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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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Tasty Vegan Options: Consumed By Healthy Eating

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The restaurant market still hungers for healthy options. This entrepreneur is feeding that need, serving earth-conscious customers and gym junkies.  

Her desperation for a healthy meal fueled the fire for business.

Leigh Klapthor, 31, couldn’t find enough eateries that sold healthy food that was not bland, so decided to start her own.

“It is no fun to go out with friends and you are always the girl with the green salad,” she says.

“I wanted to find a way where being healthy is not such a chore and I also wanted for it to be affordable.”

Klapthor, who dropped out of a course in marketing communications at the University of Johannesburg, ditched a job in corporate marketing to pursue her passion for food.

A patron at Sprout Café. Picture: Gypseenia Lion

In 2017, she started Sprout Café at the Stoneridge Centre in Edenvale in Johannesburg with a loan she received from her husband’s business and money that was given to them as a wedding gift.

“Everybody underestimates what everything will end up costing [when starting a new business]. In my mind, I thought R150,000 ($10,588) would work. I thought I would get my shop fitting and everything done and in the first month we would be able to pay salaries with the money we make,” says Klapthor.

But she soon realized the unforeseen challenges faced by many entrepreneurs. She had to eventually pump in a capital of R350,000 ($24,706) to start the venture.

“So I had a couple of life lessons at the beginning. I had to end up using our savings but I didn’t mind having to do that because I trusted and believed in the vision.” 

But though she did, the banks did not because they often declined all her loan applications.

 “I think there are so many young black and enthusiastic individuals that have brilliant ideas and vision but the investment capital is not there. Though I do not have the capital as well to assist them, I would say keep going because the vision is greater,” Klapthor says.

Sprout Café offers health food, light meals, vegan food, and vegetarian and ketogenic diet food.

With her corporate marketing skills, she advertised her food on social media and gained a lot of traction.

“I want to create food on Instagram and people are like, ‘oh my God, I want to eat that’ and when they come into the store, it is the same deliverable they receive,” she says.

Sprout Café turns over R3 million ($211,677) annually and has 10 employees. 

After only two years of business, she has recently opened a second branch in the heart of the busy Moove Motion Fitness Club in Sunninghill in Johannesburg.

“There are people that are on specific diets and there is no one that is giving these people food. There is no one that is saying, vegan people want to be healthy too. They are making a conscious decision to preserve the environment and preserve their health and they are making these decisions but there is no one that is there to accommodate them.”

Klapthor says that the world is moving towards a plant-based lifestyle and she believes that many have recently caught on to that idea recently. 

Trend translator Bronwyn Williams of Flux Trends,  reiterates Klapthor’s views on how the world is adopting healthier habits. She believes that Generation Z is choosing good, clean fun the most.

“Yes, South Africa is not exempt from the global movement towards more locally-sourced and earth-friendly products and packaging,” Williams says.

However, Williams believes that because 64.2% of the South African population still lives in poverty, clean and organic food still remains costly for the majority of people.

“That said, unfortunately, earth-friendly consumer options remain a luxury that only the upper middle class can really afford to support and enjoy… certified organic, eco-friendly products tend to cost far more—up to 40% more than ‘regular’ packaged produce, it would be disingenuous to say that what the market wants is locally-sourced, earth-first produce when the majority of South Africans are struggling just to put any food on the table,” Williams says.

‘Every day, you should be able to eat a Sprout meal without having to feel any kind of guilt and shame,’ Leigh Klapthor says. Picture: Gypseenia Lion

Though Klapthor knows more people are opening healthy-eating establishments because they see that it is a trend, she believes that they need to be in touch with the reality of an ordinary person’s life and consider the cost implications.

“You can’t charge someone R150 ($10.59) for a Beyond Meat burger and expect her to come back tomorrow for the same burger. People are tight with their money and they work hard for it, they do not want to let go, for instance, of R500 ($35.29) in three days,” Klapthor says.

“We want to provide a healthy lifestyle, something that is consistent and that people can live through, and not just a treat-themselves-to at the end of the month. Every day, you should be able to eat a Sprout meal without having to feel any kind of guilt and shame.”

Obviously, it is a concept that has worked and keeps her business healthy as well.

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Young women in Soweto, South Africa, say healthy living is hard. Here’s why

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Data from South Africa has shown that over two thirds of young women are overweight and obese. This predisposes them to non-communicable diseases such as diabetes and hypertension. Most women are not exercising enough, and consumption of processed and calorie-dense foods and high amounts of sugar is common.

