MilMed MayJune 2006.qxp - SA Military Health Service

VOLUME 22 NO 2 - 2006

“The Surgeon General says ...”the backbone of any military organisation. This is no different in theSAMHS.All these promotions, no doubt, augur well for the Human Resourcetransformation of the SAMHS. The transformation of the SAMHS is astrategic issue for me, and therefore all the above promotions are asignificant milestone to that end.In the same vein, I would like to congratulate all the winners of theNon-Commissioned Officers Skills Competition held at Lohatla in theNorthern Cape in May this year. The skills competition is more than justa friendly competition between units. It forms an integral part of ourcombat readiness in the SAMHS. Readiness is not an issue of choicefor SAMHS, but part of our core business.In conclusion, I would like to urge forward all our members as westrive towards a world-class Military Health Service for all our men andwomen in uniform. Keep up the good work that you all are doing.2Lt Gen V.I. RamlakanDMG, MMS, MMB, OStJ“Our commitment and role as‘midwives of peace’ ... continue togrow.”Our Commander-in-Chief, President Mbeki, in his State-ofthe-Nationaddress earlier this year, referred to this period ofour history as the Age of Hope. The President said, “ourcountry has entered its Age of Hope…this promises to be thedawn of a golden age of growth – an upswing longer than the boomof the 1960s and indeed longer than anything in the postwar period”.As the South African Military Health Service, we have every reason tobe hopeful given the new direction that our organisation is beingsteered into. Already there are definite signs of hope for us, some ofwhich I would like to highlight in this column.Our commitment and role as “midwives of peace” in the region andthe continent continue to grow. It is within this context that we, theSAMHS, as an institution of government need to understand our role.The recent deployment to the Comoros is a clear demonstration ofsuch understanding by the SAMHS.It gives me great pleasure to report that 90 members of the SAMilitary Health Service deployed on 13 May this year to the Comorosas part of the African Union mission. Their deployment, in a verysignificant way, contributed towards ensuring peaceful presidentialelections in that country. This mission would not have been a successif it were not for the dedication and commitment of every member ofthat contingent.I also would like to make use of this opportunity to congratulate allour members who have been promoted since my appointment as theSurgeon General on 01 August 2005. Firstly, the seven BrigadiersGeneral namely, Brigadier General Dabula (GOC, 1 Mil), BrigadierGeneral Matseke (Director Reserve Force in the SAMHS), BrigadierGeneral Mahlangu (Director Res & Vet Policy at Policy and PlanningDivision), Brigadier General Ford (GOC GSB Thaba Tshwane,Brigadier General Mathibe (Director Personnel Acquisition at theHuman Support Centre) and most recently, Brigadier GeneralMadlala-Msimango (Director Nursing) and Brigadier General Langa(Director Military Health Human Resource). All these BrigadiersGeneral are people of colour and significantly, four of them (i.e. 57.1%) are women.In terms of promotions of colonels, 23 Lt Cols have been promotedand 9 (i.e. 39.1%) of these are women. In terms of other officers, aftercareful consideration, 364 promotions have been signed. Of this total,238, (i.e. 65.4%), are people of colour. Coincidentally, 238 (i.e.65.4%) are women. It must be said though that this is just the firstround in terms of promotions in this group. The second round will beaimed at filling all the vacancies created as a result of the above LtCols having been promoted to Col.It is now common knowledge that the promotion of Warrant Officerstook place last year. These promotions went a long way in enhancingrepresentivity in that rank group. Last but not least, earlier this year inMarch, nearly 400 NCOs were promoted of which 338 are people ofcolour. These men and women are the future leaders of the SAMHS. Awell-trained and disciplined Non-Commissioned Officers Core formsMolaudi wa rona ya ka sehlohong, moPoresidente Mbeki, polelong yahae ya setjhaba maqalong a selemo sena, o ile a bua ka nako ena eoreiphumanang ho yona histroring ya rona jwalo ka nako ya tshepomme sena se thepisa qaleho ya nako ya kgolo e fetang ho phahamaha thuo ho ileng ha bonwa ka dilemo tsa bo 1960 mme ebile, kgatelopele ena, e feta efe kapa efe e bileng teng ho tloha ka mora ntwa.Jwale ka SAMHS, re nale tokelo ya ho ba le tshepo mabapi le tsela eo lebotho la rona le kgannelwang ho yona. Ho se ho bile ho nalematswao a tlisang tshepo ho ba bang ba rona. Ke rata ho hlahisa amang a matswao ao leseding. Boikemisetso ba rona le karolo eo re ebapalang ho tlisa kgotso dinaheng tsa bo ahisani le kontinenteng ena,di tswela pele ho hola. Rona SAMHS jwalo ka karolo ya mmuso, retshwanetse ho utlisisa karolo eo re e bapalang. Ho diploya maloko arona Comoros, ke ponahatso e hlakileng ya kutliwisiso eoKe ka motlolo ke tsebisang ka maloko a 90 a SAMHS a ilengdeploya ho la Comoros ka di 13 Motsheanong lemong sena. Malokoana, a ne a le tlasa tsamaiso ya African Union. Ho deploya ha bonaho thusitse ho nnetefatsa hore dikgetho naheng eo, e ba tsekgutsitseng. Ketsaholo ena, e ka be e sa tswelapele ntle le boineelo leboikemisetso ba maloko ana.Ke rata hape ho nka monyetla ona ho thoholetsa ditho tsohle tsarona tse ntsheditsweng pele mosebetsing ho tloha ha e sale ke nkamarapo jwale ka Surgeon General ka di 01 Lwetse 2005. Pele, diBrigadier General tse supileng eleng, Brigadier General Dabula(GOC 1 Mil), Brigadier General Matseke (Director Reserve Force –SAMHS), Brigadier General Mahlangu (Director Res & Vet Policy –Policy & Planning Division), Brigadier General Ford (GOC GSB ThabaTshwane), Brigadier General Mathibe (Director Personnel Acquisition –HR Support Centre), Brigadier General Madlala-Msimango (DirectorNursing) le Brigadier General Langa (director Military Health HumanResource). Kaofela di Brigadier General tsena, ke batho bammalamee ibile, ba bane babona, (57.1%) ke basadi.Hola di ntshetsopele tsa di kolonele, di Lt Col tse 23 di ile tsantshetswapele. Ba 9 (39.1%) ya bona ke basadi. Ha re sheba dioffisiring tse ding, ka mora ho nahana ho matla, ho ile ha saenwa dintshetsopele tse 364. ho tsona, 238 (65.4%) ebile batho ba mmala.Ebile ho makatsang, 238 (65.4%) ke basadi. Motjha wa bobedi wa dintshetsopele, otla sebediswa ho tlatsa di kgeo tse hlahileng ha hofetiswa di Lt Col ho ba di Kolonele.Ha jwale ho se ho tsebahala hore di Warrant Officers di ile tsantshetswapele selemong se fitileng. Di ntshetsopele tsena di ile tsathusa ho tlisa kemelo ya mmala maemong ao. Qetelong, Di NCO tsekabang 400 di ile tsa tswellisetswa pele mosebetsing ka kgwedi yaHlakubele lemong sena. Ho bona, ba 338, ebile ba batho ba mmala.Banna le basadi bana ke bona baetapele ba SAMHS ba kamoso.NCO e maitshwaro a matle le thupello e entle, e netefatsa matla asesole seng kapa sefeng. Ho jwalo le ka SAMHS.Di ntshetsopele tsena, di paka hore di phetoho le ntjhafatso di feladi phetahala mona SAMHS. Ho fetola SAMHS, ho hlile ho bohlokwahaholo ho nna. Ho sale jwalo, di ntshetsopele tsena, di paka kgatelopele e bohlokwa maikemisetsong a ka a phetolo eo. Ho sale jwalo, kerata ho thoholetsa bahlodi ba NCO Skills Competition e ileng yatshwarelwa Lohatlha hola kapa Leboya. Thlodisano ena, hase feelathlodisano ya setswalle pakeng tsa ba sebetsi mmoho. E bohlokwa hothusa hlopisetsong ya SAMHS ho dule e le malala a laotswe. Ho baseemong sena, hase boikgethelo ba SAMHS, empa e le karolo ebohlokwa ya mosebetsi wa rona.Ke rata ho qetella ka ho kgothatsa ditho tsohle tsa rona tsa sesole,ho tswella pele ka mosebetsi o motle oo ba o etsang ho nnetefatsahore SAMHS e maemong a phahameng lefatsheng.V.I. Ramlakan

Editor‘sColumnA ‘new’ MILMED MAGAZINEfor the SAMHSIt is an honour for me as a serving member of the SAMHS to be appointed as theEditor of MILMED. From the word go, the Corporate Communication section hasset out to improve the magazine in total. The saying, “change is as good as aholiday”, rings true to this edition of MILMED. Let me explain...In our quest for sound directional change, the magazine has been reviewed viaa careful planning process. Aspects looked at have included DOD initiatives andwhat the cross-section of the magazine’s target audience is.The result is that the design, layout and content of the magazine have changedwith more topical and informative articles being placed. Also, part of themagazine’s vision is to empower our members in the SAMHS. In light of this,MILMED will become more interactive: pertinent medical issues will be discussedvia a medical forum section and, mirroring this, sections will be placed that giveinformation on health issues and the correct use of language. More internationalmedical news is being sourced and a “letters and sports” section is to be includedfrom the next edition.This is only a taste of what is to come, but what we do need is for you, the reader,to contribute to ‘OUR MAGAZINE’ in the SAMHS. As a publication, we are alwaysin need of material (articles with photographs) and would appreciate anycontributions. If you are not sure as to what type of articles to write, photographsto take or how to go about it, give our office a call and we will gladly assist.Enjoy reading your MILMED, and do not forget to write those letters for ourletters column!E bile motlotlo ho nna jwale ka leloko ka SAMHS, ho behwa setulong samotsamaisi wa lesedinyana la MILMED.Ho tloha qalong, Corporate Communication, e ikemiseditse ho fetola le hophahamisa sebopeho sa MILMED. Mantswe a reng phetoho e lokile jwale kamatsatsi a phomolo, a feela a paka sebopeho sena sa MILMED. Ere ke hlalose:Maikemisetsong a rona a ho leka ho fetola lesedinyana la rona ho ya ka molao,re ile ra sheba dintho tse tshwanang le dintshetsopele tsa DOD le hore e ka baba badiba rona ke bomang mme ba lebelletseng ho tswa lesedinyaneng.Ka hoo, tjhebeho le mookotaba tsa lesedinyana di fetohile. Ho se ho kentsweditaba tsa dihooho tse ntjha-ntjha e bile tse hlahang ho babadi leseding. Ka haamang a maikemisetso a lesedinyane le thlahiso leseding, MILMED ho tloha jwalee tla hokahana le babadi haholo. Ditaba tsa bohlokwa tsa bophelo di tla hahellamaqepheng a buang ka tsa pholo. Ho sale jwalo, di phuputso di sa etswa mabapile ditaba tsa bophelo tsa matjhaba-tjhaba. Karolo tsa mangolo le dipapadi, di tlakenngwa lesedinyaneng hotloha thlahisong e latelang.Hona, empa e le tatso ya tse sa tla feela. Re hloka dinyehelo lesedinyaneng laRONA la SAMHS ho tswa ho babadi. Jwalo ka lesedinyana, re dula re hlokadihlahiso tse kang dipale le ditshwantsho mme re tla thabela di nyehelo tsa lona.Ha eba motho a se na bo nnete ka hore a ngole di taba (article) kapa a nkeditshwantsho tse jwang, a ka ikopanya le kantoro ya rona ho thola thlahisoleseding.Ke tshepa hore le tla itumella ho bala MILMED. Le se lebale mangolo ao a yangho mohlahisi ao!Lt John SverdloffLt John Sverdloff (Editor, MILMED)EDITORIAL COMMITTEECol P. van der Merwe (D Anm H)Col L. Kirstein (SSO Corp Comm)Lt J.D.V. Sverdloff (Editor)COVER DESIGNSANDF Visual CommunicationsMAGAZINE DESIGN & LAYOUTLt J.D.V. SverdloffJOURNALIST2Lt S. SegoneLANGUAGE EDITINGSAMHS Language SupportLt Col M. Sibanyoni (Sotho Translation)CORRESPONDENCEThe EditorMILMEDPrivate Bag X102Centurion0046E-mail: milmed@mweb.co.zaTEL: 012-671 5066FAX: 012-671 5278REPRODUCTION AND PRINTINGSAN Publications Unit021-787 32425

