Bonitas – innovation, life stages and quality care

The lowdown on diabetes in children and teenagers

The diagnosis of type 1 diabetes in children can be overwhelming, especially in the beginning. Suddenly you and your child – depending on your child’s age – must learn how to count carbohydrates and monitor blood sugar levels and give injections. But even though there is no cure, it can be managed.  Diabetes is a chronic disease, characterised by high levels of blood glucose. ‘In type 1 diabetes your immune system, the body’s system for fighting infection, attacks and destroys the insulin-producing cells of the pancreas,’ explains Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund. ‘It can lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves. However, advances in blood sugar monitoring and the delivery of insulin have improved blood sugar management and quality of life for children with type 1 diabetes.’ Statistics currently show that there are close to 5 000 adolescents that live with Type 1 diabetes in South Africa. Type 1 diabetes can be either: Hyperglycaemia: When your blood sugar levels are too high. It is the hallmark of diabetes onset and it usually continues to occur on and off after you start treatment Hypoglycaemia: Sugar levels are too low. This usually occurs as the result of diabetes treatment, particularly insulin administration which lowers blood sugar How does diabetes in children and adolescents start? It can come on suddenly or gradually in children and teens and parents often aren’t aware of the symptoms or patterns that point to a potential diabetes diagnosis. Symptoms may be similar to those of flu but, if diabetes is the cause, the sooner it’s diagnosed, the better. Symptoms of Hyperglycaemia: High blood sugar Increased hunger The body’s cells are not able to utilise glucose for energy due to a lack of insulin or insulin resistance, leading to a craving for more food. Dry mouth: A dry mouth is one of the most common symptoms which can cause trouble chewing, swallowing or speaking, dry cracked lips, sores or infections in the mouth or a furry, dry tongue Frequent urination (especially at night):  Excess glucose in the blood spills into the urine, drawing water with it and increasing the frequency of urination. This in turn increases thirst Weight loss:  Despite increased food intake, the body starts breaking down fat and muscle for energy, due to the lack of insulin Fatigue: The body’s cells cannot use glucose for energy efficiently, leading to feelings of tiredness and fatigue Blurry vision: High sugar levels in the blood can damage the tiny blood vessels in the eyes, causing fluid to seep into the lens, potentially causing blurry vision Slow-healing sores or frequent infections:  Over time, high blood sugar levels narrow your blood vessels, slowing blood circulation and restricting much needed nutrients and oxygen from getting to the wounds. As a result, even small cuts and wounds may take weeks or months to heal Fruity-smelling breath: The breakdown of fat for energy produces ketones, which can cause a fruity smell in the breath Ketoacidosis: This is when blood sugar levels are very high and the body starts making ketones. It is a very serious condition that needs immediate in hospital treatment, sometimes in the intensive care unit. If not treated right away, there is a  risk for diabetic coma. A child with a diabetic coma loses consciousness because of brain swelling due to very high blood sugar levels Symptoms of Hypoglycaemia: Low blood sugar  Trembling: Low blood sugar levels trigger the release of adrenaline, which causes shakiness Sweating:  The body’s response to low blood sugar includes releasing adrenaline, which can cause sweating Hunger: The brain detects low blood sugar and signals the body to eat Irritability or moodiness: Low blood sugar levels can affect brain function, leading to mood changes Fatigue: The brain and muscles are deprived of glucose, leading to feelings of tiredness Paleness: The body’s stress response to low blood sugar can cause blood vessels to constrict, leading to paleness Headaches: The brain is sensitive to changes in blood sugar levels, low levels can cause headaches How is type 1 diabetes treated? A daily dose of insulin is needed to keep the blood glucose level within normal ranges. Insulin is given either by injection or via an insulin pump. Your child’s healthcare provider will show you how to give your child insulin with either method.  Dr Hadebe says, ‘to make it easier for children and adolescents to monitor glucose levels and administer insulin the Scheme offers Insulin Pump Therapy and Continuous Glucose Infusion Monitoring device (CGM) to members under the age of 18.’ Eating the right foods to manage blood glucose levels. This includes timing meals and counting carbohydrates Exercise Regular blood testing Regular urine testing for ketone levels How can I help my child live with type 1 diabetes? The diagnosis affects the entire family emotionally – there are various support groups and organisations for children with Type 1 diabetes and their families. A younger child may not understand all the life changes, such as glucose monitoring and insulin injections, this can lead to anxiety and depression. They may feel different from their peers, try to treat them as a normal child, with managing diabetes as just one aspect of their daily life. Ask your healthcare provider for more information and call them if you need help.  Also ensure they are following the treatment plan and are eating the right foods, exercising and testing their blood and urine.  Early detection and comprehensive management are key to ensuring children with Type 1 diabetes lead healthy, fulfilling lives. Remember that your GP is your first port of call for all your healthcare needs. 

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 30 of your pregnancy

You now officially have ten weeks left of your pregnancy, this can be both an exciting and overwhelming realisation, and feelings of anxiety during this time are normal. Your little one’s kicks and growing baby bump are reminders that your due date is increasingly getting closer. Your body at week 30 Your back and feet may be increasingly getting more painful as your baby grows in size. Swollen ankles and feet are normal, so remember to give yourself some time to put your feet up and invest in some comfortable footwear. Bloating, constipation and  stretch marks are normal at this point in your pregnancy. The fatigue you felt in your first trimester may be returning. You could be struggling to sleep at night, which will leave you feeling drained during the day. Don’t be afraid to ask for help at this time, you’ll need extra hands now and after your baby has been born. Your baby at week 30 As your delivery date grows closer, your baby is constantly growing in size, and at this point she is roughly the size of a cabbage. Your little one is also prepping for the big day and they should have (or will be soon) changed position, facing head down with their face towards your back (known as the occipito-anterior position) – ready to enter the pelvis. This is the ideal position for birth, however it is possible for your baby to be lying another way inside you. Some babies will only turn this way closer to your due date. Things to keep in mind at week 30 It’s normal to feel anxious about your approaching delivery. Going to antenatal or birth classes can help you feel more prepared for what is to come. Do exercises that can help you prepare your body for what it will go though, certain yoga and pilates positions can strengthen your muscles and help make the process quicker and smoother. If you find that your anxiety is overwhelming, chat to a health professional, as you may be experiencing antenatal anxiety. This is nothing to be ashamed about, and is something that can be managed with the help of professionals.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 29 of your pregnancy

Week 29 of your pregnancy and you may notice that your body is taking more strain. Be mindful of this and don’t be afraid to take it easy if needed. Make sure that you’re still eating healthily (and remembering to take your prenatal vitamins) and exercising gently, both are important to your health as well as your growing baby’s. Your body at week 29 You are now entering the last phase of your pregnancy, and because of this you may find this very challenging, both physically and mentally.  Your back, pelvis and feet are probably aching, and you’ll experience constipation, frequent urination and shortness of breath. Your baby at week 29 Your baby is now filling more of your womb, this means that any kicks, which used to be soft and barely notable, may feel more like hard pokes now. Your little one is also growing rapidly, and will probably have doubled in weight before birth. At this point many of their organs are almost fully developed, meaning they have a good chance of survival if born premature. That being said, their lungs still have lots of developing to do, which is why preemies need help breathing via a ventilator. Things to remember If you haven’t already, start planning your maternity leave. In South Africa, moms are entitled to four months of unpaid leave. If you’re still feeling able to work, you’ll probably want to keep most of your leave for after birth, so that you can spend as much time with your growing baby as possible. Generally speaking, maternity leave begins about a month before birth –  and the good news is dads are now entitled to 10 consecutive days of parental leave. Your employer is obliged to keep your job for you until you return from leave, so you won’t have to worry about losing your job.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 28 of your pregnancy

Welcome to week 28 of your pregnancy, you are now in your third trimester – the final stretch before birth! Your baby will do lots of growing during this time, and your body may start taking some strain in the final weeks before delivery. You’ll probably be feeling both nervous and excited, soon you’ll be able to take your little one home! How your body will be feeling at week 28 If you haven’t started experiencing it already, you may notice that back ache and pelvic pain are becoming an issue. This is due to the fact that pregnancy hormones cause your ligaments to loosen, which can cause lower back and pelvic pain. Your changing centre of gravity also puts strain on your back. Excruciating pain in your pelvic reason is cause for concern and the culprit could be symphysis pubis dysfunction (SPD). Luckily this isn’t harmful to your baby, but is probably very painful to you. Chat to your doctor if you’re feeling pain that you see as abnormal. They’ll probably recommend a physiotherapist to you as physio can help minimise your pain and improve your muscle function. Other common week 28 pregnancy symptoms include Braxton-Hicks contractions, frequent urination, swollen ankles and feet, sleeping problems, stretch marks, heartburn and indigestion and constipation. Your baby at week 28 Your little one is growing fast, and is now the size of a head of lettuce. Around this time your baby will begin to open and close their eyes,  and can sense changes in light. Your baby’s heart rate will have lowered to about 140 bpm (and at birth this will have dropped to around 130 bpm). If you were to have an ultrasound now you may notice hair on your baby – this is known as lanugo, which is fine hair that grows on babies before birth. This will disappear at birth or shortly afterwards.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 27 of your pregnancy

