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A Hundred Times More Infectious Than HIV

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People carry some ailments for decades before symptoms manifest and it’s too late for treatment. Those who do get diagnosed must grapple with expensive medical costs. What then is the solution?


How do you test for a virus when you don’t know you have it?

Hepatitis B is one such. Often times, it remains undetected until it is viral, at which stage, it is often too late.

It leads to an infection of the liver that can cause both acute and chronic disease. When chronic, it attacks the liver, eventually causing scarring (cirrhosis) of the organ, liver failure, and cancer.

There are various types of hepatitis viruses including types A, B, C, D and E. Types A, B, and C are the most common. All five hepatitis viruses can cause acute disease, but the highest numbers of deaths result from liver cancer and cirrhosis that occur after decades of chronic hepatitis B or C infection.

According to the World Health Organization (WHO), an estimated 257 million people are living with the hepatitis B virus (HBV) infection, however, the rate of diagnosis is extremely low, at approximately 9% of all HBV-infected persons.

In February, Abbott Laboratories announced, “the world’s most sensitive rapid diagnostic test for the detection of hepatitis B surface antigen… This highly-sensitive, easy-to-use, rapid lateral flow test enables identification of those with the virus and facilitates linkage to care in every healthcare setting”.

This is a monumental victory for healthcare practitioners, who are working on the ground to eradicate the virus, says Dr Andrew Scheibe, a medical doctor who focuses on HIV, viral hepatitis and infectious diseases among key populations, specifically people who use narcotics.

Dr Andrew Scheibe, a senior technical advisor for TB and HIV Care. Picture: Supplied

“What’s useful about it is that it’s very easy to use and you get results in 15 minutes. Compared to the previous test, you’re able to detect more people who are infected… [as] it detects more hepatitis B surface antigen (HBsAg) in the blood… this is very useful in the field as it is a rapid test,” he says.

Scheibe is a senior technical advisor for TB and HIV Care and has research affiliations with the University of Pretoria’s Department of Family Medicine and the Urban Futures Centre at the Durban University of Technology.

The rapid diagnostic test by Abbott Laboratories is likely to empower health practitioners to fight a battle that has seemed insurmountable on the continent.  

A report released by WHO states that the organization “has set baseline targets to diagnose 30% of HBV-infected individuals by 2020 and 90% by 2030. In order to reach these targets, rapid testing is imperative. Testing and diagnosis of HBV is the gateway for access to both prevention and treatment services and is a critical component of an effective response to the hepatitis epidemic”.

From an economic perspective, it is imperative that hepatitis B mortality rates be reduced because a significant number of the people who become symptomatic manifest from middle to late life.

“Those are people who should be economically active, so that has a huge economic consequence. And the treatment of people who have liver failure is very expensive,” Scheibe says. 

In sub-Saharan Africa, the overall hepatitis B carrier rate in the general population is 5%-20%, which is amongst the highest in the world. Viral hepatitis is also a growing cause of mortality among people living with HIV.

“About 2.3 million people living with HIV are co-infected with hepatitis C virus and 2.6 million with hepatitis B virus,” according to WHO.

There are other socio-economic factors that make the virus endemic in sub-Saharan Africa, these are dictated by lack of basic resources, as well as population density. 

“A lot of the factors are linked to socio-economic and environmental factors. With hepatitis B in particular, it’s transmitted through bodily fluids, so if there aren’t good personal and public hygiene practices, that can foster an environment where these infections are spread,” Scheibe says.

“If you are in an area where there’s a high population living with an infection, it means that the likelihood of people contracting it is higher… This is a concept we call the community viral load. If, in sub-Saharan Africa, there already is a lot of hepatitis B, people will automatically be at a higher risk of contracting it, because they are more likely to come into contact with people who have the infection.”

The virus is transmitted through contact with the blood or other body fluids of an infected person.

“The virus is a hundred times more infectious than HIV. It’s one of those conditions that people can live with without knowing they are infected… a proportion of those people will go on to develop live cancer, which we have few treatments for,” Scheibe says.

