Polygraph testing

by : Johanette Rheeder

Employers are often faced with misconduct or criminal activities such as misappropriation of property or theft in its work environment, without knowing exactly where, how and by whom it is committed. It is crippling the business and the employer is at its wits-end how to find the culprits! To make things worse, you suspect that there are accomplices amongst your employees, sharing in the illegal proceeds and helping to hide the crime!

What to do? Can you send all your employees for a polygraph test?
This is what happened in the case of Amalgamated Pharmaceuticals Ltd v Grobler NO and others[2] where the third, fourth and fifth respondents were dismissed for misappropriation of company property. A polygraph test showed that they could be responsible for the serious stock losses suffered by the applicant. The Labour Court agreed with the reasoning of the Commissioner who found that, in practice, a polygraph does not serve to prove that someone is actually lying, for the questions are often too broad to exclude that which is neither intended nor sought. And it most definitely does not prove that someone is guilty. It is merely an indication of deception.

It has been widely accepted by the Labour Court and the CCMA in cases such as Sosibo & others and[3] that, polygraph testing in the workplace is highly contentious and the admissibility of its results remains moot. The sole reliance by the employer on unspecific polygraph results is insufficient to discharge the onus in terms of section 192 of the Labour Relations Act 66 of 1995 to prove that the dismissal was fair. To discharge this onus, the test of a balance of probabilities is used. To only present polygraph evidence is not enough to show that the dismissal was fair because there is no corroborating evidence.

Does that mean that an employer cannot use polygraph testing?
No, it does not, however there are some strict rules relating to polygraph tests that need to be adhered to, unless the employer wants the test to be found unreliable, unfairly applied and useless in the CCMA or the Labour Court!

Firstly, the employer cannot force any employee to submit to such a test. Refusal to do so does not indicate guilt and is also not necessarily grounds for dismissal. Preferably, the employer should obtain written consent.

Secondly, the employer should agree with the Polygraphists on the questions to be asked. It should not be vague, otherwise the employer will sit with answers that do not take his case any further.

Consent means informed consent. For that purpose the employee should be informed that the examinations are voluntary, the reasons for and type of questions should be explained, it should be explained that he/she has a right to have an interpreter and should he/she prefer, another person may be present during the examination, provided that person does not interfere in any way with the proceedings.

Generally, employers are permitted to use the polygraph test to investigate specific incidents where employees had access to the property which is the subject of the investigation and there is reasonable suspicion that the employee was involved in the incident.

The employer must also been subjected to economic loss or injury to the employer’s business like theft of company property or the employer is involved in situations such as combating dishonesty in positions of trust, or combating serious alcohol, illegal drugs or narcotics abuse or fraudulent behaviour within the company or deliberate falsification of documents and lies regarding the true identity of the people involved.

Polygraph results cannot be released to any person but only to an authorised person. Generally it is the person specifically designated in writing by the employer whom requested the examination.

Polygraphists have been accepted as expert witnesses whose evidence needs to be tested for reliability. Therefore the Polygraphists should be called to testify as an expert witness. He must testify how the test was performed, his qualifications, the type of test used and the questions asked and if necessary, a medical doctor should also testify on the issue of manipulating body functions to mislead the Polygraphists, if that becomes an issue at the hearing.

The remaining question is whether their refusal could be said to have been a breach of their duty of good faith. Although an employee has a duty to act in good faith, it is accepted by the CCMA and the Labour Court that it does not follow that this duty extended to an obligation to undergo polygraph tests. It might be that the employee can be expected not to hamper the investigation, but a refusal in itself should not be seen as an act of hampering the investigation. It should be remembered that in our law, the employer must prove the guilt of the employee and the employee must not prove his innocence through polygraph testing.

Polygraph testing is highly contentious and the admissibility of its results is often in dispute. If they are to be accepted as relevant, such tests must at the very least be supported by corroborative evidence[4].

Wear yellow with Lance - 2 October 2010

This Saturday, Lance Armstrong will be wearing yellow to raise awareness of the 28 million people living with cancer worldwide—and we invite you to join him and thousands of others in wearing your support.

