Many people find that the aims and themes of traditional medicines stand in a precarious position as we see the imminent rise of technology-based medicines/therapies in the wake of biotechnology. The biggest reason for this may be in the way traditional medicines and health practices, tend to focus on more than just the physical components of sickness and well-being and this does not always communicate well with the new technologies and practices making their way into the healthcare space of South Africa. For instance, someone who may be ailed by a twitching eye, may be diagnosed on the physical aspects of their eye, which is then understood considering pathology around visual/ocular components of the face. Then the additional step of relating this to the psycho-social-spiritual status of the person with the twitching eye. The purpose of this blog entry is to investigate the developing space of biomedicine & biotechnology and how this new paradigm in medicine works with traditional medicines in South Africa.     

To begin, in Southern Africa traditional medicine and health practices are widely used by the population where there are “between 200,000―300,000 traditional healers in South Africa; with the healer-patient ratio of 1:500–1200, as compared to the medical doctor-patient ratio of 1:40000” (Mothibe & Sibanda 2019). This distribution/ratio is one which may have increased or decreased since the census data had been collected but nonetheless emphasises the reliance on traditional medicine even with the availability of Western medicines and practices.

More so, unlike Western medicines that may have emphasis on the physical/material aspects of healthcare along with pathology, traditional medicine is fundamentally different in that it has two branches. The first branch consists of ‘medication therapies, which involve healing by knowledge of herbs and nature’ (Makinde, 1988: 88). The second branch is known as ‘non-medication therapies, which use manual, physical, mental and spiritual methods,’ or even a combination of these to treat the ailed (International Bioethics Committee, 2013: 3). Traditional medicine aims at treating ailments by considering more than just the physical manifestations of the ailments, but also consider psychological, social and spiritual manifestations of the ailments too.

In South Africa, biotechnology is an emerging field with a lot of research being conducted currently relating mostly to the methods and practices of western medicine. Nonetheless, there seems to be a space for traditional medicine to have a closer relationship with biotechnology since traditional medicine and biotechnology/biomedicine are both concerned with the biology and physical make up or organisms and how ailments can be addressed at this level. However, when one must consider the psychological, social and spiritual aspects of traditional medicine, there seems to be an incommensurability that builds between traditional medicine and biotechnology. And thus, the studies of traditional medicine and those of biotechnology diverge quite significantly and even how one becomes a practitioner and practices in each paradigm is really worlds apart. Nonetheless, there is both common ground and unfamiliarity for both that I will discuss below.

The traditional medicine route is not the same, having a fundamentally different structure and institutionalisation. Firstly, when one wishes to become a Sangoma (traditional healer in South Africa) the way in which they receive knowledge and are taught may be irrational or cryptic. “It is often kept secret, being mainly transmitted orally, as pointed out above. It can also combine natural and supernatural resources and be deemed to be acquired at birth or through a gift or special revelation to certain initiates” (International Bioethics Committee, 2013).

One who becomes a practitioner of traditional medicine is one who is already chosen by certain conditions and not necessarily someone who pursuits being a practitioner out of interest or wonder. One who wants to be a practitioner is then initiated by school of traditional medicine, which may or may not be registered under the Traditional Healer’s Council/Traditional Healers Organisation, and that may take months or years, depending on the individual. Once the initiation process is completed, the initiate has a ceremony done and is then granted the cloths/materials that are worn by accomplished practitioners, besides that there is very little to tell regarding the quality of their education or even the roadmap they took to completion. Many of the practitioners of traditional medicine are registered by the Traditional Healers Organisation, yet many more remain unregistered and undocumented, even with the sheer numbers they serve regularly. The presence of traditional healers in the HPCSA is something which is rather removed from the professional body and remains a bit of an anomaly when one must look at health policy in the country.

Biomedicine in this case presents a more scientific approach with rigorous testing, core principles, hypothesis and replicable results and traditional medicine in this case deals with a traditional, spiritual approach, based on tailored-individuated responses to ailments and non-standard tests, dosages and approaches. This means that there is a divergence in the way in which these practices are conducted and based on the view one takes, it is possible to value each for different reasons. Nonetheless, in the era of technology that we find ourselves, one sees that traditional medicine has less and less ground to integrate biomedicine let alone biotechnologies. Moreso, when one looks at the regulatory issues around traditional medicine, there seems to be a big issue of inclusion into the HPCSA.