Congratulations, you are now in the last week of your second trimester and approaching the third, which will start at the beginning of week 28 –  so you are nearing the final stretch of your pregnancy. You’ll find that you’re probably becoming more used to your little one moving around inside of you and while you may have enjoyed less fatigue during trimester two, this unfortunately may begin to change. Your baby at week 27 Your baby is starting to pack on the final pounds before birth (which should be in 13 weeks, but not all babies arrive at their due date). Inside of your uterus, your little one will be kicking and grasping, slowly developing their muscle tone before birth. Your baby will also be practicing breathing and swallowing with the amniotic fluid. Your body at week 27 Haemorrhoids are a common pregnancy, thanks to your uterus becoming larger and putting pressure on your veins. Haemorrhoids are swollen veins in the anus and rectum, and these are both uncomfortable and painful. While these are unwanted, they generally aren’t harmful to you or your growing baby and normally go away after birth. Other pregnancy symptoms common during this time are leg cramps, aching pelvis and back, heartburn bleeding gums,  constipation, trouble sleeping, frequent urination and stretch marks. Things to remember at week 27 At week 27, something you can start considering is putting together a birth plan. A birth plan is a written document that communicates your wishes during your pregnancy (think of the ideal way you’d like your birth to go) as when the time comes, you probably won’t be thinking clearly.  There is no right or wrong way to go about doing this – some may be detailed and others just cover the basics, the choice is yours!

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 26 of your pregnancy

Although you are yet to meet your baby, they are slowly taking over your life and you may notice weekly and even daily changes in your body. Some days you’ll feel better than others, and it’s important that you take each day as it comes. Both by taking advantage of your good days, and being gentle on yourself on the bad ones. How your body may feel during this time Tiredness, an achy body, a sore mouth and stretch marks are all part of your pregnancy journey. Your belly and breasts are also growing, so make sure that you accommodate your body and dress in clothes that are both supportive and comfy. Your baby’s growth at week 26 Your little one’s lungs are now working hard, getting ready for the day that she’ll need to start using them. At this time the lungs start to produce surfactant, which’ll make it possible for your baby to breathe at birth. Your baby’s suck reflex is  growing stronger (they may even suck their thumb!), and their eyes may open for the first time around now and they’ll start to practice blinking. Not only this, but your little one also has eyelashes that are starting to grow. Now that your baby can hear you, you can also spend some time talking to them. Research has shown that babies prefer the sound of their mothers voices and you may even notice that they start responding to the sound of your voice, and by late pregnancy they should be able to distinguish between voices. What you should keep in mind at this time Something to keep aware of during your pregnancy is the possibility for gestational diabetes. Gestational diabetes is high blood sugar levels during pregnancy, and it’ll go away after birth. However, moms who develop gestational diabetes are at higher risk of developing type 2 diabetes after birth. Warning signs are unusual thirst, frequent urination and dizziness, if you feel like you are checking these boxes then it’s important to speak to your doctor about treatment. If treated effectively, there is no reason you shouldn’t have a healthy pregnancy.

Bonitas – innovation, life stages and quality care

Debunking myths about Mpox

Myths are widely held beliefs about various issues, including illness and disease. They come about through frequent storytelling and retelling. Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund, helps debunks myths about monkeypox (mpox).  Myth 1: Mpox (formerly monkeypox) is a new disease created in a lab Fact: The mpox virus was discovered in Denmark (1958) in a colony of monkeys at a laboratory kept for research.  The first reported human case was in 1970 in the DRC. Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is found regularly in parts of Central and West Africa and can spread from person to person or occasionally from animals to people.   Myth 2: Mpox comes from monkeys Fact: Despite its name, monkeypox does not come from monkeys. The disease earned the name when the ‘pox like’ outbreaks happened in the research monkeys. While monkeys can get mpox, they are not the reservoir (where a disease typically grows and multiplies). The reservoir appears to be rodents. Myth 3:  Only a handful of people have contracted mpox Fact: Globally, more than 97 000 cases and 186 deaths were reported across 117 countries in the first four months of 2024. South Africa is among the countries currently experiencing an outbreak.  On the 5 July, it was reported that the number of mpox cases in the country has risen to 20. This after four more cases have been confirmed in Gauteng and KwaZulu-Natal in the last few days. 15 patients have, however been given a clean bill of health.  Myth 4:  It is easy to diagnose mpox Fact: It is easy to mistake mpox for something else. While the rash can be mistaken for chickenpox, shingles or herpes, there are differences between these rashes. Symptoms of mpox include fever, sore throat, headache, muscle aches, back pain, low energy and swollen lymph nodes. Fever, muscle aches and a sore throat appear first. The rash begins on the face and spreads over the body, extending to the palms of the hands and soles of the feet and develops over 2-4 weeks in stages. The ‘pox’ dip in the centre before crusting over. Laboratory confirmation is required. A sample of one of the sores is diagnosed by a PCR test for the virus (MPXV). Myth 5: Mpox is easily treated Fact: ‘Currently,’ says the National Institute for Communicable Diseases (NICD), ‘there is no registered treatment for mpox in South Africa. However, the World Health Organization (WHO) recommends the use of TPOXX for treatment of severe cases, in immunocompromised people’. However, the Department of Health (DoH) has only obtained this treatment, with approval on a compassionate use basis, for the five known patients with severe disease.  There is no mpox vaccine currently available in South Africa. Myth 6: You can get mpox from being in a crowd or from a public toilet seat Fact: Mpox is not like Covid-19 which is highly contagious. It spreads through direct contact via blood, bodily fluid, skin or mucous lesions or respiratory droplets.  It can also spread though bites and scratches. Studies have shown that the virus can stay on surfaces but it is not spreading in that way or in a public setting. The risk of airborne transmission appears low. Myth 7: Mpox is deadly Fact: While mpox lesions can look similar to smallpox lesions, mpox infections are much milder and are rarely fatal. That said, symptoms can be severe in some patients, needing hospitalisation and, in rare cases, result in death. It is, however, painful and very unpleasant. So, it is important to avoid infection. Myth 8: Mpox is sexually transmitted  Fact: You can become infected though close, direct contact with the lesions, rash, scabs or certain bodily fluids of someone who has mpox. Even though this could imply transmission though sexual activity, it is not limited to that.  You can also be exposed if you are in close physical proximity to infected people, such as spouses or young children who sleep in the same bed.  Myth 9: I can’t protect myself from getting Mpox Fact:  You can take precautions: Avoid handling clothes, sheets, blankets or other materials that have been in contact with an infected animal or person. Wash your hands well with soap and water after any contact with an infected person or animal and clean and disinfect surfaces. Practice safe sex and use personal protective equipment (PPE) when caring for someone infected with the virus. Myth 10:  You can’t stop other people being infected by you Fact: You may not protect them by 100% but you can isolate. Also, alert people who have had recent contact with you.  Wash your hands regularly with soap and water or use hand sanitiser, especially before or after touching sore and disinfected shared spaces.  Cover lesions when around other people, keep skin dry and uncovered (unless in a room with someone else).  Mpox is a notifiable medical condition but is treatable, if you are concerned, call the DoH toll free number of 0800 029 999 but remember, your GP is your first port of call for all your healthcare needs. 