Right now, cancer kills more people than AIDS, malaria and tuberculosis combined—but incredibly; cancer is not at the top of the world’s agenda.

Together, we can change that. Supporters like you have already made yellow the universally recognized symbol of the fight against cancer, and on October 2, LIVESTRONG Day, you can use that symbol to join in a global statement of strength and courage.

Wear yellow with Lance on LIVESTRONG Day—Saturday, October 2.

There’s a great tradition at our LIVESTRONG Challenge events: thousands of supporters wear yellow and cheer on participants as they head towards the finish line.

That home stretch has become known as the Yellow Mile. It represents solidarity and support for the fight against cancer—and it’s a powerful moment to witness the whole community standing together as one.

In just four days, you can help Lance extend that Yellow Mile all around the globe. The more people who wear yellow on LIVESTRONG Day, the closer we’ll move towards ending the stigma against cancer—and, one day, to a world completely free from the disease.

Join Lance and supporters in more than 50 different countries by wearing yellow on LIVESTRONG Day.

Let’s show the world that we’re tough enough to take on cancer—and win.

Thanks,

LIVESTRONG

Consumer Protection Act

The DTI has, not unexpectedly, deferred the implementation date of the Consumer Protection Act to 31 March 2011.

This provides some breathing space for input into regulations, and for industries / associations to lobby their statutory / regulatory bodies to apply for exemption from provisions of the Act where their own legislation adequately protects the rights of consumers (patients).

Billions to be spent to upgrade hospitals: Minister

Published 27 Sep 2010 Article by: Sapa0 Comments South Africa will spend billions to improve health care by renovating dilapidated hospitals, Health Minister Aaron Motsoaledi said on Monday.

"We will put massive investment -- it will be more than what the country spent during the soccer World Cup," Motsoaledi told reporters at Inkosi Albert Luthuli Hospital in Durban.

Motsoaledi, doctors, engineers and Development Bank of SA (DBSA) representatives were attending a workshop aimed at preparing for the revamp of Durban's King Edward VIII Hospital.

The hospital was one of five that would receive a massive, billion-rand face lift, Motsoaledi said.

The other hospitals were Nelson Mandela Academic Hospital in the Eastern Cape, Dr George Mukhari and Chris Hani Baragwanath Hospitals in Gauteng and the Limpopo Academic Hospital.
"The revitalisation is [part] of the ten point programme which is needed in preparation of the National Health Insurance (NHI). I am here to start that process."

He said they had decided to involve all health stakeholders in the revitalisation programme.

"This has never been done before. We are discussing how it can be done and we will be forming task teams."

Motsoaledi said the actual cost of revamping hospitals would be known after the teams had started their work.

Dr Massoud Shaker, provincial health department head of infrastructure, said the project manager for King Edward would be appointed before the end of the year.

DBSA divisional executive Lucy Chenge said her bank would be a partner and "possibly finance it".

Lift, Escalator And Passenger Conveyor Regulations, 2010

Take note that the Minister of Labour has under section 44(1) of the Occupational Health and Safety Act, Act 85 of 1993 incorporated the hereinafter listed standards into the Lift, Escalator And Passenger Conveyor Regulations, 2010.

This notice was given in Government Gazette 33561,Regulation Gazette 9380 Government Notice Regulation GNR. 829 dated 17 September 2010.