NEWS CLIPSNEWSNEWS CLIPSNEWS CLIPS NEWSIG SAMHSreceivesaccreditationWritten by Lt John SverdloffPhotographed by Sgt Lebogang Tlhaole (SA Soldier)6When Lt Gen Vejaynand Ramlakan wasInspector General (IG) of the DOD, his visionwas that the DOD Inspectorate and the fourservice inspectorates general should becomeworld-class institutions.This materialised when IG DOD received ISO 9001:2000accreditation on 17 December 2002, with the IG SAMHSfollowing suit at the official handover of the highlyacclaimed certificate to Brig Gen Rupert Cloete at DefenceHeadquarters on 12 April by the CEO and President of theSouth African Bureau of Standards (SABS), Mr MartinKuscus.The Inspector General of the SAMHS was the first of thefour Inspectors General to take up the challenge of gainingaccreditation during August 2003, when they startedimplementing ISO 9001:2000.Lt Col Mervyn Penwarden, the managementrepresentative, said that it was very challenging to adoptISO 9001:2000 in the SAMHS Inspectorate because it is abusiness culture being adapted into a military concept.Functions were executed according to approved policiesand practical experience.He, however, emphasised that since the adoption of ISO9001:2000, all processes in the SAMHS Inspectorate arenow clearly defined and documented. This ensures that theSAMHS Inspectorate operates according to set standardisedmethods. An example is report writing, where there is atemplate for each report.During February 2005, the SAMHS Inspectorateapproached the SABS, who are the custodians of ISO9001:2000, for accreditation.The SABS explained to IG SAMHS the requirements to beFltr: The IG of SAMHS, Brig Gen Rupert Cloete, accepts the ISO9001:2000 certificate from the CEO and President of the SABS,Mr Martin Kuscus, while the Surgeon General, Lt Gen VejaynandRamlakan, looks on.met for accreditation and the process began when a formalapplication was submitted. Later, the SABS conducted apreliminary audit to ensure that IG SAMHS had the potentialfor accreditation.A complete accreditation audit was then conducted at theSAMHS Inspectorate during October 2005. During Marchthis year, full accreditation was received with no findingslogged. It is a requirement of the SABS that at least sixmonths of records prior to accreditation are utilised as apoint of reference (proven track record).According to Mr Kuscus, passing accreditation withoutgenerating any findings is a rare occurrence.Since the implementation of the Quality ManagementSystem, the SAMHS Inspectorate has been able to improveits service delivery with regard to internal auditing. Forexample, the time frame for an audit report to reach anaudited unit has been reduced from three months to sixweeks.During April 2006, the SABS conducted a follow-up auditof IG SAMHS with no major findings. These audits areconducted every six months.The ISO 9001:2000 is an international quality standard,regulated by the International Organisation forStandardisation. The SABS is the custodian of the ISOstandards in Southern Africa and has incorporated theISO 9000 family of standards into the South AfricanNational Standards (SANS).

CLIPSNEWS CLIPSNEWS CLIPS“An African Answer to Fighting Aids”Excerpt from The Boston Globe\Opinion Editorial/Dr. MantoTshabalala-Msimang (SA Minister of Health).Global leaders will converge for a special session of theUN General Assembly to review progress and seekagreement on the best path toward universal access totreatment and prevention of HIV and AIDS.The session focuses on an exceptional challenge.However, it is also part of a complex, interlocking set ofproblems demanding our attention. Due to the limitedresources available to combat HIV and AIDS, the moreinclusive we make the priorities that we set, the better.In the run-up to the special session, African officials haveconsulted widely to strengthen our consensus on the bestway forward.Dr. Manto Tshabalala-Msimang the Minister of Health ofSouth Africa said, “We agreed that there has to be arenewed focus on prevention as the mainstay of ourresponse to the spread of HIV infection and the impact ofAIDS. We also agreed that our common purpose would bebetter served if the international donor community were toalign itself more closely with the plans that Africans areestablishing for themselves.“In South Africa, we launched the Comprehensive Plan forManagement, Care, and Treatment of HIV and AIDS twoyears ago, and it is almost entirely funded by the nationalbudget. The plan has three pillars.“First, we try to ensure that the majority of South Africanswho are HIV-free remain that way, by making the countryhostile terrain to the virus. Our interventions includecampaigns to promote safe and healthy sexual behaviourand to remove the stigma attached to AIDS. We offercounselling and testing, free distribution of male and femalecondoms on a massive scale, and programmes to preventmother-to-child transmission of HIV. There also are broadergovernmental interventions to combat poverty andmalnutrition, to improve the socio-economic status ofwomen, and to deal with the challenges of violence.“Also, we have to help those who are infected to stay ashealthy as possible. This means improving the nutrition ofthose affected, redoubling our efforts against tuberculosis,and ensuring that everyone has access to prophylaxis andtreatment for other opportunistic infections. Good nutritioncannot rid a person of HIV, but it can improve the immunesystem and be an important factor in staving off illness.“When faced with ill health, many of our people turn toAfrican traditional medicines, which sustained them throughgenerations of colonialism and apartheid. In response, weare investing in research and development of thesemedicines to treat various ailments, and we are establishingthe efficacy of such medicines in alleviating conditionsassociated with AIDS.“Lastly, once an HIV-positive person has a high CD-4 cellcount or exhibits stage 4 AIDS-defining illness as defined bythe World Health Organisation, the patient is eligible forantiretroviral treatment at government expense. The HealthSystems Trust, an independent group that monitorshealthcare delivery in South Africa, recently reported thatour progress in delivering antiretroviral treatment "hasprobably been swifter than in any comparable country."“Building the infrastructure to deliver treatment safely andeffectively on a large scale is no easy task in the publichealth environment that we inherited from apartheid.Caregivers have to be recruited and trained, clinicsaccredited, and testing, monitoring and reporting systemsput in place. There have to be reliable supplies of affordabledrugs that meet our regulatory standards.“Above all, the programme has to be built up in a mannerthat strengthens the overall public health system to deal withthe broader burden of disease facing us, ranging frominfections to trauma and chronic ailments such as diabetesand cardiovascular diseases.“The Washington-based Hudson Institute has said ourplan is "the only one that has taken into consideration suchimportant issues as the future recurrent cost obligations thatwill be required to sustain it, independent of externalfinancial support," and "is based on the uncompromisingdictates of science and medicine”.“It is critically important to recognise that antiretroviraltreatment is but one of the components in our response tothe scourge of HIV and AIDS. Despite the fact that ourprogramme cannot be compared with some others in termsof its scale and comprehensiveness, we believe that thenumber of patients receiving antiretroviral treatment cannotbe the only measure of our success or failure.“If we let that happen, we risk short-changing the otherefforts, especially on the prevention front, that we aremaking to ensure the health of our people”.7

8NEWS CLIPS“South Africa Launches TB Crisis Plan”Daily International Pharma Alert\News.Reports that the South African Ministry of Health haslaunched the TB Crisis Plan, an initiative that will work tocombat the spread of tuberculosis (TB). Notes that SouthAfrica has the third-largest population of TB-infected peopleon the African continent. Health Minister Manto Tshabalala-Msimang said: "The plan that we have devised tackles somefundamental shortcomings in our TB control system thathave undermined our best efforts to come to grips with thisdisease." The plan will involve training local TBmanagement teams at a provincial level and providingmore TB medications to the most disease-prone provinces inthe country - KwaZulu Natal, Eastern Cape, Western Capeand Gauteng, which account for 80% of the country's TBcases.“UN seeks to persuade Sudan to accept peacekeepers”Angola Press\News.The article reports that Senior UN diplomats will seek topersuade Khartoum on Tuesday (23 May 06) to accept UNpeacekeepers in the violent Darfur region after UN chiefKofi Annan accused Sudan of violating international law.Says despite a peace deal signed by the government andthe main Darfur rebel group on 5 May 06, dozens havebeen killed in clashes between rebels and governmentarmedArab militias. Mentions that Khartoum is underinternational pressure to accept a transition to UNpeacekeepers, initially resisted and said such a deploymentwould cause an Iraq-like quagmire that would attractIslamist militants into attacking the UN troops.“A Rolling Clinic for South Africa's Rural Poor”Excerpt from The Washington Post\Feature\Terry Leonard.This feature looks at the train by the Transnet Foundation,named Phelophepa -- a combination Tswana-Zulu wordmeaning "good, clean health." Adds that for nine months ayear, Phelophepa travels the rails to remote outposts,bringing health care to areas where the poor are generallyunderserved. Declares that this was the first time the trainhad stopped at Kirkwood, a picturesque town near SouthAfrica's southern coast, nestled among orange groves andnearly impenetrable scrub below the rocky foothills of theZuurberg mountains. Highlights that the train is a rollingclinic, not a hospital. Its staff members do not performsurgery or do lab work. Reveals that it works in partnershipwith local health departments, clinics and public hospitals.Mentions that most people who visit need only basic care,but there are usually a few who require urgent or extendedtreatment. Says Africa is by far the world's poorest continent.Adds that while South Africa is the continent's richest country,poverty is still pervasive, and nobody has a smaller sharethan the rural poor, who earn less than $2 a day.“Killing them with morality”Exerpt from The Sunday Times\Review\Peter Gill.The review looks at how the international communityresponds to HIV and AIDS and adds that five years ago theUnited Nations held a special general assembly on AIDS,the first ever devoted to a disease, and then issued one ofits lengthy and sonorous declarations. Says there have beenreal achievements since then and the AIDS catastrophe hasled to important breakthroughs in the way the rich worlddeals with the Third World, but we are still nowhere nearreversing the tide of the disease, and there are now big flawsin the strategy for tackling it. It states that the West’s focuson abstinence and drugs cannot beat AIDS in Africa, butpromoting women’s rights can. Notes that women nowrepresent nearly 60% of all infections in Africa, and mosthave led blameless monogamous lives. Declares that only16% of infected people in Africa are able to receive theantiretroviral drugs that can keep them alive. Since the UNlast met in special session the financial commitment to AIDShas grown enormously. Money is also flowing through theGlobal Fund, and at the Gleneagles summit last year, TonyBlair got the G8 group of leading industrial nations to worktowards putting every poor person who needs them onantiretrovirals by the end of the decade. Highlights that mostAfrican governments were themselves shockingly remiss intheir early response to AIDS. One essential purpose of theUN session is to remind them of their duty and that Africawill also have to address the social inequality behind AIDS.It is the lack of women’s rights — in the schoolroom, in theworkplace, in the home and in the bedroom — thataccounts for the current growth.New imaging facility an African first for cancerpatientsDistributed by FCB Redline.Herna van Reenen.In a multi-million rand development that will have a majorimpact on the way patients - mainly cancer sufferers - aretreated in South Africa by facilitating early, cost-effective andnon-intrusive diagnoses for oncology, neurology andcardiac medicine, a state-of-the-art imaging facility hasbeen installed at the radiology diagnostic imaging practiceof Dr Labuscagne and Partners at the Little Company ofMary Hospital in Groenkloof, Pretoria.Officially opened on 6 February 2006 by Professor ErichReinhardt, head of Siemens Medical Solutions worldwide,the new facility consists of the first hospital-based cyclotronproduction unit in Africa for the manufacture of isotopes for