It was this knowledge that sparked the establishment of the Health Life Trajectories Initiative. It’s being run in South Africa, India, China and Canada and aims to provide interventions that can help young women stay healthy before, during and after pregnancy.

In South Africa, this randomised controlled trial will provide one-on-one support as well as peer group sessions to over 6000 young women. The idea is provide them with information, and to help them set and maintain goals for healthier lifestyles.

Researchers from the Medical Research Council and Wits University’s Developmental Pathways for Health Research Unit are running the South African arm of the study. We wanted to start by better understanding our target population – that is, young women aged between 18 and 24 living in Soweto.

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Soweto is a large, densely populated urban township which comprises one third of Johannesburg’s population. Soweto is becoming rapidly urbanised, but the majority of people are still very poor and struggle to provide food for their families.

We conducted a series of focus group discussions and in depth interviews to unravel health behaviours, barriers and facilitators to wellbeing and health with young women from Soweto who had not yet had a child. We also asked them about what sorts of interventions they’d prefer to support and guide them.

The women offered important insights that showed it’s not enough to simply promote healthy eating and exercise without considering the very real environmental and structural constraints present in South Africa.

Barriers to healthy choices

The 29 participants spoke about many different facets of health. These included happiness and mental wellbeing, faith, social support, body image, and lifestyle behaviours.

They identified many barriers to healthy eating, among them the cost of and access to healthy food options. Some women also said they had little access to exercise facilities such as gyms and were afraid to exercise on the streets because they feared being assaulted or harassed. One woman said:

No, I don’t feel safe because we have drug addicts, traffic, women trafficking: it’s not safe for us to walk in the streets.

The women we interviewed painted a picture of an environment in which healthy behaviours are difficult to implement or sustain. One said:

Small businesses that are opening up in my community and they all sell fries, literally they just all sell fries…

Women told us that cheap and unhealthy fast foods are on every street corner: “bunny chow” – hollowed out bread stuffed with curry – vetkoek (a fried dough bread stuffed with different fillings) and fried chips are affordable and available within a few steps of most houses. As a result, women did not want to go out of their way to purchase healthier, more expensive foods.

Our interviewees also didn’t feel able to demand that healthier food be bought for their homes, because many were not contributing financially and were therefore not in a position to control food purchases. Women reported being financially dependant on relatives and male partners.

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Exercise

They also said that opportunities for physical activity were neither provided nor prioritised for women in Soweto. Some women said that a lack of facilities made it difficult for them to participate in any exercise, as they did not have access to gyms or fields to exercise.

Other women told us that there were gyms, sports grounds, parks, and even free aerobics classes at community halls in their area. However these facilities often get vandalised quickly, and can no longer be used. More importantly, they didn’t feel safe enough to exercise on the streets, perhaps by jogging or running. They also felt unsafe walking around in leggings or tights. Women were fearful of human trafficking, sexual assault, and violence – very real issues in this community.

Crucially, our research found that young women did not see obesity as a sufficient reason to change their behaviour. But they said they would be motivated to exercise and eat better if they were diagnosed with a non-communicable disease like diabetes.

This suggests that obesity has become normalised in South Africa – and this needs to be addressed.

Policy interventions

These findings are now being worked into our interventions, and we are cognisant of the contextual realities that may affect young women’s ability to change their lifestyles. We hope that this research, along with whatever findings emerge from our interventions, will inform policy makers and motivate them to implement necessary changes in this community.

Women in Soweto and in South Africa in general need support to live healthier lifestyles. This support needs to come from policy makers. If South Africa does not step up and support young women by providing them with access to safe spaces and affordable healthier foods, and by controlling the oversupply of unhealthy options, the country may not be able to curb its ever increasing rise in obesity and related non-communicable diseases.

-Alessandra Prioreschi: Associate Director and Researcher at the Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand

The Conversation

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Measles: Should Vaccinations Be Compulsory?

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Following a measles outbreak in Rockland County in New York State, authorities there have declared a state of emergency, with unvaccinated children barred from public spaces, raising important questions about the responsibilities of the state and of individuals when it comes to public health.

Measles virus is spread by people coughing and spluttering on each other. The vaccine, which is highly effective, has been given with mumps and rubella vaccines since the 1970s as part of the MMR injection. The global incidence of measles fell markedly once the vaccine became widely available. But measles control was set back considerably by the work of Andrew Wakefield, which attempted to link the MMR vaccine to autism.