In South Africa, the lack of political will to meet the goals set out by WHO has been criticized by medical practitioners who feel dealing with the virus decisively would be beneficial for all.  

“I think a lot of work needs to be done to get government to put it on their political agenda, particularly, if it’s affecting people who are at high-risk, that government may not want to deal with.

“For example, [these are] men who have sex with men, sex-workers and people who take drugs. In many contexts, those are politically sensitive topics, but it would be very important for government to embrace,” Scheibe says.

Happy Phaleng, the MSM (men who have sex with men) Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa, says the rapid diagnostic test serves as a much-needed form of assistance for a queer community that, at times, is not prioritized because of stigma.


Happy Phaleng, the MSM Programme Coordinator at OUT-LGBT Well-Being in Pretoria, South Africa. Picture: Motlabana Monnakgotla

Phaleng, who was vaccinated as a result of a study that was taking place at work, says his hepatitis B awareness was scant prior to the vaccination. He says in some cases, people resist getting vaccinated.

“I remember when they started the study, it was quite a struggle to get people vaccinated… You look at things like PrEP (Pre-Exposure Prophylaxis), you still find people who say, ‘let me go think about it,’ even though it’s free and on-the-go.”

However, on the day he meets FORBES AFRICA, he is armed and ready with the hepatitis B and C pamphlets that are laid out in front him as he has a frank conversation about risky lifestyles.

He says there’s a certain demographic of people who are privy to information as a result of being privileged to access, he also says there are cost implications to purchasing certain news items and money is not easy to come by.      

“Class plays a role. There’s a certain class of people, in this case, the medical space, who would know about medical developments. Some people don’t read, and those who do, won’t take it in because it doesn’t affect them directly,” he says.

Phaleng also frankly states that people tend to be their own worst enemies as a result of unfounded fears that prevent them from accepting help. 

“We are too resistant to new things and we also have the notion that, ‘I’ve lived before without this vaccine. Why am I complicating my life with medications and vaccination?’ This ties in with the concept that, ‘what you don’t know, won’t kill you’.”

Innovations are good and well, however, studies and pilots defeat the purpose of what they are intended for as they are, at times, exploitative and not reciprocal. He alludes to the idea that citizens tend to be treated like guinea pigs by those who work on the ground on fact-gathering missions.

“In South Africa, we have had so many piloted studies and, as people, we get tired… I’ve worked with people who conduct studies can’t enter our communities and urge us to try new things and, the next thing you know, the medication no longer exists because of the outcomes of the study.”

“They just want to use our bodies to get their PhDs and launch their products.”

Scheibe, who has been working in the field of harm reduction and substance use for the past eight years, says that more people in high-risk groups may acquire the infection and they should also be vaccinated.

According to NCBI, these include, but are not limited to, people who frequently require blood or blood products; people interned in prisons; persons who inject drugs; and people with multiple sexual partners.

Duncan Tsegula, who is a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being, is a recovering drug user who used to share needles while homeless in the streets of Pretoria.

The Project, which has been running for four years, focusses on reducing the risk of harm, with particular focus on homeless (needle) drug users. Tsegula has been a leader for two years.


Duncan Tsegula, a peer outreach team leader for the Harmless Project at OUT-LGBT Well-Being. Picture: Motlabana Monnakgotla

“Before I became a member, I was a client of the same project. They were giving out needles, to us, guys using on the street. It got to a point where people were discarding them on the street. We came up with a solution which was a needle exchange,” Tsegula says.

“If we give you 10 needles this week, we come back next week to give you more, and you return the old ones. That’s when we are sure that you are not discarding them on the streets. So far, for the past year-and-a-half, it has been working and the city council has stopped complaining.”

He confirms that he’s witnessed people sharing and repurposing needles. Some of the sharing of needles was due to desperation because homeless people are profiled and turned away from many businesses even when they are purchasing products.   

“I was one of the people sharing needles. It was not easy to access a needle even if you had money because of the way you look. 

“About 12 years ago, when my boss needed a needle to inject, the pharmacy refused him and he eventually broke a window. He was withdrawing and because of anger, he broke a window and was arrested.