use in a world class laboratory run by a radiochemist andpharmacist with a PET/CT camera capable of doing wholebody scans, primarily on oncology patients.Cyclotron-produced radioisotopes are used to makeradiopharmaceuticals for use in the positron emissiontomography (PET). This involves the use of minute quantitiesof low-level radioactive chemicals that are detected by thehighly sensitive PET imaging system that uses positronemittingradioisotopes. When a positron - a positivelycharged electron particle - collides with an electron, the twoparticles annihilate one another, releasing energy as twogamma rays that shoot off in exactly opposite directions.These two rays strike crystals in a ring of detectors around apatient, enabling sophisticated computers to then turn theinformation into an image.The imaging facility at the Little Company of Mary Hospitalis unique because of the close proximity of the self shieldedcyclotron that produces the radioactive isotopes fordiagnostic imaging to the Biograph PET/CT camera.This combines the detailed metabolic information ofpositron emission tomography with the anatomical detailprovided by modern-day, multi-slice spiral CT scanners.Until recently, PET/CT has not been available in SouthAfrica, as the short half-lives of positron emitting isotopessuch as Florine-18 makes it impossible to transport forperiods longer than three hours.Capable of reaching very high production yields, the RDS111 Eclipse D cyclotron produces Fluoro-deoxiglucucose(FDG), the synthesis of which is started by the radiation ofenriched water used as target material on the cyclotron.During this first step of production, the Oxygen-18 moleculeis transformed to a Fluorine-18 molecule. After radiation ofthe enriched water, the product is sent to the synthesis unit,housed in a shielded hot cell. The fluorine molecule is thenchemically attached to a glucose molecule and transformedto FDG.Following the synthesis, single syringe dose units arecalibrated for each patient at any given time at a specificlocation in South Africa to lower the radiation to the users ofthe syringe. Before the product is packaged and transportedto different sites across South Africa, quality control, sterilityand pyrogenicity testing are all performed in-house onstate-of the-art equipment according to the specifications ofthe British Pharmacopoeia.Man-made prostate created by womenIssued by Monash South Africa.Wholly owned by Monash University, Australia.In a giant step towards understanding prostate disease,Melbourne scientists have grown a human prostate fromembryonic stem cells.A study published in the March edition of Nature Methodsdescribes how human embryonic stem cells were developedinto human prostate tissue equivalent to that found in ayoung man, in just 12 weeks.Co-first authors of the study, Monash Institute of MedicalResearch (MIMR) scientists PhD student Prue Cowin and DrRenea Taylor (also from the Monash Immunology and StemCell Laboratories), said the discovery will allow scientists tomonitor the progression of the prostate from a normal to adiseased state for the first time.“We need to study healthy prostate tissue from 15-25 yearold men to track this process. Understandably, there is alack of access to samples from men in this age group, so tohave found a way we can have an ongoing supply ofprostate tissue is a significant milestone,” said Dr Taylor.“As nearly every man will experience a problem with theirprostate, we’re very excited about the impact our researchwill have,” she said.While prostate cancer is the most common cancer in men,the impact of benign prostate disease (BPH) is equallysignificant – up to 90 percent of men will have BPH by thetime they reach 80 years of age. BPH is not usually lifethreatening,but has a dramatic impact on quality of life.Prue Cowin said the discovery will allow scientists toobserve first-hand the factors that play a role in thedevelopment of prostate disease.“The tissue we’ve grown behaves as a normal humanprostate, so it’s the perfect model for testing the differenthormones and environmental factors we believe play a rolein the onset of prostate disease,” said Prue.“We grew the prostate tissue by ‘telling’ the embryonicstem cells how to become a human prostate gland. We thenimplanted the cells into mice, where they developed into ahuman prostate, secreting hormones and PSA; thesubstance in the blood used to diagnose prostate disease,”she said.Prof Gail Risbridger, Director of MIMR’s Centre forUrological Research and leader of the research project, saidthe discovery will have a significant impact on prostatecancer and BPH research.“If we can understand how to make normal prostate, wecan work out how BPH develops as part of the normalageing process,” she said. “We will also have theopportunity to study the transition of healthy prostate tissueto cancer. Not only will this enable us to develop new, moreeffective ways of treating diseases that affect nearly everyman, but we hope, eventually, to find a way to prevent thesediseases in the first place,” said Professor Risbridger.Director of the Monash Immunology and Stem CellLaboratories at Monash University, Prof Alan Trounson, saidstem cells and cancer were an important new area ofmedical research and the production of prostate tissue fromembryonic stem cells provides a new tool for examining theorigins of cancer and role of primitive stem cells.Research collaborators are the Monash Institute ofMedical Research, Monash Immunology and Stem CellLaboratories, Department of Anatomy, University ofCalifornia, San Francisco, USA, Australian Stem Cell Centreand TissuPath Laboratories, Melbourne.9

alaria CaseMalaria Case StudyWritten by Capt E. Basson(AMHU Northern Cape)Malaria and the mosquito have hounded the militaryfor decades (Borza, 1987). Malaria represents oneof the most important infectious disease threats todeployed military forces (Sanchez, Bendet, Grogl,Lima, Pang, Guimaraes, Guedes, Milhous, Green and Todd,2000:275–282). Malaria in soldiers has a serious economicimpact in terms of both lost productivity and treatment cost forthe state (Malaria among US military personnel returning fromSomalia, 1994:397–399). A contingent of South African National DefenceForce members has since November 2001 been deployed inBurundi, as part of a peacekeeping mission. No information isavailable regarding the prevalence of malaria among militarypersonnel during deployments in Burundi and East Africa.The Aim of the StudyThe aim of the study was to investigate the prevalence ofMalaria in the users of Mefloquine Hydrochloride – Mefliam®when administrated to soldiers stationed in East Africa andspecifically Burundi. The results of this study can also beexpoliated to the local population. If Mefloquine is the drug ofchoice and prove to be effective during military deployments toEast Africa and Burundi, the presumption can be made that thePlasmodium organism in areas are not resistant to theMefloquine. Mefloquine will thus be an effective malariamanagement tool as a therapeutic and preventative drug. Theinformation gathered in this study would aid the armed forcesof the world. This information would help in selecting the mosteffective antimalarial prophylaxis to use during extended10The ProblemStatementMefloquinehydrochloride–Mefliam® has beenused for thetreatment of malariainfections amongstmilitary forcesdeployed in Burundiand East Africa. Thechemoprophylactic efficacy and usability of this drug has neverbeen determined in Burundi.The importance of the StudyCurrent information on drug-resistant malaria in the tropicaland subtropical regions of Africa is insufficient and unreliable.Multidrug resistance necessitates the use of alternative drugsthat may be expensive and difficult to administrate and oftenhave side-effects (WHO Tropical Disease Research, 1993:22).Malaria is becoming more difficult to manage. This demandsthe use of alternative drugs, which are generally moreexpensive, more difficult to administer and often have adverseside-effects.The “ABC” of malaria prevention (SCAT, 2003:6)The “ABC” of Malaria preventionA: Awareness of the malaria riskB: Avoidance of getting Bitten by mosquitoesC: Compliance with chemoprophylaxisD: Early DetectionE: Effective treatmentTHE PREVALENCE OF MALARIA IN MEFLOQUINE HYDROCHLORIDE -MEFLIAM® USERS DURING THE DEPLOYMENT OF MILITARY FORCESIN BURUNDI, EAST AFRICA.E. Basson (M Env Health), Dr H. Roberts (DTech Env Health),Prof C. van der Westhuizen (D. Sc Agriculture), Dr H. De Beer (PHD Microbiology)deployments to East Africa and specifically Burundi. The resultsof this study will prove if Mefloquine Hydrochloride - Mefliam®is an effective drug to use as an antimalarial and the risk ofsoldiers being deployed in East Africa contracting malaria willbe reduced. The results of the study could also be helpful tointernational travellers visiting that part of the continent. Thefact that 111 people used Mefliam® and four presented withmalaria symptoms, is a good indicator that Mefliam® is agood option as an antimalarial drug in East Africa andspecifically Burundi.Sample SelectionThe target population was South African National DefenceForce soldiers deployed in Bujumbura, Burundi, for more thanthree months. The group/population consisted of 336members and the sample group size (chosen portion) of 111members. Of the 336 members, 11 (3,29%) were females. Thedemographics of the different race groups were:229 (68,37%) Black;70 (20,84%) Coloured;33 (9,87%) Caucasian; and4 (0,91%) Asian.

