By helping hundreds of hospitals like HCA Healthcare hire nurses faster and with less aggravation, Iman Abuzeid has built the rare VC-backed startup that’s already profitable. It likely won’t be long before it becomes a unicorn.



Iman Abuzeid walked into the Andreessen Horowitz annual barbecue in the summer of 2019 with two term sheets from other VC firms already in hand, but she was determined to leave with a third. The cofounder and CEO of Incredible Health was sure she wanted a16z managing partner Jeff Jordan, the former CEO of online restaurant reservation marketplace OpenTable and senior vice president at eBay, to help grow her nurse-hiring startup.



What she didn’t realize is that she would not only land a key investor that night but also one of her company’s marquee customers. Amid the endless trays of hamburgers and ribs at the home of Ben and Felicia Horowitz, Abuzeid, 36, walked past Tina Knowles (Beyoncé’s mom) and CBS anchor Gayle King, and honed in on Bernard Tyson, the late CEO of Kaiser Permanente. Abuzeid says she started the conversation with Tyson the same way she does with all hospital executives she’s pitching. “We’re in a huge nursing shortage,” she tells them. “I’m guessing your units are understaffed, and they don’t have enough nurses?”



<div class="wp-block-image"><figure class="aligncenter is-resized"><img loading="lazy" decoding="async" src="https://specials-images.forbesimg.com/imageserve/6164696ab451d8779655eb93/Incredible-Health-cofounder-and-chief-technology-officer-Rome-Portlock/0x0.gif?fit=scale" alt="Incredible Health cofounder and chief technology officer Rome Portlock" width="394" height="493"/><figcaption>Incredible Health cofounder and chief technology officer Rome Portlock&nbsp;INCREDIBLE HEALTH</figcaption></figure></div>



Within a month of that barbecue, San Francisco-based Incredible Health, which Abuzeid cofounded with chief technology officer Rome Portlock, 41, had landed Jordan’s firm as the lead investor of its $15 million Series A round. Soon after, it also had inked a deal to work with Kaiser, which encompasses 39 hospitals and is now one of her company’s biggest customers.



To help hospitals find nurses, San Francisco-based Incredible Health flips traditional hiring on its head with hospital customers essentially paying to pitch themselves to nurses who join for free. “The biggest challenge now is chasing the demand for nurses,” says Jordan, who sits on Incredible Health’s board.



Since its 2017 launch in California, more than 500 hospitals have signed up for Incredible Health, including HCA Healthcare and Stanford Health Care, in addition to Kaiser. The company focuses on filling permanent jobs, rather than short-term travel nursing or contract gigs. Hospital customers pay for annual subscriptions with tiered pricing, based on the number of nurses they plan to hire. Revenue is expected to reach $16 million this year, triple last year’s $5 million. That growth helped Incredible Health gain a spot on this year’s Next Billion-Dollar Startups list, one of 25 companies we think most likely to reach a $1 billion valuation.



Unlike most venture-backed startups, Incredible Health is profitable—“accidentally profitable,” as Abuzeid likes to say. Each state has its own rules on healthcare licensing, making expansion slower in this business than it would be in a less regulated one, and Incredible Health is careful to line up enough employers and nurses to make the marketplace work in each state before moving on to the next one. That slow-and-steady strategy has helped the company move into 21 states profitably, and Abuzeid plans to go national in 2022.



Nurses are just a starting point, Abuzeid explains, with the long-term goal to be the “market leading company in healthcare labor.” The company is looking to expand to customers beyond hospitals in the future to urgent care, surgical centers, skilled nursing facilities and home health. Abuzeid expects the company might eventually serve doctors, physical therapists and pharmacists.



<hr class="wp-block-separator"/>



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">“I wanted to build and create things that would have an impact on a large scale. Not just one-on-one with patients.”</blockquote>



<hr class="wp-block-separator"/>



The&nbsp;<a href="https://www.bls.gov/news.release/ecopro.nr0.htm" target="_blank" rel="noreferrer noopener">U.S. Bureau of Labor Statistics</a>&nbsp;projects that healthcare and social assistance will “add the most jobs of all industry sectors”—around 3.3 million over the next ten years—as aging Baby Boomers need more care and the number of Americans with chronic conditions continues to rise. Rather than be a one-off solution for job-seekers, Incredible Health is taking a page from LinkedIn, which Microsoft bought for $26 billion in 2016, by creating a social network of nurses and building tools like salary estimators and free continuing education credits. Abuzeid says there are hundreds of thousands of nurses on the platform and hospitals have made thousands of hires (she declined to give specific numbers). The average salary for a registered nurse in the U.S. is around $90,000 (though there is significant regional variation). Nurses who use Incredible Health get a 17% salary bump on average when switching jobs, says Abuzeid. “It enables us to not just be the place where a nurse—and eventually every healthcare worker—finds his or her job,” she says, “but it’s also the place where they manage their career.”https://embedly.forbes.com/widgets/media.html?src=https%3A%2F%2Fe.infogram.com%2Faff4c3da-198c-4df7-b243-cdeca107ebe4%3Fsrc%3Dembed&amp;display_name=Infogram&amp;url=https%3A%2F%2Finfogram.com%2Fbar-1h8n6m3n0p9oz4x&amp;key=cfc0fb0733504c77aa4a6ac07caaffc7&amp;type=text%2Fhtml&amp;schema=infogram



Abuzeid was born to Sudanese parents in Saudi Arabia, where her father, an ear, nose and throat surgeon, had taken a job. While her grandfathers in Sudan had started businesses in transportation, agriculture and real estate, her two older brothers became doctors like their father. One brother is an ear, nose and throat surgeon in Seattle, while the other is a trauma surgeon outside of Atlanta. Abuzeid started down the same path, getting her undergraduate and medical degrees from University College London. But it was her grandfathers’ influence that gave her the courage to leave the daily practice of medicine. “It made me very comfortable with risk,” she recalls.



At age 24, Abuzeid skipped her medical residency program in the U.K. and moved to the U.S. for a job in healthcare consulting. It was the start of a decade-long journey to becoming her own boss. “I wanted to build and create things that would have an impact on a large scale,” she says. “Not just one-on-one with patients.”



<hr class="wp-block-separator"/>



<h3 class="wp-block-heading" id="h-coming-up-short">Coming Up Short</h3>



<h4 class="wp-block-heading" id="h-even-before-the-pandemic-some-states-were-facing-shortfalls-of-registered-nurses-these-six-states-will-have-the-biggest-gaps-by-2030">Even before the pandemic, some states were facing shortfalls of registered nurses. These six states will have the biggest gaps by 2030.</h4>



<div class="wp-block-image"><figure class="aligncenter size-large is-resized"><img loading="lazy" decoding="async" src="https://cms.forbesafrica.com/wp-content/uploads/2021/10/Screenshot-2021-10-15-at-16.03.03-1024x657.png" alt="" class="wp-image-53006" width="593" height="380" srcset="https://cms.forbesafrica.com/wp-content/uploads/2021/10/Screenshot-2021-10-15-at-16.03.03-1024x657.png 1024w, https://cms.forbesafrica.com/wp-content/uploads/2021/10/Screenshot-2021-10-15-at-16.03.03-300x192.png 300w, https://cms.forbesafrica.com/wp-content/uploads/2021/10/Screenshot-2021-10-15-at-16.03.03-768x493.png 768w, https://cms.forbesafrica.com/wp-content/uploads/2021/10/Screenshot-2021-10-15-at-16.03.03.png 1512w" sizes="auto, (max-width: 593px) 100vw, 593px" /><figcaption>Source: The National Center for Health Workforce Analysis, July 2017</figcaption></figure></div>



In 2009, she joined Booz &amp; Co. in New York City, consulting on hospital operations and strategy. She then got her M.B.A. at Wharton and landed as a product manager at San Francisco-based digital healthcare startup AliveCor, which was developing a personal heart-monitoring device connected to a smartphone. That’s where she met cofounder Portlock. An MIT graduate with a degree in computer science, Portlock had previously worked for Linden Lab (creators of the video game Second Life) and EventBrite before becoming one of the first engineering hires at AliveCor. After two years of working together, the duo struck out on their own. “I knew [Iman’s] the kind of person that will make things happen and get things done,” says Portlock.



In 2015, they started working on Lift League, customer-retention software for small and medium-size healthcare companies, which was accepted into an accelerator program run by venture firm NFX. But after multiple strategy sessions trying to figure out how to grow it, they scrapped the concept. For their second venture, Abuzeid and Portlock decided to apply the concept of Hired.com, originally a recruitment tool for software engineers, to healthcare. “That was where we saw the model of employers applying [for] the talent,” says Abuzeid. Many hospitals were still stuck in the dark ages, pushing paper and taking months to hire nurses and other staff, even as healthcare spending was closing in on 18% of U.S. GDP, while tech hovered around 10%.&nbsp;



Portlock’s sister, brother-in-law and sister-in-law were all nurses, so they vetted the idea with family before floating it by potential hospital customers. In January 2017, with less than two months to go until the NFX Demo Day, they hunkered down, with Portlock writing code and Abuzeid cold-calling hospitals and shaping the business plan. Portlock was also juggling a newborn baby. He now counts the age of the company—four years—by the age of his first child. By March, Incredible Health was in contract discussions with HCA Healthcare, one of the largest hospital systems in the country. The first check (which is framed on the wall of the company’s office in San Francisco) arrived a few weeks later, as did a $2.4 million seed investment led by James Joaquin at Obvious Ventures.



<a href="https://players.brightcove.net/2097119709001/HkGIdDTwWg_default/index.html?videoId=6276662253001">https://players.brightcove.net/2097119709001/HkGIdDTwWg_default/index.html?videoId=6276662253001</a>



When the pandemic hit in March 2020 and cases overwhelmed hospital ICUs, hospitals were focused more on surviving than hiring. Now ,18 months later, hospitals are contending with a different challenge: staff burnout. David Jones, chief human resources officer at Stanford Health Care, says the number of nurses taking leaves of absence from the health system has increased 312% over the past year due to pandemic-related burnout and stress. As the demand for nurses increases, job-seekers have more power in the face of growing shortages, he adds. This means employers who make the first offer are most likely to seal the deal. “Speed is right now probably the most important variable in how nurses decide where they want to work if they’ve got multiple opportunities,” says Jones. Even before the pandemic, California was predicted to have a shortage of 44,500 nurses by 2030,&nbsp;<a href="https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/nchwa-hrsa-nursing-report.pdf" target="_blank" rel="noreferrer noopener">according to federal estimates</a>. Incredible Health’s software, Jones says, “has really helped us get in line first and be able to present our opportunities and to try to close the deals much more quickly.”



Incredible Health estimates the average hospital customer can save at least $2 million that would otherwise go to traveling nurses, HR or other administrative costs. (Neither Stanford nor Kaiser would confirm the financial payoff of their deals with Incredible Health.)



For job-seekers, it’s also a much faster, more transparent system. Shenita Anderson, an ER nurse, says she had multiple job offers within two weeks of building what she calls her “power profile” on Incredible Health. She accepted two in Los Angeles: a full-time gig at Cedars-Sinai and a per-diem opportunity at Glendale Adventist. Compared with filling out tons of online applications to never hear back, Incredible Health’s process was not only easier, but let her know where she stood because she could see which recruiters were looking at her profile. “[It] took some of that angst out of the equation,” says Anderson, who is now pursuing a doctorate in nursing at UCLA, where she is researching how to help African American smokers quit, while also working full time.



For Abuzeid, the success of Anderson and other nurses is personal. After all, the odds were stacked against her—on paper, at least. “Raising money as a Black female founder is, of course, challenging. The statistics are kind of stacked against you in many ways,” says Abuzeid, who points out that just 1% of VC money goes to Black founders and even less to Black female founders. Knowing the chances, she sought mentors and applied her skills at fundraising. It worked out for her in an industry dominated by white men—and she hopes the same is true for the tens of thousands of nurses her company seeks to empower. “You just have to go for it,” says Abuzeid. “You just have to be as assertive as you can be.”



By Katie Jennings, Forbes Staff

Screenshot 2021-10-15 at 16.01.00

Meet The Sudanese Doctor Who Turned Nurse Staffing On Its Head

MEDICAL TECHNOLOGY CONSTANTLY pushes boundaries with its innovations. Over the years, we’ve seen disruptions like 3D bio-printing; the Internet of Medical Things; virtual reality for mental health; robotic surgery and nanomedicine – precision healthcare at a molecular level. 



Early in the pandemic, telemedicine took center stage as patients and healthcare workers turned to technology out of necessity, but it remains to be seen if its popularity will last.



 It was also during the pandemic that Microsoft experimented with its mixed reality (MR) headset, the HoloLens 2. The headset enables surgeons to view 3D holographic images of a patient, obtained from X-rays or CT scans, and supports hand gestures and voice commands. 



Recently, at its annual Ignite conference in March, the company announced Microsoft Mesh, a mixed-reality platform built on Azure that can be accessed on the HoloLens as well as other VR headsets, smartphones, PCs, Macs and tablets, making it more mainstream. 



