadone. This is in part because in the US, thousands have died of methadone overdose.

The US Centers for Disease Control notes that these deaths have primarily been linked to the use of methadone for pain relief however, rather than as an OAT drug. The rate at which people have overdosed on the drug has dropped in the US since the country’s regulator curbed the use of methadone for pain relief. This is despite the distribution of methadone for OAT programs going up significantly over the same period.

Meanwhile, evidence from Norway shows that when that country rolled out a national OAT program, total overdose deaths from opioids came down, as the program helped people to get off illicit drugs like heroin.

According to Dr Andrew Scheibe, a medical doctor and harm reduction researcher at the University of Pretoria, “most overdoses on methadone are [linked to] pain medication, and not so much around its use for opioid agonist therapy”.

Scheibe notes that there are risks linked to methadone use in OAT but these can be managed. “The highest risk of overdose on opioid agonist therapy is in the first couple of weeks of use. So in the first couple of weeks or even months, people are on direct observed therapy.” In other words, they take their medication at the clinic under the watch of clinicians.

Doing this from primary healthcare facilities in South Africa will require additional resources. According to Andy Gray, who sits on the Essential Medicines List committee, “there has been a fair bit of back and forth with the national health department on questions of capacity [at primary healthcare clinics]”. Gray noted that this is also given the “need to provide comprehensive services to users, not only OAT”.

According to Scheibe, while observed daily treatment is needed in the beginning of OAT “it is also important that people can [transition] to take-home methadone when they’re stable, because that then allows them to resume other parts of their lives”. Scheibe says that “the COVID epidemic pushed many countries to allow take-home methadone … and there was no change in overdose deaths due to methadone as a result”.

In the US, following lockdown regulations, OAT clinics began providing users with weeks’ worth of methadone at a time, after previously requiring daily observed treatment. A paper in Lancet Public Health reviewed six studies which analysed the impact of this and found “no evidence of increased methadone overdose risk as a result of the [more flexible] guidance”. (Though one study has since come to the opposite conclusion).

Prices coming down

A final concern about OAT has previously been the high price tag of methadone, which has historically been provided by a single supplier in South Africa – Equity Pharmaceuticals. But in recent years prices have come down as new products have entered the market. These include a product by Adcock Ingram called Adco and another by Umsebe Healthcare called Misyo.

Both of these products were registered by the country’s medicines regulator, SAPHRA, in 2021. But Misyo only came to market in 2023, while Adco was launched in February 2024.

Equity is still the government’s supplier of methadone, as the most recent tender was awarded in 2023, before the new players were able to bid. A new tender will be issued in 2026 however.

At present, Adco sells at R368 (including VAT) for a 100 ml bottle, and there are 10 milligrams of methadone per ml.

Users on OAT start on a low initiation dose, and steadily increase their daily intake until they reach a stabilisation dose. This level varies across individuals, though the global recommendation is 60-120mg a day.

At a stabilisation dose of 90mg, the Adco product cost about R33 a day – a lot less than the R150 people pay for heroin in Joe Slovo. These prices would inevitably come down even further once they were negotiated on tender.

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