StudyNo control group was established. This was done due toethical and moral guidelines prohibiting people from enteringan endemic malaria area without access to proper antimalarial prophylaxis. The sample was selected by using simplerandom sampling.QuestionnairesThe questionnaire aims of determining the following:Perception of the user regarding the malaria threat;compliance with taking the medication;possible side-effects which may have occurred due to thechemoprophylaxis; andthe prophylactic efficacy of Mefliam®.Each respondent gave his/her written consent. Thequestionnaire was in English, the thread language of the SouthAfrican National Defence Force. This information enabled theresearch team to detect what kind of prophylaxis each memberis using. The alternative drugs to be used were Mefliam® andDoxycycline.The airforce pilots and two female soldiers used Doxycycline.The female soldiers used Doxycycline due to the side-effects ofMefliam® indicated in the Mefliam® package insert (1997:2).Sample RealisationQuestionnaires were handed to 120 participants. Eightparticipants used Doxycycline, and due to the aim of the studythey were not included. The other 112 respondents usedMefliam®. One of the questionnaires was returned backincomplete. The return rate for the questionnaires was 100%.Hundred and eleven (92,5%) of the initial 120 questionnaireswere relevant to the study.ResultsOnly relevant results that emerged were dealt with. Thefollowing results were reported:perceptions of malaria threat;awareness of preventative methods of malaria;malaria history of members;perceptions of malaria and the use of antimalarial prophylaxisduring deployments;knowledge of the antimalarial drugs which are currentlybeing used;the importance of taking the antimalarial prophylaxis;and ascertaining whether the users of Mefliam® contractedmalaria during their deployment in Burundi.In this following section the emphasis will fall on the behaviourof the mosquito and the stimuli attracting it to the host.Although the compound eye of the mosquito has less resolvingpower than that of most mammals, the aperture allows bettervision in the dark (Hutchinson, 2004:Internet). The eye of amosquito forms a number of functions. It detects movement,colours, shapes and edges of objects (Hutchinson,2004:Internet). The studies by Bellamy and Reeves in 1952,reported that mosquitoes followed the CO2 plume upwind, butthen visual cues led them to the unbaited traps. This proves thatvisual stimuli would lead a mosquito to fly towards a prominentobject when lacking an odour plume (Hutchinson,2004:Internet). Although the Anopheles mosquito prefers torest on dark surfaces (Maharaj, 2004:Personalcommunication), mosquitoes are visually stimulated by objectsthat are in contrast with the background (Hutchinson,2004:Internet). Since the Anopheles mosquito feeds exclusivelyduring the night, especially at dusk and dawn, lighter skinswould be perceived as contrasting on the black background ofthe night and would therefore attract the Anopheles mosquito.African populations have traditional perceptions concerningdisease prevention, treatment and management. Somediseases are considered suitable for management by westernmedicines, while other diseases are considered the exclusivedomain of local traditional health practitioners. The decision touse western medicine for an illness is often considered as a lastresort (Nchinda, 1998:398). There is no medical evidence tosupport the use of homeopathic preparations for the preventionor treatment of malaria (SCAT, 2003:15; Barnes, 2005 :Personal communication).ServicesThe service or unit where the member is working is animportant variable during the deployment in an endemicmalaria area. This is also an indication of the level of exposureto malaria and the chemoprophylaxis that should beconsumed. The service where the respondent is working weredetermined and provided. Logistics, transportation and othersupport units scattered in the deployment area are not alwayspart of the communication lines and disciplinary structures. Thismakes the compliance with the antimarial regimen of thesemembers more of a challenge. Engineering units are involvedin construction projects in tropical conditions with the buildingof roads, sewerage works, networks, water pumps andpipelines. These members are sometimes compelled toovernight in tropical conditions with constant rains, living in wetand humid conditions. These conditions is the optimal breedingground for mosquitoes and therefore these individuals are atgreat risk of contracting malaria (SCAT, 2003:9). Military Policemembers work in shifts. These personnel are working at nightand are more exposed to the bites of the Anopheles mosquito(WHO, 2002). They are working in and around artificial light,which attract mosquitoes (Hutchinson, 2004:Internet). Kitchenpersonnel often work during the dark hours of the day betweendusk and dawn. This is the time of day when members are themost exposed to the bites of the Anopheles mosquito (Wood,1993:67-68; SCAT, 2003:10). Around the kitchens intemporary military bases stagnant water, due to the constantcleaning of the facility, and kitchen sewerage water as part of11

CaseStudythe normal processes in the kitchen facilities, is usually found.This stagnant water attracts mosquitoes for breeding purposes.Mosquitoes need relatively clean water to lay their eggs (Curtis,1996:1-7; SCAT, 2003:9). Constant pest control and mosquitocontrol in and around these facilities is crucial. Army guardspatrol the area during the night or stand guard at entrances.Due to the high temperatures at night in the area, it isuncomfortable to wear long sleeve shirts and therefore skin isexposed for the mosquitoes to feed on.The stationary androaming guards must constantly be reminded to takeprecautions to prevent mosquito bites. The guards must beissued with the prescribed repellents. Health care workers(SAMHS) are potentially exposed to the plasmodium organismsby means of a needle stick. This is called “induced malaria”(MacArthur et al., 2001:28). Military personnel that areinvolved in tasks requiring fine coordination and spatialdiscrimination such as scuba diving (Navy), piloting an aircraft(SAAF) and those driving heavy machines (Engineers) arediscouraged to use Mefliam®, as dizziness and vertigo havebeen reported as side-effects (www.cdc.gov/search.htm; SCAT,2003:15).According to clinical trials done in Kenya, East Africa,Mefloquine got a 95% prophylactic efficacy (Meuhlberger,Jelinek, Schlipkoeter, von Sonnenbeurg and Nothdurft,1997:357-363). Barnes (2005:Personal communication) andTalmut (2005:Personal communication) claimed a 95%prophylactic efficacy of Mefloquine internationally. Mefloquinehad a 100% prophylactic efficacy in a double-blind, placebocontrolled trial with 204 Indonesian soldiers, using the drug for13 weeks. (Ohrt et al., 1997:963-972). The evidence from anumber of large trails on the continent indicated a prophylacticefficacy of over 90% in Africa (Steffen, Fuchs, Schildknecht,Naef, Funk and Schlagenhauf, 1993:1299-1303). This studyshowed that 4 out of 111 persons that used the Mefloquine(Mefliam®) tablets contracted malaria within the first fivemonths of deployment to Burundi. The following is statisticalfeedback:The value of this section is to determine statistically ifMefloquine is an effective anti malarial prophylaxis. Theconfidence interval and Wilson reliance interval (Score Method)will be utilised as statistical guidance.Confidence interval (CI)p = proportion of positive responsesn = individualsr = characteristics of interestz = 1,96 for a 95 percent confidence intervalbegin value; top value = [p - z?; p + z?]n = 111r = 4p = r/n = 4/111 = 0,036 = 3.6%CI of population: p ± z?[p (1-p)]/n = 0,036+ 1,96?[(0,036)(0,97)]/1110,036 ± 1,96?[0,03492/111 = 0,036± 1,96?0,00031450,036 ± 1,96.0,0177 = 0,036 ± 0,0348CI = [0,0708; 0,0012]Because (p) is so small, a false indication can be experiencedregarding the prophylactic efficacy of the drug. A more reliabletest is thus necessary. For this purpose, the Wilson relianceinterval is to be used.Wilson Reliance Interval (Score Method)A = 2r+z²; B = z?[z²+4r(1-r/n)]; C = 2(n+z²)CI = [(A-B)/C; (A+B)/C]A = 2r+z² = 2(4) + (1,96)² = 8 + 3,842 = 11,842B = z?[z²+4r(1-r/n)] = 1,96?[1,96²+4(4)(1-0,036)]= 1,96?[3,842+16(0,964)]B = 1,96?[3,842+16(0,964)] = 1,96?19,266= 1,96.4,389 = 8,603C = 2(111 + 1,96²) = 2(114,842) = 229,683CI = [(11,842-8,603)/229,683; 11,842+8,603)/229,683CI = 3,239/229,683; 20,445/229,683CI = [0,0141; 0,0890]According to this statistical method there is a 95% certaintythat, when a population is using Mefloquine, the chance ofgetting malaria will be between 0,0141 and 0,0890. In otherwords an individual got a 1,4% to 8,9% chance of contractingmalaria when he/she is using Mefloquine (Mefliam®). Usingthe score method the confidence interval out of a population of336 is 4,7 to 29,9 members. The results of the study indicatethat the prevalence of malaria in the users of Mefloquinehydrochloride was 3,6% with 95% Wilson reliance interval of(1,4%; 8,9%) (Altman, Machin, Bryant, Trevor, Gardner andMartin, 2000:9-11). According to the study Mefloquine(Mefliam®) got a high prophylactic efficacy in Burundi, EastAfrica. This result is in line with international tendencies andstandards.DiscussionAccording to studies done by Col Robert DeFreitas of theMedical Corps of the US Army during 2003, relapsing malariais the primary military medical problem of malaria casesworldwide. The conclusion is that antimalarial prophylaxiscourses are either not taken or is ineffective. Falciparummalaria is the greatest threat to the lives of soldiers in themilitary due to drug resistance (DeFreitas, 2003:Presentation).Complications can present very rapidly and the drug resistancecan present as an epidemic. The type of military mission alsoplays a role in the malaria health threats. Most malariaexposure and least compliance occur during combatoperations (DeFreitas, 2003:Presentation). During combatoperations soldiers are living and sleeping in tents or in theopen. Soldiers have to work during night (dusk and dawn)when mosquitoes are most active (Wood, 1993:67–68).Soldiers are working under pressure and there is sometimes notime or little opportunity to take the antimalarialchemoprophylaxis. During non-violent operations such aspeacekeeping operations or humanitarian assistance, low orabsent threat of hostile action may permit more emphasis ondisease and non-battle injury threats. It should therefore be the12

14CaseStudyfield testing of new malaria drugs are required to replacepresent drugs when resistance makes them unusable. Theemergence of multi-drug resistant malaria will continue toconfound the drug development of antimalarial drugs. Themedical community must have a better understanding of themechanics of drug resistance. Resistance to Mefloquine hasbeen documented in East Africa and sporadic cases areoccurring in West Africa. As these and other reports of drugresistance continue to evolve, the need for a replacement drugfor weekly prophylaxis will continue to escalate. Halofantrinewas developed as a backup drug for Mefloquine in acollaboration effort between the US Army and SmithKlineBeecham. However, its usefulness is limited by possible crossresistancewith Mefloquine, cardiac toxicity and poorabsorption.The military should document the clinical relevance of drugresistance. They should also examine the potential for spreadof resistance in the field. There is mutual agreement that thecritical methodology and approach required to describeantimalarial drug resistance required well documented clinicalstudies with adequate follow up, confirmation that adequatedrug levels were reached in the users of antimalarialprophylaxis and that the drugs were used regularly. Mappingmalaria transmission intensity and resistance using geographicpositioning systems has to be developed for the mapping ofmalaria across the continent. This process will have thepotential for predicting potential malaria epidemics andmonitoring control. Results of these studies in otherinternational armies have facilitated documentation of clinicallyrelevant resistance to Mefloquine, Halofantrine, Chloroquine,Proguanil plus dapsone and atovaquone (Queguiner, P. andEngers, 2001:149-151). These and other data will help guidethe selection of the next generation of prophylactic drugs.Future directions must focus on basic and applied research fora better understanding of the modes of actions. Futuredirections should also concentrate on the mechanisms ofresistance to these drugs. The synthesis and design of newdrugs would hopefully result in the development of safe andeffective drugs that circumvent the malaria parasites elusivemechanics of drug resistance. Multiple drug resistance infalciparum malaria will continue to pose problems for targetingthe blood stages of malaria (Queguiner et al.,2001:149–151).There must be an increased emphasis towards developingdrugs with true causal prophylactic properties. An increasedemphasis towards developing drugs with radical curativeproperties before blood stages emerge and cause clinicaldisease must also be clear. The solution for the current malariaproblem is to establish a critical mass of investigators,collaborators and clinical centers that are focused andcommitted to document and evaluate malaria resistance,examine the potential for spread of resistance in the field andthe discovering and development of new medication. Militaryresearch on malaria in Africa is a serious requirement.Collaborations with other defence forces for information onclinical trials and drug resistance surveillance are pivotal forfuture drug selection and malaria management. No otherprivate or government organisations will adopt this process,due to the limited monitory possibilities. Should this endeavournot be successful, we cannot expect to protect deployedsoldiers who will be scattered on missions in diversegeographic locations all over the world against malaria.The Optimal Antimalarial RegimenA short course of antimalarial medication that would result inseveral weeks of protection would be highly desirable.Tafenoquine for 3 days protects for 10 weeks (Queguiner et al.,2001:149–151).The taking of daily medication without supervision is notsuccessful. Daily Doxycycline requires supervision.Weekly regimens are generally superior to daily regimens.Antimalarial chemoprophylaxis with a longer half-life allowsmissed doses to be made up.Antimalarial chemoprophylaxis with a longer half-life keepsthe intravenous and intracellular chemoprophylactic levels highto prevent the build-up of resistance among malariaplasmodiums.Commands emphasis on all the deployed military membersin a malarious area to create a routine of the consumption ofthe antimalarial drugs, for example once weekly “MalariaMonday.” This routine will lead to more streamlinedsupervision.Simpler is better. A single drug is a necessity; two drugs areeasily confused or forgotten.Antimalarial medication administered before deployment forshort exposures would be highly desirable. During shortexposures/visits to malarious areas, people tend to easilyforget, because they are not part of the unit routine.Consistent malaria policy among military personnel.The ultimate malaria prophylaxis would be a single dose ofmedication or immunisation administered during basic trainingthat is 100% efficacious against malaria worldwide without anyadverse effects.ConclusionMalaria is an important social, economic and developmentalhealth problem affecting military members, their families andtheir communities. The best chance to successfully combat thedisease will require collaboration between those who controland the researchers. The irradication of malaria is placed on astrong research base, international collaboration and sustainedgovernmental support. Mefloquine is closely aligned withmilitary needs.This biodefence agent addresses the operationally relevantmalaria species, P. falciparum, and drug-resistant phenotypesof this species. It has an operationally suitable frequency ofdose. The shortcomings of Mefloquine have been the adverseevent profile on the background of military use, particularlyneuropsychiatric events and limitations in suppressivemanagement of vivax malaria. In terms of a biodefence system,these are not critical, as they are reasonably predictable andmanageable. While chemoprophylaxis remains the cornerstoneof malaria casualty control, attention will always need to bepaid to compliance. With comparable attention to tailoringMefloquine use, as that paid to appropriate uniform fit orweapon allocation, most service personnel will be wellprotected with Mefloquine during military operations inmalarious areas.