The HoloLens 2 project was led by Professor Thomas Gregory who used the original HoloLens for its first MR surgery back in 2017. He brought together 15 surgeons across 13 countries to perform a series of MR orthopedic operations. Shoulder surgeries were chosen because it requires 3D planning and modeling of the shoulder. Professor Stephen Roche, orthopedic surgeon at Groote Schuur Hospital and the University of Cape Town in South Africa participated in three surgeries; one in South Africa and assistance with two others in France and Germany.



 “Technology is playing a bigger role in surgery, research, and healthcare and certainly during Covid-19, where trainees have not been able to operate, this has highlighted the use and need for technology in training and teaching,” says Roche. 



The HoloLens 2 lets us manipulate images in real-time so intraoperative findings can be checked with surgical planning, he adds. 



“It allows us to access the internet during surgery and more importantly, we can bring a surgeon into the theater virtually for advice, which would be a massive benefit for a continent like Africa, with many of our colleagues working in poorlyresourced areas.” 



Another company targeting disadvantaged communities in South Africa is a start-up called Robots Can Think, which adapted during Covid-19 by 3D-printing personal protective equipment (PPE) for healthcare workers. 



<div class="wp-block-media-text alignwide is-stacked-on-mobile" style="grid-template-columns:35% auto"><figure class="wp-block-media-text__media"><img loading="lazy" decoding="async" width="917" height="1024" src="https://www.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-917x1024.jpg" alt="" class="wp-image-50857 size-full" srcset="https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-917x1024.jpg 917w, https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-269x300.jpg 269w, https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-768x857.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-1376x1536.jpg 1376w, https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil-1834x2048.jpg 1834w, https://cms.forbesafrica.com/wp-content/uploads/2021/04/Natalie-Raphil.jpg 2000w" sizes="auto, (max-width: 917px) 100vw, 917px" /></figure><div class="wp-block-media-text__content">
<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">At Robots Can Think, we strive to use AI for good, to place AI in a meaningful way in the hands of all, from Sandton to Kagiso, to deep rural Eastern Cape. – Natalie Raphil</blockquote>
</div></div>



Natalie Raphil, founder of Robots Can Think, says that during level 5 of the lockdown in South Africa, when imports and exports were at a standstill and PPE was in demand, she read about healthcare workers using cloth to cover their face and nose due to PPE delays. 



“I have access to a 3D-printer and decided to print face shields and masks with the 3D-printing material I had available. I then distributed them to medical staff in public hospitals, those in Alexandra in Johannesburg and so on,” says Raphil.



Raphil has a PhD in Artificial Intelligence (AI) from Stanford University and started Robots Can Think three years ago with a current focus on the medical and healthcare sectors. After questioning the inclusivity of AI for the visually and hearing impaired, she realized things needed to change. 



The start-up came up with an AI module that is fitted on to existing walking sticks, and once activated, assists the visually-impaired to navigate outdoors.



“The device captures real-time images and the AI then recognizes objects such as traffic lights, traffic light colors, how many vehicles/ pedestrians (essentially objects) are in front of the visually-impaired, all the while navigating them to their final destination.”



The device then either communicates back to the visually-impaired via speech through a Bluetooth device or via sensory pulses emitted from the device to the hand holding the stick. 



The AI walking stick is still in a testing phase, and runs on proprietary software that includes image recognition, image/text to speech, and text/speech to sensory conversion software, hosted on-premise.



Raphil credits Robots Can Think’s partner, All Round Tech, for its engineering genius in developing the AI module for walking sticks. Once approved, it will be made available to purchase; supplied to medical organizations; and will be donated to the needy. 



Over the next two years, Robots Can Think will focus on exploring medical tech to enhance the continent’s adoption of AI, invent products that are easily accessible to all and continue to use AI for good, says Raphil. 



“At Robots Can Think, we strive to use AI for good, to place AI in a meaningful way in the hands of all, from Sandton to Kagiso, to deep rural Eastern Cape in South Africa.”



BY NAFISA AKABOR

HoloLens2

The Advancements In Medical Technology That Go Beyond Covid-19

While most cases of the COVID-19 coronavirus have been reported in the U.S. , Europe, and China, the virus is spreading rapidly across the African continent. 



The confirmed worldwide cases for the virus have surpassed 50 million with the current figure being at 86,979,718.



The increase in newly reported cases around the world has led the World Health Organization (WHO) to declare the coronavirus a global pandemic. 



The death toll continues to rise globally now surpassing <a href="https://www.forbesafrica.com/current-affairs/2020/09/29/coronavirus-claims-the-lives-of-more-than-1-million-people-worldwide/">one million</a>. It is currently at 1,878,992.



The U.S. leads with 365,740 deaths. Brazil comes second with 197,777. India&#8217;s deaths are at 150,151; Mexico is with 128,822 deaths, and The U.K is with 76,329.



China, where the virus originated from, maintains that the country&#8217;s death toll is at 4,634.



The figure of the global recoveries stands at 61,684,121.



The African continent now has a total figure of 2,895,592 confirmed cases of Covid-19, while the death toll stands at 68,872. The continent has made 2,388,345 recoveries. 



Here are the country-wide numbers for Africa:



<figure class="wp-block-table is-style-regular"><table><tbody><tr><td>Country </td><td>Confirmed Cases </td><td>Confirmed Deaths</td><td>Confirmed Recoveries</td></tr><tr><td>Algeria</td><td>100,873</td><td>2,782</td><td>68,185</td></tr><tr><td>Angola</td><td>17,756</td><td>410</td><td>11,376</td></tr><tr><td>Benin</td><td>3,304</td><td>44</td><td>3,185</td></tr><tr><td>Botswana</td><td>15,440</td><td>45</td><td>12,481</td></tr><tr><td>Burkina Faso</td><td>7,342</td><td>86</td><td>5,443</td></tr><tr><td>Burundi</td><td>842</td><td>2</td><td>687</td></tr><tr><td>Cameroon</td><td>26,848</td><td>448</td><td>24,892</td></tr><tr><td>Cabo Verde (Cape Verde)</td><td>11,983</td><td>113</td><td>11,608</td></tr><tr><td>Central African Republic (CAR)</td><td>4,963</td><td>63</td><td>1,924</td></tr><tr><td>Chad</td><td>2,289</td><td>105</td><td>1,876</td></tr><tr><td>Comoros</td><td>995</td><td>13</td><td>759</td></tr><tr><td>Congo</td><td>7,107</td><td>108</td><td>5,846</td></tr><tr><td>Cote d&#8217;Ivoire (Ivory Coast)</td><td>22,855</td><td>138</td><td>22,154</td></tr><tr><td>Democratic Republic of the Congo (DRC) </td><td>18,248</td><td>599</td><td>14,723</td></tr><tr><td>Djibouti </td><td>5,854</td><td>61</td><td>5,752</td></tr><tr><td>Egypt</td><td>144,583</td><td>7,918</td><td>115,414</td></tr><tr><td>Equatorial Guinea</td><td>5,286</td><td>86</td><td>5,154</td></tr><tr><td>Eritrea</td><td>1,445</td><td>3</td><td>740</td></tr><tr><td>Eswatini&nbsp;(formerly Swaziland)</td><td>10,338</td><td>252</td><td>6,094</td></tr><tr><td>Ethiopia</td><td>126,241</td><td>1,963</td><td>112,813</td></tr><tr><td>Gabon</td><td>9,605</td><td>66</td><td>9,415</td></tr><tr><td>Gambia</td><td>3,812</td><td>125</td><td>3,677</td></tr><tr><td>Ghana</td><td>55,168</td><td>335</td><td>53,928</td></tr><tr><td>Guinea</td><td>13,845</td><td>81</td><td>13,199</td></tr><tr><td>Guinea-Bissau</td><td>2,455</td><td>45</td><td>2,398</td></tr><tr><td>Kenya</td><td>97,398</td><td>1,694</td><td>79,966</td></tr><tr><td>Lesotho</td><td>3,206</td><td>65</td><td>1,496</td></tr><tr><td>Liberia</td><td>1,779</td><td>83</td><td>1,406</td></tr><tr><td>Libya</td><td>102,880</td><td>1,546</td><td>77,435</td></tr><tr><td>Madagascar </td><td>17,767</td><td>262</td><td>17,298</td></tr><tr><td>Malawi</td><td>7,110</td><td>199</td><td>5,753</td></tr><tr><td>Mali</td><td>7,349</td><td>284</td><td>5,070</td></tr><tr><td>Mauritania</td><td>14,981</td><td>367</td><td>12,639</td></tr><tr><td>Mauritius</td><td>531</td><td>10</td><td>513</td></tr><tr><td>Mayotte</td><td>6,045</td><td>56</td><td>2,964</td></tr><tr><td>Morocco</td><td>445,439</td><td>7,581</td><td>416,708</td></tr><tr><td>Mozambique</td><td>19,542</td><td>171</td><td>17,069</td></tr><tr><td>Namibia</td><td>25,887</td><td>222</td><td>21,777</td></tr><tr><td>Niger</td><td>3,557</td><td>112</td><td>2,152</td></tr><tr><td>Nigeria </td><td>92,705</td><td>1,319</td><td>76,396</td></tr><tr><td>Réunion</td><td>9,173</td><td>42</td><td>8,706</td></tr><tr><td>Rwanda</td><td>8,955</td><td>110</td><td>6,878</td></tr><tr><td>Sao Tome and Principe</td><td>1,024</td><td>17</td><td>987</td></tr><tr><td>Senegal</td><td>20,156</td><td>433</td><td>17,782</td></tr><tr><td>Seychelles</td><td>354</td><td>1</td><td>224</td></tr><tr><td>Sierra Leone</td><td>2,724</td><td>76</td><td>1,924</td></tr><tr><td>Somalia</td><td>4,714</td><td>130</td><td>3,612</td></tr><tr><td>South Africa</td><td>1,127,759</td><td>30,524</td><td>920,879</td></tr><tr><td>South Sudan</td><td>3,589</td><td>63</td><td>3,131</td></tr><tr><td>Sudan</td><td>23,316</td><td>1,468</td><td>13,524</td></tr><tr><td>Tanzania</td><td>509</td><td>21</td><td>183</td></tr><tr><td>Togo</td><td>3,770</td><td>69</td><td>3,515</td></tr><tr><td>Tunisia </td><td>147,061</td><td>4,934</td><td>110,324</td></tr><tr><td>Uganda</td><td>36,407</td><td>290</td><td>12,387</td></tr><tr><td>Western Sahara</td><td>10</td><td>1</td><td>8</td></tr><tr><td>Zambia </td><td>23,495</td><td>417</td><td>19,672</td></tr><tr><td>Zimbabwe</td><td>17,194</td><td>418</td><td>11,813</td></tr></tbody></table></figure>







Note: The numbers will be updated as new information is available.

KENYA-HEALTH-VIRUS

[IN NUMBERS] Coronavirus Update: COVID-19 In Africa

TOPLINE: Some U.S. cities have now run out of space in their ICUs, with many more on the brink of being overwhelmed as Covid hospitalizations keep skyrocketing to new national records on a daily basis.



<h4 class="wp-block-heading">KEY FACTS</h4>



<a href="https://twitter.com/TCBPubHealth/status/1326888035129176064?s=20" target="_blank" rel="noreferrer noopener">Jackson, Mississippi</a>—the state’s capital—has “zero” ICU beds available, while the rest of the state has “very few,” State Health Officer Dr. Thomas Dobbs said.



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/tulsa-has-run-out-of-icu-beds-and-el-paso-is-out-of-morgue-space-heres-the-latest-grim-toll-of-covid/?sh=78c74f022133">Tulsa</a>&nbsp;health officials announced Tuesday night that the city had run out of ICU beds.



<a href="https://www.stltoday.com/news/local/state-and-regional/running-out-of-room-st-louis-hospitals-forced-to-turn-away-patients-from-rural-areas/article_0e17fc93-3e67-5a49-9a33-0b346618b5c3.html" target="_blank" rel="noreferrer noopener">St. Louis</a>&nbsp;hospitals are so overwhelmed they’re reportedly having to turn away some patients.



In North Dakota, nurses are being allowed to continue working in certain cases even if they are<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/covid-positive-nurses-allowed-to-keep-working-in-north-dakota-amid-staffing-crisis/?sh=392003af60fd">&nbsp;Covid-positive</a>, as Gov. Doug Burgum (R) has warned that the state’s healthcare system could soon be pushed beyond its limits.



A field hospital has been set up for surge capacity in<a href="https://www.npr.org/2020/10/22/926809402/wisconsin-opens-a-field-hospital-at-state-fair-grounds-as-coronavirus-cases-spik" target="_blank" rel="noreferrer noopener">&nbsp;Wisconsin</a>, with<a href="https://www.bostonglobe.com/2020/11/13/metro/mass-reopen-field-hospital-dcu-center-worcester/" target="_blank" rel="noreferrer noopener">&nbsp;Massachusetts</a>&nbsp;planning to reopen one in December, and $10 million going toward converting a parking garage in<a href="https://thehill.com/homenews/state-watch/525995-nevada-hospital-turns-parking-garage-into-covid-19-surge-unit" target="_blank" rel="noreferrer noopener">&nbsp;Reno, Nevada</a>, into a Covid unit.