“Our project is peer-driven and people who were there and used drugs have links with the clients, so it’s easier for them to communicate with us, but it’s not easy.

Along with the clean needles, the project provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.

They also provide alcohol swabs to prevent infection when users inject. “Some of the guys go through bins while they collect litter for recycling, they might cut themselves while doing that. The swabs are used to clean the surface area where they are going to inject,” Tsegula says.

Along with drug users, sex-workers are also profiled and are not afforded equal rights.

Phaleng says, “there are many people who take drugs for their own reasons but what we’re saying is, ‘even though you’re using for your own reasons, do it the safe way.’ Because, you can imagine if I’m injecting drugs and I still have that I’m going to – I might infect that person with a range of things.

“Sex-work is work. Everybody has the right to health. They also deserve to be treated fairly and access medication.

“A healthy society is a very productive society. If we get to a point where we succeed in preventing illness rather than treating them, will save large amounts of money,” Phaleng says.


Along with the clean needles, Harmless Project at OUT-LGBT Well-Being provides homeless clients with toiletries, condoms, lubricants, showers, haircuts, water, a weekly meal of choice and a weekly movie of choice.

Scheibe echoes his sentiments.

“We must understand that we need to move away from criminalization because that has very negative public health consequences which, in turn, have very negative financial implications.”

For his work with hepatitis, he’s the light at the end of the tunnel, but he is cautiously optimistic.

“It’s important to be optimistic that progress can happen, should happen and is already happening. It’s very clear that we have the tools, and we know what needs to be done.

Scheibe says very little will change, “unless there is a recognition that policies that criminalize sex work and drug use, or are discriminating on women, are re-evaluated. There needs to be a lot of focus in addressing those, or we will never be able to eliminate hepatitis or HIV.”

Health

10 Rules Of Email That Will Reduce Your Stress Levels

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Email and smart phones can be stressful. Academics are calling this constant work connection “technostress”. Consequently, many European countries are now offering employees the “right to disconnect”.

The way email is used is complex, it cannot simply be labelled as “good” or “bad” and research shows that personality, the type of work people do and their goals can influence the way they react to email.

Good practice with email use is not just about limiting the amount of emails sent, but improving the quality of communication.

Here are ten tips to reduce the stress of email at work:

1. Get the subject line right

Use clear and actionable subject lines.

The subject line should communicate exactly what the email is about in six to ten words, to allow the recipient to prioritise the email without even opening it. On mobile devices, many people only see the first 30 characters of a subject line. So keep it short. But make it descriptive enough to give an idea of what the email is about from just the subject line.

READ MORE | Burnout, stress lead more companies to try a four-day work week

2. Ask yourself: is email the right medium?

Are you in the same office? Could you go and speak to the person? Could you call? Often these other forms of communication can avoid the inefficient back and forth of emailing.

Instant messaging and video calling platforms like Slack and Skype could be more appropriate for quick internal back and forth messaging. Also, remember that most of the advice below applies to all types of electronic communication.

3. Don’t email out of office hours

Research shows that out-of-hours emails make it harder for people to recover from work stress.

Try and influence your company culture by avoiding sending or replying to emails outside your normal working hours.

Management should lead by example and avoid contacting their staff outside of their normal working hours. Some workplaces even switch off email access to employees out of hours. Consider implementing this while keeping a backup phone system for emergency contact only.

New research has also shown that just the expectation of 24-hour contact can negatively affect employee health.

READ MORE | A Career Secret Weapon: Thank-You Notes

4. Use the delay delivery option

Some people like integrating their work and family lives and often continue working from home during their off-job time. If you are one of these people, or if you work across time zones, consider using the delay delivery option so your emails do not send until the next working day and do not interfere with other people’s off-job time.

5. Keep it positive

Think about the quality of email communication. Not just the quantity. Changes to email use should also focus on the quality of what is being sent and take into consideration the emotional reaction of the recipient.

Research suggests that conflicts are far easier to escalate and messages to be misinterpreted when communicated via email. Therefore, if it is bad news, think back to rule #2: is email the right medium?

