Tuberculosis infections in the Northern Cape have been rising steeply, particularly in the John Taolo Gasetsewe District.

A recent forum explored what was happening in the province, and what could be done to address the situation and reduce the spread of the disease.

TB neglected for some time

The district has the second highest rising rate of TB in the country. According to Audrey Kgape from the provincial Department of Health, the rise may be caused by different reasons including poor adherence to treatment.

She said efforts to curb the spread of TB had dipped when the country turned its focus on HIV as the priority health issue.

“As a result, most of the energy was directed to HIV and TB was neglected for some time,” Kgape said.

Dikeledi Senatle, a professional nurse and a TB survivor, said she believed the stigma attached to having TB was the main cause of the poor adherence levels.

“Wearing a mask can be very challenging,” Senatle said, explaining how people in the infectious phase of TB were supposed to wear masks in public in order not to spread their infection to others, particularly when they cough.

MacDonald Keetsamang from Networking HIV & AIDS Community of Southern Africa (NACOSA) said poverty was also driving the rise in TB.

Watching people’s reaction

“Our people want to be permanently placed on a disability grant, and that is why some of them will default on their treatment,” he said.

As Nacosa we are facilitating consultative forums for community based organisations and funded some to facilitate community dialogues around TB which also includes the mines.

Malebogo Marumo a community health care worker said she one day decided to wear a mask and went to town; this was just because she wanted to see the people’s reaction towards her, and starting from the hiking spot she struggled to get a lift.

Until she got into a taxi which the passengers look so frustrated and angry at the driver that how could he want to put their lives at risk with a TB patient.

Marumo said from that day she noticed that it is not easy to live and be accepted in the society with TB especially MDR.

Basic hygiene a challenge

Phillemon Mailinga from Hearts of Compassion, an NGO that focuses on palliative care, said basic hygiene education was important to reduce the risk of TB infections. Basics such as washing hands, opening windows, smart coughing and adhering to TB treatment, although important, may not be applied by patients living in shacks without running water – making basic proper hygiene a challenge.

Malinga said Hearts of Compassion found poor and unemployed patients found it difficult to adhere to treatment.

It was suggested that the Department of Education join the fight against rising TB levels as children were becoming infected and their studies were being affected in cases where they were hospitalised for long periods. – Health-e News.

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Mpho Lekgetho

You’d think that by a certain age, you’d have mastered taking care of your skin and boast a glowing, flawless skin. And indeed, many people have a great skin until their their late 30s, 40s or even 50s.

So, how is it possible that, having skipped acne during your teens and 20s, you’re now suffering?

Alternatively, you may be asking why your acne has returned, after you thought you’d won the battle in your late teens.

According to a previous Health24 article, 85% of adolescents develop mild acne (zits), while 15% develop clinical acne ranging from mild to severe.

University of Cape Town professor and doctor of dermatology, Rannakoe Lehloenya told Health24 that there are many factors that can cause people’s skins to flare up later in life.

Endogenous factors

Acne may be endogenous (caused by internal factors), or it could be exogenous (external factors).

“For some people it is endogenous. Some may be suffering from late onset acne and for others it could be persistent. Persistent acne is more affected by hormones, especially when polycystic ovarian syndrome is involved. Unfortunately, adult acne tends to be more common in women than men.

“In some instances, genetic predisposition plays a significant role. Children of parents whose acne persists into adulthood unfortunately tend to suffer the same fate,” says Lehloenya.

If one eliminates endogenous factors as the cause of adult acne, exogenous factors may be the problem.

Exogenous factors

Lehloenya says that occlusive and comedogenic cosmetic products are one of the causes of exogenous acne. When used on the skin, occlusive cosmetic products, such as petroleum jelly and certain other oils, leave a film which prevents moisture loss from the skin. Comedogenic cosmetics tend to block up the skin’s pores which may result in comedones, better known as blackheads.

“Besides cosmetics, certain medication, such as antiepileptics and antipsychotics cause acne. Steroids are a common cause – whether taken orally or produced by the body in excess.”

Acne! Why now?

Brenda Maye*, a former teacher from Cape Town, recalls how she developed adult acne just before she turned 40. She had become a mom for the third time and because her daughter was already three years old, she knew it couldn’t have anything to do with her hormones.

“While my acne was the least of my dermatological woes, I still found myself asking why and why now, as I didn’t suffer as a teenager or even in my 20s.

“I started my search for a solution. After trying a few products that were quite expensive, a friend finally introduced me to a product with a chemical composition that agrees with my skin.

“I have never looked back. I do still get the odd zit, here and there, but when that happens I know it’s because I haven’t been cleansing my skin properly.