Vineet Arora, a hospital expert at the University of Chicago, warns that Illinois is “dangerously close” to exceeding capacity, telling<a href="https://www.npr.org/2020/11/12/934266517/illinois-health-care-workers-say-hospitals-will-run-out-of-icu-beds-by-thanksgiv" target="_blank" rel="noreferrer noopener">&nbsp;NPR</a>&nbsp;that ICUs will run out of space by Thanksgiving.



<h4 class="wp-block-heading">WHAT TO WATCH FOR</h4>



Several other places around the country—like Kansas City and<a href="https://www.rochesterfirst.com/coronavirus/strong-hospital-nearing-100-capacity-as-covid-19-cases-surge-in-monroe-county/" target="_blank" rel="noreferrer noopener">&nbsp;Rochester, New York</a>—are also pushing the limits of their health care capacity. In<a href="https://www.npr.org/sections/health-shots/2020/11/14/934185297/covid-19-hospitalizations-surge-in-dakotas-its-like-we-opened-up-a-spigot" target="_blank" rel="noreferrer noopener">&nbsp;South Dakota</a>, a health official told NPR that it’s “a possibility” the state would follow North Dakota in taking the exceptional step of allowing nurses with Covid to work in Covid units at hospitals and nursing homes, provided they are asymptomatic. That’s a step Dr. Steffanie Strathdee, Associate Dean of Global Health at UC San Diego and author of “<a href="https://protect-us.mimecast.com/s/pOQeCZ6ZQ7fAY0XwTysi5X?domain=theperfectpredator.com" target="_blank" rel="noreferrer noopener">The Perfect Predator</a>,” told&nbsp;Forbes&nbsp;earlier this week was “crazy” for North Dakota to take. Another looming problem could be a lack of nurses nationwide. During the spring surge, scores of health workers flocked to New York, which was the hardest-hit city in the country. But the crisis now is nationwide, meaning there could be competition for health workers in many places.



<h4 class="wp-block-heading">KEY BACKGROUND</h4>



The U.S. has set a new record for hospitalizations for four-straight days, according to data from<a href="https://covidtracking.com/data" target="_blank" rel="noreferrer noopener">&nbsp;The COVID Tracking Project</a>, and the trend seems to only be accelerating. Significantly adding to the problem is that new cases are also not only increasing, but constantly increasing at a faster pace, as well. The U.S. added more than 180,000 new cases on Friday, again setting a new record, which keeps getting broken<a href="https://www.forbes.com/sites/tommybeer/2020/11/14/another-grim-new-record-us-tops-180000-new-infections-friday-covid-cases-rising-in-all-50-states/?sh=6c8aa7821ea5">&nbsp;day after day</a>. Just 10 days earlier, the U.S. had never topped 94,000 cases in a single day. And before the fall surge, the daily case record stood at just over 75,000. Hospitalizations stood at 68,516 on Friday, according to The COVID Tracking Project.<a href="https://covidtracking.com/data/charts/us-daily-deaths" target="_blank" rel="noreferrer noopener">&nbsp;Deaths</a>, which lag behind increases in cases and then hospitalizations, have been on a steady rise since mid-October. The U.S. is now averaging more than 1,000 Covid deaths a day.



<h4 class="wp-block-heading">TANGENT</h4>



<a href="https://www.cnn.com/2020/11/10/us/el-paso-covid-mobile-morgues/index.html" target="_blank" rel="noreferrer noopener">El Paso, Texas</a>, is dealing with an even more grim problem than hospitals reaching capacity—the city has run out of morgue space.



<h4 class="wp-block-heading">FURTHER READING</h4>



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/tulsa-has-run-out-of-icu-beds-and-el-paso-is-out-of-morgue-space-heres-the-latest-grim-toll-of-covid/?sh=78c74f022133">Tulsa Has Run Out Of ICU Beds And El Paso Is Out Of Morgue Space—Here’s The Latest Grim Toll Of Covid</a>&nbsp;(Forbes)



<a href="https://www.forbes.com/sites/nicholasreimann/2020/11/10/covid-positive-nurses-allowed-to-keep-working-in-north-dakota-amid-staffing-crisis/?sh=392003af60fd">Covid-Positive Nurses Allowed To Keep Working In North Dakota Amid Staffing Crisis</a>&nbsp;(Forbes)



<a href="https://www.npr.org/sections/health-shots/2020/11/14/934185297/covid-19-hospitalizations-surge-in-dakotas-its-like-we-opened-up-a-spigot" target="_blank" rel="noreferrer noopener">COVID-19 Hospitalizations Surge In Dakotas: &#8216;It&#8217;s Like We Opened Up A Spigot&#8217;</a>&nbsp;(NPR)



<a href="https://www.forbes.com/sites/tommybeer/2020/11/14/another-grim-new-record-us-tops-180000-new-infections-friday-covid-cases-rising-in-all-50-states/?sh=6c8aa7821ea5">Another Grim New Record: U.S. Tops 180,000 New Infections Friday, Covid Cases Rising In All 50 States</a> (Forbes)



-By Nicholas Reimann, Forbes Staff

COVID-19 Intensive Care Unit Within A Houston Hospital Cares For Patients As Cases Continue To Rise

Here’s Where You Can No Longer Get An ICU Bed Because Of Covid

Zola Brunner, the founder of BeyondLupus, says lupus patients have been directly affected by Covid-19 because there is a shortage of the drugs they require.



In April 2018, South African media entrepreneur Zola Brunner was only a month away from celebrating her 25th birthday when she received a life-changing phone call. Around noon, her rheumatologist informed her that her test results had returned positive for lupus. The nightmare she had dreaded all along, quickly turned into an earth-shattering reality.



“I was perplexed because it was not a straight diagnosis, I was told my symptoms also resembled that of lymphoma, a cancer of the lymphatic system,” she says.



Lupus is a chronic autoimmune disease causing inflammation and pain in any part of the body. The body’s immune system, which usually fights infections, attacks healthy tissue instead. Commonly affected are the joints, skin and internal organs such as the kidneys and heart.



While anyone can develop the disease, certain people are at a higher risk. This includes women between the ages of 15 to 44, as well as people from certain racial groups and ethnic backgrounds.



“A month later [after the diagnosis], I was sitting in hospital, and had no job,” Brunner says. All the trips to hospital meant she had to resign from a job she loved, as the producer of eNCA’s BackChat, a youth current affairs TV show.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="1024" height="693" src="https://www.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-1024x693.jpg" alt="" class="wp-image-46042" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-1024x693.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-300x203.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-600x406.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671-768x520.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/2-e1592210720671.jpg 1116w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /><figcaption>Zola Brunner working from her hospital room. Photo supplied.</figcaption></figure>



She then made a decision to turn her pain into purpose.



In July that year, she started BeyondLupus, an advocacy page that has attracted a following of over 5,000 people around the world.



“I started it for two reasons. Firstly, I did not know anyone personally that had lupus and I wanted to relate to others. And secondly, I am a story-teller at heart and wanted to use this platform to give other lupus warriors the freedom to share and read each other&#8217;s experiences,” says Brunner.



Covid-19 impact on lupus patients



As Covid-19 turns the world on its head, those with low immunity need to be extra-vigilant as they are more susceptible to contracting the coronavirus.



For patients with autoimmune conditions such as lupus and rheumatoid arthritis, the pandemic has also brought with it another major problem: the reduced availability of the drugs used to treat them.



In March, US president Donald Trump was embroiled in controversy when he tweeted that “hydroxychloroquine and azithromycin, taken together, have a real chance to be one of the biggest game-changers in the history of medicine… hopefully, they will both be put in use immediately”.



Dr Joyce Ziki, a specialist rheumatologist in Johannesburg, says that plasmoquine/chloroquine, used for the treatment of lupus, is one of the drugs “that has been thought to prevent and or cure Covid-19 in conjunction with other drugs”.



“Plasmoquine/chloroquine was being used for prevention and treatment of patients with Covid-19 and hence it became unavailable in pharmacies in South Africa. Many patients with lupus or rheumatoid arthritis could not get the drug. The situation was worse in late March until May. Supplies are beginning to improve now,” she says, further adding that information regarding its efficacy in the management of patients with Covid-19 is currently controversial and inconclusive as studies are ongoing.



“Many members of the BeyondLupus community have come to me to tell me that they have been directly affected because there is a shortage of supply for [the drugs] and they are upset,” Brunner says.



As a result, BeyondLupus published a petition to put forward in collaboration with the Lupus Foundation of South Africa concerning the stockpiling of the drugs to the South African Health Products Regulatory Authority (SAHPRA).



Brunner says SAHPRA responded saying they would keep aside the plasmoquine/chloroquine medicine specifically for lupus patients.



“If you want to ensure that your medication supply is on track, you can message them or email them and they will make sure that they store it,” offers Brunner.



In a web statement, Dr Boitumelo Semete-Makokotlela, CEO of the South African Health Products Regulatory Authority (SAHPRA), urged pharmacies to effectively manage the access to chloroquine containing products and limit any possible stockpile as “it could have important negative public health consequences”. Semete-Makokotlela further stated that the benefits as well as the potential risks of the use of chloroquine as a treatment in patients with coronavirus, are still being investigated.

How Lupus Patients Are Being Impacted By Covid-19

Kenya is perhaps one of the quieter domains of the global Covid-19 pandemic. However, as its hold intensifies across the country, Kenyans, from all walks of life, have found themselves not only preparing for the worst but also taking stock of the impact it has already had on their lives. 



By his own admission, Musa Esevwe, a 49-year-old sculptor and entrepreneur, had never, in his life, experienced trouble with his sleep. That is until Covid-19 arrived in his hometown, Nairobi, in mid-March.



Within the space of a week, a national curfew was announced via Presidential address. Not long after, as confirmed cases jumped to 91, a partial lockdown was imposed around the Nairobi Metropolitan Area, restricting the movement of people in to, and out of, the city.



Travel was tightly regulated and international flights temporarily suspended. The few who do manage to make it to the country, by road or sea, must endure a mandatory two-week quarantine, at the border, before they can obtain official approval to proceed to their final destination.



Meanwhile, inside Kenya’s borders, lives changed overnight. Intensive lockdown measures severely hampered trading for both informal vendors and businesses, causing upheaval in some areas. In April, small business owners clashed with police over the forced closure of their establishments, in Nyeri, a busy provincial hub in Central Kenya.



Schools have been shut since March and, while official numbers are yet to be published, thousands have lost their jobs and livelihoods. Those, still fortunate to be in employment, have had to transform their homes into offices.



“It is like a very bad dream that we are living in now. The happiness and security we once had has gone&#8230; we are no longer dreaming, even for those who can still sleep,” says Esevwe whose own business, which was heavily dependent on the disposable income of the middle class and occasional tourists, has been destroyed by the pandemic.



Along with Esevwe, among the hardest hit are the nation’s families, who, for months now, have been confined to their houses.



The lockdown period has been particularly difficult for Kamweti wa Mutu, an international development professional and amateur nature photographer, living in Nairobi. Currently out of work, and with his wife, now the family’s sole breadwinner, stationed in Tanzania, he’s had to play multiple roles to keep his household afloat.



“The quarantine order [on March 13] was sudden, but commendably prompt, meaning it was a somewhat tough transition getting our two children; Charlie, 11, and Adia, 8, settled into home-schooling routines. After a week, we [had to] put our house-help on leave, with some pay, so as not to place [any] undue risk on either her or us,” he says.



Prior to the pandemic, Mutu was actively looking for work. However, the economic turmoil set off by the virus is now a cause for concern.



“I have struggled to find full-time employment for a while [now] but my family has been very supportive with understanding and prayers. The kids have a good grasp of this, in light of the pandemic, but it’s not [yet] getting them anxious. As a household currently on one income, this aspect is a grave one. Most worrisome is my wife losing her post [because of the pandemic], or worse, one of our family members falling ill,” he continues.



Perhaps the most traumatic impact of Covid-19 on the family is their separation. With travel into Kenya currently restricted, Mutu’s wife won’t be able to return until her consultancy with an environmental organization in Tanzania concludes.



When she does, it will probably have to be by road as international flights are suspended. After crossing the border, she’ll have to spend 14 days at a quarantine center, receiving a special permit to enter Nairobi only once she tests negative for the virus.



While this has added an extra layer of anxiety to their situation, the family is choosing to focus on the bigger picture, insists Mutu.



“We have talked a bit about this, and what it would mean for a normal life, even beyond the current situation. However, we have not delved deeply into worst-case scenarios other than how Covid-19 is devastating other families and societies. We have stocked up on enough essentials including non-perishable foodstuffs, water, face-masks, and power to last us a while.”



Elsewhere in the city, Sophie O, who asked that we change her name for this report, is also finding life under lockdown a challenge. The 30-year-old Marketing Manager works for a major multinational in Nairobi and is doing her best to adapt to the ‘new normal’ of being based from home.



“It&#8217;s been quite difficult especially because I have three children; a nine-month old, a two-year-old and a six-year-old. It’s been hard for the two-year-old to understand that I am ‘at work’, he keeps barging into [work] calls and expecting us to play. Now, I have to keep my camera off during conference calls although ideally, as a standard, it would have to be on,” she says.