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 25 of your pregnancy

As you enter week 25 of pregnancy, you will be nearing the end of the second trimester and the start of the third. You may find that your rise in energy levels you felt at the beginning of your second trimester is now beginning to drop. Your baby at week 25 Your baby is now roughly the size of a cauliflower and they are slowly starting to become the chubby baby you’ll expect at birth, as fat is added to their body every day. Your little one is also starting to develop a sense of balance, becoming more aware of what is up and down. Not only this but your baby’s lungs are slowly developing closer to maturity, as blood vessels (caprillirs) grow and they start to practice breathing in amniotic fluid. Your body at week 25 As your baby grows, it is normal that your back and pelvis may be starting to take some strain. This is also thanks to pregnancy hormones which cause your ligaments to soften. To avoid any injuries, make sure you aren’t tempted to over stretch if you’re doing something such as yoga and don’t lift any heavy objects around the house or office. If your back is feeling sore, gentle exercise in water, such as aqua aerobics, can help alleviate the aching. However, if your back is seriously painful , chat to your doctor about finding a physiotherapist who can help you during this time. Other common pregnancy symptoms around this time are heartburn, sore feet and ankles, camping in your legs, swollen and bleeding gums, dizziness,  trouble sleeping and stretch marks. Although many aspects of pregnancy (and certainly afterwards) are rewarding, there are also many parts of it which can be uncomfortable. Things that you should keep in mind Cravings are a natural part of pregnancy (and these generally peak in your second trimester), and they are the sudden desire to eat a particular kind of food. These can be odd foods and combos that you’ve never had the urge to eat before, and generally these are personal to you. Strange combinations, such as pickles and ice cream, might suddenly be on your most wanted list. Just be aware of what you are consuming, as trying to keep things healthy will be best for your growing baby. Unfortunately big meals can also mean heartburn, so little and often can often be the answer here. The book: http://picklesandicecreamcookbook.com/

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 24 of your pregnancy

You’re a good few weeks past half way of your pregnancy, which means you are closer than ever to finally meeting your little one. In terms of months, you’re about 6 months in, which means you only have 3 left to go! Your Body at Week 24 As you near your third trimester, you may notice that your body is feeling more uncomfortable thanks to your growing baby. Back ache, tired swollen feet, leg cramps and constipation are all pretty common during pregnancy. You’ll also be gaining weight (which is completely normal) and your breasts are also bigger. Heartburn may be something that you’re struggling with and this is  normal during pregnancy thanks to hormones and your growing baby taking up space. Your pregnancy hormones are the reason the valve between your stomach and throat doesn’t close as it should, as the hormones relax the tight muscle between your stomach and your esophagus. Your growing uterus can also put pressure on the stomach, making it more likely that acid can spill out. Your Baby at Week 24 As your baby grows, they are putting on more and more weight, and their muscles are developing and gaining strength – which means their kicks are getting stronger and harder. Your little one also has hair at this point, however, none of it is pigmented yet. Your baby is pretty active now, and you should feel them move around regularly, however, unless you don’t feel your baby moving around for long periods of time, stillness is nothing to be concerned about. Things to take note of While it may seem obvious, eating healthily and frequent exercise are both ways to stay mentally, physically and emotionally happy and healthy during pregnancy. While a few stresses here and there are common, a constant state of worry or sadness is probably a sign of antenatal depression or anxiety. If you feel like you don’t have the energy for small tasks or every small detail of your pregnancy is triggering anxiety, it may be best to both seek the support of those you love, and medical professionals.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 23 of your pregnancy

Your growing baby is making her presence known, and you may regularly feel little kicks inside you when she is awake. Your body is also starting to take some strain, and you may have uncomfortable feet and back to name a few. While you are excited to meet your little one, you may notice this excitement in strangers who might attempt to touch your baby bump, and this added attention is not necessarily something you’re happy with. Your body at week 23 At week 23 you may be experiencing a variety of bodily aches and pains as your body takes on the strain of growing and carrying a small human. Leg cramps, swollen feet, bleeding gums and a tired, sore back are unfortunately all normal during pregnancy. During this time you may also feel stressed out and overwhelmed. Although pregnancy is a beautiful and exciting time, it can also be very stressful for moms to be. You may be under financial strain, and you may feel pressure at work to finish up pieces of work before going on maternity leave. All of this is normal, and if you feel like you’re not coping well it’s important to speak to a health professional who can help you through this tough time. Your baby at week 23 Your baby is now the size of a squash and in their 23 week, your baby is now able to survive outside your body if they are born prematurely (although they aren’t’ ready to be born yet and have lots of growing to do!). Their lungs are developing and their face is fully formed, it just needs to do some filling out first. Your baby is also gaining weight each week (they should double in weight in the next 4 weeks), so by the time your baby is born, she’ll be the plump, chubby little one you’re expecting. Their middle ear bone is also hardening, and they are able to hear you talking to them. Things you should remember at week 23 During your second trimester as your baby bump grows you may experience both wanted and unwanted attention to your baby bump, as well as advice from everyone – from strangers to your mother. Dealing with this added attention can be overwhelming at first, but be sure to state your boundaries clearly if strangers attempt to touch your bump. While some moms-to-be may not mind extra attention, others may not like the invasion of their space when strangers want to touch their growing baby belly.

Bonitas – innovation, life stages and quality care

Partnership with GOTG brings water to teaching hospital

When a hospital has interrupted water supplies, the consequences are dire. Water that is essential not only for handwashing, hygiene and drinking but for cleaning and sterilising instruments, laundry, cooling medical gas and suction compressors for patients on ventilators. The list is endless.  It is clear that both the patients’ health and the medical staff’s ability to provide quality healthcare will be severely compromised.  This is what happened at Kalafong Hospital – an 1 118-bed teaching hospital in Atteridgeville, Pretoria. The hospital was built in the 1973 and services a large population of residents in Pretoria and beyond. The University of Pretoria uses Kalafong Hospital as a training institute for the Faculty of Health Sciences.  They reached out to Gift of the Givers (GOTG) with respect to water challenges at the hospital and GOTG agreed to step up to another issue that required humanitarian aid.  ‘We rely on stable water supply to service patients adequately and provide a safe training environment for our students,” said Professor Priya Soma-Pillay, the Chairperson of the School of Medicine at UP.  ‘As the Chairperson of the School of Medicine at UP responsible for training at our health facilities, I’m grateful to Gift of the Givers Foundation and Bonitas for hearing our plight. With consistent and reliable water supply we can ensure the health and safety of patients, staff, students and the proper functioning of medical equipment.’    GOTG began exploring the possibility of a borehole to supply uninterrupted water and partnered with Bonitas Medical Fund for funding.  Drilling began on 20 January this year and by the 26 January they found water at 148 metres.  The borehole currently yields 8 000 litres per hour and is literally a fountain of life for this healthcare facility. In addition, 8 x 10 000 litre water storage tanks have been installed. The partnership between Gift of the Givers and Bonitas began in 2018, the key objective: To provide relief to the most vulnerable and marginalised communities, specifically in the field of healthcare interventions.  Bonitas donated R1.2 million to the Kalafong Hospital borehole project. Lee Callakoppen, Principal Officer of Bonitas says, ‘This and the other projects carried out together with GOTG, align with the Scheme’s commitment to being the medical aid for South Africa.  It is the perfect partnership, as we have the same passion and drive to assist where it is needed most. ‘ The borehole will provide water to the hospital’s reservoir and supplement the municipal water supply by 150 000 litres a day. This is over half of the hospital’s daily consumption of between 200 000 and 250 000 litres.  It will also help lower running costs by reducing the water bill, these savings can be channelled into other operational costs.   Importantly though, when there are intermittent water cuts in the area, the hospital can rely solely on the borehole to continue to function efficiently.  The water was tested using The South African National Standard (SANS) 241 test – a drinking water specification that outlines the minimum requirements for potable water to be considered safe for human consumption, after an ultraviolet system was installed Other projects involving the partnership between GOTG and Bonitas include:  Sponsoring final year medical students who were struggling financially, water interventions at Tower Psychiatric Hospital, Senekal Orphanage, Cwebeni Village in the Eastern Cape, disaster relief after the KZN floods and the sponsoring an audiology programme testing the hearing of 16 000 learners in KZN. Dr Imtiaz Sooliman says, ‘We know what a difference this consistent water supply has made to Kalafong Hospital. After all, clean water is life and clean water is health.  We look forward to our continued partnership with Bonitas, always with the health and wellness of South African being the priority.’

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 22 of your pregnancy

Your second trimester has you feeling more yourself, and feeling your growing baby moving inside your tummy is bound to bring a smile to your face. Your body may be feeling some strain as your baby grows in weight and size, and you’ll need to remember to eat healthy in order to ensure that you little one receives all the needed nutrients from you. Changes to your body at week 22  Your body may be feeling slightly uncomfortable all round thanks to the changes that pregnancy has had on your body. You may notice your back, pelvis and hips aching, leg and foot cramps, as well as swollen feet. This can be alongside heartburn, constipation (and possible haemorrhoids) as well as stretch marks. Your baby’s growth at week 22 Your baby is now approximately the size of a coconut and is sleeping in cycles – the time that you don’t feel them moving around will be when they are asleep. At this time your little ones taste buds are developing, and what they find tasty later in life may be influenced by what you’re eating. So try to keep it healthy and to stick to fruit and wholesome veggies. Their eyes are almost fully developed but lack colour in the iris. Your little one is also becoming more sensitive to outside stimuli, so you may notice that they react to loud noises. Things to remember at week 22 During your pregnancy, eating healthily is something that is important to keep in mind. Afterall, what you eat is nourishment for your baby. During your second trimester try and eat foods that are rich in protein, calcium and iron. These will help your baby’s growth – protein helps in tissue development, calcium helps in the formation of bones and teeth, and iron helps carry oxygen to your developing baby.

