PRIMARY HEALTH CARE
Hospitals handle the more serious cases of illness and injury.
In South Africa there are two main types of hospitals:
- Public hospitals: These state hospitals offer free or low cost health care to the general public who don’t have access to medical aids
- Private hospitals - Are more expensive and are mainly used by people who are members of medical aid schemes.
What is Primary Health Care?
- The word ‘primary’ means ‘first’, ‘basic’, ‘main’, ‘elemental’ or ‘fundamental’. Therefore, in the context of heath care it means the basic or initial step to being and staying healthy.
- In other words the basic health care required for keeping body, mind and soul healthy.
- The basic step in keeping healthy is living a healthy life e.g.
- Eating good nutritious food.
- Exercising regularly
- Keeping the body clean
- Living in hygienic conditions.
- Taking alcohol in moderation (or better still, abstaining!).
- Not smoking or taking drugs.
- Taking the necessary precautions to prevent illnesses and diseases.
- The required primary health care to provide advice on healthy living and the necessary precautions against illnesses and diseases are provided by:
- Medical practitioners in private practice and private hospitals to people who can afford it belong to medical aids.
- Clinics established by the public health sector for people who do not belong to medicals aids.
Family Planning
- Advice on family planning.
- All types of contraception e.g. condoms, injections, etc.
- Assistance is given to women who are pregnant and HIV positive or, who are HIV positive and wish to have a baby.
- Assistance for women with unwanted pregnancies and who wish to have an abortion.
Immunization
- The immunization requirements are aimed at preventing life-threatening diseases such as tuberculosis, polio, diphtheria, whooping cough, hepatitis B, measles, mumps and rubella.
- The initial vaccines that are administered to babies shortly after birth are: BCG (polio) and OPV (tuberculosis) thereafter babies must be immunized at regular intervals with the other vaccines and boosters as set out in the immunization programmes.
- If the full programme is not followed the child will not have full protection.
- At birth vaccines are given in hospital and follow-up immunization place at the clinic.
- Immunization programme includes:
BCG – at birth
Polio, DTP (diphtheria, tetanus and polio), HBV (hepatitis B) and HIB (meningitis) - (at birth, 10 weeks, 14 weeks, + the following three months);
Measles (9months)
MMR (measles, mumps, rubella) (18 months)
Polio, DTP (18 months),
DTP and Polio (5 years)
Hepatitis A plus booster
- Immunization is a very important aspect of primary health care and it is imperative that the required immunization programme be adhered to for it to be effective.
- National immunization campaigns against polio and measles are held every 4-5 years in addition to scheduled immunizations with the aim to eradicate these diseases.
- Travelling: Vaccines that are generally necessary for persons travelling abroad, especially in Africa and other developing countries are hepatitis A and B, yellow fever, typhoid, certain strains of meningococcus and cholera.
Prevalent and chronic diseases
Prevalent and chronic diseases – Among the life-threatening diseases that are prevalent in South Africa and receiving priority attention are:
- Tuberculosis:
- TB is a serious health problem in this country.
- S.A. is one of the 22 countries with highest infection rates in the world.
- People with HIV are more susceptible to the infection and have less resistance to it.
- The increase in TB infections is directly attributed to the increase in HIV infections is directly the cause of the increase in TB infections.
- TB is one of the oldest known diseases and is caused by the bacteria called tubercle bacilli.
- It is often the infection is localized and without obvious symptoms, but it may progress to the active form of chronic TB.
- Infection can be detected in persons who have not yet developed the disease, by means of a test.
- The bacilli can remain dormant for years before becoming active.
- TB spreads when a person infected with the active form of the disease coughs infected droplets into the air, which are then inhaled by other people.
- The disease is not spread through a single exposure but by extended contact with an infected person.
- Typical symptoms include persistent cough, night sweats, fatigue, loss of weight and appetite and fever. Sputum is often streaked with blood.
- Gradual deterioration of health and occurs and, if the disease is untreated, death can occur.
- TB can be treated, however, it is essential that patients take their medication on a regular basis for it to be effective.
- Unfortunately many people stop taking their medication and relapse – in order to overcome this situation a system known as DOTS which stands for ‘directly observed treatment strategy’, has been implemented where health workers observe and monitor patients taking their medication
- HIV/Aids:
- A disease of serious concern that is rapidly becoming a pandemic
- People are encouraged to be tested and know their status.