With schools now closed, and most students across the country taking classes virtually, many parents, especially those with younger children, are burdened with the added responsibility of home-schooling. In this, Ms O admits that she is struggling.



“Personally, I’ve really done my best just keeping track with all the lessons they have to do. I think probably if I didn’t have to be ‘at work’, I could have done a better job in terms of being there for my daughter but it’s quite a challenge. You have to work because work pays the bills and work also pays the school fees,” she says.



Factors, firmly out of her control, are also impacting her productivity.



“The practicalities of working from home, like having a workstation, I have had to figure out. But with the internet&#8230; some days it’s good, some days it’s bad, and some days you have a blackout and there’s nothing you can do!” she laments.



The experience of both these families hints at the wider setbacks being faced by businesses and the Kenyan economy, as a whole. From Nairobi, Edwin Macharia, Global Managing Partner at multinational advisory firm, Dalberg Advisors, has been leading a fortnightly webinar series advising African leaders and policymakers on how best to respond to the ongoing crisis. He insists that they must appreciate the severity of the pandemic’s impact and act accordingly.



“Our job [on the webinar] is to make sure that [leaders] are sufficiently shaken and begin acting appropriately. China bought the world a couple of weeks to prepare and get ‘ahead of the curve’ in terms of intervention but, unfortunately, that jolt wasn’t hard enough in some places. This is very quickly moving from being a health concern to actually being an economic concern,” Macharia warned attendees in early April.



At the time, despite relatively low levels of confirmed cases, African economies were already feeling the pinch with stock markets plummeting and currencies devalued. A few weeks later, as the threat escalated, the UN Economic Commission for Africa (UNECA) declared that a funding gap of $100 billion needed to be filled in order for governments to battle the pandemic, and its consequences, across the continent.



“The long-term economic effects will become more apparent in the coming months. Inputs not available locally will be inaccessible due to tighter border controls, while markets, for producers serving several industries, will be diminished, leaving many households without a sustainable income,” predicts Macharia.



If they are to have any hope of success, Macharia emphasizes that responses to Covid-19 in Africa will have to be a collaborative effort.



<figure class="wp-block-gallery columns-1 is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex"><ul class="blocks-gallery-grid"><li class="blocks-gallery-item"><figure><img loading="lazy" decoding="async" width="1024" height="890" src="https://www.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-1024x890.jpg" alt="" data-id="46114" data-full-url="https://www.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-scaled.jpg" data-link="https://www.forbesafrica.com/?attachment_id=46114" class="wp-image-46114" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-1024x890.jpg 1024w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-scaled-300x261.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-scaled-600x522.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-768x668.jpg 768w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-1536x1335.jpg 1536w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/Edwin-Macharia-Global-Managing-Partner-at-Dalberg-Advisors-2048x1781.jpg 2048w" sizes="auto, (max-width: 1024px) 100vw, 1024px" /><figcaption class="blocks-gallery-item__caption">Edwin Macharia, Global Managing Partner at Dalberg Advisors</figcaption></figure></li></ul></figure>



“Flattening the curve demands that governments, institutions, and business leaders are intentional in how they implement their response strategies. Organizations will need to go beyond [their] usual business continuity planning while the public sector needs to re-model institutions in order to slow down the current trajectory of infections while ensuring long-term resilience.”



An example of these wider response strategies are already at work in a number of Kenyan hospitals. Dr Michael Mwachiro, Secretary-General at the Surgical Society of Kenya, is currently stationed at Tenwek Hospital, a faith-based teaching and referral hospital in Bomet County, 230 kilometers west of Nairobi. On May 13, the county recorded its first Covid-19 fatality, at Longisa Hospital, the only public referral hospital in the area.



<figure class="wp-block-gallery columns-1 is-cropped wp-block-gallery-2 is-layout-flex wp-block-gallery-is-layout-flex"><ul class="blocks-gallery-grid"><li class="blocks-gallery-item"><figure><img loading="lazy" decoding="async" width="335" height="502" src="https://www.forbesafrica.com/wp-content/uploads/2020/06/thumbnail_PHOTO-2020-06-16-13-12-13.jpg" alt="" data-id="46121" data-full-url="https://www.forbesafrica.com/wp-content/uploads/2020/06/thumbnail_PHOTO-2020-06-16-13-12-13.jpg" data-link="https://www.forbesafrica.com/life/2020/06/15/covid-19-in-kenya-we-are-no-longer-dreaming/attachment/thumbnail_photo-2020-06-16-13-12-13/" class="wp-image-46121" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/06/thumbnail_PHOTO-2020-06-16-13-12-13.jpg 335w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/thumbnail_PHOTO-2020-06-16-13-12-13-300x450.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/06/thumbnail_PHOTO-2020-06-16-13-12-13-200x300.jpg 200w" sizes="auto, (max-width: 335px) 100vw, 335px" /><figcaption class="blocks-gallery-item__caption">Dr Michael Mwachiro, Secretary-General at the Surgical Society of Kenya</figcaption></figure></li></ul></figure>



“We’re now seeing more community-transferred cases in Kenya. I think the advantage that we may have had [compared to] other parts of the world is that we were watching as things were unfolding and, because of that, we had a bit more time to prepare [as a country], and put some measures in place. But if you read the news, or listen to the radio, you’ll hear people complaining that we should have intervened earlier but that’s a difficult thing [to do] if you look at how many stakeholders are involved along with the nature of our economy and public health system,” he says.



Part of these preparations, Mwachiro says, included immediately training the country’s health workers on Covid-19 procedures along with introducing measures preventing the movement of people from hotspots in major cities into rural Kenya, where a bulk of the population lives.



“Nairobi and Mombasa already have containment measures in place. The bigger concern is that, if Covid-19 moves out of the cities to other parts of the country, the effects would be much scarier. These [rural] areas are where the older people are, who are much more vulnerable.”



In addition to the supplementary training for medical personnel, some elective procedures and non-essential surgeries have been put on hold so that all available resources can be committed to fighting the virus at hospitals. However, besides preparedness, maintaining the morale of doctors and nurses will continue to be an ongoing concern throughout the crisis.



“We’ll have to deal with the levels of anxiety and motivation experienced by healthcare workers and first responders taking care of these patients. Doctors and nurses are human, too, and they are experiencing the same emotions as everyone else. You can imagine that, in as much as [their] families are worried about them, they, too, are also worried about their families, and themselves, as well,” he says.



Some medical professionals responding to the crisis, in parts of the country, have had to make the difficult decision to live apart from their families as they work to contain the virus. But the taxing nature of their work, coupled with extended periods of isolation, means that counseling and support services will need to be made available to them as the cases continue to rise.



<blockquote class="wp-block-quote is-layout-flow wp-block-quote-is-layout-flow">&#8220;We’ll have to deal with the levels of anxiety and motivation experienced by healthcare workers and first responders taking care of these patients. Doctors and nurses are human, too, and they are experiencing the same emotions as everyone else. You can imagine that, in as much as [their] families are worried about them, they, too, are also worried about their families, and themselves, as well.&#8221;</blockquote>



As it stands, Kenya, like most of the continent, has not been as badly hit when compared to epicenters in Europe or North America. However, this may be due to the fact that the worst is still on its way. In May, the World Health Organization estimated that up to 190,000 Africans may be killed by the pandemic, at its peak.



With Covid-19 due to exert immense pressure on our public health systems, it does offer some important lessons for the future, explains Mwachiro.



“What this outbreak has brought about, for us in Africa, is [the fact] that we need to invest more in our healthcare systems. This has been said so many times&#8230; there have even been a number of strikes [in Kenya] by various stakeholders, all of them trying to highlight these issues. This is a good wake up call. I honestly believe that, if we had spent more on health [before the crisis], it would have gone a long way in helping us to be better prepared. Hopefully, once this [pandemic] resolves, we can keep the momentum going and we can continue looking inwardly for solutions.”



Naturally, Covid-19, with its grim predictions and disruption of lives, has many Kenyans worried about the future. Nevertheless, the challenges of the moment are being met in stride. Families have quickly adjusted to new ways of living while their leaders seek sage advice on how best to address the crisis, and doctors continue to make sacrifices, day in and day out, as they brace for the worst.



Perhaps, most important of all is that, in the pandemic’s wake, hope has become an obstinate presence in all quarters of Kenyan society.



– Marie Shabaya

Kamweti wa Mutu with his two children; Charlie, 11, and Adia, 8, with their Golden Retriever, Nalia, pictured at their home in Nairobi

Covid-19 In Kenya: ‘We Are No Longer Dreaming’

Equity Group Foundation, with support from Equity Bank, Mastercard Foundation, and the family of Dr James Mwangi, commit Ksh1.1 billion to support Kenya’s immediate needs to protect frontline medical staff.



Perhaps the most gratifying aspect of the coronavirus pandemic has been the concerted effort between corporates and individuals to forge partnerships and collaborations driven by a common purpose.&nbsp;



The Equity Group Foundation (EGF) and Mastercard Foundation are the latest in the line of big names pledging their robust support to help beat the pandemic in Africa.



They have just announced a commitment of Ksh1.1 billion to provide Personal Protective Equipment (PPE) to frontline medical staff dealing with Covid-19 patients in public hospitals in Kenya.



Equity Bank (with Ksh300million), and the Mastercard Foundation (with Ksh500million), a long-time partner of EGF, are providing support as part of their Mastercard Foundation Covid-19 Recovery and Resilience Program.



The funding also includes a donation of Ksh300million from the family of Dr. James Mwangi, the Founding Chairman of EGF and Managing Director and Chief Executive Officer of Equity Group Holdings Plc. EGF will work in partnership with the Ministry of Health and the Covid-19 Emergency Response Fund in this endeavor.



Mwangi, also FORBES AFRICA’s Person of the Year&nbsp;in 2012, says about the initiative: “It started when my attention was drawn to a group of students and doctors who were raising funds for PPEs for young post-graduate students, especially in Kenyatta National and Referral Hospital (KNH).”



A member of Kenya’s Covid-19 Emergency Fund Board, he adds: “We invited the CEO of the Kenya Medical Association and a group of doctors from KNH and University of Nairobi where we established the need for PPEs for medical staff handling Covid-19 patients in the country. A team of seven was formed to help structure this initiative.”



This initiative will be to ensure availability of PPEs across the country as also scale up a mental wellness support system for medical staff.



Reeta Roy, President and CEO of the Mastercard Foundation says: “Healthcare workers are at the frontlines of caring for all of us, safeguarding community health. We must keep them safe. We are grateful this partnership meets the immediate needs precipitated by Covid-19, which the Foundation is prioritizing through our Mastercard Foundation Covid-19 Recovery and Resilience Program.” “We will endeavor to continue with our engagement and mobilization of our partners to extend our partnership towards procurement of diagnostic kits. We believe there is a chance for every Kenyan to get the support they require to overcome the Covid-19 infection,” concludes Mwangi.

49651099816_09e7ec6872_o

Big Names Back Covid-19 Response In Kenya

By Paul Polman, Siddharth Chatterjee and Myriam Sidibe



The United Nations (UN) Secretary-General Antonio Guterres has said that now is “a defining moment for modern society.  History will judge the efficacy of the response not by the actions of any single set of government actors taken in isolation, but by the degree to which the response is coordinated globally across all sectors for the benefit of our human family.”



Governments, the private sector and development institutions need to come together in innovative ways not just to flatten the curve of infection and mitigate the economic disruption, but also to prepare for the new normal of the post-Covid world in Africa and the rest of the world. &nbsp;Greater partnership between the public and private sectors is going to be critical. The fight to flatten the coronavirus curve is an acid test for stakeholder capitalism and especially for multilateralism.



As Covid-19 continues to spread sickness and death, Africa has so far escaped the worst effects. The continent’s lagging healthcare infrastructure, however, makes it highly vulnerable if the virus reaches the high-velocity community transmission we have seen in Italy, Spain and New York.&nbsp; Not only are health systems delicate, but crucial medical supplies are far from sufficient, and social protection as a whole is weak.



With the health crisis also becoming an economic and soon a social crisis, the continent is under siege.&nbsp; Many companies are struggling through the economic slowdown, with tourism and smaller enterprises the most challenged. With bankruptcy and job losses looming, many families are already reducing spending and consumption.&nbsp; In the absence of significant fiscal stimulus – which few African countries can afford anyway – some projections are cutting the continent’s GDP growth in 2020 by as much as eight percentage points.



No one knows for sure what is ahead, with scenarios changing daily as new information comes through. Many firms are focused on business continuity, employee safety and simply survival and lack the luxury of assisting external stakeholders. But it’s time for an all-hands-on-deck response, both to flatten the curve of infections and keep businesses resilient, and to be ready to restart as physical distancing ends.&nbsp; More than ever before, the private sector needs to deploy its full capabilities to innovate and bring positive, sustainable change – to help secure strong markets in the future.



There are several areas where private sector support is essential. Current priorities include unified communication platforms to enable populations to practise the needed preventative behaviors (washing hands, wearing masks, and practising physical distancing), as well as managing stocks of essential materials, test kits, ventilators and oxygen and PPE. Support would also include protecting the most vulnerable people from the economic effects of the pandemic, especially where curfews are enforced.



