Mediclinic Southern Africa

Mediclinic Southern Africa introduces new technology in a public-private initiative

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Mediclinic and Dr Gawie Bruwer, in partnership with the Tygerberg Hospital and the Western Cape Department of Health, are in the process of performing 10 prostatectomy surgeries with the use of the Da Vinci robot at the Mediclinic Durbanville Hospital

Dr Bruwer, a Urologist at Mediclinic Durbanville, is one of only 17 surgeons in South Africa who is accredited to operate using the da Vinci Surgical System. The system is very complex, which means training and accreditation are vital.

The da Vinci Surgical System was implemented at Mediclinic Durbanville in 2014 and has made a significant difference to the way prostatectomies are performed. The instruments used for the procedure, such as surgical scissors and pliers, are minute—in some cases, as small as a centimetre in length—so the surgeon can easily manoeuvre them via the hand controls and get to the hard-to-reach tissue.

Thanks to powerful processors and so-called EndoWrist technology, the da Vinci converts the surgeon’s arm and hand movements into much smaller, more refined and accurate actions inside the patient’s body. You can also set it [the da Vinci] so that the movements are, for instance, five to 10 times smaller or more subtle.

The da Vinci has mechanical wrists that bend and turn to mimic the movements of a surgeon’s hands during surgery. As the surgeon controls it, the robot operates on the patient, translating the surgeon’s hand movements into smaller, more precise movements. The system works the same way on the inside of the patient as it does during open surgery. The movement of the robot’s arms inside the patient’s body is a precise replica of what the surgeon does on the outside with their arms, but the movement is three times smaller on the inside. This removes any tremor that the surgeon might have. A 10-times magnification of the inside of the body allows surgeons to see even the smallest veins and arteries, which can be seen far clearer than with the naked eye.

More than 60% of Dr Bruwer’s patients at Mediclinic Durbanville are discharged the day after surgery, which is a considerably shorter stay in hospital than traditional open surgery patients who require ICU care before being transferred to a normal ward. Robotic surgery lowers the risk of infection and the reduction in blood loss minimises the risk of blood transfusions. Patients’ pain levels are comparatively lower, following the keyhole surgery, and the need for the use of a catheter is also shorter. Da Vinci patients often return to work after about two weeks, far sooner than the traditional six weeks, following open surgery.

Collaboration is key

These life-saving procedures form part of a process aimed at alleviating the surgical waiting lists at public facilities in the province, ultimately, assisting over 100 public sector patients. This is the first time such urological procedures will be performed using this new technology as part of the collaboration between private and public hospitals.

“This specific initiative is part of the Mediclinic Corporate Social Investment Strategy and not only will we make a difference in the lives of 10 patients by doing these procedures, we will also be strengthening our relationship with our colleagues in the Public Sector,” says Mediclinic Southern Africa CEO, Koert Pretorius.

“I think one of the biggest challenges that we face in the health industry in South Africa is access to good, quality healthcare. We all know about the shortage of healthcare professionals and the fact that technology is not always available in the public sector. So, we are very proud of the relationship we have developed over many years, specifically with the Western Cape Department of Health. We have performed 50 procedures already during the 2017/2018 financial year in the Western Cape for public sector patients but this is the first time we will be doing robotic surgery. We’ve done 18 cataract procedures, 12 other neurology procedures and also 20 ear, nose and throat procedures during this current financial year,” he adds.

Mediclinic Southern Africa represents the Southern African operations of Mediclinic International, the sixth largest private hospital group in the world. Mediclinic Southern Africa has more than 7 100 beds in 52 multidisciplinary hospitals in South Africa and Namibia. As part of Mediclinic International, Mediclinic Southern Africa aspires to be regarded as the most respected and trusted provider of acute-care and specialised hospital services by its patients, doctors and funders.