The incorporated standards are:
• "SANS 1543": the specification for escalators and passenger conveyors, published by the South African Bureau of Standards;
• "SANS 1545-1": the specification for lifts: Safety rules for the construction and installation of lifts: Part 1: Electric lifts, published by the South African Bureau of Standards;
• "SANS 1545-2": the specification for lifts: Safety rules for the construction and installation of lifts: Part 2: Hydraulic lifts, published by the South African Bureau of Standards;
• "SANS 1545-3": the specification for lifts: Safety rules for the construction and installation of lifts: Part 3: Lifts for persons with physical disabilities (stair-lifting platforms), published by the South African Bureau of Standards;
• "SANS 1545-4": the specification for lifts: Safety rules for the construction and installation of lifts: Part 4: Lifts for persons with physical disabilities (vertical platforms), published by the South African Bureau of Standards;
• "SANS 1545-5": the specification for lifts: Safety rules for the construction and installation of lifts, Part 5: Electric and hydraulic access, goods only lifts, published by the South African Bureau of Standards;
• "SANS 1545-6": the specification for lifts: Safety rules for the construction and installation of lifts: Part 6: Rack and pinion lifts, published by the South African Bureau of Standards;
• "SANS 1545-9": the specification for lifts: Safety rules for the construction and installation of lifts: Part 9: Lift landing doors fire resistance testing, published by the South African Bureau of Standards;
• "SANS 50280": standard for the design, safe use and maintenance of scissors lifts, published by the South African Bureau of Standards;
• "SANS 10360": the standard for the maintenance and repair of electric and hydraulic powered lifts, escalators and passenger conveyors, published by the South African Bureau of Standards;
• "SANS 21": the specification for escalators, safety rules for the construction and installation of escalator and passenger conveyors;
• "SANS 50081-1": the specification for electric lifts, safety rules for the construction and installation of lifts, published by the South African Bureau of Standards;
• "SANS 50081-2": the specification for hydraulic lifts, safety rules for the construction and installation of hydraulic lifts, published by the South African Bureau of Standards.

The World Health Statistics 2010

The World Health Statistics 2010 (based on 2009 data) has been released recently.

Country outcomes are listed in tables and includes outcomes of each of the MDG’s.

It covers per country and per region:
Mortality and burden of disease, Cause-specific mortality and morbidity, Selected infectious diseases: number of reported cases, Health service coverage, Risk factors (drinking water, tobacco, LBW, etc), Health workforce, infrastructure and essential medicines, Health expenditure, Health inequities and Demographics.

It shows the following, amongst others, for South Africa:
• Life expectancy has declined from 59 in 1990 to 52 in 2008 for males, and from 68 to 55 for females.
• By 2008, SA is reported as having 8 doctors per 10 000 population, 41 nurses per 10 000 and 3 pharmacists per 10 000.
• As far as the availability of essential medicines are concerned, no data is available for the public sector, but the private sector is reported as having 71% of selected generic medicines available.
• In terms of health expenditure:
o SA spent 8.5% of GDP on health in 2000, and 8.6% of GDP in 2007.
o Government spent 10.9% of its total budget on health in 2000, and 10,8% of its total budget on health in 2007.
o The % of private expenditure has decreased slightly over the same period from 59.5% to 58.6%, of which 93.9% are reported as “out-of-pocket” spend in 2007
o On a per capita basis, SA has increased total health spend from $803 to $1148 at average exchange rate of which $290 and $375 are government per capita spend. (figures in PPP also available)

For the African continent, the following are pertinent:
• “Despite … gains, the coverage of critical interventions such as oral rehydration therapy (ORT) for diarrhoea and case management with antibiotics for acute respiratory infections (ARIs) remains inadequate. As a result, diarrhoea and pneumonia still kill almost 3 million children under 5 years old each year, especially in low-income countries.”
• “While there were some improvements in the WHO African Region, less than 50% of TB cases were reported in this region in 2008.”
• “In the WHO African Region (where HIV prevalence among adults was the highest) only 45% of pregnant women in need in low-income and middle-income countries received treatment…”
• “Non-communicable diseases and injuries caused an estimated 33 million deaths in developing countries in 2004 and will account for a growing proportion of total deaths in the future. Tackling risk factors such as tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol (while also dealing with the socioeconomic impact of cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) will depend not only upon effective healthcare services but also upon actions taken in a variety of policy domains.”

Broken sewage works info not for public - govt

Water

Published 15 Sep 2010 Article by: Sapa0 Comments Information on hundreds of dysfunctional sewage treatment plants will not be made public, the government said on Wednesday.

In a written reply to Parliamentary questions, Water and Environmental Affairs Minister Buyelwa Sonjica said that revealing such information could lead to "serious misinterpretation" of the data.

"What is available and was published... in the 2009 Green Drop Report, is the summary of the performance of each of the 449 WWTWs [waste water treatment works] that were assessed," she said.