6. Try ‘no email Friday’

In order to shift company culture and get people thinking about other methods of communication than email, try a “no email Friday” on the first Friday of every month, or maybe even every week. This is an initiative suggested by experts from the National Forum for Health and Wellbeing at Work, and is being used by businesses around the globe. Employees are encouraged to arrange face-to-face meetings or pick up the phone – or just get on top of the many emails they already have in their inbox on that day.

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7. Make your preferences known

Research has shown that not only too much but also too little email can cause stress due to a mismatch between the communication preferences of different people. Some people may like being emailed and cope much better with high email traffic than other means of communication. For these people, reducing the amount of emails they receive may cause more stress than it alleviates.

So consider people’s individual differences and make yours known. Add your preferred contact preferences to your email signature whether it is email, text or instant messages or a phone call.

8. Consider a holiday ‘bounce back’

Having a backlog of emails that builds up over the week appears to be one of the most commonly mentioned sources of technostress for workers. Think about setting up a system where emails are bounced back to the sender when someone is on holiday, with an alternative contact email for urgent requests. This would let you come back to a manageable inbox.

9. Have a separate work phone

Make this the only mobile device you can access work emails on, which gives you the freedom to switch it off after work hours. Also consider turning off email “push” (this is where your email server sends each new email to your phone when it arrives at the server) and instead choose a regular schedule (such as once per hour) for emails to be delivered to your phone (this also increases battery life).

10. Avoid late night screen time

Research suggests that late night smart phone use reduces our ability to get to sleep and also leads to constant thoughts and stress about work. This in turn reduces your sleep quality. Make the bed a phone-free zone to improve your sleep hygiene.

The Conversation

-The Conversation

-Ricardo Twumasi; Lecturer in Organisational Psychology, University of Manchester

-Cary Cooper; 50th Anniversary Professor of Organisational Psychology and Health, University of Manchester

Lina Siegl; PhD Researcher, University of Manchester

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Take Your Medicine: This $1.5 Billion Health Startup’s Smart Pills Keep Patients From Forgetting

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Are patients taking their medications correctly, and are the medicines working? A handful of digital health startups tries to make it easier to tell — say, by embedding a tracking system into pills they swallow.

Only 25% to 50% of patients worldwide take medications correctly, and in the U.S., roughly 125,000 people die annually from not correctly taking their prescriptions, according to a 2018 study led by Leah Zullig, a health services researcher at the Duke University School of Medicine.

Failure to take prescribed medicines also increases costs to the healthcare system, by about $300 billion annually, Zullig estimates. Jonathan Watanabe, an associate professor of clinical pharmacy at UC San Diego’s Skaggs School of Pharmacy & Pharmaceutical Sciences, says that number would likely be even higher if you included what it costs hospitals to treat symptoms that arise from improper medicine intake (for example, patients with high blood pressure who have strokes as a result of not taking their medicines)—more than $500 billion annually, or 16% of U.S. healthcare costs, he estimates.

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For the most part, the responsibility has been in the hands of the patient. Think pill boxes marked with the days of the week, or their high-tech versions—apps, like Medisafe and CareClinic, that help users self-report their own intake and schedules. These reminder devices don’t go far enough, say some doctors, because they fail to address a very human fault that patients report as their primary reason for not taking their medication: forgetfulness.  

We Are Our Own Prince Charming

“We need to take responsibility for our own health and care, but when it comes to drug-taking and medication use, that may not be sufficient,” says Dr. Niteesh K. Chouhdry, a professor of medicine at Harvard Medical School and executive director of the Center for Healthcare Delivery Sciences at Brigham & Women’s Hospital in Boston. “We need to leverage these devices in a way that closes the loop—doctors to pharmacists to patients back to pharmacists.”

Proteus Digital Health, a Redwood City, California-based tech health startup, hopes to create that loop. Founded in 2004 by Andrew Thompson and Dr. George Savage, the company makes a 1 millimeter sensor—“the size of a poppy seed or grain of sand,” says Thompson—that is embedded in medications, which are then swallowed.