Traditional medicine practitioners have, for the longest time, enjoyed the perks of being undocumented and non-standard because of how individualised (non-objective) the approaches of many practitioners has been. This freedom has allowed them to experiment and find new ways/old ways in nature without the red tape that professional bodies come with. Nonetheless, this means that the regulation of traditional medicine varies widely, with some practices not subject to the same stringent standards as biomedicine. This can lead to concerns about safety, quality, and efficacy. Many traditional medicine practices have not undergone the extensive clinical trials that biomedical treatments require. This makes it difficult to scientifically validate their efficacy and safety. The quality of traditional medicine products can vary due to differences in preparation methods, ingredients, and dosages. This variability poses a challenge for scientific validation. Traditional remedies often involve complex mixtures of ingredients, making it difficult to isolate the active compounds and understand their mechanisms of action.

From the looks of things, the relationship between biotechnology/biomedicine and traditional medicine is one which is still maturing and may become something fruitful for all in the future. However, as things stands, there is a lot of work to be done to bring them closer to one another and this begins with understanding their individual values. At this stage, nonetheless, traditional medicine has no place in biotechnology and thus cannot be considered biomedicine as of yet, but they may yet change in the future.

 Written by: Tony A  Shabangu

References:

International Bioethics Committee. 2013. ‘Report of the IBC on traditional medicine systems and their ethical implications.’ International Bioethics Committee. Website: https://unesdoc.unesco.org /ark:/48223/pf0000217457, (accessed 19 January 2019).
Makinde, A. (1988). African Philosophy, Culture, and Traditional Medicine. Center for International Studies Ohio University.
Mothibe, M. E. & Sibanda, M. (2019). African Traditional Medicine: South African Perspective. Sefako Makgatho Health Sciences University, Pretoria, South Africa.

The post Is biotechnology/biomedicine a safe space for indigenous and traditional medicines? first appeared on KHACA.

There are methods that can be used to test for male infertility known as the semen analysis. Thus,  the semen analysis (SA) represents the most basic evaluation of male infertility. The evaluation of semen parameters is currently based on the standards defined in the laboratory manual for the examination and processing of human semen created by the World Health Organization (WHO).  The WHO laboratory manual for the examination and processing of human semen 1st Edition was published in 1980 to the current 6th Edition, there have been significant advances with the incorporation of recent developments in semen examination techniques, methods of sperm preparation and cryopreservation, and new technologies to improve quality control and assurance (Boitrelle et al., 2021). Recent scientific advances in the understanding of sperm DNA fragmentation (SDF), seminal oxidative stress (OS), and reactive oxygen species (ROS) testing have shed additional light on the prognosis of reproductive outcomes in terms of natural conception and assisted reproductive technology (ART). Given the growing awareness that chromosomal abnormalities and gene mutations often underlie a diverse spectrum of male infertility, genetic and genomic testing are gaining attention in this new 6th Edition (see chapter “Extended examinations”). In the chapter “Advanced examinations”, some other tests used in research are described, such as sperm acrosome reaction, functional analysis of transmembrane ion flux and transport in sperm, and methods for the evaluation of chromatin condensation (Boitrelle et al., 2021). Even with these new advances in semen analysis the problem with male infertility remains and exacerbate societal issues.