- Clinics provide:
- Advice on how to protect oneself from contracting the disease.
- Condoms to help prevent the spread of the HIV virus.
- Testing for the HIV virus.
- Counselling
- Assistance to those who have been raped and or been exposed to HIV.
- Advice and assistance to women who are HIV positive and are pregnant, or want to have a baby.
- Assistance to children who are HIV-positive to keep them as healthy as possible.
- HIV positive people are provided with antiretroviral treatment.
- Diabetes and hypertension (high blood pressure):
- These chronic diseases are often called the ‘silent killers’ as a person may have them for some time without realising it and all the while they are damaging the body.
- People should be checked for these diseases; this is especially relevant for older persons and persons who are overweight or people who have a family history of these diseases.
- Once diagnosed, the diseases can be controlled with medication.
Health Education
Health education, at schools and on an outreach basis, takes place according to health awareness programmes as determined by the Department of Health annually e.g. Breast Cancer Education or according to the needs of the community as determined by the Department of Health on a Provincial or Local basis.
Nutrition and Dietetic Services
Some clinics do have the services of a nutritionist – enquire at the local clinic whether this service is available.
Antenatal Care
- Regular checkups of mother and baby.
- Supplements of iron and folic acid are given to the mother
- Genetic counselling for people who have a family history of genetic diseases, have had a child with a hereditary disease and women over the age of 30 years.
Pregnancy
- Women who are pregnant have regular check-ups to ensure that the pregnancy is running smoothly and to detect problems when they arise.
- People who have a family history of genetic diseases or have had a child with a hereditary disease and women over the age of 30 years are counselled as to the possibility of birth defects and be advised of the options open to them.
- During pregnancy women are given iron and folic acid supplements.
- Women with unwanted pregnancies do have the option of an abortion.
- Births take place in a hospital.
Post-natal and neo-natal care
- Neo-natal care takes place in hospital and post-natal care at clinics.
- Clinics: At least 3 post-natal checkups are provided.
- The Perinatal Problem Identification Programme (PPIP) implemented by the health authorities whereby, when a mother’s life is at risk, another woman provides what is called “kangaroo mother care” and other interventions to reduce the risk and prevent serious consequences for the mother/baby.
Trauma treatment
Primary trauma treatment is provided at the clinic e.g. sexual harassment and other cases of minor pain and injury, while more serious cases are referred to hospital.
Physiotherapy
Service provided by hospitals
X-rays and blood tests
Service provided by hospitals.
Basic Dental Health Services
Some clinics provide dental services and patients should contact their local clinic for information in this regard.
Medical Social Work Services
Some clinics provide this service and people requiring such assistance should contact their local clinic for information in this regard.
Other Services
- Children:
- Free health care for all children under the age of 6 years.
- Vitamin A supplementation programme for children.
- Overall checks are done to determine whether a child has other health-related problems needing special care and attention e.g. diabetes, otitis media (ear infection), throat infection, has been raped or sexually abused etc.
- If a child is asthmatic, counselling is provided for the family on how to deal with, prevent and cope with asthma attacks.
- Women:
- Screening for breast and cervical cancers.
- Sexually transmitted diseases:
- Treatment of all sexually transmitted diseases e.g. genital warts, syphilis, gonorrhoea and HIV.
- Addiction:
- Assistance, advice and counselling is provided for persons with alcohol and/or drug problems.
- Rape and abuse:
- Injuries are treated and emergency treatment given to prevent sex diseases and pregnancy.
- Advice given on follow-up treatment (also for HIV).
- Assistance given to the victim to lay a charge with the police should the victim request such assistance.
CONTACT NUMBERS for the Provincial Departments of Health
- Free State: (051) 405 4488
- Eastern Cape: (040) 609 3650
- Gauteng: (011) 355 3000
- Kwazulu-Natal: 0800 005 133
- Mpumalanga: (013) 766 3429/30
- Northern Cape 053 830 0709
- Limpopo: (015) 293 6000
- Western Province: (021) 483 3235
- North West: (018) 387 5276
OTHER USEFUL TELEPHONE NUMBERS: - Expanded Programme on Immunization: (012) 312 0099
- AIDS HELPLINE: 0800 012 322
- CHILD HELPLINE: 0800 055 555
- WOMEN ABUSE HELPLINE: 0800 150 150
A general practitioner is a medical doctor who provides primary care.