IV KAP STUDYKEY FINDINGS FOR THE SAMHSHWritten by Lt Col Adrian D. van Breda(Military Psychological Institute)MASIBAMBISANE –We stand United in the Fight!The HIV KAP study monitors changes in the HIV-relatedknowledge, attitudes and practices of the Departmentof Defence (DOD) members. This KAP study is a thirdof its kind and was conducted in June 2004.A total of 5,082 employees participated in the 2004 KAPstudy. This constitutes 6,8% of the SA DOD population. Ananalysis of demographic data indicates that this sample isadequately representative of the SA DOD population.This article provides a summary of key KAP findings atnational level. The SAMHS is a key driver in HIV prevention inthe SA DOD. It is therefore important for SAMHS members totake note of HIV trends in the entire organisation.The Overall Prevention Programme Evaluation of keyfindings pertaining to the entire DOD community include thefollowing:a. Awareness of Masibambisane. There is an increase inexposure to the Masibambisane programme. In 2004, threequarters (76%) of the DOD were aware of Masibambisane andclose to half (44%) had received training in the previous twoyears.b. Readiness for Change. There has been an improvement inthe ability of DOD members to evaluate their risk for HIVinfection based on their behaviour. This is important, as it is astep towards increased readiness to change risky behaviour.c. Attitudes to Condoms. There is an increased willingness touse condoms with a new sexual partner – in 2004, 60% ofDOD members were positive about using condoms.d. Risk Behaviour. There has been a slight reduction in riskbehaviour over time. In 2004, 69% of DOD members reportedno risk behaviours in the previous year. A third (31%) of thosewho did report risk behaviour, also reported consistent condomuse – a dramatic improvement from the previous KAP studies.e. Adverse Outcomes. The percentage of people reporting anHIV positive test or symptoms of Sexually Transmitted Infectionshas remained stable over the three KAP studies. This is probablygood news, given that there has been an increase in HIV in thegeneral South African population.f. Summary: Overall we detect an increase in our efforts toprevent HIV, an improvement in knowledge about HIV andattitudes towards condoms, a reduction in risk behaviour and astabilisation of HIV and STI infections. This suggests that we aremaking a positive difference to HIV in the military community inSouth Africa. These findings are illustrated in the graphic below.Specific Findings: The following specific findings in the KAPstudy have generated six recommendations:a. Programme Rollout. The HIV programme has not rolled outadequately. Although there has been an increase in HIVprevention efforts, these have reached less than half of theDOD population. The data indicate that those who have beenexposed to HIV prevention programmes have better knowledgeand attitudes and lower risk behaviour.b. Mechanisms of HIV Transmission. Almost half the DODpopulation still do not know the facts concerning how HIV isand is not transmitted. This leads to difficulty in assessingwhether a particular behaviour is high risk or not; and further,to whether or not one’s own behaviour places one at risk forHIV infection. The ability to assess a personal risk for HIVinfection is an important part of behavioural change.c. Occupational Exposure. More than half the DODpopulation is unsure about how to protect themselves fromexposure to potentially infected blood when helping someonewho is bleeding from injury. Furthermore, there has been noimprovement in this knowledge over the past three years.d. Condom Knowledge and Use. We thought that, by now,people would know how to use condoms correctly. However,half the DOD population still lack knowledge. For instance, athird of DOD members think one can use oil-based lubricantson a condom. In addition, only about a third of people whohave multiple partners use condoms consistently.e. Antiretroviral Knowledge. For the first time, we asked basicknowledge questions about antiretroviral therapy. Only 17% ofthe DOD population had the correct knowledge. For example,only two thirds of respondents know that ARVs cannot cure HIVand only a third know that ARVs can make you feel ill. Largenumbers of respondents (up to almost half) were uncertainabout the facts.f. Sexual Risk Behaviour. Approximately a third of DODmembers report sexual risk behaviour. These respondents aremuch more likely to report an HIV positive test or symptoms ofSTIs.Recommendations. In the light of these findings, specificrecommendations for the SAMHS on HIV prevention in the SADOD are:a. Programme Rollout. We should facilitate the comprehensiverollout of the HIV programme across all units, using the MilitaryCommunity Development Committees (MCDC) and HIV WorkPlace Programmes. In particular, World AIDS Day activities andHIV training should be advanced.b. Mechanisms of HIV Transmission. HIV trainers shouldaddress the mechanisms of HIV transmission in more depth,pulling this information through into insight regarding therelative risk of various behaviours (eg oral sex, French kissing,holding hands). This should be followed by efforts to increaseaccurate self-assessment for HIV risks based on recent (past 12months) behaviour.c. Occupational Exposure. We need to increase OHS and HIVtraining on self-protection when assisting an injured personwho is bleeding.d. Condom Knowledge and Use. Knowledge regarding correctcondom use should be developed. The importance of usingcondoms consistently with all partners when engaging in riskbehaviour, should be made explicit in HIV training.e. Antiretroviral Knowledge. Knowledge of antiretroviralsshould be promoted among all members of the DOD,particularly in those areas where ARVs are available throughPhidisa or the national rollout.f. Sexual Risk Behaviour. A more concerted effort towardsfewer sex partners, with emphasis on abstinence/faithfulness,should be made in all facets of the HIV programme – training,mass awareness, etc.Conclusion. While the KAP Study demonstrates that we aremaking progress in the fight against HIV and AIDS, it alsoindicates many areas where we need to work much harder.15

Written and Photographedby Lt J. Sverdloff16Netcare, ER24 and Lifeline … these are some ofthe civilian emergency care response units onesees on a regular basis speeding to the scene ofan emergency and, once there, administering thebest medical care possible.Bearing this in mind, one wonders how effective ourparamedics training and practical application in the field is.Recently, MILMED was afforded the opportunity to gainvaluable insight into the heartbeat of the 1 Military HospitalAmbulance Department in Thaba Tshwane.Back in time …During the early nineties, the Officer Commanding1 Military Hospital, Brigadier Jansen van Rensburg, saw aneed for an ambulance department at the hospital as it wasregularly utilising the Pretoria Ambulance Service.This brought about the establishment of 1 Military HospitalAmbulance Department in 1991, under the guidance of SgtMark Louwrens, Sgt Piet Steenkamp and Sgt ‘Biks’ Boshoff.National Servicemen doing their two years’ militarytraining in the South African Medical Service were utilisedand underwent all the necessary medical training requiredof a basic ambulance assistant. During this time NationalService was reduced to one year, seeing the last intake oftwenty members at 1 Military Hospital AmbulanceDepartment in 1993.The PresentLt Jayson Nerwich, SO1 Ambulance Services, explainedthat the ambulance department at 1 Military Hospital nowconsists of only permanent force posts housing foursections. Each section has a shift leader (sergeant) with acrew of six emergency medical practitioners who haveundergone intensive medical training.Members do their training at the School for Military HealthTraining (SMHT) and the courses completed are on par withthose of their civilian counterparts. These include the BasicEmergency Ambulance Training (BAA) course and theAmbulance Emergency Care Assistant (AEA) course, whichform part of the Intermediate Skills Programme. Othercourses offered are military oriented, which allows forspecialisation as a theatre orderly, or members are able toreceive training involving the diagnosing and treatment ofminor ailments. The final module is the operational orderlyvocational module.“Day to day operations consist of a section working twoday shifts and two night shifts, after which members receivefour days off. Day shifts are from 06:30 to 18:30 andevening shifts from 18:30 to 06:30 the following morning,”added Lt Nerwich.During the day, shift leaders go about conductingpersonnel maintenance, administrative duties and in-servicetraining, which involves the refreshing of skills involvingExcellence throughCommitmentvehicle extrication (extraction) and CPR (cardiopulmonaryresuscitation) techniques and the use of equipment.The department does inter-hospital transfers of patients andprimary call-outs such as motor vehicle accidents and heartattacks.Emergency Call OutThe time is 23:20 and operational paramedics, Lt JaysonNerwich, S Sgt Ernie Francis and Sgt Brendon Scott talklight-heartedly about their experiences in the SAMHS. LtNerwich mentions that it is quiet for a Friday night. Thesewords had scarcely left his lips when at 23:31 an urgentmessage for medical assistance is received on the two-wayradio from the Pretoria control room. The informationrelayed is that a man had been shot in the stomach.Moving up a gear and turning on the siren and emergencylights, Lt Nerwich’s demeanour changes as he concentrateson driving the Toyota RSi response vehicle as quickly andsafely as possible to the scene of the incident in PretoriaNorth. Sgt Scott is on hand to give continuous directions.At the scene, blue and red emergency lights break theevening’s darkness. Medical personnel from ER24 and theSAMHS hurriedly take out medical equipment andpolicemen fire a barrage of questions at witnesses.The trio quickly assess the situation and ascertain thatthere are two patients who have been shot at close rangeand the other ‘pistol whipped’. Mr Stefan Els is lying in theparking area with a stomach wound, whilst the second gunshot victim is walking around with blood dripping from anear. The third has a painful right cheek.Mr Els is coherent and visibly in a lot of pain with asubstantial amount of blood around him. The medical teamimmediately begin to stabilise the patient by drawing 15 mgof morphine for pain relief. Working fast and effectively, SgtScott establishes intravenous lines (drips) on each arm toreplace lost fluids or blood, and then administers 5 mg ofmorphine.The seriously injured victim is then carefully moved onto aspinal board. S Sgt Francis notably says, “We are doing this