“I also think that making minor changes in my diet made quite a difference – I eliminated as much processed food from my diet as possible,” said Maye.

Standard treatment

Lehloenya says that there is unfortunately no quick fix for a skin affected by acne.

“The best treatment approach is to identify the underlying causes – endogenous, exogenous or both – and find ways of managing them.

“Once you’ve identified the underlying cause, you can address the problem – the condition is not refractory, or stubborn.

“Acne treatment similar to other age groups is the best way forward once you have identified and started managing the underlying drivers,” said Lehloenya.

^{*Not her real name}

^{Images credit: iStock}

Stefni Herbert

There are as many ways to train as there are coaches, plans, online articles and books.

Even seasoned riders can get lost in the sea of intensity zones, HIIT workouts, mobility moves, plyometrics, strength work and core training.

That’s because coaching and training advice trickles down from the professional tiers, where you need meticulously monitored training plans to squeeze out every potential watt for even the smallest marginal gains.

But for the average rider who just wants to get fit and pick up some speed and stamina to hang with (or hammer with) their usual riding crew, it doesn’t have to be that complicated.

The first step, of course, is to ride your bike! That lays your foundation.

Then build on it by hitting the following training high notes to develop strength, speed, mobility, and stability.

1. Burpees

Cycling by itself doesn’t do much to develop core strength – in fact, core strength often suffers in cyclists. But that doesn’t mean your core isn’t critical to cycling.

Research shows that when the core fatigues, pedalling mechanics break down, paving the way for poor performance and injuries.

Cycling also doesn’t do much to build your bones. One seven-year study of competitive master cyclists found they actually had lower bone density than their non-athletic peers. So resistance training and/or some impact exercise are important.

One word here: Burpees. This multi-faceted move that combines push-ups, squats and jumps can bolster your core, strengthen key cycling muscles and help you build bone density.

As if that weren’t enough, a study published in Applied Physiology, Nutrition, and Metabolism showed that active women who performed just one set of 8 x 20 seconds (with 10 seconds of rest between 20-second reps) of a single whole-body aerobic–resistance training exercises like burpees four days a week not only improved their aerobic fitness as much as their peers who ran on treadmills for 30 minutes four days a week, but also significantly improved their muscular endurance, a huge benefit for long, hilly rides.

Do it: Perform 10 to 15 reps, two to three sets, two to three times a week.

• Stand straight arms at sides.
• Squat down, placing hands on floor, shoulder width apart.
• Jump legs back into high plank, pushup position.
• Perform pushup.
• Jump legs toward hands, back into the squat position.
• Extend legs and jump up, swinging arms overhead and repeat.

2. Tabatas

Named after exercise scientist Izumi Tabata, these all-out efforts train your body to recruit maximum muscle fibres and to fire them faster as well as raise your lactate threshold, which makes even your hardest rides feel easier.

They also help you hang onto your precious fitness when time is tight and you can’t squeeze in longer days in the saddle.

Because they’re super short, it’s also easy to psyche yourself up for them (one set takes just four minutes, which includes the rest intervals). Adding them to your usual training can help you see improvements fast.      

In a study published in the Journal of Sport Science & Medicine, exercisers who added just one high-intensity interval session, like tabatas, to their usual moderate cardio-training routine improved their VO2 max by 10% compared to a 3.9% improvement among their peers doing a similar amount of moderate training alone.

Do it: Perform once a week

• Warm up for five to 10 minutes.
• Pedal as hard as possible (you’re going for maximum power output) for 20 seconds.
• Soft pedal for 10 seconds.
• Repeat six to eight times.
• Rest four to five minutes.

If you are accustomed to interval training, repeat for another set – or two, if you’re feeling game. If you’re new to intervals, stick to one set.

3. The Founder

If you’re like most people, you spend a great deal of the day sitting. All that time planted on our behinds puts our glutes on extended inactive duty to the point where they eventually stop doing their job when we want them in action, like keeping us stable in the saddle and helping us charge up hills.

Keep your glutes – as well as your hamstrings and the muscles that support your spine – strong and active with one simple move: the Founder, the keystone move in Foundation Training.

The Founder is grounded in glute activation and strengthens the whole posterior chain from your shoulder blades to your knees for better mobility and injury prevention.

Do it: At least once a day

Stand with your feet shoulder-width apart, knees slightly bent, and weight on your heels. Hinge forward from your hips, pressing your butt back and extending your spine. Reach back with your arms, pulling shoulders down toward your butt. Hold 15 seconds.