The Green Drop Report - an audit of 449 of South Africa's 852 municipal WWTWs, conducted between August 2008 and July 2009 - was released, after long delays, in April this year.

According to the document, a total of 403 facilities were not assessed owing to, among others, "municipal officials not sufficiently confident in their levels of competence" and "municipalities not managing waste water services according to expected requirements".

It also found that of the 449 works that were assessed, skills shortages had resulted in many not being operated correctly and "the effluent water quality is no longer compliant".

Among the Parliamentary questions posed to Sonjica - by Democratic Alliance (DA) MP Annette Lovemore - was whether information for all WWTWs would be made available to the public, and if not, why not.

The Minister replied: "No, such detail [sic] information is not available to the public. Revealing details of such a high technical nature will lead to unnecessary additional administrative challenges and serious misinterpretation."

Speaking to Sapa, Lovemore said that not making public information on potential threats to people's health was unacceptable.

"It's not acceptable. Each municipality is required to report on results [from WWTWs] each month. If there is a health risk, people should be told."

She said that over and above the risks to human health of sewage water finding its way into rivers and streams, the contaminated water also affected crop irrigation, drinking water for livestock and the health of the environment.

In her reply, Sonjica further said that not all WWTWs had been issued licenses or permits to operate. She did not say how many.

Reasons for municipal sewage works not having operating licenses included that some had not applied for one, some did not meet the standard required for a license, and others had "insufficient capacity" to submit the application.

Her department had launched a special project "to address the current backlog in licences", she said.

Health Awareness Topics for October

( Month of October : Mental Health Awareness Month)

1 – International Day for older persons
1 – National inherited disorders day

6-10: Eye Care awareness week

8 – International day for Nature Disaster reductions

11 – 16 National Nutrition Week

10 – World Mental health day

12- 20 – World Bone and joint week
12 – arthritis awareness day

14 World Sight Day

15 – National Foetal Alcohol Syndrome Day

16 – World Food day

17 – World Trauma day
17 – World Spine Day
17 – International day for eradication of poverty

20 – National Down Syndrome Awareness
20 – World Osteoporosis day

21 – 25 Infection Control Week

23 – National Iodine Deficiency Disorder day

24 - World Polio Day

29 – World Stroke Day

4 legal requirements when training your employees

When you train your employees, remember these four legal requirements…

4 legal requirements when training your employees

1. You must provide any information, instruction, training and supervision that may be necessary to ensure, as far as is reasonably practicable, the health and safety at work of your employees (Section 8(e),OHSA)

2. You must ensure that your employees fully understand the hazards associated with the work they perform, and the plant or machinery they use. They must also have the authority to implement the precautionary measures you’ve taken (Section 8(i), OHSA)

3. You must inform all employees regarding the scope of their authority (as contemplated in Section 37( 1)(b) (Section 8)(j), OHSA)

4. You must instruct your employees on the proper use, maintenance and limitations of the safety equipment and facilities you’ve provided (Section 2.5, General Safety Regulations, OHSA). This means training them accordingly

Cosatu released Economic Policy

Cosatu released its Economic Policy document today (“A Growth path towards full employment”). Its views on nationalisation, changes in taxation, ownership, etc were widely reported in the media (http://www.timeslive.co.za/Politics/article658469.ece/Highlights--Cosatus-key-economic-policy-proposals).

The views on healthcare were, however, not so widely reported. It includes the following:

COSATU supports the DoH’s 10 Point Plan, but states that nevertheless, there is a need for the advisory committee on NHI to urgently conclude on path of transition towards the NHI, and mandate the National Treasury to translate the commitment to the NHI into Rands and Cents, by making the necessary budgetary allocations to phase in the system.

The key challenges facing the healthcare sector are :

1. Staff shortages;
2. availability of medicines (incl improved efficiency between warehouses, hospitals and clinics); Infrastructure backlogs;
3. Inadequate systems ( ICT, Management, Administrative support);
4. availability of equipment.
   