The sensor, made of “elements found in a typical diet,” including magnesium and copper, says Thompson, will turn on when it contacts a patient’s stomach acid. It then sends a signal a the palm-size patch that patients wear on their skin. The patch, which also tracks physiological signs like steps, rest and heart rate, then sends information to a smartphone app for patients and the desktop browser portal that doctors use.

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The idea for the system, called Proteus Discover, came to Thompson during an American Heart Association conference in 2003. Thompson, who had previously started two medical device companies with Savage, including the publicly traded FemRx, which was acquired by Johnson & Johnson for $22 million in 1998, noticed that none of the companies presenting at the conference were doing anything with digital technologies.

“Silicon and software was innovating every other industry at the time except for pharma,” Thompson says. So he brought his idea for a medicine that communicates with a computer to Savage.

“George looks at me and says, ‘That is the stupidest idea you’ve had in your entire life.’ And then we began to argue,” Thompson says.

In 2017, the FDA approved an antipsychotic drug with Proteus technology, the agency’s first-ever approval for a medicine with digital ingestion tracking system. Abilify MyCite, the drug made with Tokyo-based Otsuka Pharmaceutical, treats schizophrenia, bipolar disorder, depression and Tourette syndrome.

The company has raised $420 million in venture capital funding from investors including Novartis Venture Fund and Kaiser Permanente Ventures at a $1.5 billion valuation. Otsuka, which has a special focus on mental health drugs, announced in October 2018 an $88 million investment in Proteus to continue developing other medications that use the tech-health venture’s ingestible sensors. More than 1,000 patients have used the pill-tracking system, amounting to 195,000 pill ingestions, says the company.

EtectRx, Keratin Biosciences

Other companies have sprung up in the drug delivery space, including etectRx, a Newberry, Florida, health-tech startup with a similar digital health system model. Instead of working with a pharmaceutical company to embed its sensors in a pill, etectRx creates an empty gelatin capsule with an embedded wireless sensor. Its capsule has not received FDA clearance yet, but it can be used in clinical studies that have been approved by the agency’s Institutional Review Board, a committee that reviews and monitors scientific research.

Keratin Biosciences (formerly Microchips Biotech and KeraNetics before the two merged in July 2018) wants to improve medication intake by getting rid of human error altogether. Instead of a pill, this Lexington, Massachusetts, company makes a microchip with hundreds of sealed compartments, each of which can store up to 1 milligram of a drug.

The chip, which originated in a lab at the Massachusetts Institute of Technology, can be activated by a wireless signal that triggers the compartments to release the drug, based on a preprogrammed dosing schedule.

Digital health startups must figure out how to get the new drug delivery methods they are delivering to patients and consumers in a scalable way, which will require collaboration and a commitment from Big Pharma. “The core thing we want the pharmaceutical industry to understand is that we want to integrate silicon software into the definition of their products in order to make information and data a part of what they do,” Thompson says.

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Then there is the matter of consumer hesitance about swallowing hardware that records private activity. While these inventions are meant to help patients, the monitoring aspect has raised privacy concerns from consumer advocates who worry that the information will eventually be shared not just with doctors but with insurers who want to raise premiums or even employers who want to know what drugs a job candidate is taking.

“Security of the data is very important, but in medicine, privacy can be lethal,” Thompson argues. He says that the main issue is not so much privacy but whether companies make it clear to patients where their data is going. “People are happy to share information and data if they know and understand exactly what it is being used for.”

Proteus can claim its smart pills are effective, but it’s still early for most startups that aim to improve the way patients take their medicine.

“This is a tough problem to fix,” says Choudhry from Harvard. “It’s all about forgetfulness, and that is a complex and, frankly, normal behavior.”

-Angel Au-Yeung; Forbes Staff

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Depression in the work place

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One in four South African employees are diagnosed with depression annually. There are ways you can seek help while your identity is protected by law.


You find your life spiralling out of control. There is an overwhelming feeling of helplessness and the things that used to interest you do not anymore. If this is what you are going through, you are not alone.