Bring your arms up overhead and reach forward with hands and press back with your hips. Hold 15 for seconds.

Fold forward again, keeping your back flat and knees bent. Breathe deeply a few seconds. Place your hands on your thighs and return to a stand.

4. Threshold drills

The cornerstone of cycling improvement is raising your lactate threshold so you can produce more power at a comfortable heart rate. Probably the most effective way to increase your power at threshold is to perform long, steady intervals where you hover right at or just below threshold.

These intervals are especially effective for flatlanders who want to improve their hill climbing ability without traveling to an actual hill.

Just ask Mount Washington women’s record (1:07:32) setter Victoria DiSavino of Buffalo, New York.

“I work long hours so I don’t have the opportunity to travel to the hills to train,” she says. “I just go out and do three 20-minute efforts at threshold, which is pretty much the equivalent of the power you use to go up Mount Washington.”

Threshold drills are relatively easy to do but require concentration because it can be easy to let your mind (and your effort) drift.

Do it: Perform once a week

After a good warm-up, ride 10 minutes at a steady effort, at an exertion level of 6 to 7 on a 1 to 10 scale, about 85% of max heart rate and where you can speak just a few words at a time.

Recover for five to 10 minutes (you’re aiming for adequate recovery, so you can maintain your target intensity for the next effort), and then repeat two more times.

Once those feel easy, do two to three 20-minute steady-state efforts, recovering for 10 to 20 minutes between each.

Read more: Lactate threshold 101

^{This article originally appeared on www.bicycling.co.za}

^{Image credits: iStock}

Selene Yeager

Basically, there’s a lot to get done. So when you see the word “rest” on your schedule, it’s easy to breeze over.

Why would you do nothing when there’s always something to cross off the list?

The answer is simple: Not running is just as important as fitting in that long run.

Rest days help strengthen your body, sharpen your focus and reinvigorate your spirit so that you actually want to keep training.

“Rest is not a four-letter word to be ignored,” says Kevin Vincent, doctor and director of the University of Florida Running Medicine Clinic.

“The big reason you need it is recovery and recuperation. Every time you run, your body has to adapt to get stronger.”

Read more: 10 signs that you need a rest day!

That’s because when you run, you aren’t just building stamina and strength. You’re also breaking your body down, causing a tiny amount of tissue damage.

Allowing yourself time to recover afterward is what makes it possible for you to come back better next week, next month, next race.

“As much as athletes focus on their volume of training and the speed at which they do workouts, what they do outside of running is equally important to becoming stronger and more resilient in the future,” says Adam Tenforde, assistant professor of physical medicine and rehab at Harvard University, and former distance runner.

Bonnie Marks, psychologist at the NYU Sports Performance Centre, agrees. “If you don’t have time to recharge, it can lead to staleness and general apathy about training.”

Read more: The overtraining matrix

In other words, rest right and you’ll run better and be healthier. Skip it, and you’ll slowly fall apart.

Follow these training tweaks and build a stronger – more rested – you.

Help your muscles recover from hard workouts with this foam rolling routine:

Whether you’re a recreational runner or regularly training, there’s value in taking at least one day off each week – even if you’re doing a run streak. That off day is when your body uses nutrients and undergoes biological processes and hormone cycles to rebuild itself, says Tenforde. Here, four more reasons to chill:

1. Your muscles bounce back

When you run (or do any exercise), you create microscopic tears in your muscle fibres, and your body likes those about as much as you like trying to open a sweaty GU packet.

So it responds by rebuilding your muscles stronger, in preparation for the next session.

The catch: That response only happens with time off. Dr Vincent says that, depending on the length and intensity of your workout, the body needs a minimum of 36 to 48 hours to reboot.

Without it, the body has no opportunity to rebuild and strengthen muscles; they just continue to break down. That negates all the hard work you put in.

2. You avoid stress fractures

If you’re trying to sidestep an injury (and, um, who isn’t?), rest is crucial. Running is great for your bones – the impact stresses the tissue and, just like a muscle, that increases cell turnover and forces the bone to remodel with stronger structures, says Dr Vincent.

“But if you run today, tomorrow and the next day, it never has time to fully repair.”

Eventually, you could be looking at a stress fracture – and a season on the sidelines.

Read more: 6 common injuries you should never train through

3. Tight tendons are protected

Tendons are connective tissues that hold the muscle to bone, so they work constantly as the body moves. But blood doesn’t get to them easily, so they take longer to repair than tissues that have higher vascularity (like muscles), explains Dr Vincent.

If they don’t get that time, the constant pounding can cause chronic damage, like tendinitis – which is inflammation from overuse.