   • 70% of the case load in the public health system is now taken up by HIV/ AIDS cases, crowding out the capacity to treat other medical conditions.
   • There is a disconnection between national policy and the allocation of resources (e.g. a hospital CEO doesn’t meaningfully control staff, budget or procurement).
   • Under-regulation of the private health sector and overconcentration of resources. In this, COSATU proposes that “the state should minimize and where possible eliminate the profit motive, build internal capacity and should reverse reliance on Private Public Partnerships.”
   
   The COSATU proposals include:
   • Integrate Community Care Workers into the public service. The state should lead the process of training, particularly the training of nurses and doctors and resist the incursion of the profit motive in the process, Department of Health to establish a Nursing Directorate (Increase the Nurse/people ratio from 4 (per 1000 people) to 8 per 1000 and the ratio of physicians to 1000 people to 1 over the short to medium term from the current 0.69
   • Improved administration (incl an ICT system for efficient record keeping and information flows).
   • Improved medicine delivery systems to patients.
   • Review the pay structure, conditions of employment and career development in the health system.
   • The state should establish a pharmaceutical company:
   “The pharmaceuticals sector is also dominated by a few large players and plays an important role in the health system. In line with the need to address health disparities, a state-owned pharmaceutical company needs to be set up in order to produce medicines on a non-profit basis. This is important especially in the light of the HIV/AIDS pandemic and the vulnerability of the Southern African region to diseases. The state pharmaceutical company therefore puts the democratic state in a powerful position to have impact on the health profile of the Southern African population, not just South Africans and will reduce the vulnerability of the region from being exploited by multinational pharmaceutical companies.”
   
   The full document is available at: http://us-cdn.creamermedia.co.za/assets/articles/attachments/29577_cosatu_booklet.pdf

Refugees Act, 1998

To amend the Refugees Act, 1998, so as to amend, insert and delete certain definitions; to clarify how applications for refugee status rejected as manifestly unfounded and unfounded must be dealt with; to empower the Director-General to establish the Status Determination Committee; to revise the provisions relating to withdrawal of refugee status; and to provide for matters connected therewith.

3 basic steps to a lock-out procedure

There are three basic steps to a lock-out procedure: PRE, MID and POST. Make sure you include each in your procedure.

PRE-lock-out starts with the issue of a lock-out or work permit by the responsible person. This is followed by the drawing of locks and keys, de-activating the equipment or process through conventional or other means and the securing of the lock on the lock-out device. This is accompanied by the completion and hanging of the tag on the lock. This tag will show who is working on the machine and the date on which the lock-out was one. It also makes it easy to see if the lock-out is currently in use.

MID-lock-out continues by ensuring that the correct control has been locked, effectively disconnecting the power. Secure the key on the person who performed the lock-out and start the maintenance or other work. This stage continues until all work is complete.

Warning!

The removal of the lock by someone other than the one who placed it there should only be allowed under extreme circumstances, and then only with the express authority of the person who signed the permit, e.g. in the absence of the key holder. Once all activities are completed, get permission to remove the lock and tag and to restore the power supply.

POST-lock-out begins with a thorough inspection to remove all tools, loose parts and other maintenance equipment. Replace all the machine guards and other guards. Personnel must all be accounted for and be clear of all moving or hazardous mechanisms. Power is then restored and the necessary tests carried out before resuming normal operation.

Do not let medication trip you up

Did you know that certain medicines can increase the risk of falls in the elderly? This is according to a report by the Medical Control Council. Knowing which medicines are a problem could prevent a serious accident.

Take action:
If you're 65 or older, or a loved one is, then it's important to take note of the following: sedatives and tranquillisers seem to be particularly problematic in terms of falls and consequent fractures. Antidepressants, antihypertensives, hypoglycaemic agents and alcohol may also increase the risk. Discuss the use of these medicines with your doctor – especially if you're at risk, or already suffering from, osteoporosis.

Just how long after an IOD must our company continue paying?

Compensation for temporary total or partial disablement

“(3)(a) Notwithstanding section 29 the employer in whose service an employee is at the time of the accident shall be liable for the payment of the compensation referred to in subsection (1) for the first three months from the date of accident.”