WHETHER ANSWERING EMERGENCY CALLS IN THECONTROL ROOM OR ADMINISTRING TREATMENTTO A PATIENT IN AN AMBULANCE, SAMHS PARA-MEDICS ARE COMMITTED TO SERVE.S Sgt Ernie Francis (AEA) ensures that the patientreceives sufficient fluid replacement whilst en routeto Kalafong Hospital.to stop any further movement which could increasebleeding.”The patient, now stabilised, is further assessed. Hisstomach is found to be hard, indicating internal bleeding.He is lifted and carefully carried to the ER24 ambulance,and before long is transported to Kalafong Hospital as apriority one patient. En route S Sgt Francis, Sgt Scott andER24 medical personnel continually reassess the patient’svital signs for stability. Lt Nerwich follows close by in themedical response vehicle.On arrival, the patient is taken to the stabilisation room inthe casualty department, where Dr Sibi and his staff areready to receive the patient.Sgt Scott informs him that there had been a shootinginvolving three victims. Mr Els had been shot in the leftabdominal level of approximately the twelfth rib. Hisbreathing is bilaterally equal and clear with nosubcutaneous emphysema (air under the skin).He further adds that the bullet had entered the front andexited his back. 5 mg of morphine and two litres of Ringerslactate are administered, with a third litre being used tokeep the vein open.Sgt Scott then shows Dr Sibi the patient’s wound andinforms him that there were no other injuries.He then later explains to the patient’s fiancé what is goingto happen: that medical personnel are going to flush thepatient’s abdomen to determine the extent of the internalbleeding. The wound would be cleaned in theatre and x-raystaken to assess lung and chest injuries.After all documentation is completed and after wishing MrEls and his fiancé well, the crew are congratulated by DrSibi on the high standard of work produced.ER24 medical personnel on the scene treated the other twopatients.“... the bullet hadentered the front andexited his back.”Lt Jayson Nerwich (MSO) and Sgt Joyce Nkadimeng(BAA) attend to urgent calls at the 1 Military HospitalAmbulance Department Control Room.17

EL FASHIR : CAMP and AIRPORTOperation CorditeWritten by Maj Rita van Schalkwyk whilst on deployment in Sudan18Deploying in the Sudan is matchless to the DRC orBurundi. It is a country with diverse cultures andrules which make the peace-keeping mission verydifficult.The desert is an amazing place. When we arrived n thecountry it was the end of the winter and a barren waste-landwith just a few trees and shrubs. With the beginning of therain season the entire desert was transformed into apicturesque landscape. Shrubs sprouted everywhere, therivers started to flow and Kurtum came to life. Sadly the rainseason only lasts two months. During summer thetemperature is merciless, reaching 55°C and the humidity isuncomfortably high. Sandstorms are the order of the day!At night the temperature drops rapidly, which is a welcomerelief assuring a good nights sleep.In Sudan time stands still. Initially I perceived the people tobe primitive and at least 200 years behind. Then I realisedthat their nomadic ways made them so much different. Theystill use donkeys and camels for transport. They do not seemto realise that they are poor and accept life as it is. Theladies dress in bright and gay coloured dresses and do mostof the work, collecting firewood, water, tending to thegardens and building. Everybody is very friendly and onecan talk to those who can converse in English.Most villages have curfew after sunset. There is noelectricity and water has to be pumped on a daily basis.We are working with eighteen other nationalities withdifferent ways and means of doing their tasks. This madeadapting to one another very difficult but, as time went by,it became easier.The South African contingent is situated in the Darfurregion. Our members are in camps in Kutum, Mellit orMahla. These camps were constructed and are maintainedby Pacific Architects and Engineers. This company employsDeploymentsDeploymentsmostly South Africans. The medical company, MedicalSupport Solutions, provides medical support and we workalongside them, which is also very difficult, as they do notfollow the rules and regulations that we have to adhereto.Languages mostly spoken are Arabic, French and English.Not all people understand English. There is a large diversityof religions with different beliefs and practices. Somenationalities are found to spit everywhere and some havethe habit of washing their feet in the hand washing basins.This takes some getting used to!At Kurtum there are two IDP camps (internally displacedpeople) housing thousands of refugees. Food support isfrom the United Nations. People feel unsafe to move backto their villages, as the women are raped when they go tocollect food and firewood.Transport of uniformed members and logistical support ismostly done by helicopter. Road transport is difficult, as theroads are sandy and rivers have to be crossed. Sustainmentflights to Sudan take place only once per month.This is indeed a unique experience. Our mission has beenextended for the second time, therefore lengthening ourdeployment time by seven weeks. We only receive 1$ perday from the African Union. Despite this we as South Africansoldiers realise that there is a job to be done and we dreamwith the locals that the time for peace will come very soon!

“The Comorosis a great eye opener”Written by Capt B.D. Matras(MTT AMISEC)Greetings from the beautiful islands of the UnionDes Comoros with its white sandy beaches, tallpalm trees, crystal clear water with coral reefsand a volcano that might erupt at any time.Coming here to the Comoros has been a great eye openerfor all of us. The Medical Task Team (MTT) was sent to theComoros Islands as part of the African mission for securityduring elections in the Comoros (AMISEC). The MTTconsists of 20 members in all, who have to deliver medicalsupport to all AMISEC members deployed on all threeislands (Grand Comoros, Anjouan and Moheli). Thisincludes the RSA contingent, as well as elements fromRwanda, Nigeria, Egypt, the DRC, and Mozambique.The composition of the MTT at the moment is a MTTcommander who is also deployed as the medical officer(Maj N. Badli), a nursing (PHC) officer, pharmacist, socialworker, environmental health officer, medical platooncommander, 12 OECPs and a pest control operator.A fully equipped Level 1 medical facility was erected at theMission HQ situated at the Ikoni Base in the GrandeComoros, which is also the largest of the three islands. TheOECPs deployed on the two remaining islands (Anjouanand Moheli) had to establish a medical facility to treatcommon illnesses within their scope of practice. Themedical officer, who was also the MTT commander, paidvisits to the respective islands on a weekly basis,accompanied by the social work officer and theThe TeamSeated fltr: Capt B. Matras (MTT 2IC), Lt P. Magabutlane (Social WorkOfficer), Lt I. van den Berg (Pharmacist), Capt T. Thaba(Environmental Health Officer), Sgt V. Manenzhe (Pest ControlOperator).Standing fltr: Cpl V.E. Thobejane (OECP), Maj N. Badli (MTTCommander), L Cpl W. Sindane (OECP), Sgt L. Tsime (OECP),Lt L. Kwele (Medical Platoon Commander).environmental health officer for a comprehensive medicalsupport service.All MTT members conducted themselves in an exemplarymanner, which speaks of professionalism. Sometimes wehad to execute our daily task under extreme weatherconditions, but the job was done. All AMISEC memberswere treated equally and no inequity was tolerated, as thiswas an AU mission. The Union des Comoros now has a newpresident, and I can proudly say that the MTT (AMISEC) waspart of the success of this mission.It is safe to say that no medical emergency was reportedto us during this crucial time. During this deployment theMTT, in conjunction with the MAOT FSE deployed with us inthe Comoros, had a well-planned evacuation system inplace in case anything happened.The people of the Comoros are a very friendly and kindpeople. These people endure a lot of adversity and somesuffer in silence, so making a difference here has been verysatisfying. The MTT AMISEC really gave the best of their timeand effort to make sure that all AMISEC members deployedin the Comoros were healthy.Well done!Written by Capt Lebo Lebese (1 Military Hospital)When deployed on mission or simply away fromhome one will inevitably miss the familiaritiesand conveniences of being home. In theSANDF during missions we are highlydependent on our support elements to make our job simple,convenient and pleasurable; not merely tolerable.One of these support elements are our chefs, as anyonecan attest to the simple fact that a single bad meal orhunger can make one miss home terribly. The chefs in theofficers’ mess at Basoko Base in Kindu, DRC, made surethat we never had the opportunity to complain or even misshome. It is impossible to please all the people all the time,especially when we come from different backgrounds andhave special dietary requirements and limited resources.Despite these difficulties they went above and beyond theircall of duty to ensure that we were all satisfied.Having dessert at almost every meal is not a necessity buta luxury even at home, let alone in the mission area. I saluteWarrant Officer Bremmer and his team for a job well doneto ensure that everybody was comfortable. The team set ahigh standard of service delivery which would be envied byany organisation.19

DRC,a Personal AccountWritten by Lt Wilma Vermeulen(Area MHU KZ Natal)It was with great apprehension that I disembarked fromthe MI 8 helicopter to stand on Beni soil. This is whereI was to spend the next three months as social workofficer for the Battalion. Soon, I was exposed to life inMadiba Base and Beni town. Madiba Base is a relativelylarge base as it can accommodate a battalion as well as thesupport elements such as medical staff and engineers. Thebase has a Level 1 hospital, staffed by a doctor and threenursing officers. The Ops Medics (OECP) deploy with thevarious companies.Beni is a small town by our standards, but it has an activemarket where virtually anything can be bought, frommaterial, soap, clothing, fish and all types of meat. Theprices vary according to your nationality. Locals pay inCongolese Frank and therefore pay less. Monuc personnelpay in US dollars and will pay up to five times more for anitem.The local community was incredibly friendly to the SouthAfrican contingent. They were excited when they saw us andwould shout “Afrique de Sud”, “South Africa”, “Souza” andeven “Mandela”.Bravo, Charlie and Delta company was deployed in otherareas of the DRC and as social work officer it was my taskto visit the companies. Many of the places were veryinaccessible. Gina (D-Coy) was two hours drive from Bunia,in a Casspir! The roads in the DRC are incredibly bad. Thereare few tar roads and those in rural areas are full of very bigpotholes. But even so, it was great to see the response of thelocal community to the South Africans. When we drovethrough towns and villages, the community would leavewhat they were doing, come to the side of the road andwave and greet us.We sometimes question our role in peacekeeping,wondering if its just a money making scheme. The truth isthat the South African contingent is having a tremendousimpact on the creation of peace and stability in the DRC.The Congolese are very appreciative of our efforts andmany locals build their houses next to the RSA bases as theyseek the protection our forces are offering them. For acountry that has known only war and conflict, our presenceis of utmost importance.My experience of the DRC has broadened my knowledgeof the political and cultural history of the country as well asour role in the country’s future.Deployment is a huge sacrifice to make, but the gains aremore than the losses. It is an experience that has made meextremely grateful to be a South African and incrediblyproud to be a member of the SANDF.Training toachieve an holisticapproachWritten by Lt Maahir Pretorius (3 Med Bn Gp)The vision of 3 Medical Battalion Group is that theReserve Force unit is a fully integrated andtransformed contingent-ready unit of choice insupport of the Mobile Military Health Formation(Mob MH Fmn) thereby providing a cost effective andvoluntary expansion capability to the South African MilitaryHealth Service (SAMHS).The unit’s mission is to grow 3 Med Bn Gp throughtransformation, recruitment and training to contingentreadiness, thereby providing a combat-ready Military HealthTask Group in support of the Mob MH Fmn.3 Med Bn Gp is situated in Goodwood, Cape Town andtakes pride in the fact of being the biggest Reserve Forceunit in the SAMHS.According to Maj N.A. Hanekom, the SO2 HR of 3 MedBn Gp, representivity at the unit is in its final stages of totalimplementation. He says that “constant and continualrecruitment is a vital part of our everyday activities as we aimto actualise our vision”.The Battalion presently has vacancies for fully trainedpersonnel in essential musterings such as medical officers,operational emergency care orderlies (OECOs) and drivers.Several unit members completed their BAA medicalcourses earlier this year and others attended the third officialdriving and maintenance (D & M) learners course, whichmet all requirements and standards. Further D & M trainingpresented by this unit is scheduled for other reserve forcemedical battalions in the Mob MH Fmn. Other functionalcourses currently being attended by members includeofficers’ formative and transport administration training.The unit prides itself in being one of the SANDF units tohave participated in the Opening of Parliament.Participation in combat-readyness exercises include –Exercise REFRESHER, Exercise REALITY and most recentlyExercise INDLOVU (Exercise LANCET).The unit’s goal dictates the provision of a specialisedmilitary health operational air, maritime, landward, clinicaland evacuation capability to the Mob MH Fmn.Quoting the Acting Officer Commanding 3 Med Bn Gp,Lt Col J.A. Fabricius, “this goal directs all our actions totraining and force readiness. It is a continuous struggle toreach this goal but its realisation has already actualised(referring to deployed unit members). Nothing comes easy –and this makes it all worth the effort.”20