“Mediclininc SA has often made it clear that from our perspective, we think there should be a lot more cooperation between the private and the public sectors in South Africa. We have a dire shortage of healthcare professionals, access to healthcare is a big challenge and unless we cooperate, we will not be able to optimise these scarce resources or provide access to the latest technology to patients in the public sector as well.

“Although this is part of our Corporate Social Investment (CSI) initiative, we think this type of cooperation can be expanded and there are different models that we think can work well for public-private cooperation. We are very positive about public-private partnerships, we often have excess capacity that we can make available to the public sector. When we do it as a CSI initiative, we don’t charge the patients or the government, but I’m sure that this model can be developed further into offering low-cost services to the public sector and we are very fortunate because our private practicing doctors are normally very keen to cooperate and to support these type of initiatives,” Pretorius explains.

Dr Nomafrench Mbombo, the Western Cape MEC for the Department of Health says that these public-private partnerships are vital within the health sector and to achieving the goals of the Department of Health.

“The vision for the Western Cape Department of Health is about providing health for all, irrespective of whether you’re public or private. The mission talks about providing credible answers to health in partnership with the relevant stakeholders and institutions within a balanced and well-managed health system, and our values are related to caring, accountability, integrity, innovation, repeat innovation, respect and responsiveness.

“The current status in the public healthcare sector is that there is an immense service pressure. There is an overload on service requirements, which leads to delays in treatment. It is especially difficult for patients with multiple diseases that require a combination of treatments and doctors, and those who require operations, which are often delayed. For example, for the knee or hip replacement—you find they can wait as long as two to three years. It means that something needs to be done but there are the issues of budget constraints, the economy going down, mismanagement in human resources and a lack of healthcare professionals—all of these result in us, as the State only, not being able to do anything quicker.

“Therefore, you will need assistance, which is through the private sector. Formally, the common view held was that the public sector and private sector were two separate groups, and that the private sector held more importance or credibility. The private sector was “the other”. In some instances, amongst my colleagues, you can still hear elements of separation in how they refer to the private sector, however, from where I am sitting, it is no longer about whether we should collaborate and work with the private sector, it is about the ‘how’,” she explains.

Mbombo explains that the Western Cape Health Department has an open-door policy and is focussed on creating an enabling environment for the formation of public-private partnerships through engagements and meetings with private sector groups and private/public health forums and discussions. She believes that collaboration is the best strategy for achieving a well-functioning health sector where every citizen can receive adequate medical care.

“Currently, there’s a lot of debate about whether health is a commodity or a human right—I subscribe to both. It’s a human right according to the Constitution, however, by being a human right, it doesn’t guarantee that we will have all the answers and, therefore, we have to incorporate aspects of the private sector. The growth of the healthcare sector rests on public-private partnerships. More than ever, economic development, growth and prosperity is a team sport. No single government or organization can successfully implement a development programme single-handedly.

“As I stated, the question is no longer about whether the state and the private sector should collaborate. Instead, the focus should be on finding ways to achieve unified strategies and opportunities. We have moved away from the “othering” because, at the end of the day, we are talking about one person—the patient. We know that health is an investment—a healthy population is an absolute basic requirement and a prerequisite to bringing the skills and the human capital required,” she says.

In South Africa, the public-private collaboration has been debated for more than a decade. There are glaring disparities in health spending, in the inequitable distribution of healthcare professionals and in the access to care delivered in the public and private sectors. This favours affluent groups who can afford private health insurance. It has been reported that the private health sector spends approximately six times more per capita than the public sector but covers only 16% of the population. This leads to debates on the unfairness of the distribution of resources.

Despite this debate, SA has long recognised the action between the public and private sectors as a policy objective. The Charter of the Public and Private Health Sectors was drafted to get the private and public sectors to agree on priority problems, how these should be tackled and the role of the private sector in transforming the health sector as a whole. Collaboration is beneficial in that it promotes and results in the increased accessibility and availability of services, an increase in the quality and quantity of the manpower available, and it would improve primary care services, which, in turn, would improve quality of life. 

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