One of the social issues concerning male infertility is its connection to Intimate Partner Violence (IPV) particularly in low-income and middle-income countries. Intimate partner violence IPV is the most common form of violence against women, defined as any form of violence by a current or former male intimate partner within a union, and can present as physical, psychological or emotional, or sexual violence, or as economic coercion and controlling behaviours (Wang et al., 2022). I can only imagine how important this matter is especially in patriotic sociaties and/ or where (toxic) masculinity is high and men think that only the women are responsible for sexual and reproductive health. For example, where men believe that it is only the women that can be infertile and never the men – as it may be so due to some cultural ideas in South Africa and possible Africa. The most recent estimate from WHO indicates that, worldwide, 27% of ever-married or ever-partnered women aged 15–49 years have experienced physical or sexual violence (or both) committed by intimate partners at least once in their lifetime, whereas the prevalence over a 12-month period was 13%. This poses a problem, seeing that De Jonge et al., (2023) mentions that literature database contains many publications demonstrating that in comparison with women, men are characteristically less likely to seek routine healthcare unless intervention for an acute medical issue presents. The reason for this is that men tend to associate seeking medical care with weakness and/ or a threat to their masculinity and/ or  because an underlying health issue may be revealed. So, to fill that void, women make up to 80% of health care decisions for their family and the male partner. They further explain that, in the field of Medically Assisted Reproduction (MAR)  it is frequently said that women provide the primary motivation for an infertility investigation including for that of her male partner. However, it is difficult to find any specific evidence in literature data to confirm or refute this assertion, and thus must be considered as anecdotal. Inference of men taking a ‘passenger’ role in the investigation of infertility for the couple comes from one study showing that both men and women felt that fertility is a woman’s issue (De Jonge et al., 2023). This is obviously a problem, because as research indicates many of the sexual and reproductive issues are not always or only the women’s problem. Therefore, one can notice how it is important to have a more male inclusive sexual and reproductive health.  

As the saying goes: prevention is better than cure! Therefore, how do we prevent or rather help lessen male infertility. The more obvious way is to have awareness campaigns around this matter.  To develop community (public) education and from as early as male puberty starts so that no one is left behind.  Starting early can help lessen the stigma that also comes with male infertility and decrease the burden on IPV. The focus on education and public awareness on women fertility has not particularly solved the injustices that are linked to sexual and reproductive health. Hence, we need to also think and strategise how we can have these programs aligned or be complementary to those existing men’s health and/ or Gender Based Violence (GBV) awareness campaigns program. For example, non-profit organisation such as the men’s forum or men imbizo could be used for dialogues on this matter from a community based model. In addition, promotion of healthier lifestyle is imperative since there are many behavioural and environmental factors which can have a direct or indirect impact on how a man’s body ‘produces’ semen. Therefore, one can adopt the following healthy lifestyle habits:

• Avoid drug and tobacco use and drinking too much alcohol, which may contribute to male infertility.
• Avoid high temperatures found in hot tubs and hot baths, as they can temporarily affect sperm production and motility.
• Avoid exposure to industrial or environmental toxins, which can affect sperm production.
• Limit medications that may impact fertility, both prescription and non-prescription drugs.
• Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy. However, avoid excessive exercise.
• Avoid wearing very tight underwear for prolonged periods of time
• Cut back on caffeine consumption. (Two cups of coffee a day is fine)
• Avoid steroids used in body building. These compounds disrupt hormone production, and can actually stop your body producing sperm.
• Eat more antioxidant-rich foods like fresh fruit and vegetables. Not only can this assist in conditions like high levels of ROS (Reactive Oxygen Species) in semen, but will improve your overall health too! (Winjland Fertility 2024).

In conclusion, male infertility is a serious matter and can affect the individual and couple in question. Not addressing this matter is an injustice. An injustice that needs to be ratified and addressed. Therefore, we can start rectifying these injustices by developing policies that are inclusive of male sexual and reproductive health, then develop some education and advocacy campaigns to raise awareness on this matter, and promote healthy lifestyle amongst men. This will not only ensure human rights, i.e., rights to health, but will also aid in helping to address some of the short comings that may be found in science and technology for male sexual and reproduction in terms of  analysis, health promotion, diagnostic tools, affordability, accessibility, and specialist in this research field.  

 Written by: Fikile M Mnisi

References:

Boitrelle, F., Shah, R., Saleh, R., Henkel, R., Kandil, H., Chung, E., Vogiatzi, P., Zini, A., Arafa, M., & Agarwal, A. 2021. “The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis”.  Life. Vol. 11 (1368): p. 1- 13.

De Jonge, C. J., &  Gellatly, S.A., Vazquez-Levin, M. H., Barratt, C.L.R. 2023. “Male Attitudes towards Infertility: Results from a Global Questionnaire”. World J Mens Health. Vol 41(1): p. 204-214.

Wang., Y, Fu., Y, Ghazi, P., Gao, Q., Tian, T., Kong, F., Zhan, S., Liu, C., Bloom, D.E., & Qiao, J. 2022. “Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis”. Lancet Glob Health. Vol. 10 (8): p 20-30.