Joint Senior Command and Staff ProgrammeCapability Visit to SAMHSOn 25 May 2006 the SAMHS capability visit tookplace at Wallmansthal. The intention of the visitwas to introduce the main operationalequipment of the SAMHS to learners and in sodoing, assist them in creating the correct perceptions interms of capabilities, characteristics and limitations for thecampaign planning process.The Joint Senior Command and Staff Programme(JSCSP) is designed as an accredited joint programme forsenior officer training for selected officers of the SANDFand other invited countries to be appointed ascommanders and staff officers at the operational level ofwar, with the focus on the provision of training for jointand multi-national operations.Officers attending the JSCSP will after completion of theresidential phase of the programme, presented fromJanuary to November at the South African National WarCollege which is divided into various modules namelyCorporate Management and Security Studies modulesrunning concurrently, followed by Joint Warfare andMilitary Operations Other Than War. The programmeconcludes with an exercise at the War Simulation Centrethat incorporates all the various aspects addressedthroughout the year.As part of the programme, service command andcapability visits are undertaken to provide theJSCSP learner with an insight into the strategies,organisation, capabilities and modus operandi of theservices. The purpose therefore will be to broaden thelearners’ scope of campaigning, with specific reference tothe services components in the joint environment.The demonstration began with a tandem parachuteWritten by Lt Col S. Knoetze, Directing staff (JW)Photographed by Lt J. Sverdloff7 & 8 MEDICAL BATTALION GROUPS SHOWEDTHEIR WORTH DURING THE SAMHSCAPABILITY VISITdisplay, followed by a sand model explanation and amechanised formation drive-past to show how the SAMHSdeploys in a conventional mobile operation. The airdroppable surgical post was on display and the chemicaland biological protection capabilities of the SAMHS werealso displayed and explained.The capability demonstration consisted of the tacticaldeployment of 7 Med Bn Gp together with 8 Med Bn Gpcombat support assets, which was facilitated by the MobileMilitary Health Formation. The opportunity was used toenable the learners to comprehend the casevac system ofthe SAMHS and to understand the unique complexitiesfacing Military Health elements during operations.Since the SA Naval Staff College had recently included thecampaign planning process as part of the SA Navy JuniorStaff and Warfare Course curriculum, the course alsoattended the capability demonstrations. This enabled theSA Navy Staff College to better prepare learners forcampaign planning, and that is why capability visits to thevarious services and formations in the SANDF have alsobeen included.All the JSCSP learners where suitably impressed and wereprovided with much of the information needed for planningpurposes that will be required for the rest of the programme.The SAMHS must be congratulated for a job well done!21

The Combat Training Centre in Lohatlha was onceagain host to the 2006 NCO Skills Competition.The competition took place from 7 to 12 May2006. Under the decree of the Sergeant Major ofthe SAMHS, WO1 Moses Sebone, the principles of thecompetition were not to be compromised for anything belowexcellence.Monday 8 May marked the official start of the annualcompetition after the teams had undergone the clearing-inprocess, which ran smoothly under the supervision of RSM‘Smiley’ Ericson of the Military Health Combat TrainingCentre.By the break of dawn most of the teams, comprising of fivemembers each of whom one had to be female, were alreadyin the shooting range despite the chilly weather of theNorthern Cape. The teams were in high spirits as they sangto keep themselves sane and warm.WO1 ‘Charlie’ King from GSB Thaba Tshwane explainedin detail how the shooting exercise would be conducted. Assoon as the clock struck seven in the morning, the first shotwas fired. Maj Billy Kraft was also on hand to calculatepoints and assist in the shooting exercise.The shooting evaluation involved members firing fiverounds at a target in the prone, kneeling and standingposition. This was done in order to achieve the best possiblegrouping in order to accumulate maximum points for theirrespective teams. The evaluation took the better part of theday, and the teams were all eager to shoot and get thiscompetition started on a very high note.After all the teams were finished with the exercise, theywere reintroduced to chopper drills (with the assistance ofthe SA Air Force) as this would enable them to properlyexecute the drills when the chopper flew them from one gridreference to another. The day’s events were concluded whenthe chopper arrived and ferried the teams to their respectivepoints.The second day started off with the teams being in highspirits. Under the close supervision of WO1 Hansie Siyale,FSM MHTF, and S Sgt Willem Phakola, instructor at the SMT,teams underwent diverse evaluations, which includedsignals. Here, participants had to know various radiofunctions, such as naming the parts and establishingcommunication between the man-pack radio and theCasper.Teams furthermore completed a medical evaluationheaded by S Sgts Dhlamini and Norman. Participants wererequired to assist a ‘patient’ with an open fracture of thelower leg. The task was completed with ease, as mostparticipants are operational emergency care practitioners.WO1 Boude Motsamai, on the other hand, hadenthusiastic drivers lined up to be tested. He explained thatthe participants are tested on their practical driving skillsbased on the K53 model, using heavy and sedan vehicles.Drivers are required to do off-road and uphill and downhilldriving. He also said that the evaluations had gonereasonably well and that four out of six participants haddone superbly well.WO1 van Niewenhuizen had participants scratching theirheads as they carried out map plotting and explainedCHILLS, SKILLSandCOMPETITIONSAMHS NCOs FROM ACROSS THECOUNTRY BATTLED IT OUT IN ACLOSELY CONTESTED SKILLSCOMPETITION.Written by 2Lt Sello SegonePhotographed by F Sgt André Bester (5 ASU)various points. All the teams were only allowed to visit twoevaluation points, which made the second one their last RVfor the day. But participants were also required to observewhatever objects they encountered along the way and plotthe object on the map provided. Participants were providedwith compasses to aide their plotting of their point-to-pointmovement. To their surprise the participants were alsoafforded a second chance to hover above the ground in achopper.The third day of the competition saw all the participantsreaching their last two evaluation points, with team AMHUKZN lagging behind and giving all the evaluators a scare.Luckily they showed up in time just before sunset. Most ofthe evaluators attributed this to a lack of sufficient mapreading techniques, which could have grave consequences.By now the participants had already made peace with the22

(SMT), under the leadership of Cpl Makhumsha, was so farahead, they were nowhere to be seen. This team seemedmore determined than ever despite suffering terrible blisters.They overtook every team on their way in a desperate bid toretain their pride and possibly the title.Even though the route march was a tiresome exercise,team 3 Military Hospital kept their spirits high by singingfrom start to finish. They also had words of encouragementall the way through whenever one member was about togive up. No team displayed more esprit de corps than thisteam.Cpl Mathe Lesenyego from IMM described the walk asvery testing. Most of the participants are on the verge ofbreaking down, but they had a mandate to finish.Team SMT emerged victorious after the march, much tothe delight of their acting officer commanding, Lt Col ThaboChabalala, as well as RSM Solomon and FSM HansieSiyale.An important parade and ceremony followed later in theafternoon. A rock-laying ceremony took place in the unit.Brig Gen Potgieter, who was the first to lay a rock, led thisceremony. The rest of the dignitaries, Brig Gen Moodley andBrig Gen Magasela, GOC CTC, followed by laying rocks.Then it was time to announce the overall three positions inthe winner’s parade. In the first place was IMM, followed bythe School for Military Health Training and the School forMilitary Training.After all the formalities the participants were treated to abraai and soft dinks to thank them for a job well done. BrigGen Moodley, GOC AMHF, and the Warrant Officer of theSAMHS, WO1 Sebone, also took the time to conveygreetings from the Surgeon General, who could not attenddue to other commitments.WO1 Sebone complimented the participants on theirwholehearted devotion to the competition, as they are theones who ensure its success. He promised a lot of changesto be implemented, as the competition is to become theSADC Force Preparation Competition.The results were as follows:1st place: IMM.2nd place: School for Military Health Training.3rd place: School for Military Training.terrible weather conditions.The last day of the competition saw the participantsbraving the winter chills, ready to tackle the last obstaclethat lay ahead of them - the 15 km route march. Thisentailed the teams walking a total distance of 15 kilometreswith all their kit, weighing less than 20 kg and not more than30 kg.With most of the officers commanding and regimentalsergeant majors of the different teams being present, theparticipants were even more motivated and inspired to flythe flags of their different units high by performing betterthan before. At 07:00 the siren sounded and the teamsstarted with the march. The route was rather flat in thebeginning but turned sandy and rocky as the march went on.After 5 km, the team from the School for Military TrainingBest Formation TeamsThe Area Military Health Formation trophy: AMHU Gauteng(68.71%)The Tertiary Military Health Formation trophy: IMM(72.58%)The Mobile Military Health Formation trophy: 8 Med Bn Gp(57.24%)The Military Health Training Formation trophy: SMHT(72.16%)Best Team in Different Evaluation Points15 km Route March – SMT; Driving and Maintenance –AMHU MP; Medical – SMHT; Shooting – AMHU KZN;Signals – IMM; Map reading – AMHU MP; Observation –SMHT; Memory – AMHU NC; Navigation – AMHU MP.23