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Coronary CT – detecting disease before it becomes life threatening

Radiology imaging techniques play a crucial role in the early diagnosis, management and monitoring of lifestyle diseases. Advancements in high-quality imaging, using reduced radiation doses, have positioned radiology ideally for this role. This contributes significantly to the understanding and treatment of these conditions.  One such condition is cardiovascular disease, which accounts for approximately 30% of deaths worldwide, coronary artery disease is the commonest form.  Dr Vishesh Sood, a diagnostic radiologist practising at SCP Radiology, says ‘radiology’s role in diagnosing and managing coronary artery disease is pivotal.’ What is coronary artery disease? Coronary artery disease is the gradual narrowing of the coronary arteries, which supply blood to your heart.  What causes this narrowing? It is caused by plaque building up in the inner lining – a process known as atherosclerosis. Plaque is made up of deposits of varying degrees of fatty substances, cholesterol, cellular waste products, calcium and fibrin. As it builds up in the arteries, the artery walls become progressively thickened and stiff. What happens when this build up occurs? These signs and symptoms of coronary artery disease occur when the heart doesn’t get enough oxygen-rich blood. Reduced blood flow to the heart can cause a wide range of symptoms, most commonly chest pain (angina) and shortness of breath. A complete blockage of blood flow can cause a heart attack, which means that blood flow to a part of the heart is reduced for a long enough time and the heart muscle is permanently damaged or dies. What are the risk factors you CAN control? High blood pressure Elevated cholesterol levels Smoking Diabetes Overweight or obesity Lack of physical activity Unhealthy diet and stress What you can’t control However, it’s important to note that genetics also play a crucial role in determining an individual’s risk level. Managing coronary artery disease involves adopting lifestyle changes such as a healthy diet, regular exercise, and quitting smoking, along with medications like statins to lower cholesterol. A coronary CT empowers doctors to recommend these changes and treatments, with the aim of preventing serious cardiovascular events How long does this condition take to develop? Coronary artery disease generally progresses gradually over decades. The disease may go entirely unnoticed, until a significant blockage causes problems or a heart attack occurs. ‘Which is why,’ says Dr Vishesh Sood, ‘we advocate the use of a CT Coronary Angiography, the most sensitive imaging method to confirm the disease.’ He says, ‘This is particularly important in patients with non-specific symptoms, for example chest pain, which could be caused by a range of problems like musculoskeletal issues, gastrointestinal conditions or even anxiety. In these instances, coronary CT angiography is an excellent non-invasive test to confirm whether high levels of plaque are present in the coronary arteries.’ What is a CT Coronary Angiography (CTCA)? It produces detailed images of the heart for precise evaluation of the coronary arteries. A contrast dye is injected into a vein (usually in the arm) before imaging, to increase the visibility of any obstructions in the coronary arteries. The advantages It provides high resolution images of the coronary arteries, during a short, non-invasive procedure.  The disadvantages Even though CTCA provides detailed images of the coronary arteries, it does not allow for interventions, such as inserting a stent during the same procedure. It is used primarily for diagnosis.  Dr Sood says, ‘This is not the only method for detecting coronary artery disease. The diagnostic ‘gold standard’ has always been coronary/catheter angiography.’ What is a Coronary (Catheter) Angiography  During this procedure, a catheter is threaded through blood vessels to the coronary arteries and a contrast dye is injected to make the arteries visible on X-ray images. The advantages It allows for detailed analysis of the blood flow within the coronary arteries. If a balloon needs to be inserted to stretch open a narrowed or blocked artery, it can be done at the same time. ‘Although’, says Dr Sood, ‘the more popular choice is to insert a permanent stent to allow blood to flow more freely, which can also be performed during a Coronary Angiography.’ The disadvantages It is an invasive procedure. Threading a catheter through blood vessels, usually from the groin or wrist, up to the coronary arteries can be uncomfortable for patients. It may take an hour or longer to complete and may result in bleeding, infection and some potential damage to blood vessels.   Who makes the decision to do either procedure? The specialist will do a thorough assessment and then makes the decision. ‘The choice between cardiac CT and angiogram depends on the specific situation, the information needed and individual patient factors,’ explains Dr Sood. ‘Cardiac CT is often used for initial screening non-invasive assessment, while conventional coronary angiography is usually for cases where more detailed information about the blood flow is required or when the plan is to insert a balloon or stent into the artery to expand it.’  CTCA is quickly becoming a cornerstone in modern cardiology to detect coronary disease can be detected and managed before it becomes life threatening.  

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 21 of your pregnancy

At week 21 of your pregnancy you’re now just over half to meeting your baby for the first time. You’re still in your third trimester, so take advantage of feeling better with a smaller baby bump while you can. Your body at week 21  Typical pregnancy symptoms during this are an achy back, swollen feet, heartburn, hot flashes, forgetfulness (nicknamed ‘baby brain’) and leg cramps. You may have also noticed stretch marks on tummy, breasts, thighs and butt, and this is thanks to your quickly growing tummy and baby. Headaches during pregnancy are fairly normal, especially if you’re slightly tired or dehydrated. However, if you experience bad headaches for hours on end, or ones that won’t go away, consult your doctor as you may have high blood pressure. This is also known as pre-eclampsia, which is a pregnancy complication characterised by high-blood pressure and protein in your urine. Your baby at week 21 Your baby is now the length of a banana or a carrot. Around this time your baby will also start sleeping and waking at different times (not necessarily the same as yours though). Your baby is also drinking amniotic fluid, although the placenta is how they receive the majority of their nourishment. Things to keep in mind at week 21 Braxton Hicks contractions are also known ‘false labour’ and they are your body’s way of preparing you for labour. These contractions are your womb contracting and relaxing and while they can be uncomfortable, they aren’t painful. Braxton Hicks contractions vary in length, and aren’t rhythmic, which is what differentiates them from normal contractions. There isn’t a treatment for these contractions, but changing your position (if you’re lying down) or taking a relaxing bath or nap can help ease them. If you’re unsure of whether or not you’re having Braxton Hicks contractions or labour contractions, contact your doctor immediately, as you may be going into preterm labour.

Bonitas – innovation, life stages and quality care

Championing the fight to prevent pneumonia

Every year a day is set aside to raise awareness of pneumonia, promote prevention, treatment and provide an annual forum for the world in the fight against pneumonia. The theme for World Pneumonia Day in 2024* is, ‘Championing the fight to prevent pneumonia’.  According to the World Health Organization (WHO), pneumonia is one of the most common causes of morbidity in SA children, despite improvements in immunisation and HIV management programmes. WHO also states that globally a child dies from pneumonia every 30 seconds. This is higher than malaria, HIV/AIDS and tuberculosis combined. In South Africa, flu and pneumonia ranked second (after intestinal infectious disease) as the leading cause of death in children under 5 years. This just doesn’t make sense when vaccines are available in both the private and public healthcare sector for children and adults. As part of the Expanded Programme on Immunisation, babies have a series of 4 vaccinations: At 2 months of age, 4 months, 6 months and 12–15 months. What is Pneumonia? Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund says, ‘pneumonia is a respiratory infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus, causing symptoms such as cough with phlegm or pus, fever, chills and difficulty breathing’.  Types of Pneumonia Bacterial pneumonia Viral pneumonia Fungal pneumonia Aspiration pneumonia: This type is more common among certain people, including older people and those with nerve disorders or swallowing issues The flu shot as the first line of protection  Dr Hadebe recommends having a flu vaccine and says it is the first line of defence when it comes to protecting yourself. Studies show it reduces the risk of contracting flu by about 50 to 60% and also helps prevent the development of Pneumonia.   According to the New England Journal of Medicine (NEJM – 2015), ‘In addition to reducing the risk of hospitalisation for an influenza (flu) infection itself, flu vaccination appears to reduce the likelihood of hospitalisation for influenza-associated complications such as pneumonia.’ Perhaps the more telling piece of data shows that only 29% of the overall population have been vaccinated against flu, emphasising the need for more effective delivery of preventative services to prevent Pneumonia deaths. Pneumococcal vaccine  There is also a vaccine that protects you against Streptococcus pneumoniae bacteria which causes 80% of Community Acquired Pneumonias (CAPs). These streptococcal bacteria can spread from the nose, throat and ears to cause pneumonia – a severe infection of the lungs. It also protects you against other pneumococcal diseases including those of the bloodstream (Bacteraemia) and the lining of the brain and spinal cord (Meningitis). Who should have the Pneumococcal vaccine? People over 65, particularly in a retirement village  Anyone with heart and lung problems, including asthma or with chronic illnesses like anaemia, diabetes or kidney failure. Immune-suppressed people, including those who are HIV-positive Caregivers and close contacts of any of the above Smokers, as they are more prone to respiratory illnesses Cancer sufferers The WHO reports that some preliminary studies suggest that obesity and especially extreme obesity, may also be a risk for more severe disease. Signs and symptoms of Pneumonia may include: Chest pain when you breathe or cough Confusion or changes in mental awareness (in adults aged 65 and older) A cough, which may produce phlegm Fatigue Fever, sweating and shaking chills Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) Nausea, vomiting or diarrhoea Shortness of breath When to see a doctor? With virtual consultations readily available, it’s recommended you first consult your doctor via a telephone or video call to discuss your symptoms, especially if you are having difficulty breathing, chest pain, persistent fever of (39°C) or higher or a persistent cough, especially if you’re coughing up phlegm. Your physician will then decide whether you need a face-to-face consult and examination. Dr Hadebe says that, despite the evidence of the efficacy of these vaccinations, there is not enough uptake. ‘It is up to each one of us to take charge of our health, this includes having regular wellness checks and ensuring that you have a flu vaccine and, if you are vulnerable to develop pneumonia, have the pneumonia vaccine at the same time.’ Remember that your GP is your first port of call for all your healthcare needs.