Medical practitioners must be insured

Regulations published on 30 August 2010 under the Health Professions Act require health practitioners, which include doctors, specialists, dentists and psychologists practising for their own account, whether in partnership, association or by way of a company allowed for in the Act, to obtain professional indemnity insurance. The insurance must be obtained from an insurer registered under the Short-term Insurance Act.

The requirement does not extend to those practitioners employed, for example, by the State at provincial hospitals. That is presumably on the basis that the State is liable for the negligent conduct of those professionals and has the financial means to meet any judgment.
Medical practitioners have not previously been required to be appropriately insured for medical malpractice claims. In some circumstances, patients with meritorious medical malpractice claims against practitioners have found the practitioner to be uninsured and without any funds to meet a judgment.

So much for the good news!

There are problems with the regulations.

The extent of the insurance cover required is not stipulated. Even cover of R10 000.00 per an event is wholly inadequate. On the face of the regulation, a medical practitioner who obtains professional indemnity cover for R1.00 will comply with the regulation.

The regulation is also silent on what would be considered adequate cover in the aggregate. For example, where an obstetrician obtains cover for an exposure of say R10m for any claim, that is well and good but will be of a limited benefit where there are two or three such claims. The aggregate should therefore not be limited to the amount of a single claim. A greater annual aggregate of all possible claims is needed.

The question also arises whether the cover must be taken out for claims made during the insured period. Nor is provision made for any run-off cover. For example, a doctor will comply with a regulation where at all times while practising, the doctor had maintained a professional indemnity insurance policy in place but immediately the practitioner retires, the policy ceases. Cover is therefore needed for all claims that arose during the practitioner's working life during which the professional indemnity cover was maintained.

Because of the general three year prescription period and a longer period (up to 19 years) when the patient is a minor, a claim may only be made against the practitioner well after retirement or when the practitioner has ceased to practise medicine and embarked on another career.

These issues should have been dealt with.

Where a practitioner has indemnity cover from an entity other than a short-term insurer, for example, through membership of a recognised society or organisation such as a medical protection society, then that society or organisation has to register as an insurer under the Short-term Insurance Act within four months of 30 August 2010.

That four month registration period is clearly too short and extensions may have to be granted.

The regulations are promulgated under a section of the Health Professions Act which allows the Minister of Health to determine conditions under which a practitioner may practise, after consultation with the Health Professions Council. It is presumed that the appropriate consultations were held and that the effect of requiring indemnity cover to be obtained only via a registered insurer was duly considered. But was this attempt to force medical protection societies to register as insurers subject to proper consultation?

Practitioners with an independent practice who currently have indemnity cover via membership of a recognised society or organisation will have a four month period of grace within which to obtain insurance through a registered insurer. That may involve the relevant society or organisation obtaining the appropriate registration, alternatively, the mounting of any successful challenge by the relevant society or organisation to the regulations or insuring for limited losses only.

Written by: Donald Dinnie, Director, Deneys Reitz Inc.

Man's arm wedged inside machine

A man was injured on Thursday when his arm was caught in a mechanical steel-drum wrapping machine at a factory on Langeberg Road in Durban, KwaZulu-Natal paramedics said.

"It is thought that the man had been using the machine to wrap steel drums in heavy duty plastic prior to their being transported. While doing so, the man's arm was caught in the moving part of the machine," said Netcare 911 spokesperson Jeff Wicks.

Wicks said other workers in the factory shut down the power and the machine was immediately switched off.

"Officers of Netcare911's specialised rescue unit arrived at the factory to find the man's arm still firmly wedged inside the machine," said Wicks.

The rescue team used advanced rescue tools to free him. His arm was not amputated.

"The man was treated and stabilised at the scene by paramedics before he was transported to the hospital for the care he required," said Wicks.
- Sapa



Published on the Web by IOL on 2010-09-02 13:35:23

Foetal Alcohol Syndrome

What is Foetal Alcohol Syndrome?
Foetal Alcohol Syndrome refers to a group of abnormalities in growth and development that occur in children whose mothers consumed excessive amounts of alcohol whilst pregnant.