4. Your brain has time to chill

Yes, running is a form of stress relief. But every time you lace up, it increases the levels of the stress hormone cortisol in your body.

Why? “The body doesn’t know if you’re running away from danger or if you’re running for fun,” saysDr  Vincent.

That cortisol bump can cause mood issues, irritability, sleep problems and other health issues if stress levels are chronically high, says Marks.

Think of it like a scale: Overtrain, and you’ve tipped too far in one direction; schedule regular rest days, and you’re back in balance.

^{This article was originally publised on www.runnersworld.co.za}

^{Image credit: iStock}

Ted Spiker

It was an operation that earned him acclaim, but the world’s first heart transplant also provoked hate mail and outspoken criticism of South African surgeon Christiaan Barnard, 50 years ago.

Critical letters

“We did not realise that it would take the public by storm and create such an outcry,” says Dene Friedmann, a specialist nurse on the cardiovascular team, standing in the same Cape Town operating theatre where the medical feat took place.

Its watery-green tiled walls, visited by schools and the public, stir many memories for her of the historic procedure – and its aftermath.

“There were people who wrote quite critical letters to Professor Barnard, horrible letters calling him ‘the butcher’,” says Friedmann, now in her seventies.

It rained insults

“I have heard of human vultures, but it is the first time I have saw one with a name on it,” said one letter dated just one month after the operation and sent from Illinois in the United States.

“You had the audacity to assume the authority of God by pretending to become the giver of life,” said another from Hong Kong.

The French magazine Paris Match summed up the ethical debate in a headline: “The battle of the heart. Do surgeons have the right?”

But the scientific community welcomed the technical advance – the United States had also been seeking the accolade – and ordinary citizens sent congratulations.

A political dimension

At the time the heart was not considered a mere organ – it was more a symbol of deeper meaning, for some, the bringer and taker of life itself.

Unlike today, there was no common legal definition of brain death and the surgical team did not want to be accused of removing a beating heart to give it to another human.

There was also a political dimension, with South Africa’s apartheid government delighted to have some good news.

“They used Professor Barnard as the ambassador for the country,” recalls Friedmann.

‘Empty chest’

It was on the first floor of Groote Schuur Hospital on December 3, 1967 that Louis Washkansky received the donor heart of Denise Darvall, the 25-year-old victim of a road accident.

Darvall’s father had agreed to the procedure. In the operating theatre Friedmann leaned in to assess Washkansky on the table.

“I looked into this empty chest with no heart in it, a man lying there without a heart in his body and just a lung heart machine keeping him alive. It was very scary,” she says.

In the room next door, Barnard ordered that Darvall’s ventilator be turned off. After about 12 minutes her heart stopped beating and it was quickly moved to the theatre where 53-year-old Washkansky awaited it.

“There were still a lot of medical ethics issues. It was the first time time that a heart transplant was being done… and he did not want anybody to be able to say we took out a beating heart from a patient,” Friedmann says of Barnard, who died in 2001.

“There was a feeling of nervousness: is this heart going to beat and take over the circulation? When it started, it was so exciting, so wonderful.”

The rhythm of life

Barnard, then 45, said of the operation: “The heart lay paralysed, without any sign of life. We waited – it seemed like hours – until it slowly began to relax. Then it came like a bolt of light.

“There was a sudden contraction of the atria, followed quickly by the ventricles in obedient response. Little by little it began to roll with the lovely rhythm of life.”

Coming as it did during the apartheid years race became a consideration when selecting a donor, but only to avoid allegations of prejudice.

The pioneering operation could in fact have been performed weeks earlier, when a coloured man’s heart became available.

“Professor Barnard had decided that the first donor had to be a white person, because of apartheid. We did not want anyone to say ‘You are taking out a black person’s heart to put it in a white patient’,” says Friedmann.

Collapsed immune system

She also squashed the rumour that persists about a black South African, Hamilton Naki, participating in the first transplant but that he was deprived by the apartheid government of any recognition.

“He was very talented, but he never operated on patients,” says Friedmann, who worked with Naki on many laboratory tests on dogs.

Just 18 days after the world first of the Washkansky operation, the patient died. The autopsy revealed that his lungs gave out, but not the heart, because his immune system had collapsed, resulting in pneumonia.

Today, a heart transplant – while still a high-risk procedure – no longer makes headlines.

Around 3 500 transplants are carried out each year, of which about 2 000 are in the United States.

About 88% of patients survive the first year after surgery, 75% survive for five years, and 56% 10 years after the operation, according to the US National Heart, Lung, and Blood Institute (NHLBI).

^{Image credit: Wikimedia Commons}