Bonitas – innovation, life stages and quality care

Tackling women’s health holistically

‘A woman’s health is her Capital’ As far back as 2014 at the World Health Organization’s (WHO) ‘Partnership for Maternal, Newborn and Child Health Forum’, South Africa stated their alliance with WHO’s statement and said, ‘the health of mothers and their children is key to achieving development equity.’ Which is why Bonitas Medical Fund, the Medical Aid for South Africa, has teamed up with CareWorks, to bolster its mother and childcare benefits and introduce a new Female Health Care Programme. With this renewed commitment to the health and wellbeing of women and toddlers, the Scheme will shine a light on the importance of preventative care and empower women to prioritise their health. ‘In South Africa, women face a range of health challenges influenced by socioeconomic, cultural and environmental dynamics at play,’ says Dr Themba Hadebe, Clinical Executive at Bonitas. ‘Many of these healthcare factors are unique to women. Early disease detection and appropriate care programmes are proven key factors in improving treatment outcomes and prognosis. Dr Hadebe says, ‘It is common knowledge that women often put their own health needs aside to care for their families. This programme will pro-actively assist women and provide them with support, to ensure that they access prevention services when they need to, as well as treatment plans.’ Top health issues in South African women are: Non-Communicable Diseases (NCDs) Diabetes in South Africa’s is the second deadliest disease and is also the leading cause of death among women in the country. 68% of women are obese, which is a strong risk factor for Type 2 diabetes. In addition, it is estimated that 10% of pregnant women in South Africa have gestational diabetes, which may go undiagnosed. This evidences the urgent need for screening and diagnosis.  Breast and Cervical Cancer The statistics are stark: 1 in 6 women worldwide is estimated to develop cancer during their lifetime. By 2040, there will be a projected rise to 30 million new cancer cases amongst women globally. Screening services are encouraged for early HPV (Human Papilloma Virus) detection and breast cancer diagnosis.  Mental Health Approximately 25.7% of South Africans are affected by probable depression, with similarly elevated levels of anxiety, particularly among women. These rates are influenced by socio-economic status, adverse childhood experiences and educational levels. HIV/Aids South Africa has one of the highest HIV prevalence rates in the world – with women, especially young women, being disproportionately affected. Of the 7.3 million adults living with HIV, 64% are women. According to Dr Mizpah Moru, the Clinical Service Manager of CareWorks, ‘The programme is focussed on educating and empowering women to take control of their health and to address any barriers that may stop them accessing health services. ‘We have a highly skilled female team of clinicians who understand the specific healthcare needs of women.’ Online Assessment and Preventative Screening There are various modules in the Self Health Evaluation (SHE) – each are educational and designed to alert potential red flags related to the likes of cardiovascular disease, hypertension and diabetes. Other modules deal with prevalent cancers, mental health, pregnancy and communicable diseases like HIV, as well as screening questions for TB and STIs. SHE and risk identification will enable targeted messaging to members. Screening results will trigger a support process to assist members in accessing appropriate, targeted care programmes. ‘We’ve taken proactive steps to address their unique healthcare needs. Our aim is to provide inclusive, tailored healthcare solutions at every stage of life,’ says Dr Hadebe.  Female members will be encouraged to access their Bonitas benefits to: Promote preventative care strategies for both females and toddlers  Detect non-communicable diseases such as hypertension, diabetes, mental disorders, cancers, etc.  Help females plan appropriately during their reproductive ages Help expecting mothers to detect and manage any risks and complications as early as possible in their pregnancy Improve access for females and toddlers to essential care Improve parent education and awareness about toddler care Expansion of the Maternity Programme  The comprehensive Maternity Programme includes support for new parents with milestone reminders for children under three, immunisation reminders and online screenings for infant and toddler health.  Enhanced support for expecting mothers, includes: Early identification of high-risk pregnancies Weekly engagement for high-risk pregnancies Post-childbirth follow-up calls Online assessments for pregnancy and mental health Midwives and nursing sisters will provide nurturing and caring support to women who have suffered a miscarriage and assist them in working through both the physical and mental issues associated with the loss of their baby.  Support will be offered to parents of neonatal babies  The programme also includes a library of female specific health topics – with a monthly focus – screening reminders and support, all communicated through SMS, WhatsApp, emails, calls and other existing digital platforms.  ‘The aim of the new Female Health Care Programme is to raise awareness and promote education around health and wellness,’ says Dr Hadebe. ‘It’s about influencing behaviour positively and encouraging early screening and preventative services. Importantly, it is also about providing inclusive, tailored healthcare solutions at all stages of life, to help members live their healthiest life.’

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 20 of your pregnancy

Congratulations to you and your baby, you’re officially halfway through your 40 week pregnancy. It’s crazy to think that 20 weeks ago you had your last period, and now a new life is blossoming inside of you – you may even know their gender and are thinking about possible names. Your baby at week 20 You little one is now roughly the size of a grapefruit or banana, and if you haven’t been able to feel your baby move around, at week 20 things may change. Although your baby still has a fair amount of room inside of you, and you should feel her moving around inside your tummy.Their heart is pumping between 120-160 beats per minute and their senses and reflexes are becoming more developed. How you’ll feel at week 20 You may have noticed the appearance of a dark vertical line on your belly, this is normal in pregnancy and is known as a linea nigra. This line isn’t a problem and is caused by hormones during pregnancy. If you’re wanting to travel or are planning to organise a baby nursery in your house, use the time during your second trimester to your advantage, as your pregnancy symptoms won’t be as intense as they were in your first trimester, and your belly won’t be inconveniently big just yet. But that being said keep your needs in mind and don’t push yourself to do something if you aren’t feeling comfortable. Things to remember at this time During your pregnancy you may experience lower back pain thanks to your growing baby putting increasing strain on your body. If your pain is unbearable it’s best to seek the advice of your doctor or physio, but if you are managing there are a few things you can do to make your life more comfortable. Practicing prenatal yoga, deep breathing, being aware of your posture and a pregnancy belt are all things which can help ease your tired back.

Bonitas – innovation, life stages and quality care

Time to quit. World No-Tobacco Day

‘A billion deaths can be prevented this century, if governments act now to reduce tobacco use’. [World Health Organization] Ahead of World No-Tobacco Day, commemorated annually on 31 May, the World Health Organization (WHO) is calling on governments to adopt policies that shield children from exposure to harmful tobacco products. This year’s theme: ‘Protecting children from tobacco industry interference’, gives young people across the world, the platform to urge the tobacco industry to stop targeting them with products that are harmful to their health.  Statistics indicate that smoking among young people remains high. More than 38 million youngsters, aged between 13 and 15, are using some form of tobacco. Tobacco use affects all communities. It has direct harmful effects on health, but also impacts a country’s economy and environment and hinders their achievement of Sustainable Development Goals*.   ‘Lifestyle-related diseases stemming from tobacco, alcohol and obesity, have overtaken infectious diseases and become one of the biggest killers,’ says Dr Themba Hadebe, Clinical Executive of Bonitas Medical Fund. ‘We often think tobacco use is no longer an issue. And, while the number of people smoking in South Africa has fallen by over 20% over the past two decades, the reality is that we still have a long way to go.’ One of the reasons for the decline in cigarette smokers is that South Africa is part of The WHO Framework Convention on Tobacco Control (FCTC). The FCTC is an international treaty which requires governments to, amongst other things, raise tobacco taxes, ban tobacco advertising and make public places smoke-free. It also urges governments to protect their policies from tobacco industry interference and to ensure children grow up free from commercial pressure to start smoking. South Africa was one of the first country signatories to the FCTC on 16 June 2003, the treaty was enforced on 18 July 2005. The facts are clear: Tobacco is harmful to your health. It was responsible for a million deaths during the 20th century and tobacco use could kill 1 billion during the 21st century.   ‘We encourage you to take action now,’ says Dr Hadebe. ‘If you are a smoker, quit and if you’re a non-smoker, help a friend or family member to quit.’ He says there are a number of support groups available. ‘At Bonitas we offer our members a fully supported stop smoking programme through GoSmokeFree. The programme, available through participating pharmacies, begins with a pre-quit assessment and then one-on-one sessions with a nursing sister and trained advisors to develop an individual plan to stop smoking. ‘When you quit smoking, good things start to happen,’ says Dr Hadebe, ‘you can feel and see almost immediate improvements to your health.’ The health benefits  Not only can you save up to R1 000 a month when you quit your 20-a-day habit, but you will enjoy the following health benefits: After 20 mins: Your blood pressure and pulse rate slows After 8 hours: Your nicotine levels reduce by half and oxygen levels return to normal 24 hours: Carbon monoxide leaves your body and lungs start to clear mucus and smoking debris 2-3 days: Your sense of smell and taste is enhanced 72 hours: Breathing is much easier and energy levels will increase 3+ months: Your skin starts to look younger and your teeth whiter 5 years: Heart attack risk falls to half that of a smoker 10 years: Your risk of lung cancer falls to half that of a smoker and heart disease risk to the same as someone who has never smoked It’s never too late to quit and it’s easier to stop smoking with the right support. Try the following: List the reasons you want to quit Set a date to give up smoking Tell people you are quitting Use stop smoking aids  Join a free support group (even on Facebook) for support and advice Have a plan for when you are tempted to smoke (a distraction) List your smoking triggers and how to avoid them Keep cravings at bay by keeping busy Exercise away the urge to smoke Throw away all your cigarettes before your start Remember: Never give up giving up!