In South Africa, 4.5 million people suffer from depression, costing the country $16.6 billion of its Gross Domestic Product due to lost productivity, either due to absence from work or not attending work citing sickness.

These are figures by the IDEA study of the London School of Economics and Political Science in 2016.

According to the South African Depression and Anxiety Group (SADAG), depression is among the prevalent mental disorders in South Africa, resulting in one-in-four South African employees diagnosed with depression annually.

Meet Mfuneko Mthi, a prison warden from Kokstad, a little town nestled between South Africa’s KwaZulu-Natal and Eastern Cape provinces. Today, he sounds upbeat and has a positive outlook on life but this was not the case two years ago.

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He suffered from depression. It all started when he and his childhood friend were shot at by a gang leader in their community.

Mthi escaped death but the trauma manifested as depression.

The two years took a toll on his personal and professional life.  

As a prison warden, he had to work closely with prisoners and at times, their correctional services uniforms would bring back painful flashbacks of his offender.

From then, it progressed to the perpetual submission of medical certificates, one after the other, as he desperately tried all means to run away from his inner demons. 

“I started reporting sick from work on a regular basis, even though I was not sick. I could not face the correctional services uniform after I had seen my offender, during the victim-offender dialogue (VOD),” Mthi says. 

“The VOD is a voluntary process, where the offender and victim are able to talk about the effects of the crime. Through the VOD program, victims of crimes… engage with offenders and communities so that relationships can be restored and forgiveness sought,” states a report by the Department of Correctional Services.

During the times that Mthi was present at work, leaving early also became a regular practice and isolation was his best-kept secret to maintain sanity, he says.

I would leave early to go to my place and consume alcohol. I used up all my leave and sick days at work just to avoid being around people.

Mthi needed to go back to the root of the problem in order to get the help he needed.

He details how he and his friend were attacked by the same perpetrator on two separate occasions.

“When I was in my teens, a gang leader who was feared in our community, used to recruit the youth to commit crimes. When my friend and I refused, he assaulted us. It is then that our parents opened a case of common assault with the police,” Mthi says.

The unexpected happened.

“On the day we got back from his bail hearing, he shot my friend and I, saying that nobody presses criminal charges against him.” 

Mthi suffered multiple gun-shot wounds but his friend did not survive the onslaught.

 As the wounds healed, the internal scars continued to bleed; life’s problems rubbed salt into Mthi’s wounds.

“A friend of mine committed suicide in 2017 and till this day, we do not know what led to him doing that.

“But he did make us aware that he was experiencing a series of problems, and his job as a prison warden was taking a toll on him due to the number of traumatizing things that happen in prison,” Mthi says.

 He would drown his sorrows in alcohol when the waves of depression were unrelenting.

“I would drink a lot to help me sleep most of the time. Even though I would go out sometimes, I got to a point where I was overdoing it and that led to me being broke and that created a cycle which would lead to more depression.” 

Mthi realized he had a problem and he took the first step towards healing.

He called SADAG, an organization in South Africa at the forefront of patient advocacy and educating society on mental illness.

 “They told me that I had depression symptoms and advised that I go see a nearby clinical psychiatrist,” Mthi says.

According to Charity Mkone, a clinical psychologist, the societal stigma associated with depression makes it difficult for it to be warranted an illness. 

“It is something that is not seen as a real illness…people think that it is something that you can control and that you choose whether to be depressed or not. They also think that because of certain circumstances – such as being a prominent figure – you do not have a right to be depressed,” she says. 

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However, that is not true. Most people, according to Mkone, have had some form of depression in their life, where they present SIGMECAPS symptoms (as defined in the box-out).

 “To some degree, we have all expressed these feelings at a point in our lives. But it is usually a phase. But for someone struggling with depression; that becomes a dominant way of feeling, as opposed to someone who is feeling like that because of the circumstances, and once the problem has disappeared, they are fine. A depressed person would still feel depressed,” she says.