This is also a unique opportunity to challenge sceptics, in both the not-for-profit and for-profit sectors, with a new blueprint of collaboration. The World Health Organization has issued guidelines on engaging the private sector as part of a whole-of-society response to the pandemic and has signed an iconic partnership with the International Chamber of Commerce. The African Union and the Africa Centres for Disease Control and Prevention have also launched a public-private partnership known as the Africa Covid-19 Response Fund, which raises resources to prevent transmission and support sustainable medical responses.



In Kenya the national government has led the charge in fighting Covid-19 by rapidly scaling up a large array of public health interventions and putting into force social interaction rules. To complement the government’s preparedness and response efforts for the next six months, the UN, together with humanitarian non-governmental organizations launched a flash appeal seeking over $267 million to respond to the critical needs of 10 million of the country’s most vulnerable people.&nbsp;



So far, the pandemic has not been the finest hour for international cooperation. But the role of the UN and the private sector have never been more critical as an enabler of multisectoral partnerships for deliveries, and also to keep the focus on the most vulnerable that these partnerships need to reach. &nbsp;



In Kenya, and under the leadership of the government, the UN has built a model to catalyze public-private action: the SDG Partnership Platform. It is a tested instrument for engagement that has brought together a variety of private players in previous initiatives to co-create and rapidly deploy, with government, large-scale shared-value solutions to address the challenges our societies and the planet are facing. It is through such a mechanism, for example, that the UN mobilized the private sector to carry out a maternal mortality reduction campaign in Kenya’s northeastern counties, one that was recognized as a global best practice.



Kenya’s<a href="https://www.covid19businessresponse.ke/"> National Business Compact on Coronavirus</a>, a gathering of companies aimed at accelerating local action and supporting governmental efforts against the pandemic, got successfully off the ground with the help of the UN SDG Partnership Platform, and champions from private sector and civil society. &nbsp;



The Kenyan model of cooperation could take shape all over Africa. Such models allow governments to foster an ecosystem of purposeful partnerships; to amplify private-sector philanthropy, corporate social responsibility and policy advocacy for national mitigation; and to accelerate shared-value partnerships. It also allows the UN to play its role as a neutral broker, and steer a much-needed balance between lethargic action on one hand and misdirected reactions on the other.&nbsp;



This may well be the blueprint needed to fight the next global pandemic, whose speed and fury could surpass what we are witnessing now.



– <a href="https://twitter.com/PaulPolman">Paul Polman</a> is co-founder of IMAGINE, Chair of the International Chambers of Commerce and former CEO of Unilever; <a href="https://twitter.com/sidchat1?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor">Siddharth Chatterjee</a> is the UN Resident Coordinator of Kenya and <a href="https://twitter.com/Myriam_Sidibe">Myriam Sidibe</a> is a Senior Fellow at Mossavar Rahmani Center for Business and Government at Harvard Kennedy School.

Myriam Sidibe, Siddharth Chatterjee, and Paul Polman join Kenya’s First Lady Margaret Kenyatta, in Nairobi, Kenya at an event; Photo supplied

Op-Ed: How Multilateralism Through Public-Private Partnerships Is Key To Flatten The Curve

Arnon Rosan manufactures giant Lego-like building blocks, which can be converted into furniture or walls for offices, classrooms, and military training operations. They’ve been used to build a life-sized ice castle in New York City’s Bryant Park and a 17-foot-tall menorah in Washington, D.C. But now his company, EverBlock Systems, is sending truckloads of plastic blocks and interlocking wall units from New York to Louisiana to build a temporary hospital for coronavirus patients.



“We don&#8217;t wish for disaster, certainly,” Rosan says of the virus sweeping the country. “But we&#8217;re happy to be able to respond with something that we know people need and solves the problem quickly and efficiently.”&nbsp;



State and federal governments and health systems across the United States are scrambling to find space to treat patients as coronavirus cases have quickly overwhelmed emergency rooms and ICUs. Convention centers and arenas from Los Angeles to Philadelphia are being transformed into temporary hospitals, as are outdoor spaces, such as New York City’s Central Park.Today In:&nbsp;<a href="https://www.forbes.com/healthcare">Healthcare</a>



The one thing all these places have in common? “They have enough room to set up safe and appropriate working environments for the medical staff &#8230; and the equipment and supplies that are needed,” says Dr. Irwin Redlener, Director of the National Center for Disaster Preparedness at Columbia University.&nbsp;



For his part, Rosan is busy working to fulfill an order to build 2,000 patients pods and 130 nurses stations for the field hospital under construction inside the Ernest N. Morial Convention Center in New Orleans.



Louisiana-based Dynamic Construction Group, the primary contractor on the hospital project, tapped EverBlock on March 26 to provide its products. At that point, Rosan had a head start: there were nearly a thousand wall panels and 60,000 blocks in his company’s warehouse ready to load onto the 53-foot trucks that would take them down to New Orleans. But he’ll need to provide a lot more. Rosan estimates the total project will require close to 6,000 panels and 150,000 blocks. In addition to 13 full-time employees, he’s recently hired 9 temporary workers to help scale up production at the company’s manufacturing facility and warehouse in the Bronx.&nbsp;



“We&#8217;re being asked to deliver a year&#8217;s worth of product in one month,” says Rosan. Though his usual orders have dried up, he’s already expecting EverBlock’s revenues to more than double from an expected $7.5 million to more than $20 million by the end of this year. The convention center contract alone will likely come in well above $10 million, he says.&nbsp;



This isn’t Rosan’s first time supplying material for disaster relief projects. His previous company Signature Systems Group, which he founded in 1999, manufactured temporary floor and roadway systems that could gain access to remote sites, such as oil rigs. Rosan says he supplied modular floors for tents used by the National Guard following Hurricanes Katrina, Ike and Sandy. He also worked on the flooring for a tent project for the World Food Programme in Haiti after the earthquake.&nbsp;



In 2013, he sold Signature Systems Group to a private equity firmand was looking for something new to keep busy. He declined to disclose the deal price, but said at the time of the sale, the company had around $90 million in revenue. His current company began as a side project — the idea for developing the company’s giant blocks came from his kids. But when customers began to realize their potential, the company took off.&nbsp;



“People seem to just engage and resonate with this concept of ‘Wow this oversized building block. I can build anything,” he recalls.



<figure class="wp-block-image size-large"><img loading="lazy" decoding="async" width="960" height="669" src="https://www.forbesafrica.com/wp-content/uploads/2020/04/Everblock-again.jpg" alt="" class="wp-image-43978" srcset="https://cms.forbesafrica.com/wp-content/uploads/2020/04/Everblock-again.jpg 960w, https://cms.forbesafrica.com/wp-content/uploads/2020/04/Everblock-again-300x209.jpg 300w, https://cms.forbesafrica.com/wp-content/uploads/2020/04/Everblock-again-600x418.jpg 600w, https://cms.forbesafrica.com/wp-content/uploads/2020/04/Everblock-again-768x535.jpg 768w" sizes="auto, (max-width: 960px) 100vw, 960px" /><figcaption>Inside the Ernest N. Morial Convention Center in New Orleans.  EVERBLOCK SYSTEMS</figcaption></figure>



EverBlock is delivering the walls and blocks that make up the tented structures in which patients will sleep. Each pod is an individual chamber that will have its own ventilation duct to ensure that patients with different viral loads are kept separate. Dynamic Construction is working on the ventilation, electrical and all of the other construction components needed to make the temporary hospital function.&nbsp;



“These beds will be for patients who are not fragile. They don’t need to be on a ventilator, they don’t need an ICU bed, but they still need to be hospitalized,” Louisiana’s Democratic Governor Jim Bel Edwards said earlier this week at a press conference outside the convention center. While the original plan had been to care for 1,000 patients at the facility, Edwards had to quickly double that number a few days later in response to the surge in patients. The goal now is to have 1,000 beds set up by early next week and the full 2,000 beds by April 20.&nbsp;



“My philosophy is when these things happen, you have to react in real time,” Rosan says. “That&#8217;s something that we&#8217;re just really good at — that quick rallying of resources to make it happen.”



&#8211;<a href="https://www.forbes.com/sites/katiejennings/">Katie Jennings</a>, Forbes Staff, Healthcare

Everblock Systems

This Entrepreneur Built Tent Floors After Hurricane Katrina. Now He’s Building A Pop-Up Coronavirus Hospital

As the COVID-19 coronavirus makes its way around the world, it’s increasingly likely that people will be exposed to the virus, which can resemble other flus and colds but — becomes increasingly dangerous as it gets more severe.&nbsp;



Here’s a quick guide to COVID-19 symptoms, what to do if you have symptoms, and when you should see a doctor. It can take 2-14 days for symptoms to actually appear after exposure to the disease,&nbsp;<a href="https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html" target="_blank" rel="noreferrer noopener">according to the Centers for Disease Control</a>, and when symptoms do appear, they tend to start gradually and become worse.



The main symptoms to look out for are:&nbsp;



<ul class="wp-block-list"><li>Fever</li><li>Shortness of breath</li><li>Coughing, usually dry (meaning little or no phlegm)</li></ul>



The World Health Organization adds that&nbsp;<a href="https://www.who.int/news-room/q-a-detail/q-a-coronaviruses" target="_blank" rel="noreferrer noopener">less common symptoms</a>&nbsp;may also include “aches and pains, nasal congestion, runny nose, sore throat or diarrhea.”&nbsp;&nbsp;



As you may have noticed, these symptoms apply to many other diseases as well. It’s impossible to tell whether you have COVID-19 without a test, and in some areas, there’s a shortage of tests. In the United States, the CDC is&nbsp;<a rel="noreferrer noopener" href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html" target="_blank">currently advising doctors</a>&nbsp;to give tests to:



<ul class="wp-block-list"><li>Patients already hospitalized who are showing symptoms</li><li>Patients showing symptoms who have other chronic illnesses that put them at higher risk, such as lung disease, heart disease, or diabetes</li><li>Patients showing symptoms who, within the past 14 days, had been exposed to someone who has a confirmed or suspected case of COVID-19&nbsp;</li></ul>



If you have mild symptoms and aren’t at risk, the CDC&nbsp;<a href="https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html" target="_blank" rel="noreferrer noopener">advises against</a>&nbsp;seeing a doctor.&nbsp; Instead, it recommends that you:&nbsp;



<ul class="wp-block-list"><li>Stay home and avoid public areas.&nbsp;</li><li>Try to separate yourself from the people you’re living with, even to the point of using a different bathroom, if possible</li></ul>



If you belong to a high-risk group, you should call your doctor to discuss what you may need. More advice about what to do when you’re home sick, including tips on cleaning and other care, can be&nbsp;<a href="https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html" target="_blank" rel="noreferrer noopener">found here</a>.



If you have more severe symptoms such as a high fever, shortness of breath, chest pain, bluish lips or a bluish hue in your face, you should see a doctor immediately. If possible, call ahead to your healthcare provider and let them know you’re on your way and suspect the symptoms are related to COVID-19. That enables them to adequately prepare for you and protect both employees and other patients from possible exposure.&nbsp;



One thing to note: right now researchers think it’s possible for people to be contagious with COVID-19 before showing any symptoms. The World Health Organization also notes that some people who are infected never appear to show symptoms or feel unwell, yet are still able to pass on the disease.&nbsp;



So even if you’re feeling healthy, it’s good to follow your local health authority’s&nbsp;<a href="https://www.forbes.com/sites/brucelee/2020/03/14/with-covid-19-coronavirus-here-are-10-ways-to-social-distance-yourself/#2caf43e9606c">guidelines about social distancing</a>&nbsp;in order to&nbsp;<a href="https://www.forbes.com/sites/tarahaelle/2020/03/13/why-everything-is-closing-for-coronavirus-its-called-flattening-the-curve/#1cef0c656e2b">decrease the risk</a>&nbsp;of spreading the disease further. Also, don’t forget to regularly and thoroughly&nbsp;<a href="https://www.forbes.com/sites/ninashapiro/2020/03/15/soap-and-water-1o1-why-its-best-for-covid-19-and-every-day/">wash your hands with soap and water</a>.&nbsp;



&#8211;<a href="https://www.forbes.com/sites/alexknapp/">Alex Knapp</a>, Forbes Staff, <a href="https://www.forbes.com/science">Science</a>

gettyimages-1205057755-170667a

What Are The Symptoms Of COVID-19 Coronavirus, And When Should You See A Doctor?