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 19 of your pregnancy

At week 19 you’re just one week off being halfway through your pregnancy! Your baby is now the size of a mango, and the exciting news is that you’ll soon find out (if you want to) whether your baby is a boy or a girl. Your body at week 19 You may have started to notice some pelvic pain and abdominal pain due to your baby’s growth. Your muscles and ligaments are working hard to support your expanding bump and this can cause discomfort. Regular gentle exercise (and if you were fit before your pregnancy, that’s a bonus) can help strengthen the muscles around your back and pelvis which can alleviate discomfort. Leg cramps are another pregnancy symptom that many expecting moms experience. These frustrating pains can often be experienced near the end of the day. Calf stretches and drinking plenty of water are two ways in which you can help reduce cramps. Your baby at week 19 Your baby is now the size of a mango, and at this time their skin becomes covered in a greasy, waxy substance called vernix caseosa. This protects the skin from the amniotic fluid in the uterus. Your baby’s first set of teeth are developing (although these won’t be visible for a while after they are born) and hair is starting to appear on their head. Things to remember at week 19 Around week 19-20 you’ll have a morphology scan which is an ultrasound which examines your baby’s body, the placenta and umbilical cord. The scan is used to check for any structural abnormalities in your baby, but it will also be the first chance you get to see your baby. This scan is also when you’re able to find out your baby’s gender.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 18 of your pregnancy

Your pregnancy is starting to become more obvious, and if you’re trying to conceal your bump, you may start finding this more difficult. Inside your body, you may feel your little one moving inside of you – you may even notice that the movements are in response to noises as your baby can start to register sounds. Your body at week 18 You may have started to notice dizziness when you stand up. To lessen this, get up gently when you stand from sitting or lying down. Your back may be feeling increasingly achey, so avoid doing activities that aggravates it. You may also notice swelling in your hands and feet, as well as increasingly difficulty to get to sleep. Your baby at week 18 Your baby is now the size of an artichoke or a red bell pepper, and it’s around this time you’ll start to notice your baby moving around inside you. You may have noticed this previously, especially if you’ve had a baby before – but this is the time that little one’s movements become more distinct. However, they’ll feel more like a flutter than a strong kick, so don’t be concerned if you’re unsure of what you’re feeling at first.  Things to remember at week 18 Although pregnancy is a happy and exciting time for many moms-to-be, it can also be very stressful. Antenatal anxiety is both fairly common during pregnancy, especially if your pregnancy is unplanned, you have external stresses such as financial strain, or you experienced depression and anxiety prior to pregnancy. A bit of worry during this time is normal, as you are going through many new experiences. However, if you feel like your worry is crippling and you can’t enjoy day-to-day life, then you may be experiencing antenatal anxiety. This is nothing to be ashamed of, and seeking medical guidance can help make your pregnancy easier and happier.

Bonitas – innovation, life stages and quality care

Getting to grips with flu

Few common illnesses are more unpleasant than the flu. The aches, pains, chills, fever and cough are bad enough. Add the other potential symptoms including runny nose, vomiting, diarrhoea, fatigue or sore throat and you’ll want the illness to be over as soon as possible. Or try to prevent it. Annually, flu kills around 11 500 people in South Africa and 20 000 are hospitalised. ‘The seasons are changing and with it comes the ‘flu virus,’ says Dr Themba Hadebe, Bonitas Medical Fund’s Clinical Executive. ‘Now is the time to take precautions against catching flu, including having a flu vaccine, which is recommended by the World Health Organization (WHO).’ Why a Flu vaccine? Although the flu vaccine will not eliminate your risk of developing flu, it helps reduce your chances of severe infection. What are Flu pandemics? These occur when a new flu virus emerges that is significantly different from circulating seasonal strains, causing widespread illness worldwide. Best known examples are the: 1918 Spanish flu, 1957 Asian flu, 1968 Hong Kong flu and the 2009 H1N1 pandemic. The 1918 Spanish flu pandemic was the most severe, it is estimated to have been responsible for the deaths of 50-100 million people. What is Flu? Flu is a contagious respiratory illness caused by the influenza viruses. It can cause mild to severe illness and can lead to hospitalisation and even death, especially in high-risk groups such as young children, the elderly, pregnant women and people with underlying health conditions. What is the current Flu strain in South Africa? There are four types of flu viruses: A, B, C and D. Most seasonal outbreaks of flu in humans are as a result of the A and B viruses. The most commonly reported influenza viruses for 2024 are type A(H1N1) and type B. What are the most common Flu symptoms in 2024? These may include the following:  Fever of 38˚C or higher Aching muscles, especially in your back, arms and legs Chills and sweats Why do I need a Flu shot every year? ‘All viruses mutate – meaning the genetic material of the cell changes – but not at the same rate. Some mutate very quickly, including the flu virus. Which is why we get a new flu vaccine every year,’ says Dr Hadebe.  Other preventive measures include frequent handwashing, covering your mouth and nose when you cough and sneeze, avoiding close contact with sick individuals and staying home when ill. Will the flu shot give me Flu? A flu shot cannot cause flu. Flu vaccines are currently made either with flu vaccine viruses that have been ‘inactivated’ and are not infectious or with no flu vaccine viruses at all. Some side effects may occur like redness, tenderness and swelling where the shot was given but this is mild and will only last a few days. These are infinitely preferable to a bad case of flu.  Who should get a Flu vaccine? Annual flu vaccines are recommended for everyone six months and older, especially for those at higher risk of complications. The vaccine helps your immune system fight off the virus by producing antibodies which is why it’s best to vaccinate in April or May, before the start of flu season. Flu vaccinations are available at most pharmacies and the costs are generally covered by medical schemes. Anyone in the high-risk groups including: Healthcare workers  Individuals over 65 years  Individuals with chronic diseases – or comorbidities – for example: Cardiac disease, diabetes, asthma, kidney diseases (due to poorer baseline immunity)  Pregnant women  People with a BMI over 40 People who are immune compromised Who should NOT have the Flu vaccine?  Those allergic to eggs or egg proteins as the vaccine manufacturing process involves the use of chicken eggs  Infants under 6 months of age  Individuals who may have had a severe reaction to a flu vaccine in the past Individuals who may be suffering from flu symptoms already  How is flu transmitted? It spreads mainly through respiratory droplets when an infected person coughs, sneezes or talks. It can also spread by touching surfaces contaminated with the virus and then touching your mouth, nose, or eyes. What are the complications of Flu? Flu can lead to various complications, such as pneumonia, bronchitis, sinus infections, ear infections and worsening of chronic medical conditions like asthma or heart disease. Complications are more common in high-risk groups. ‘Flu viruses spread very quickly from person to person’, says Dr Hadebe.  ‘Even if the flu vaccine is not 100% effective, it will reduce your risk of getting flu, and, if you do get it, it will be a great deal milder’.  