There is no such link, and Wakefield was later struck off by the General Medical Council for his fraudulent work. But damage was done and has proved hard to reverse.

In 2017, the global number of measles cases spiked alarmingly because of gaps in vaccination coverage in some areas, and there were more than 80,000 cases in Europe in 2018.

Anti-vaxxer threat

The World Health Organisation has declared the anti-vaccine movement one of the top ten global health threats for 2019, and the UK government is considering new legislation forcing social media companies to remove content with false information about vaccines. The recent move by the US authorities barring unvaccinated children from public spaces is a different legal approach. They admit it will be hard to police, but say the new law is an important sign that they are taking the outbreak seriously.

Most children suffering from measles simply feel miserable, with fever, swollen glands, running eyes and nose and an itchy rash. The unlucky ones develop breathing difficulty or brain swelling (encephalitis), and one to two per thousand will die from the disease. This was the fate of Roald Dahl’s seven-year-old daughter, Olivia, who died of measles encephalitisin the 1960s before a vaccine existed.

When measles vaccine became available, Dahl was horrified that some parents did not inoculate their children, campaigning in the 1980s and appealing to them directly through an open letter. He recognised parents were worried about the very rare risk of side effects from the jab (about one in a million), but explained that children were more likely to choke to death on a bar of chocolate than from the measles vaccine.

Dahl railed against the British authorities for not doing more to get children vaccinated and delighted in the American approach at the time: vaccination was not obligatory, but by law you had to send your child to school and they would not be allowed in unless they had been vaccinated. Indeed, one of the other new measures introduced by the New York authorities this week is to once again ban unvaccinated children from schools.

Precedents

With measles rising across America and Europe, should governments go further and make vaccination compulsory? Most would argue that this is a terrible infringement of human rights, but there are precedents. For example, proof of vaccination against yellow fever virus is required for many travellers arriving from countries in Africa and Latin America because of fears of the spread of this terrifying disease. No-one seems to object to that.

Also, on the rare occasions, when parents refuse life-saving medicine for a sick child, perhaps for religious reasons, then the courts overrule these objections through child protection laws. But what about a law mandating that vaccines should be given to protect a child?

Vaccines are seen differently because the child is not actually ill and there are occasional serious side effects. Interestingly, in America, states have the authority to require children to be vaccinated, but they tend not to enforce these laws where there are religious or “philosophical” objections.

There are curious parallels with the introduction of compulsory seat belts in cars in much of the world. In rare circumstances, a seat belt might actually cause harm by rupturing the spleen or damaging the spine. But the benefits massively outweigh the risks and there are not many campaigners who refuse to buckle up.

I have some sympathy for those anxious about vaccinations. They are bombarded daily by contradictory arguments. Unfortunately, some evidence suggests that the more the authorities try to convince people of the benefits of vaccination, the more suspicious they may become.

I remember taking one of my daughters for the MMR injection aged 12 months. As I held her tight, and the needle approached, I couldn’t help but run through the numbers in my head again, needing to convince myself that I was doing the right thing. And there is something unnatural about inflicting pain on your child through the means of a sharp jab, even if you know it is for their benefit. But if there were any lingering doubts, I just had to think of the many patients with vaccine-preventable diseases who I have looked after as part of my overseas research programme.

Working in Vietnam in the 1990s, I cared not only for measles patients but also for children with diphtheria, tetanus and polio – diseases largely confined to the history books in Western medicine. I remember showing around the hospital an English couple newly arrived in Saigon with their young family. “We don’t believe in vaccination for our kids,” they told me. “We believe in a holistic approach. It is important to let them develop their own natural immunity.” By the end of the morning, terrified by what they had seen, they had booked their children into the local clinic for their innoculations.

In Asia, where we have been rolling out programmes to vaccinate against the mosquito-borne Japanese encephalitis virus, a lethal cause of brain swelling, families queue patiently for hours in the tropical sun to get their children inoculated. For them the attitudes of the Western anti-vaccinators are perplexing. It is only in the West, where we rarely see these diseases, that parents have the luxury of whimsical pontification on the extremely small risks of vaccination; faced with the horrors of the diseases they prevent, most people would soon change their minds.

Tom Solomon; Director of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections, and Professor of Neurology, Institute of Infection and Global Health, University of Liverpool

-The Conversation

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