Millions of Americans&nbsp;<a href="https://www.nami.org/learn-more/mental-health-by-the-numbers" target="_blank" rel="noreferrer noopener">deal with mental illness</a>&nbsp;each year, and&nbsp;<a href="https://mhanational.org/sites/default/files/2019-09/2019%20MH%20in%20America%20Final.pdf" target="_blank" rel="noreferrer noopener">more than half of them</a>&nbsp;go untreated. As the mental health industry has grown in recent years, so has the number of tech startups offering virtual therapy, which range from online and app-based chatbots to video therapy sessions and messaging.&nbsp;



Still a nascent industry, with most startups in the early&nbsp;<a href="https://www.cbinsights.com/reports/CB-Insights_Mental-Health-Briefing.pdf?utm_campaign=Webinars&amp;utm_medium=email&amp;_hsenc=p2ANqtz-9vLgEn6AfsUf_nXfn8UtBBrkhgfEFm7LsQrRFoI68CJsrXrU-zXKTi8M0sgpMW0unONnbLsAVUe6BO0cr2Vj1A0ZPhQiu4178Y2bOAidtpFApBFyw&amp;_hsmi=55818280&amp;utm_content=55818280&amp;utm_source=hs_automation&amp;hsCtaTracking=8133605e-ef8d-41b5-add2-a79fc7aa7322%7Cf61454a1-0ed7-46eb-87c7-40f56ce494c0" target="_blank" rel="noreferrer noopener">seed-stage funding round</a>, these companies say they aim to increase access to qualified mental health care providers and reduce the social stigma that comes with seeking help.&nbsp;



While the <a rel="noreferrer noopener" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897664/#__sec1title" target="_blank">efficacy of virtual therapy,</a> compared with traditional in-person therapy, is still being <a rel="noreferrer noopener" href="https://www.thecut.com/2016/12/the-potential-danger-in-therapy-apps-like-talkspace.html" target="_blank">hotly debated</a>, its popularity is undeniable. Its most recognizable pioneers, BetterHelp and TalkSpace, have enrolled nearly 700,000 and more than 1 million users respectively. And investors are taking notice.



Funding for mental health tech startups has boomed in the past few years, jumping from roughly $100 million in 2014 to more than $500 million in 2018, according to&nbsp;<a href="https://pitchbook.com/news/articles/a-look-at-the-boom-in-vc-funding-for-mental-health-startups" target="_blank" rel="noreferrer noopener">Pitchbook</a>. In May of this year, the subscription-based online therapy platform Talkspace raised an additional $50 million, bringing its total funding to just under $110 million since its 2012 inception.



The ubiquity of smartphones, coupled with the lessening of the stigma associated with mental health treatment have played a large role in the growing demand for virtual therapy. Of the various services offered on the Talkspace platform, “clients by far want asynchronous text messaging,” says Neil Leibowitz, the company’s chief medical officer.



Users seem to prefer back-and-forth messaging that isn’t restricted to a narrow window of time over face-to-face interactions. At BetterHelp, founder Alon Matas notes that older users are more likely to go for phone and video therapy sessions, whereas younger users favor text messaging.



“Each generation is getting progressively more mobile-native,” says John Prendergass, an associate director at Ben Franklin Technology Partners’ healthcare investment group, “so I think we’re going to see people become increasingly more accustomed, or predisposed, to a higher level of comfort in seeking care online.”



The ease and convenience of virtual therapy is another draw, particularly for busy people or those who live in rural areas with limited access to therapy and a range of care options.



Alison Darcy, founder and CEO of Woebot, a free automated chatbot that uses artificial intelligence to provide therapeutic services without the direct involvement of humans, says that with Woebot and other similar services, there is no need to schedule appointments weeks in advance and users can receive real-time coaching at the moment they need it, unlike traditional therapy. The sense of anonymity online can also lead to more openness and transparency and attracts people who normally wouldn’t seek therapy.



Along with stigma, the cost of therapy has historically acted as a barrier to accessing quality mental-health care. Health insurance is often unlikely to cover therapy sessions. In most cities, sessions run about $75 to $150 each, and can&nbsp;<a href="https://www.northwesternmutual.com/life-and-money/how-much-does-therapy-cost-and-how-do-you-pay-for-it/" target="_blank" rel="noreferrer noopener">go as high as $200</a>&nbsp;or more in places like New York City. Web therapists don’t have to bear the expense of brick-and-mortar offices, filing paperwork or marketing their services, and these savings can be passed on to clients.&nbsp;



BetterHelp offers a $200-a-month membership that includes weekly live sessions with a therapist and unlimited messaging in between, while Talkspace’s cheapest monthly subscription at $260-a-month, offers unlimited text, video and audio messaging.



But virtual therapy, particularly text-based therapy, is not suitable for everyone. Nor is it likely to make traditional therapy obsolete.&nbsp;“Online therapy isn’t good for people who have severe mental and relational health issues, or any kind of psychosis, deep depression or violence,” says Christiana Awosan, a licensed marriage and family therapist.&nbsp;



At her New York and New Jersey offices, she works predominantly with black clients, a population that she says prefers face-to-face meetings. “This community is wary of mental health in general because of structural discrimination,” Awosan says. “They pay attention to nonverbal cues and so they need to first build trust in-person.”&nbsp;&nbsp;



Virtual therapy apps can still be beneficial for people with low-level anxiety, stress or insomnia, and they can also help users become aware of harmful behaviors and obtain a higher sense of well-being.&nbsp;



Sean Luo, a psychiatrist whose consultancy work focuses on machine learning techniques in mental health technology, says: “This why some of these companies are getting very high valuations. There are a lot of commercialization possibilities.” He adds that from a mental health treatment perspective, a virtual therapy app &#8220;isn’t going to solve your problems, because people who are truly ill will by definition require a lot more.”



Relying on digital therapy platforms might also provide a false sense of security for users who actually need more serious mental-health care, and many of these apps are ill-equipped to deal with emergencies like suicide, drug overdoses or the medical consequences of psychiatric illness. “The level of intervention simply isn’t strong enough,” says Luo, “and so these aspects still need to be evaluated by a trained professional.



&#8211; Ruth Umoh, Diversity and Inclusion Writer, Forbes Staff.

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How Virtual Therapy Apps Are Trying To Disrupt The Mental Health Industry

It’s the worst thing to happen – to anyone.
We meet Natasha Sibanda in Johannesburg’s bustling Central Business District. On the street, the cantankerous crowd has a life of its own, their colorful clothes distinct in the morning light as they move in unison like shoals of fish.
Adjacent to this street is a tiny one-bedroom apartment the size of a matchbox and in grimy grey.
As we enter, a pall of gloom. Sibanda, only 22, lost her husband Samuel four weeks ago in Zimbabwe, his country of birth. Their only son is a year old.
“My husband was 25 years old&#8230; We were in Zimbabwe visiting family when he suddenly fell ill. We went to the hospital where they gave us a list of all the items they needed in order to help him. We had to buy all of them [with] cash at a pharmacy before they could treat him,” she says, as a lone tear rolls down her cheek.
The items totaled a bill of $300, which they didn’t have. Her sister, working in South Africa, promised to send the money the following day.
“I pleaded with the hospital to help him while we looked for the money because we both lived in Zimbabwe and had no jobs but they said his condition wasn’t serious and we had to come back when we have money because the hospital didn’t have any of the medicines needed.”
Heartbroken and worried, Sibanda took her husband home.
The night was going to be long.
At about 2AM, Samuel started vomiting. She took him back to the hospital where he was declared dead on arrival.
“I’m still not sure what killed him but I’m hurting because doctors wanted to help him but couldn’t because they didn’t have medicines and now he is dead and my son has no father,” sobs Sibanda.
Her story is only one of many painful parallels in some of Africa’s developing economies with poor – and crippling – healthcare systems.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/healthcare-got-available-everybody/" target="_blank" rel="noopener">READ MORE: ‘Healthcare Has Got To Be Available To Everybody’</a>
“You don’t want to fall ill in Zimbabwe. It’s like a backyard garage where you bring all your car parts for your vehicle to be fixed. If you have no cash, you can’t be treated,” says Mthokozisi Khuphe, a former government nurse.
Khuphe worked for government for eight years before moving to the private sector and then migrating to work in Namibia.
“When I started, there was already a crisis. I remember there was a big strike and a lot of people resigned. We, the new junior staff, had to work on everything even though we were just starting out. I would have 120 to 150 patients in a day [who] I had to help by myself,” says Khuphe.
He says Zimbabwe’s healthcare system was and still is putting patients’ lives at risk.
“Many patients lost their lives. I remember sometimes there would be no syringes, and needles were in shortage. We would reuse them repeatedly on the same patient when in fact you are supposed to use one and dispose it off immediately&#8230; There was even a time the whole hospital had one ventilator&#8230; As a nurse, it is difficult to know what can help the patient but you don’t have the equipment and the patient dies.”
Zimbabwe is not alone. Africa’s public healthcare sector is in the intensive care unit.
Although the situation is not as terrible as in Zimbabwe, the World Bank and World Health Organisation issued a report on universal healthcare in the world in December, where South Africa received a score of 70 out of 100 for Universal Health Coverage. (The National Health Service (NHS) in the United Kingdom (UK) scored 90.)
The report stated that the poor quality of healthcare in the public sector was concerning.
Jasson Urbach, a director of the Free Market Foundation and head of its Health Policy Unit says the situation is dire. There are pervasive problems with the quality of healthcare in the public sector.
“The healthcare system is a sea of mediocrity in the government-run healthcare sector, punctuated by islands of excellence in the private healthcare sector. Currently all political will is aimed at implementing National Health Insurance (NHI) [free health for all] and nothing is being done to address the current issues of pervasive poor quality in the public sector,” he says.
According to Urbach, the NHS in the UK employs 1.3 million people to service 55 million UK residents, yet the entire South African civil service employs 1.3 million people.
“To think that South Africa can run a government administered Universal Health Coverage system such as the National Health Service is unrealistic.”
He says the poor quality of services in the public sector is the single greatest challenge in South African healthcare.
“If the quality is not addressed, 70 percent of public facilities will not qualify to contract with the NHI, if it gets implemented, which will collapse service provision in the healthcare system altogether. Poor quality is not the result of shortages of funding; it is the result of poor management,” he says.
It is true.
According to inspection records published by the Office of Health Standards Compliance, a government agency in South Africa, hospitals and clinics in the government’s flagship NHI pilot program are failing to improve any faster than those in the rest of the country.
<a href="http://www.forbesafrica.com/uncategorized/2018/04/03/death-denial-fear-listeriosis-cost-south-africa/" target="_blank" rel="noopener">READ MORE: Death, Denial And Fear: What Listeriosis Cost South Africa</a>
Among the 1,427 facilities inspected, only 89 scored a pass mark of 70% or more. Facilities fell short on matters ranging from the availability of medicines to infection control.
“As an example, there are contracts with cleaning services in place in all public facilities, or cleaners are employed. If a facility is not considered clean, that is a management failure. Poor systems and processes lead to undue delays in treatment. Incompetent political managers at the provincial level, leads to incompetent appointments at hospital levels, which leads to failure of the system,” says Urbach.
Patients in South Africa’s public hospitals are dejected.
Results cited in the General Household Survey 2015 suggest healthcare received from the private sector is significantly preferred to that from the public sector, and states that users of private healthcare facilities seem to be more satisfied with those facilities than users of public healthcare facilities, across all provinces.
“Whereas 97.7 percent of users were satisfied with private facilities (91.9 percent were very satisfied), only 81.1 percent of users of public healthcare facilities were somewhat satisfied or very satisfied. Only 57.6 percent of individuals that used public healthcare facilities were very satisfied,” states the report.
According to Urbach, another problem is that the government does not have the same incentives as the private sector. It partly explains why there are poor healthcare outcomes in the public sector.
Dr Matthew Adams, a surgeon at one of the big public hospitals in South Africa, agrees with Urbach.
“Private hospitals pay two to three times more than government and they have better working conditions compared to us&#8230; essential machine breakdown and fixing them is delayed, and tenders to supply certain things are given to people who can’t deliver on time which always sets us back,” he says.
That’s not all.
Adams says hospitals are understaffed and they have to work long hours and there is misadministration by hospital management.
“[The] department says there is no more money for new doctors but not enough monitoring is done on how much is spent per patient and measures aren’t taken to see how we can save the hospital money&#8230; Hospitals are actually set up in a hierarchy, so that the first place a patient goes to is a clinic before a hospital for day-to-day assistance, but because of low quality, patients overlook lower level health centers to go to hospitals and doctors see cases they are not supposed to see adding to doctor frustration,” he says.
Frustration leads to doctors leaving the public sector for the private sector, or leaving the country altogether.
“The last time I saw statistics [about the number of doctors leaving] was in 2005 when the Health Professions Council of South Africa reported that despite the fact that medical schools produced approximately 19,500 graduates between 1990 and 2005, their records show only 9,304 new registrations during this period. This implies that a significant number of individuals, after graduating, instead of practising in South Africa, are leaving the country,” says Urbach.
Among the common reasons cited for the mass exodus of skilled healthcare personnel from the public sector are poor salaries, high workloads, poor work environments and few opportunities for advancement.
According to Liz Still, who compiles the annual Health Care in South Africa publication, the public sector does not have enough posts available to employ South Africa’s health professionals. For example, over the period 2002-2010, approximately 11,700 doctors graduated but only 4,403 posts were created in the public sector. In the field of dentistry, there were 2,140 graduates but only 248 public posts were concurrently created.
These conditions impact the quality of care.
According to various reports, last year, South Africa’s Health Minister, Aaron Motsoaledi, said more than 5‚500 medical negligence claims have been made against the health department since 2014. The number of claims grows every year. There were 1‚562 claims made in 2014/15‚ 1‚732 in 2015/16 and 1‚934 in 2016/17.
And it hurts the tax payer.
The department paid R391.32 million ($32.4 million) in medico-legal claims in 2014/15 alone and a whopping R730.87 million ($60.6 million) in 2015/16.
It is so bad that in 2016/17‚ the total value of claims rose to R1.2 billion ($99.5 million)‚ with Gauteng&#8217;s 521 claims accounting for almost half of this at R566 million ($47 million).
Romany Sutherland, an attorney at LLA INC. Law, says the majority of these cases are due to obstetric damages.
“These are children who suffer brain injury as a result of complications during birth&#8230; South Africa has a 10 percent higher cerebral palsy rate than anywhere in the world and we don’t know why this might be&#8230; To me, as an attorney, it comes down to perhaps people not being trained properly. Nurses are not involving the obstetricians soon enough,” she says.
Cerebral palsy cases cost the government about R17 million ($1.4 million) on average per case.
“Each province deals with the issues differently. I’m in the Western Cape and here; we try and negotiate or mediate these cases as soon as possible so that reasonable pay-outs are made without undue delay. I believe the best way to go with the negligence cases is to take the initiative to open discussion with your opponent,” says Sutherland.
The problem is, some health departments don’t have any decision-makers who have settlement authority. It means all negligence cases have to go before a judge in the court of law before the department can pay out. It takes longer and costs the state more money.
“The litigation process is extremely expensive. The amounts you see reported in the media don’t include costs. It is a big worry because I haven’t gone to court in nine years because I like to negotiate cases and come to reasonable settlement and the Gauteng government doesn’t allow for that to happen,” she says.
According to Sutherland, some costs to take the case through trial can be four times the amount of settlement.
The amount of money that attorneys stand to make on such cases has caused a boom in the medical negligence industry.
“There are attorneys who are touting for clients and some even paying midwives up to R30,000 ($2,500) for a file. There are also some frivolous cases where the negligence did not cause damages&#8230; yet they carry on&#8230; If such cases are settled, it is not the touting attorney’s fault but the department that is not defending those cases properly,” she says.
The rise in lawsuits is also causing medical insurance for obstetricians to rise.
“An obstetrician is currently paying R1 million ($82,830) in insurance. I think the price has gone up by approximately R100,000 ($8,283) if not more every year for the past couple of years&#8230; This is also cause for some medical students to not consider this field because insurance is just too expensive.”
Back in Johannesburg, as we part with Sibanda, she tells us she wants to go back to school to study public healthcare administration so she can help the very hospitals that didn’t give her husband timely treatment. She wants to save lives.
If only government authorities sitting in their airconditioned offices and seeking treatment in plush private hospitals knew her pain and predicament.