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 17 of your pregnancy

Week 17 your baby is getting bigger, and this week they’ll start developing more fatty tissue. You may have started to notice an achy back and pelvis, and getting a good night’s sleep may have become increasingly more difficult. Your body at week 17 At week 17 you may see an increase in your appetite, a far cry from the nausea you experienced in your first trimester. Your breasts are also increasing in size as they prepare for milk production – for some women this growth is more than others. Your growing baby’s weight can also put added strain onto your spine and pelvis, meaning you could start to experience backache. Prenatal yoga and supportive chairs and shoes, are all ways in which you can help your body feel more comfy. Your baby at week 17 Your baby is now the size of an onion or orange, and at this time her fatty tissue is starting to form – this will help keep her warm after she’s born. Although the head is still the biggest part of the body, the body proportions are starting to become more even as your pregnancy progresses. Your baby is now learning to suck, so that when they’re born they can easily feed, although this reflex won’t mature until later in your pregnancy. Around this time, your baby’s finger prints will also form. Things to remember at week 17 Your pregnancy changes your whole life, including the way you sleep. Even though the position you sleep in is something fairly simple, which you probably hadn’t put much thought into before. As your pregnancy progresses, a good night’s sleep is something that may become increasingly difficult. It’s recommended that you avoid sleeping on your back in your second and third trimester, as your uterus and baby can put pressure on your spine and vena cava. Sleeping on your left side is ideal as this supports optimal circulation. Once your belly gets bigger, you can even look into getting a pregnancy pillow, which offers support for your entire body.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 16 of your pregnancy

You are now 4 months pregnant, and have 24 weeks left to go before you birth day, although this may seem far away your baby has done so much growing in these past 16 weeks and still has lots left to do before they are born.   Your body at 16 weeks Your pregnancy hormones can make your veins stretch, giving you varicose veins. While these distinctive purple lumps are the prettiest sight, generally they are painless and harmless. Pregnancy brain is another sign of a baby that you may have noticed, many moms-to-be notice they may become more forgetful or inattentive. The exact reason for this isn’t clear, however, stress and having many items on your to-do list could be contributing factors towards this. You may also notice some pregnancy weight gain (which is normal and nothing to worry about!) and your boobs will have probably gone up a few cup sizes as your body preps for breastfeeding. Be sure to invest in comfortable bras, such as maternity or sports bras, as this can help ease any discomfort. Your baby at 16 weeks Your baby is now the size of an avocado. This week may be the one that you first start to notice small kicks from your little on moving around. Another exciting marker of this time is the fact that your baby can start hearing your voice, so make sure you chat to them throughout your day. This’ll also be roughly the time that their eyes become more sensitive to light, their bones and muscles are hardening and strengthening and their eyebrows, hair and lashes are forming.  Things to take note of around this time. During pregnancy you may struggle with constipation. This is a fairly common pregnancy complaint thanks to pregnancy hormones and the extra iron you’re taking in your prenatal vitamins. Eating more fibre, drinking lots of water, and exercise can help keep you regular.  If you’re still struggling, chat to your doctor and they may prescribe stool softeners to help.

Bonitas – innovation, life stages and quality care

Measles – it’s a serious illness

The World Health Organization (WHO) has warned of an ‘alarming’ increase in measles cases – almost 45-fold in Europe last year – but outbreaks of new cases and even deaths are being reported globally. WHO believe this is a result of fewer children being vaccinated against the disease, especially during the Covid pandemic. However, measles is preventable, thanks to a vaccine that was introduced in 1963. Since 2000, the measles vaccination programme has averted an estimated 57 million deaths worldwide.  However, the Covid-19 pandemic disrupted global vaccination activities which, in 2021, resulted in the lowest measles-containing-vaccine first-dose (MCV1) coverage levels since 2008. Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund takes a look at this ‘childhood’ disease to remind us about what causes it, the symptoms and why we should vaccinate. What is measles? Measles is caused by a virus and can affect anyone but is most common in children.  It infects the respiratory tract and then spreads throughout the body. Some of the more common measles symptoms include: High fever  Cough Runny nose  Red, watery eyes (conjunctivitis)   A rash all over the body (3-5 days after symptoms begin). Complications of measles can lead to: Ear infections Diarrhoea Pneumonia (infection of the lungs) Other respiratory infections Encephalitis (inflammation of the brain) which occurs in about one in every 1 000 people with Measles. Blindness Measles can be serious Measles is so much more than just a fever and rash that clears up in a few days.  It can cause serious health complications, especially in children under the age of 5 and adults over the age of 30. If a woman catches Measles during pregnancy, it can be dangerous for the mother and can result in her baby being born prematurely with a low birth weight. Even with the best care, people can still die after contracting measles (1 to 3 out of 1 000 people). Being vaccinated is the best way to prevent getting sick with measles or spreading it to other people. Measles is contagious Measles is easily spread through the air when an infected person coughs or sneezes. It is very contagious: One person can infect up to 9 out of 10 people around them if they are not adequately protected. In fact, an infected person can spread measles to others even before they know they have the disease – from up to four days before developing the measles rash to around four days afterwards. The measles vaccine The best protection against measles is the Measles-Mumps-Rubella (German Measles) (MMR) vaccine. The MMR vaccine provides long-lasting protection against all strains of measles. Your child will need two doses of MMR vaccine for best protection: The first dose at between 12 and 15 months of age The second dose at between 4 through 6 years The Measles-Mumps-Rubella-Varicella (MMRV) vaccine, which protects against four diseases, is also available to children from 12 months through 12 years of age. Treating measles As measles is caused by a virus, there’s no specific medical treatment, it has to run its course.  However, if your child has measles they need to drink plenty of liquids, get lots of rest and stay at home to prevent spreading the infection. Measles outbreaks The people most at risk during a measles outbreak are non-immune person (not vaccinated or vaccinated but did not develop immunity). Unvaccinated young children and pregnant persons are at highest risk of severe measles complications. The fact is that measles is still common and with a break in the vaccination regime we are seeing more outbreaks.  The best way to fight it and prevent it spreading is to vaccinate. Did you know? South Africa follows International Guidelines in providing vaccines to children. This programme is known as the Expanded Programme of Immunisation (EPI). Parents need to take responsibility to ensure their child is vaccinated on time: Not only to help protect the child against certain illnesses but also to contribute to the overall health of children in the general population.  ‘Childhood vaccines are a critical part of a child’s health, they work by stimulating and teaching the immune system how to fight certain infections,’ explains Dr Hadebe. ‘Bonitas recognises this and we cover immunisation, on most plans, according to EPI up to the age of 12.’

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 15 of your pregnancy

Congratulations, you and your baby are now at week 15, while your baby still has lots of growing to do, you should make sure that you make the most out of feeling more energetic during trimester two. Join prenatal classes, enjoy walks outside and start planning how you’ll rearrange your house for the arrival of your new bundle of joy. Your baby at week 15  Your little one is now roughly the size of an apple or pear, and at this point your baby’s ears and eyes are starting to become more developed, and are moving into the correct place on their head. Soon they may even be able to hear the sound of your voice. During this time their bones and muscles are also getting stronger, not only this but her limbs are getting longer and are able to move. You won’t be able to feel any movement just yet, but it won’t be long! Your body at week 15 At week 15, your increased energy levels may also mean that you may experience increased libido. Although you may have higher energy levels, you’ll probably also notice that your expanding belly is itchy, thanks to stretching skin. If you are feeling increasingly hungry, thanks to a reduction in morning sickness, be aware of what you’re putting into your body. Certain foods, such as ripened cheese, can be damaging to your baby. However, the inclusion of healthy snacks can be beneficial to both of you, and by doing research or chatting to a dietician, you can make sure that you include food groups that’ll be nutritious to you and your baby. Things to keep in mind at week 15 Another pregnancy symptom is sensitive gums and teeth. The reason for this is hormonal changes which increase the blood flow to your gums, making them swell. Not only this but you may be more susceptible to gum disease and pregnancy gingivitis (which about half of all women experience during pregnancy). Because of this it’s important that you look after your teeth and gums, and check in the dentist during your pregnancy.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 14 of your pregnancy

Week 14 of your pregnancy and you’re in month four of your pregnancy with five to go – almost half way already. Trimester two of pregnancy means you should be feeling renewed levels of energy and you may even notice that your appetite has increased thanks to morning sickness slowly easing up. Your baby in week 14 Your baby is now the size of a peach, and now often moves her arms and legs – but you won’t be able to feel this yet. If you could see into your belly, you may even notice your little one sucking their thumb! Around this time the grasp reflex is evolving, and hair growth is starting as follicle under the skin, so that when they’re born your baby should have silky strands of hair. Your little one’s genitals are now also fully developed, but it’ll still be difficult to tell their gender on ultrasound. Your body in week 14 Luckily during your second trimester you’ll be feeling more yourself, with rising energy levels, breasts that are less tender and dissipating nausea. You’ll also probably starting to show a bit as well, however, some moms, especially those expecting multiples, may start showing sooner. This is because your uterus is rising out of the pelvic region and into your lower abdomen. During the second trimester you’ll also notice that you’ll start to put on weight, don’t be alarmed by this as it’s completely normal and healthy during a pregnancy. Things to take note of  If you found that during your first trimester your pregnancy symptoms meant that you generally stayed away from exercise, embrace your renewed energy levels and start doing gentle exercises such as water aerobics, prenatal exercise classes and gentle walks. This’ll be beneficial to both you and your growing little one.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 13 of your pregnancy