Wijnland Fertility.  2024. “What is Male Infertility”. Accessed: 8 June 2024.  Accessed from: https://www.wijnlandfertility.co.za/male-infertility/#:~:text=Male%20factor%20infertility%20makes%20up,African%20couples%20struggling%20to%20conceive.

The post Male Infertility from Science to Societal Issues first appeared on KHACA.

In a South African context, this innovation can help address health inequality particularly disparities in screening and treatment. However, this can only be achieved if it is applied in public sector. Public sector serves 71% of the South African population and is funded by the State. Public health care facilities in South Africa often grapple with constrained resources, significantly impacting access to quality care for many citizens. These limitations manifest as shortages in human resources, essential medications, and critical equipment. Additionally, concerns around waste management and infrastructure maintenance further exacerbate the situation.

This lack of resources disproportionately affects individuals from lower socioeconomic backgrounds who rely on these facilities due to limited financial means to access health care from private facilities. This creates a situation of limited distributive justice, where access to essential health care services is not equitably distributed amongst the population. This highlights the urgency for interventions that address these disparities and ensure that vulnerable populations have access to the quality care they deserve. The potential of AI in breast cancer imaging to improve patient outcomes through earlier diagnoses, personalised treatment plans, and ultimately, a reduction in breast cancer mortality rates is significant.

However, the technology’s current development and prevalence within private organisations raises concerns about affordability and equitable access, particularly in resource-constrained settings like South Africa. The cost of procuring such technology will most likely be significant, which will be a barrier for State funded facilities. 

While private facilities catering to a limited portion of the population, approximately 29%, may have the financial means to acquire this technology, a utilitarian perspective compels us to consider the potential for maximising overall benefit. In this case, the ethical principle of utilitarianism argues for prioritising broader accessibility to ensure the technology serves the greater good of the South African population. While private facilities may possess the financial means to acquire this technology, its true potential for good lies in serving the broader population. The ability to prevent deaths and improve countless lives through early detection far outweighs the benefits of a technology confined to the privileged few.

Should the technology be introduced in a South African context, and hopefully it will be, the conversation should be geared towards using this technology in the public sector to maximise its use. The technology promises accurate breast cancer image analysis with limited human assistance. This can be used in rural areas where there are no radiologists on site or to assist facilities burdened with large number caseloads and limited health care workers on site. The deployment of AI technology in public health facilities transcends mere economic considerations. It embodies the core principle of health care as a human right, enshrined in the South African constitution. Limiting access solely to those with financial means creates a stark ethical challenge, exacerbating existing health care disparities within a country already grappling with significant socioeconomic inequalities. By ensuring equitable access, we can harness the power of AI to create a more just and effective breast cancer screening system for all South Africans.

Furthermore, this necessitates exploring strategies to make AI-powered screening financially viable within the public health care system. This could involve public-private partnerships, exploring cost-effective implementation models, and potentially leveraging international collaborations to make this life-saving technology more readily available to all. While the potential of AI for breast cancer screening is undeniable, we must acknowledge the ethical challenges it presents.

One of the most concerning issues is bias. AI algorithms are trained on vast datasets, and if these datasets lack sufficient representation of African populations, it can lead to biased decision-making and poor clinical outcomes.  This has significant implications for accuracy. AI trained primarily on European or Western data may struggle to interpret mammograms or ultrasounds from individuals with different skin tones or breast tissue densities. Inaccurate readings could lead to missed diagnoses or unnecessary biopsies, posing a real health risk.

It is paramount to advocate for responsible development and implementation of AI in health care. This requires inclusive dataset to ensure the technology can be applicable to all individuals across the globe.

 Written by: Nomfundo Maseko

References:

Dlamini, Z., Molefi, T., Khanyile, R., Mkhabele, M., Damane, B., Kokoua, A., Bida, M., Saini, K.S., Chauke-Malinga, N., Luvhengo, T.E. and Hull, R., 2023. From Incidence to Intervention: A Comprehensive Look at Breast Cancer in South Africa. Oncology and Therapy, pp.1-11.

Image: https://www.biomedcentral.com/collections/spot-breast-cancer

The post AI for Breast Cancer Screening and Diagnosis first appeared on KHACA.