Operating theatre in a cardiac surgery ward. Anesthetics.

Would You Seek Medical Care In Africa’s Public Sector?

Twenty eight million. That’s the number of people in Africa who will die from cardiovascular illness, diabetes, and other non-communicable diseases, according to the World Health Organization. That’s 46% of all deaths in Africa by 2030. Half of these deaths, according to a 2017 article in the BMC Public Health journal, are because hospitals aren’t good enough.
“Large numbers of our people continue to die prematurely and to suffer unnecessarily from poor health. Treatable conditions are not being treated on time and preventable diseases are not being prevented,” says South Africa’s Health Minister Aaron Motsoaledi on his department’s website.
It is because times are tough in South Africa. Gross domestic product growth was -0.7% in the first quarter of 2017, while unemployment increased to 27.7%. Medical aid is expensive. It costs about R4,500 ($340) a month, on average, for a family of four. That is almost half of South Africa’s average salary of R10,680  ($815) per month, according to BankservAfrica. It means a mere eight million people, out of 55 million, can afford cover.
To make matters worse, last year, 16 of the top 20 medical aid schemes had to reach into investment funds to stay afloat. It also meant that, this year, scheme members received price increases, on their cover, far higher than consumer price inflation.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/suffering-waiting-wrong-side-divide/" target="_blank" rel="noopener">READ MORE: Suffering And Waiting On The Wrong Side Of The Divide</a>
It is so bad the South African government wants to start National Health Insurance (NHI), the first step to free healthcare for all, by 2025, bankrolled by the tax payer.
The NHI White Paper says the money that people pay for private health should be directed to funding the NHI. According to Paula Armstrong, an economist at Econex, an economic consulting firm, even though medical schemes received about R18.5 billion ($1.4 billion) from a medical scheme tax credit, in 2014/15, redirecting some of this money won’t be enough and it is the poor who are likely to suffer.
“The removal of medical scheme tax credits will affect poorer medical scheme beneficiaries disproportionately. In total, 21.86% (1.9 million in 2016) of medical scheme beneficiaries will move above the affordability threshold with the removal of tax credits. The disproportionate effect on relatively poorer households will need to be considered when evaluating the rationale for removing medical scheme tax credits to help fund the NHI,” she says.
Some medical aid schemes are suffering anyway. Between 2000 and 2015, according to Alexander Forbes, the number of medical aid schemes reduced from 144 to 83. If government presses ahead with free health, they are going to lose out even more.
“I see small schemes consolidating and move into larger risk pools… Bigger pools provide bigger sustainability and that’s where I think we will see smaller schemes suffering, going forward,” says Gerhard Van Emmenis, Principal Officer of South Africa’s second largest open medical scheme, Bonitas Medical Fund.
The big question is how many of these medical aid schemes will survive.
“We do believe, at Bonitas, that we should have both, private medical schemes and NHI. You can’t just destroy or dismantle national assets like medical schemes that have proven over the years that they can contribute to the healthcare industry,” says Van Emmenis.
According to the White Paper, NHI will tackle the most needy first. That is healthcare at schools, childhood cancer, women&#8217;s health, the elderly and the disabled. Most of the people will have to wait.
“For NHI to be a success, collaboration between medical schemes and government is essential. There needs to be agreement on the roles of both players as well as which benefits will be covered by the NHI and which can be offered by the medical schemes.”
<div id="attachment_33740" style="width: 506px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-33740" class=" wp-image-33740" src="https://www.forbesafrica.com/wp-content/uploads/2017/10/Gerhard-Van-Emmenis-Bonitas-e1506931303492-300x199.jpg" alt="" width="496" height="329" />Gerhard Van Emmenis, the Principal Officer of Bonitas. (Photo by Motlabana Monnakgotla)</div>
According to Van Emmenis, specific conditions, such as mental and dental, may not be fully covered by NHI. This is the gap where private schemes could find business. Van Emmenis says medical aid schemes should find a way to work with government, instead of fighting it.
“Primary healthcare might be accessible to everyone, but then there’ll always be a complementary environment with dental benefits and a lot of other things, which is not necessarily life threatening but can improve the quality of your life. You may need packages that will attend to stress, for instance… That’s where we are going to play a part in the future,” he says.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/healthcare-got-available-everybody/" target="_blank" rel="noopener">READ MORE: Healthcare Has Got To Be Available To Everybody </a>
The problem is, there is no clarity on whether people will be allowed to belong to a private medical aid scheme in the future of free health. To make it worse, the cost of the NHI is likely to be heavy, according to Econex. It is expected to increase healthcare costs from R121 billion ($9.2 billion) for the 2015/2016 fiscal year to R256 billion ($19.5 billion) for the 2025/2026 fiscal year. The government argues it is not going to be expensive but Econex says the annual health budget is likely to increase by R200 billion ($15 billion), and not the R108 billion ($8.2 billion) stipulated in the White Paper.
NHI not only faces money problems but also has scarcity at hospitals and a blundering bureaucracy. To add to that, it would use a standard price list that may be cheaper for patients but, in the long term, less rewarding for doctors. Doctors could work longer days for less money and could look outside Africa for work.
“You’d get an orthopaedic surgeon that only works on hands and is a specialist in that… That guy will detect what sort of charges he’ll charge for his services. You can’t just take it away and decide to pay all orthopaedic surgeons the same money. I can promise you which one will be on the first plane leaving the country, it will be the guy who’s a specialist. If a doctor leaves this country today, it takes us at least seven years to replace that doctor,” says Van Emmenis.
The private hospitals that are left will also suffer.
The 2014 National Income Dynamics Study, by the Southern Africa Labour and Development Research Unit at the University of Cape Town, surveyed 28,000 people in 7,300 households and found that 41.5% of them used private healthcare in their last medical visit.
“The reality is that many people use a combination of both sectors. It means the number of people with medical aid does not equate to the number of people using the private health sector. The converse is also true with some medical scheme members using public hospitals or state clinical protocols for the treatment of specific conditions such as tuberculosis,” says Van Emmenis.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/surgery-safaris-facelift-africa-needs/" target="_blank" rel="noopener">READ MORE: Surgery Safaris &#8211; The Facelift Africa Needs</a>
Van Emmenis says Bonitas is in favor of healthcare being cheaper and wider, but wants more consultation.
Matthew Prior, Funder Relations and Health Policy Executive at hospital group, Life Healthcare, concurs.
“Until the NHI benefit structure has been defined it is difficult to say what the impact will be. In addition, the role of private medical schemes is couched in vague terms, as the benefits that will be offered by the NHI have yet to be determined,” he says.
Life Healthcare had about 600,000 admissions, in 2016 alone, excluding outpatient and emergencies, and 95% of those were patients covered by a medical scheme. Prior says Life Healthcare agrees with the fundamental objective of the NHI but much depends on how it is implemented. He says improving the nation’s health, by addressing the challenges within the healthcare sector, is a massive undertaking and a responsibility that government should not shoulder alone.
“Although the White Paper mentions shortage of staffing, there does not appear to be a coherent plan to increase supply of medical professionals to meet NHI demands. A massive re-organization of the entire healthcare system, where there is an acknowledged shortage of management skills, places any fundamental change to the healthcare system at risk,” he says.
Prior says it is also not accurate to assume that by changing the financing structure and directing more money to the public sector will, on its own, improve the delivery of quality healthcare to all South Africans.
“The key issues around healthcare resources, management skills and leadership must be properly addressed. Recruitment of doctors on contract from foreign countries is a necessary measure in the short-term but it does not build long-term, sustainable capacity in the country,” he says.
Making matters more complicated, research by Econex shows that removing medical aid tax credits will make medical aid schemes too expensive for one in five.
“Members leaving private healthcare will place additional burden on an already overburdened public sector. One would also need to carefully monitor whether organized labor will accept the impact of the tax credit removal on net income,” says Prior.
If history is anything to go by, this is not the end for medical aid companies. About 10 years ago, South Africa introduced the Government Employees Medical Scheme. It got many worried, but some private medical aid companies, like Bonitas, grow regardless.
“Bonitas had 85,000 members that belonged to government that had to go to GEMS. We had about 216,000 members and everybody thought Bonitas was going down, but today we have about 350,000 members… So with the possibility of NHI, we have shifted our emphasis and visions to developing products that can and will be complementary,” says Van Emmenis.
Private money is likely to survive the biggest shake-up in Africa’s health system, whatever the weather.