At week 13 of your pregnancy you are now in your second trimester. This trimester is often nicknamed the honeymoon period, as your pregnancy symptoms should have started easing up, and your baby is still small enough that you don’t feel uncomfortable. Your body at week 13 At week 13 your energy levels should start increasing, but if your nausea and fatigue don’t disappear just yet – don’t despair, some moms experience these for longer than others. This increase in energy won’t stick around forever, so make the most of this time while you can and tick important to-dos off your list. Your blood flow will also increase during this time, and because of this you may see blue streaks under your skin from your veins and experience an increase in libido. Your baby at week 13  Your baby is now the size of a lemon and her body proportion is slowly starting to change, although the head is still the biggest part of the body. Your baby is growing rapidly,  and during this time, her intestines are moving from the umbilical cord into the stomach. Her eyelids are shut to protect the eyes as they develop and her vocal cords are also developing, so that when your baby is born she’ll be able to cry and laugh and eventually say her first word. Things to remember in this week  Around this time is when some people choose to tell family, friends and employers that they’re expecting. You should pick when you feel most comfortable to tell everyone, however, this time is often chosen, as your risk of miscarriage will have decreased and you’ll have had your first pregnancy ultrasound, which should confirm that your baby is healthy.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 12 of your pregnancy

This is now the last week of your first trimester, which is week 1 to 12. Your clothes are probably starting to feel a little tighter than they used to, but the good news is that some of the first-trimester pregnancy symptoms, such as morning sickness and fatigue should be easing up soon. During the first trimester, your baby will have grown from an egg to a fully formed baby (with lots of growing to do) and you’ll have had your first check-up and ultrasound. Your body at week 12 At week 12 you’ll probably notice that your morning sickness may start to subside. This is because the hCG hormone is starting to level off. However, not all moms are this lucky, as some experience nausea in their second trimester as well, or even throughout their whole pregnancy. Stomach pain, cramping and constipation are also pregnancy symptoms you may be experiencing.  Not all women experience constipation, however, it is fairly common thanks to pregnancy hormones. If you experience sharp or severe pain, it’s important to seek medical help as quickly as possible. Things to keep in mind Throughout your pregnancy both your mental and physical wellbeing is important. Many articles on pregnancy neglect to explain the mental challenges that expecting moms can struggle with during this time. Pregnancy hormones, the added stresses of a new life growing inside you and previous or current depression and/or anxiety can mean that you may also struggle with antenatal depression and anxiety. Tell-tale signs of antenatal depression are feeling sad or anxious all the time, and lack of interest in things that used to.  If you do feel that you’re struggling it’s important that you reach out to a health care provider and rely on family and friends for support. Joining a support group of moms, or moms-to-be in a similar position can also help you feel more at ease. Where is your baby at in week 12 Your growing baby is now roughly the size of a lime or a plum. At this point all your baby’s important features, body parts and organs are in place, they just have lots of growing and maturing to do. Your baby’s tiny developing bone marrow is starting to make white blood cells and their muscles and nervous system are maturing.

Bonitas – innovation, life stages and quality care

Pregnancy, your body and your baby – week 11 of your pregnancy

You are now almost at the end of trimester one, which is good news as the second trimester is often seen as easier than the first. Both you and your baby will have undergone many changes during these first 11 weeks, and you’ll have gone from a hoping-to-be-mom to an expecting one. Pregnancy has its ups and downs, so it’s important that you look after yourself (and by default your growing baby) at this time. How you’ll be feeling at week 11 At week 11 your baby bump may be beginning to show, but don’t worry if your baby bump isn’t showing yet, as this varies from pregnancy to pregnancy. It’s likely that if this is your first pregnancy and you don’t have multi babies inside you, you won’t start showing as quickly. If your morning sickness if beginning to ease you may notice that you’re feeling hungrier than normal. If this is the case, make sure that you fuel up on healthy snacks that are nutritious to both you and your growing baby. You may find that your cravings are completely different from what you’d normally eat, and your old favourite food is one you that makes you feel queasy. Hormones, senses that are heightened and a need for comfort food are all reasons behind these strange (but normal) pregnancy cravings and aversions. Your baby at week 11 Your baby is now the size of a lime or a fig, and their body is slowly starting to straighten out. At this point, your baby’s hands and feet, as well as their ears, nose and mouth are becoming more developed. Hair follicles are beginning to form, as well as nail beds and their reproductive organs are developing, however, you won’t be able to tell gender via ultrasound just yet.

Bonitas – innovation, life stages and quality care

TB – Serious but Curable

Tuberculosis (TB) is a serious public health issue in South Africa.  280 000 people fell ill with TB during 2022 and, of these, an estimated 54 200 died from the disease. South Africa is one of the 30 high burden TB countries, contributing 87% of the estimated cases worldwide.  According to the Department of Health, the main driver of TB infection is HIV, with around 48% of TB patients living with HIV. As a member of the United Nations, South Africa has committed to reducing new TB cases by 80% by 2030, compared with 2015 levels. Clinical data presented by the World Health Organization (WHO) indicates that our country is meeting some of its targets but there are still too many people falling ill and dying. ‘It is important to remember that TB is curable’, says Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund. ‘However, we all need to be more aware of how contagious it is, the symptoms, the impact of the disease, the importance of getting medical attention and adhering to the treatment regimen.’ ‘TB also has a big impact on the economy, not only in terms of healthcare expenses but lost productivity – due to absenteeism and the direct and indirect costs to business.  ‘We know that not everyone has access to private medical care but public healthcare facilities offer free testing and treatment.  If you test positive for TB, the Department of Health will provide the necessary medication. Crucial to overcoming this disease is to follow and complete the treatment regimen as advised by your healthcare giver.’ Some TB facts: What is TB? It’s a disease that mainly affects the lungs but can also be found in any other body organ. It is caused by an organism (germ) called Mycobacterium Tuberculosis which is found in the sputum (a mixture of salvia and mucus) coughed up by someone with TB of the lungs. The organism (germ) usually destroys the soft tissue of the lungs resulting in difficulty breathing and blood can be coughed up in severe cases. If untreated, TB can cause death.  How is TB contracted? The disease is passed on from one person to another. The germs spread into the air via microscopic droplets if an infected person sneezes, coughs or releases saliva. The incubation period is 6 weeks.  TB Symptoms  If you are concerned about your health or having been exposed, you must get tested urgently.   Symptoms of the TB include: Excessive coughing – a cough that has been present for more than two weeks and is productive, (a cough that has phlegm) Chest pains  Loss of appetite and weight Low grade fever Night sweats Chills Coughing up blood In children the symptoms may present as a cough for 2 weeks or more, loss of energy and appetite and quite often a mild fever. Who is most at risk of contracting TB? People living with HIV/AIDS Living in the same house as someone who has had or has TB  Anyone who has had active TB in the last two years  Those with diabetes Residents of informal settlements Children under five The undernourished Alcoholics and smokers  Mineworkers  Prisoners Pregnant women Can you have TB and not be sick? TB can be ‘latent’, in other words it’s in your body but not active and therefore you not capable of spreading it. However, if your immune system becomes weak, the TB can become active and you become ill. Having HIV/AIDS is a key factor in the TB epidemic which is why it is so important that the people living with HIV are screened and treated.   How is TB diagnosed? Diagnosis of TB is quite complex since many symptoms can be quite similar to those of other common lung diseases. South Africa has moved towards more intensive and active methods of identifying cases, for example by screening all those attending primary health clinics.  TB testing and treatment is free. The Mantoux Tuberculin Skin Test (TST) and blood tests do not differentiate between latent and active TB which means a sputum sample needs to be taken or a chest X-ray.  Treating TB TB is definitely treatable. However, medication must be started as soon as possible, and it must be taken regularly – as per the instructions. Also important is to finish the course of medication. It takes six months for TB to be cured completely but, within 2 weeks of starting treatment, the person will no longer spread the disease.  Treatment must be completed. If treatment is missed, the risk of a drug resistant strain of TB is possible, which is difficult to treat and requires a longer treatment period.  How can TB be prevented? People on TB medication must complete their treatment, this prevents the spread of TB Cover your mouth and nose when coughing or sneezing Wash hands with soap and water Immunise of all babies at a clinic within 1 year of birth Keep your body healthy by eating balanced meals and exercising Stop smoking  Keep your windows open in your home if living with someone with TB – fresh air blows the TB germs away and sunshine kills the TB germs. TB in the workplace If any employees display TB symptoms, they should stay home and limit contact with others as much as possible until the results from a TB test are known. Once a person has been on TB treatment for 2 weeks, they are no longer infectious and can continue to work.

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