MSDSTraining in theSAMHS is OnTrackWritten by Lt John Sverdloff and 2Lt Sello SegonePhotographed by Lt John Sverdloff“... MSDS DOES NOT ONLY PROVIDE YOUNGSOUTH AFRICANS WITH MILITARY SKILLS, IT ALSOCONTRIBUTES TO THEIR SOCIAL UPLIFTMENT BYPROVIDING THEM WITH SKILLS THAT THEY WILLUSE IN THEIR CIVILIAN LIFE AFTER COMPLETINGTHEIR MILITARY SERVICE.”During the handing-over ceremony of the AgustaWestland A109 Light Utility Helicopter inBloemfontein in 2005, the Deputy Minister ofDefence, Mr Mluleki George, said, “The MSDS isto ensure a continuous intake of young, deserving, healthySouth Africans into the SA National Defence Force, whichwill rejuvenate the Regular Force and supply the ReserveForce.“Furthermore, the MSDS does not only provide youngSouth Africans with military skills, it also contributes to theirsocial upliftment by providing them with skills that they willuse in their civilian life after completing their military service.It also provides our youth with employment opportunities.“Currently we are providing opportunities for 6 000 youngSouth Africans in the SANDF. This figure is expected to growto 10 000 in two years’ time”. The Deputy Minister addedthat 165 recruits from the MSDS had graduated as officersat the Military Academy during 2004, and that the ageprofile of soldiers between 18 and 24 years in the SANDFhad improved from 7.1% in December 2002 to32.5% in July 2005.He further emphasised that intakes are to increase to atleast 7 000 recruits per annum, ultimately reaching 10 000.SAMHS follows suitKeeping in line with government and SANDF initiatives,the South African Military Health Service MSDS intake gotoff to a good start this year, as new recruits turned up innumbers to report for their newly chosen career in theSANDF.Approximately 170 of the anticipated 240 recruits turnedup on the first day, with the number increasing to 203 on thethird day, indicating much eagerness to start training at theMilitary Health Training Formation.They were received and cleared in by personnel from theSchool for Military Training (SMT) and the TrainingManagement Centre. The Military Police were also on handto check their luggage to make sure that nobody hadbrought in any illegal substances or objects. Soon it was off24

to the sickbay, where medical evaluations took place.Lt Sophy Monama, a nurse, said, “General medicalcheckups are conducted, which include pregnancy tests,immunisations, physical well-being as well as health status”.Maj Raymond Kgatitswe, SO1 Execution of the SMT,explained that recruits were to complete a basic trainingcourse at the Combat Training Centre in Lohatlha for aperiod of approximately three months. He added that thecourse would have special features like the prominentinvolvement of social workers who would help the recruits tobe self-dependent, and the conducting of some HIV/AIDSawareness programmes.Regular drill sessions are conducted, which is anindispensable part of a uniformed member’s conduct anddiscipline. In between the sessions the students will attendlessons in subjects such as Military Law, the Law of ArmedConflict, Civic Education, Military Security, Soldiering,Compliments and Saluting, Dress Regulations, Guards andSentries, Hygiene, Radio and Voice Procedures and FirePrevention.Field subjects to be tackled include Musketry, which,among other things, involves the cleaning, assembling andstripping of the R5 rifle, shooting range procedures andTable 1 shooting exercises.Furthermore, recruits are taught Field Craft, which teachesthem how to camouflage and conceal themselves from theenemy, Map-reading, which involves reading maps andplotting points on a map, and Buddy Aid, which gives themthe tools to use whatever means necessary to save lives withfew resources at hand.Recruits will enjoy recreational moments, as they are tohave regular physical training sessions and evaluations inorder to stimulate them and keep them fit. Chaplain’speriods will be presented on Wednesdays and churchparades on Sundays to look after their spiritual growth.Parents’ weekend will be part of the schedule, where parentsare invited to come and see their children’s progress.A bright future lies ahead for all recruits, as they will beable to further their academic qualifications aftercompleting the basic training course.Recruit Thokozani Tshabalala from Warden in the FreeState said that he is excited about his first step towardsbecoming a soldier. “I’m happy that this day has finallycome. This, for me, is a big step, as I’ll become differentfrom the ordinary civilian on the street. I believe by the endof this course I’ll be more disciplined and fitter than ever. Ireally am looking forward to this.”The Course is a SuccessOn completion of the course on 13 April 2006, theCompany Commander, Capt G.M Maritz, who was theoverseer of the basic training course, described it as a bigsuccess.With a satisfied smile he said, “The company was dividedinto eight platoons with four commanders and eightsergeants. Lohatlha provided ample space for training andinstructors made use of the Joint Training Curriculum, whichensured that the training received by SAMHS recruits is onpar with that of the other services”.Acting Officer Commanding of SMT, Lt Col ThaboChabalala, also took time off his busy schedule to welcomeback part of the group, who are attending the Battle SupportCourse. He extended his best wishes to the students onbehalf of the GOC MHTF, Brig Gen Siwisa. He, however,cautioned the students not to lose discipline. He appealedto them to put more than 100% into their studies in order tomake a success of the venture.Triumphant and upbeat, Ptes Govender, Mbatha andMontsioa described their training in Lohatlha as very difficultand not for the fainthearted, pointing out that the weatherhad been extreme. However, they paid homage to theinstructors who motivated and transformed them into theproud soldiers they have become.They now form part of the MSD group and will soonembark on the career path they have chosen in the SANDF.The Officer Commanding of the School for Military HealthTraining (SMHT), Col Theo Ligthelm, a qualified nursingofficer and emergency care practitioner, said that the SMHTreceives learners after they have completed the courses inBasic Military Training, Battle Support, and Driving andMaintenance.The courses the School offers MSD members, which areon par with those of their civilian counterparts, are the BasicEmergency Ambulance Training (BAA) course and theAmbulance Emergency Care Assistant (AEA) course. Theseform part of the Intermediate Skills Programme. Othercourses are military oriented.For the BAA course, learners are required to complete 120hours of theoretical and practical training at SMHT, afterwhich they may register as a BAA with the Health ProfessionsCouncil of South Africa, and have the opportunity tospecialise as an x-ray orderly or veterinary orderly. A further1 000 hours (6 months) of practical, on-the-job training atvarious area military health units is also completed.The intermediate skills programme consisting of a full 36weeks of intensive training includes the AmbulanceEmergency Care Assistant Course (AEA), which is 470 hourslong, after which learners may register with the HealthProfessions Council of South Africa. Learners may thenprogress to the more military-oriented modules, such as theadvanced emergency care module (120 hours), with theoption of specialising as a theatre orderly, or continue withthe diagnosing and treatment of minor ailments module(320 hours). The final module is the operational orderlyvocational module (80 hours).Once completed, learners qualify as an operationalemergency care practitioner (OECP).Col Ligthelm continued, “The motto of the MHS is derivedfrom the Latin, ‘Audaces Sevare Decemus’, ‘We train to savethe brave’. In the spirit of this we ensure that our instructorsare kept up to date with the latest in training techniques andif need be are sent overseas for enrichment training.“What is also of interest is that the school uses externalassessors from emergency care institutions when learners dotheir final assignments. This ensures that a very highstandard is maintained, ensuring that our learners receivethe best accreditation at all times.“I am happy with the enthusiasm shown by learners. Theirpass rate results compare favourably to other ambulancecolleges in provincial government”.From the January 2006 MSD intake, 12 members wereearmarked for dental assistance, 28 members for 4-yearnursing, 35 members for 2-year nursing, 37 members foroperational emergency care practice, 5 members forprotection, 20 members for patient administration, 11members for logistics, 3 members as veterinary orderlies, 17members for personnel, and 15 members for the YouthFoundation.25

40 Years’service in the SAMHS!Written and photographed by Lt Col M.J. Wentzel(Area MH Fmn HQ)26The honour as the first female to complete acontinuous period of forty years’ service in theSouth African Military Health Service belongs toStaff Sergeant Helena Susara Bronkhorst, betterknown as Staff Bronkie. She joined the Defence Force on 14August 1964 and completed her nursing training as anenrolled nurse at the former 1 Military Hospital in 1971.Staff Bronkie was very well decorated. She was awardedservice medals for 10, 20 and 30 years’ good service, theMilitary Merit Medal, as well as the General Service Medaland the Unitas Medal, apart from several commendationand appreciation certificates for good service delivery. Overthe period of forty years she served at fifteen sickbays andwill be remembered by many national service men andthose who had their CHAs done at the Bank of Lisbon MMRlately.Bronkie related many interesting anecdotes of her serviceperiod and this was quite an experience. She told about theswitchboard operator at the former 1 Military Hospital whoused to sleep every time he was doing night shift. His othertask was to accompany them to the mortuary whenever acorpse had to be taken there at night. They were becomingquite fed up with him, as they always had to cover for himwhile they had to stay awake. This went on for just too long,so they decided to scare the bright daylight out of him.This was what they did: Under the auspices of nightmatron Dina Nel, they wrapped one of the nurses toresemble a corpse and called him to escort two nurses tothe mortuary. They had to pass through many long, darkpassages and through an area barricaded off with chainsbefore they reached their destination.As they passed the chained area, the “corpse” startedgrousing and “deflating”. This was scary, but when the“corpse” lifted its head, the switchboard operator threw themortuary keys into the grass and took to his heels, leavingthe trolley speeding down the road. Luckily the two nursescaught the trolley before the “corpse” was hurt. They spenta few hours looking for the keys by the light of a smallpenlight torch. Needless to say, the switchboard operatornever ever slept again during his night shift!To celebrate her last day in the SAMHS, a specialappointment was made with the previous Surgeon General,Lt Gen Rinus Jansen van Rensburg. He spent 30 minutes ofhis valuable time embroidering on the anecdotes and thepranks the young doctors and students played on thematron and the nursing staff in the years gone by. Lt GenS Sgt Helena Susara Bronkhorst poses proudlyafter 40 years’ service in the SAMHS.Jansen van Rensburg insisted on personally serving her tea– a great honour to a person who devoted all her life tocaring for her fellow soldiers.Staff Bronkie lived a life of sacrifice, caring equally well forcolleagues, patients, troops and her aged mother whopassed away during 2003 at the ripe age of 99 years and10 days. She retired from the SAMHS with good and sadmemories but stated, that if she could have her life over, shewould definitely become a nurse again.Bronkie, we salute you – you are an example of devotionand service rendering. We wish you well and may you enjoythe time that you will spend touring South Africa!S Sgt Helena Susara Helena Susara Bronkhorst has a ‘special’ cup oftea with the previous Surgeon General, Lt Gen Rinus Jansen vanRensburg.

Fund NewsSAMHS Fund NewsBanana Beach Holiday Resort: Christmas BookingsThe prime objective of the Fund’s Banana Beach HolidayResort is to provide affordable holidays for Fund contributorswho enjoy preferential booking rights for the December andEaster holiday seasons and discounted tariffs throughout theyear.Every year demand exceeds availability of accommodationduring the popular part of the Christmas school holidays.As a result, the Executive Committee decided last year tointroduce changes to the system of allocating availableaccommodation in the interests of fairness andtransparency.This new system seems to have been well received andwas implemented again this year when, from 1 until 28February, requests for accommodation were taken only fromFund contributors. Those wanting to go to the Resort overthis season registered their requests with the Resort, which inturn forwarded them to the Fund Manager at the beginningof March. The Fund Manager separated the requestsaccording to the various categories of accommodation (ie2-bed rondavels, 4-bed chalets, etc) and allocated adedicated number to each request.A lucky draw (similar to a raffle) was then conducted foreach type of unit using numbered steel balls, kindly lent tous by the SAAF Fund, which uses a similar system forallocating its holiday accommodation during the mostpopular school holiday seasons.Schedules indicating the order in which names had beendrawn for the various types of units were then forwarded tothe Resort Manager to arrange the actual allocation ofaccommodation.A total of 158 applications were received fromfltr: Ms Edith Mothusi (SAMHS Fund), Col (Ret) Jock Stenhouse(SAMHS Fund Manager) and Ms Paulina Mnisi (Secretary to SAMHSFund Chairman) conduct the lucky draw for holiday accommodation.contributors for the 41 available units, but of these 158requests 26 contributors had indicated a preference formore than one type of unit or duplicated their request. It wasfelt that in fairness to other applicants these applicantsshould be considered only once so, only 132 requests wereincluded in the final draw. The following is an analysis ofthese applications, which were 10% fewer than last year.From this analysis it is apparent that there are 1 640units/days available during the school holidays (ie 41 unitsx 40 days), and that requests for 1 490 unit/days werereceived. This means that, for this year, we should be ableto satisfy most applicants.Type of Unit No of units available No of unit / days available No of unit / days requested No of applications(2005 applicationsshown in bracket)RONDAVELS 2 bed312081 (6)4 bed6 bed728019816 (22)416011610 (9)CHALETS 4 bed624039532 (52)6 bed1768055151 (48)8 bed312017217 (20)HOUSE sleeps 10 140505 (19)4116401490132 (176)27