Batten Down The Hatches

If you have got hard currency, you can afford to come to Africa to look good or feel better for less. Fourteen million people, spending between $3,800 and $6,000 per visit, are travelling the world looking for medical treatment with a beach holiday.
It&#8217;s a market estimated to be worth between $45 billion and $72 billion, and South Africa is sitting at the top table, according to Patients Beyond Borders (PBB), a US-based firm that has given medical tourism advice for a decade. The country has the advantage of good hospitals, English speaking doctors and breathtaking landscapes.
They call it medical tourism and it&#8217;s growing among the wealthy and not-so-wealthy. Even those who don&#8217;t have so much money are heading to hospitals in countries like South Africa where their hard currency makes it cheaper and also helps them escape hospital waiting lists in their own land.
Even in these hard times, PBB expects this multi-billion-dollar industry to increase by up to 25% per year over the next 10 years.
One entrepreneur who is banking on this is Cape Town-based Faith Cartwright, who founded Medical Tourism SA three-and-a-half years ago. Cartwright, a hospitality and guesthouse owner, noticed many of her guests were in South Africa for medical procedures.
&#8220;Who wouldn&#8217;t pay if they knew that they had to go through two years of pain waiting for a knee operation? Imagine you have decided you want children and you are told you can&#8217;t go through fertility treatment because you are 39 and cannot get an appointment,&#8221; says Cartwright.
&#8220;I thought ‘what if medical tourists like these could be given access to private medical care, have their accommodation and travel needs taken care of, and plan safaris and other tourist excursions, all through the same service provider?’&#8221;
Sitting by the harbor at the V&amp;A Waterfront, a popular tourist destination in Cape Town, it is easy to see why many decide to find a hospital bed here. Above us are the stunning peaks of Table Mountain and just down the road you can book a tour to see a great white shark, helicopter rides or pirate cruises. All this to the sound of seals, seagulls and many languages, as wealthy tourists from around the world stroll by with their bulging shopping bags.
<div id="attachment_33732" style="width: 510px" class="wp-caption aligncenter"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-33732" class=" wp-image-33732" src="https://www.forbesafrica.com/wp-content/uploads/2017/10/FaithCartwright-Medical-Tourism-e1506930410225-300x165.jpg" alt="" width="500" height="275" />Faith Cartwright, the founder of Medical Tourism SA. (Photo by Jay Caboz)</div>
Cartwright has as many customers as there are tourists on this street on this morning.
&#8220;It&#8217;s the reason why I&#8217;m so busy. Just this morning I was facilitating 65 women from Botswana to meet a doctor in Johannesburg at a fertility clinic. Sometimes you do get a good feeling about the work. But it can also be hard work and frustrating. It is rewarding when you know you are helping someone who has been struggling for years to get pregnant,&#8221; says Cartwright.
&#8220;Fertility is a big thing here. We get a lot of it from all over the world, but in Africa, there is a particular stigma that if you can&#8217;t get pregnant, you can be kicked out of your community. I also see a lot of requests for bone marrow transplants and women looking to slim themselves with gastric bypass surgery.&#8221;
It&#8217;s the start of the high tourist season in Cape Town and Cartwright is on call 24/7. For this 48-year-old mother, her time needs to be managed down to the minute.
&#8220;Thanks to the weakness of the rand, hundreds of medical procedures are available at a comparatively low cost, with most surgeries coming in at roughly a third of the price for an equivalent procedure in the UK. Affordable breast augmentation, for example, costs around $8,000 in the UK, but only about $3,600 in South Africa. More minor treatments, such as botox injections, can be even cheaper – $310 in the UK versus $70 in South Africa,&#8221; says Cartwright.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/suffering-waiting-wrong-side-divide/" target="_blank" rel="noopener">READ MORE: Suffering And Waiting On the Wrong Side Of The Divide</a>
It is not just the rich and famous that makes these journeys either. Cartwright has seen hundreds of clients from all walks of life.
&#8220;Our clients range from the ones who can afford to be pampered to those who can barely afford it. We&#8217;ve had people staying in Cape Town eating [maize meal] for 21 days straight, because that is all they could afford over their IVF (in vitro fertilization) treatment; they were so desperate to have a child,&#8221; she says.
&#8220;I had a woman come from Australia who failed 17 rounds of IVF and South Africa was her last option. She now has a daughter and came back to South Africa to try for a second.&#8221;
Using US prices as a reference, across a variety of specialties, PBB estimates South Africa to be 25% to 40% cheaper.
“Most nations in Africa continue to struggle to build out their healthcare infrastructure and are thus not yet suitable for the contemporary international medical traveler. South Africa (particularly Cape Town and Johannesburg), are exceptions, offering an array of medical care for regional and long-haul travelers, including cosmetic surgery, cardiology, dental care, joint and spine work, and ophthalmology,” says Josef Woodman, CEO of PBB.
It is not all rainbows and butterflies. Business isn’t helped by the lack of efficiency when crossing borders.
Cartwright tells of a US couple, a husband (the sperm donor) and wife, looking to come to South Africa for IVF treatment. It meant both needed to apply for South African visas. There was an error in the husband&#8217;s application, and, because of new visa regulations that required applications in person at a South African embassy, it meant he had to fly to the South Africa embassy twice. By the time they entered their application correctly he missed their window. The wife had to come to South Africa alone, and they had to find another sperm donor.
&#8220;As she was walking off the plane I asked her where her husband was. It was only then that she told me their story. Not only was it a huge waste of money for two flights to the South African embassy, but they lost out on their flight tickets and reservations in South Africa, which need to be paid for in advance before applying for your visa,&#8221; says Cartwright.
&#8220;This is where the medical tourism industry can help, resolving issues when you hit a brick wall. I would have been able to help them both get here. The process of IVF is incredibly stressful without worrying about the technicalities of international travel,&#8221; says Cartwright.
Another challenge is putting Africa on the map. Many patients know little about the country they are visiting and often make the mistake of booking doctors in Johannesburg with their accommodation in Cape Town, 1,500 kilometers away.
&#8220;Abroad, people still think we&#8217;ve got lions and elephants in our backyards. It&#8217;s very seldom I hear a good story about South Africa. Most of the things people know are about our crime, our president and that we have no water in Cape Town.&#8221;
&#8220;We need to tell the good story. South Africa is an amazing place. It&#8217;s got first-class treatment. What really stands out is that we are English speaking. It&#8217;s a calling point and a huge thing. Imagine when you go to a country like Thailand and you can&#8217;t read the road signs. Now imagine trying to be a patient there who needs medical treatment.&#8221;
While the costs for those traveling into Africa may seem affordable, it is a different story for those living in it. In South Africa&#8217;s case, the recently tabled White Paper on National Health Insurance (NHI) wants to give medical aid to all South Africans to make healthcare accessible to the poor. Its implementation has been hotly contested.
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/healthcare-got-available-everybody/" target="_blank" rel="noopener">READ MORE: &#8216;Healthcare Has Got To Be Available To Everybody&#8217; </a>
Many fear this will be the tipping point that brings the country&#8217;s health system to its knees and results in qualified doctors emigrating. The uncertainty surrounding the impact of the NHI on the private sector, and other compounding issues like an overburdened public healthcare system, could be why medical tourists choose not to come to South Africa.
&#8220;There are a huge amount of doctors in South Africa. The NHI only affects South Africans and not my clientele. In fact, I think it will encourage more doctors to work in the [medical tourism] industry.&#8221;
&#8220;The healthcare industry needs to look at more innovative ways of looking after its patients. I get calls from lots of South Africans trying to get help [with surgeries]; most don&#8217;t even know where to find a good doctor. Most South Africans can&#8217;t afford to go overseas and pay for a surgery. My uncle died of a brain tumor while he was waiting for a date to operate,&#8221; says Cartwright.
Ultimately, the success of medical tourism will depend on exchange rates, prices, quality of medical care and hospitality services on offer to tourists. Even Cartwright is keeping an eye out for opportunities elsewhere.
&#8220;I&#8217;ve been thinking seriously of emigrating to the United Kingdom and setting up base there. My plan would be to fly down to South Africa once a month and check up on the base here. Working from South Africa is too far away. Moving to the UK is quite a good move for the business. It’s central, with access to clients from Europe and America. It&#8217;s an hour&#8217;s flight to many of the medical conventions and conferences, which are great places to network. It&#8217;s also a good idea because there has been a rise in wellness travel, doing yoga retreats and all that. It’s taking off in the UK and Europe and I&#8217;d like to get in on this wave. South Africa would be an awesome destination for wellness tourism.&#8221;
Cartwright remains optimistic. She believes that medical tourism can offer a window of opportunity for doctors who still want to work in the private sector.
&#8220;I&#8217;ve found the Tanzanians to be the most sincere and humble. I&#8217;ve found that Nigerians, if you look after them, they will become part of your family for life. The people come and go. I try not to remember their names because I am so afraid of breaking their confidentially. But when they leave, we become a huge part of their lives.&#8221;
For Cartwright there is no time to stop, relax and watch the waves. She leaves the Waterfront with a phone to her ear, as usual, talking to her next medical tourist with money to spend.
<h3>Golden Oldies</h3>
A 2014 study by VISA  found the United States to be the largest hub for medical tourism. Thailand, Singapore, Germany, Korea, and Spain are quickly catching up.
Their data showed by 2025, travelers over the age of 65 will more than double their international travel to 180 million trips, accounting for one in eight international trips globally. Older travelers can afford bigger trips and are more focused on comfort and health than saving money.
The ageing traveler will transform travel and one area that is already growing in response is the medical tourism industry as more travelers opt to combine medical treatments with vacation.
&#8220;We believe that medical tourism is primed for accelerated growth as more of these older travelers seek new treatments, as well as lower-cost or higher-quality care not available in their home country,&#8221; the report concludes. &#8211; SOURCE: Mapping the Future of Global Travel and Tourism (2014) VISA

Surgery Safaris – The Facelift Africa Needs

Many in South Africa’s private healthcare industry see the government’s plan for National Health Insurance (NHI) as a death knell to their businesses. Hermann Kohloffel, the Managing Director of NHC Medical Services, sees it as a chance to improve healthcare for all South Africans.
“No matter how you slice and dice what we see coming from NHI, how we see it as a threat or a concern, it’s an opportunity. The reason why it has to be seen as an opportunity is because healthcare has got to be available to everybody. No matter how we argue about the costs, you cannot leave somebody without care. You’re not going to leave somebody suffering with cancer and say ‘well, because you don’t have the money, we’re not going to look after you’,” he says.
Kohloffel says the reason the private health centers can turn ailing people away is because they know those patients can turn to the state for help.
“The state is ultimately the saviour of the damned and the have-nots. If this was a country that just had one system, let’s say just the private system, what would happen? You’d be forced to help that person. Nobody could in good conscience kick that person out onto the pavement&#8230; If you look at other countries’ health systems, the state is the only system. The state doesn’t turn around and say ‘because you don’t pay tax, we won’t help you’.”
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/batten-down-the-hatches/" target="_blank" rel="noopener noreferrer">READ MORE: Batten Down The Hatches</a>
South Africa’s Minister of Health, Aaron Motsoaledi, says that private healthcare is sometimes unjustifiably expensive. Kohloffel agrees and says patients often pay for expensive procedures, when a cheaper option is available and will get the same outcome.
“Healthcare continues to escalate at a cost substantially higher than inflation and usually more than the GDP of the country. This automatically causes a problem because then there’s always a deficit in the funding of healthcare. As we progress as medical professionals, the technology cost is becoming a debatable factor. If you look at an X-ray, for example, the fact that today you get a digital X-ray and you get an X-ray in 30 milliseconds, doesn’t change the outcome. The patient either has pneumonia or doesn’t,” he says.
“The cost of that care, against the quality of care that you are ultimately getting, has got to be debated… It is crippling the current private healthcare system and is the main reason why patients are buying down.”
Kohloffel refers South Africa’s current health sector as an imperfect world with an imperfect system.
“You wonder how it is possible that an appendectomy in the private health system will the cost the patient between R40,000 ($3,000) and R60,000 ($4,600). In the public system you can do an appendectomy for about R3,500 ($270). You may not survive the public hospital without scars, mental and physical, but how is that disparity even possible?”
The public and private sector needs to sit together and remember that they’re both working to achieve universal healthcare, says Kohloffel. He says the private and public health sector can learn from each other.
“What we do really well is collect money, we limit our bad debts and liabilities, pay off investments and all the rest of it. What the public sector does really well is take a miniscule budget and, despite tenderpreneurship and other interesting things that come along to try and grapple at that money, they make it last for 365 days.”
<a href="http://www.forbesafrica.com/cover-story/2017/10/02/suffering-waiting-wrong-side-divide/" target="_blank" rel="noopener noreferrer">READ MORE: Suffering And Waiting On The Wrong Side Of The Divide</a>
The private sector needs to try and provide solutions, rather than criticizing the NHI.
“This doesn’t happen for two reasons; first the status quo is always more comfortable, and the second thing is a lot of people see change as a threat. It’s far easier to criticize than to come up with solutions… So the private sector is not stepping forward to embrace what the government is saying needs to be achieved, and the government does not necessarily want to hear about the stumbling blocks that are in the way of achieving a political necessity as well as what’s in the best interest of creating a sustainable solution for coming generations using a collaborative approach. Currently we need accessibility to the Department of Health so we can talk solutions and not keep having doors closed because we are the private sector.”
NHC Medical Services has four health centers in the Gauteng province – in Bryanston, Honeydew, Northcliff and Centurion. It plans to open a center in Thohoyandou, in the northern Limpopo province. It also has a network of over 1,000 doctors across the country.
Kohloffel says <a href="https://nhcltd.com/" target="_blank" rel="noopener noreferrer">NHC Medical Services</a> will need to adapt once NHI is introduced. He sees it treating patients in a preventative manner.
“In winter, we all sit there like vultures hoping for the flu season to come in. The flu comes in via some Boeing from the northern hemisphere, drops the flu here, and suddenly everybody is sick and we rub our hands together because we’re making more money. Now you’ve got to change the mindset to a system where you don’t want that plane to arrive with sick tourists and, if it does, have a strategy to reduce the chances of us catching it through other preventative measures, such as flu vaccines and vitamin boosts.”
“We are going to go from being a fee-for-service providing care organization &#8211; so when you’re sick you see me, when you’re not sick, you don’t see me &#8211; to being a preventative care-based organization. We’ll have to start to look at how to screen our patients for cardiac problems, diabetes, cholesterol and all the rest of it. It’ll no longer be for patients to have an event and then we say now we need to manage your cholesterol. So, now we don’t want people to be in hospital, we want to prevent them going to hospital.”
Private healthcare will focus on areas that NHI won’t cover.
“NHI does not cover cosmetic dentistry, it will not cover breast enlargement, and so on. People will have to buy private insurance for that,” he says.
Kohloffel’s optimism over NHI doesn’t mean he is burying his head in the sand.
“I think we’re in for a big wake-up call… NHI, for us, is going to be a big challenge. Is it going to be a financial threat? Well, people have to get used to the fact that life is going to change. Life is going to change as you know it as a consumer, and as we know it as a provider of care, if this system is implemented in its current shape and form.”

Tag: Healthcare

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