The GP examines patients, diagnoses diseases, treats acute and chronic illnesses, disorders and injuries and prescribes medication. The GP also does minor surgery and/or obstetrics. GP’s refer more serious cases to an appropriate Specialist.
General Practitioners must register with the Health Professions Council of South Africa. They work in private practice or in hospitals.
A nurse is a trained professional health worker capable of providing basic and specialized health care. They assist with the recovery of acutely ill and injured people by helping to relieve patients of pain and discomfort.
Nursing also involves health maintenance and guidance for families and communities and the treatment of life-threatening emergencies.
There are two main categories of nurses i.e.
- Registered professional nurse who has achieved a nursing qualification and
- Enrolled nursing auxiliary who carries out nursing procedures on a less specialised level.
The culture of traditional healers is based on the ancestral belief system. Healers operate under guidance of ancestors. There are two types of healers: diviners (
sangoma) and herbalists (
inyanga).
- Diviners (Sangoma) who diagnose through spiritual means. Diviners are specifically called to their profession by their ancestors. Once they have been called, they are apprenticed to a practicing healer and become a Sangoma by undergoing a series of rituals. Ancestors communicate with them through the use of bones, dreams or thoughts.
- Herbalists (Inyanga): In African culture all of nature i.e. the elements, animals and plants represent the energy of god “Ukuginisa kweNkulunkulu” and can be used to heal. The knowledge of traditional medication is passed down from generation to generation. The medicines are prepared in various ways e.g. barks and roots are boiled to provide a liquid drink, herbs are ground into powders to be taken with water, some are burnt and the smoke inhaled, preparations can be rubbed on incisions, used as an emetic, or chewed.
Of benefit to the people who wish to use their services is the fact that
Sangoma and
Inyanga are available to people living in the cities and the rural areas.
Many forms of holistic healing exist.
Most types of holistic healing derive from ancient Eastern origins. Some of the more familiar methods are:
- Yoga:
- There are many forms of yoga, however, however, Hatha-Yoga is the most popular in the West.
- Yoga involves disciplines such as breathing exercises (Pranayama) and physical exercises involving different body positions called asanas, meditation and mostly vegetarian diet.
- Yoga improves the body’s strength and agility as well as relaxation. It has beneficial effects in reducing stress depression, anger and frustration
- Massage:
- Basically it involves the manipulation of the muscles, skin and joints.
- Massage can include rubbing, pressing and kneading actions.
- It is beneficial relieving sore muscles and relaxation.
- Reflexology:
- The systematic massage and applying pressure to the various sections of the entire foot or palms of the hands.
- It is used to stimulate the organs and glands and bring them into harmony.
- Beneficial for stress relief and to generally promote good health.
- Iridology:
- The Iridologist examines the iris of the eye to detect and diagnose problems within the body.
- Chiropractics:
- Used mainly for musculoskeletal problems. It involves realigning the vertebrae and bones by manipulating the spine.
- Homeopathy:
- This type of healing is based on the premise that the cause of an illness is similar to its cure.
- Remedies are made by producing a very much diluted natural substance that would cause the same symptoms if given in larger more concentrated doses.
- Homeopathic remedies are produced using herb, mineral and animal extracts.
- They are used for a variety of diseases and illnesses.
- Hypnosis and hypnotherapy:
- During hypnosis the consciousness is placed in an altered state, where the person is neither awake nor asleep.
- It is used for a variety of problems including stress and to break bad habits e.g. smoking or excessive use of alcohol.
Home health care involves formal and informal caregivers providing health care to people who are ill in the home.
Home health care plays a vital role in promoting the health and maintaining a maximum level of comfort of people who need to be cared for at home.
Health care at home is especially important in recent times in view the fact that hospitals, hospices and homes for the aged are able to accommodate the increasing numbers of ill and aged people in the community.
Home care is provided by a number of sources including:
- Professional caregivers from the formal system e.g. nurses
- Caregivers from the non-formal system e.g. NGO’s.
- Community health workers.
- Volunteers.
The benefits of home health care are that it reduces the cost of care for the patient and allows people to be in their familiar surroundings among family and friends.