 According to SADAG, rural-based studies have found a prevalent rate of 18% depressive symptomatology and 27% rate of depression, as opposed to the urban settings where as much as 25.2% of the population is depressed and in peri-urban settlements where 34.7% of the people have postpartum depression.

 There are 23 known suicides in South Africa per day, making it approximately 8,000 suicides each year. Based on research from SADAG, for every person who commits suicide, 10 have attempted it.

In South Africa, even though women are two times more likely to suffer from depression, men are more prone to committing suicide. This is often because men in South Africa battle to come forward with mental health problems due to the stigma attached to mental health.

“It has a lot more to do with the stigma and that men don’t actually come out to say that they are depressed. It makes them feel that they are weak people because one of the symptoms of depression is deep overwhelming sadness,” Mkone says.

Men are five times more likely to be successful at suicide then women


Charity Mkone

Suicidal thoughts normally manifest when depression goes untreated for a long time.

Mkone says that when men commit suicide, they are found to do it in a more lethal manner.

  One of the first steps that could be used within communities in order to assist people suffering from depression is to be more aware of the symptoms.

The more measures are taken to educate people in the workplace and in communities concerning depression, Mkone believes this would alleviate the number of suicidal deaths because persons suffering from depression would get the help they need at an early stage.

 It is, however, important to note that depression may be caused by a number of problems such as external factors, genetic inheritance, an imbalance of brain chemicals, certain medical conditions, substance abuse as well as other various medical conditions.

This is why mental illness is a treatable condition and, as a result, 80% to 90% of people have had a good response to medical care.

Depression in the work place

Depression in the work place is becoming more visible.

“According to the medical ethical code of conduct that all clinical psychologists sign and are bound to, the sessions that you have with the client are strictly confidential unless the client gives you written consent to divulge information about their sessions,” says Mkone.

“In terms of a patient requiring a written letter for work, we can provide a medical certificate,” she says.

One in six employees are willing to disclose their mental illness, according to a 2017 survey by SADAG.

Nadine Mather, who is a senior associate at law firm, Bowmans, says: “An employee is not obliged to disclose to their employer that they suffer from depression or any other mental condition. An employee may, however, voluntarily choose to do so.”

  She added that should there be a case where the employer is aware that the employee suffers from depression and it affects their performance at work, then they may address the matter following the correct procedures, and it would be illegal if they dismiss the employee without that.

Depression is regarded as a sub-category of “incapacity” and is recognized as a fair reason to terminate an employee’s employment under the South African law should they no longer be fit to perform their duties.

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“In this regard, our law places an obligation on employers to investigate the cause, degree and effect of the employee’s depression or mental condition thoroughly, in order to ascertain the impact that it might have on the employee’s work,” says Mather.

If the employer can prove without reasonable doubt that the business or company cannot function without the duties of the employee within a certain time period, then that could result in the termination of their duties.

“Only when an employer has followed a fair process and can show that there is no prospect of an employee recovering sufficiently to justify their continued employment, or improving within a time period during which an employer could cope without suffering significant loss as a result of an employee’s absence, would termination of the employee’s employment for depression or a mental condition become justifiable,” Mather says.

“On the other hand, where the employee is too ill to work and the employer fails to follow a fair process, the employee may, in certain circumstances, be awarded compensation up to a maximum of 12 month’s remuneration,” she says.

When an employer realizes that their employee is suffering from depression, they are obligated to support them.

In Mthi’s case, the employers were supportive.

They tried to accommodate him by removing him from traumatizing environments that made him feel uncomfortable.

Mthi is no longer on medication for his depression, but along the way, he has found the positive aspects of life. 

“I go to the gym during my spare time and I also sell t-shirts. With the money I make from selling them, I assist the less fortunate in my community, by buying them school uniforms,” Mthi says.

He is also working with some of his colleagues to build houses in his community.

Proving that Mthi is no longer the bleak and lost man he was two years ago, he initiated a Facebook page last year called Depression is Real.

The page provides a platform to those who would like to talk about depression.

As depression is on the rise in the country, so are those that have won the war over the illness, like Mthi.

The trick is to seek help – before it’s too late. 

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