Incidence
• The World Health Organisation describes foetal alcohol syndrome as the most preventable cause of mental retardation worldwide.
• Previous studies have indicated that South Africa has one of the highest incidences of foetal alcohol syndrome in the world.
• The Western Cape had an incidence of foetal alcohol syndrome of around 7.5% in children in 2001. The Northern Cape had an incidence over 10% in children.
• Higher incidences of foetal alcohol syndrome are associated with higher levels of poverty and lower levels of education.
• High risk communities in South Africa have at least a 4 fold higher incidence of foetal alcohol syndrome than high risk communities in developed countries.

How Alcohol affects the Developing Foetus
• Alcohol exposure affects the development and function central nervous system and endocrine system of the foetus.
• Alcohol exposure can also cause abnormal gene expression in the foetus.
• The consumption of alcohol affects the blood flow to the uterus. As the blood flow is decreased, the oxygen nutrient delivery to the foetus is compromised. Without sufficient oxygen and nutrients, the growth and development of the baby is affected.
• The majority of the development happens during the 1st trimester. Alcohol consumption during the 1st trimester is therefore very dangerous and can result in a number of developmental disorders.
• The 2nd and 3rd trimester involves mostly growth for the foetus. Excessive alcohol consumption during the 2nd and 3rd trimester results in slowed growth of the foetus. This can result in a low birth weight and smaller stature as the child grows.
• Oxidative stress on the developing foetus as a result of the alcohol also plays a role in the abnormal growth and development of the foetus.

The Effects of Foetal Alcohol Syndrome
• It is very difficult to estimate the extent of the effects that alcohol consumption during pregnancy has on a foetus. One reason for the difficulty is the natural variations in intelligence and development of children as a result of genetics and environment.
• Whilst children with severe foetal alcohol syndrome are easily identified, milder cases may never be recognised. We will never know what the child’s potential may have been if the mother had not consumed alcohol during pregnancy.
• Foetal alcohol syndrome can have a far-reaching impact on the community. If these children are not correctly diagnosed and managed then they are less likely to progress in school and are at risk of repeated failure in academic and learning environments. If these children drop out of school they are more likely to turn to crime, drugs and violence, than other children. This has a long term impact on the health, safety and economy of the community.

Signs and Symptoms
• Children who are born with foetal alcohol syndrome have a number growth and developmental disorders ranging in severity. Milder cases of FAS may never be diagnosed.
• Children with severe foetal alcohol syndrome will be smaller than children of the same age.
• FAS children will also have a lower IQ than other children.
• These children will display abnormal behavioural characteristics. These include very short attention and concentration spans which are often associated with hyperactivity (as seen in Attention Deficit Disorder).
• FAS children also frequently display signs of aggression and can be very difficult for teachers and caregivers to handle.

Diagnosis
The diagnosis of FAS is based on the presence of the following abnormalities:

Size:
• Low weight
• Small height
• Small occipito-frontal circumference

Appearance:
• Small inner canthal distance
• Decreased length of the palpebral fissure
• “Railroad track” ears
• Strabismus
• Ptosis
• Flat nasal bridge
• Anteverted nares
• Thin border of upper lip
• Hirsutism
• Oral clefts

Behaviour:
• Attention-deficit disorder
• Hyperactivity

Coordination:
• Fine motor dysfunction

Cardiac:
• Cardiac abnormalities such as a cardiac murmur and cardiac malformations

Safe levels of Alcohol during Pregnancy
• There is still much debate as to what exactly the safe levels of alcohol consumption during pregnancy are.
• Therefore the best advice for women, is not to drink at all during pregnancy.
• Studies have indicated that 2 drinks a day, or 1 binge drinking session of 6 or more drinks, is sufficient to cause foetal alcohol syndrome

Treatment
• There is no way to reverse the effects of foetal alcohol syndrome.
• The child’s growth and development cannot be accelerated or improved.
• Developmental disorders can be managed with occupational and speech therapy, physiotherapy and other classes which teach language, motor, learning and social skills. Managing the difficult behaviour can be very trying for caregivers, teachers and parents.
• A skilled group of professionals is needed to improve the child’s behaviour, social skills, learning and development.
• Unfortunately most of these cases occur in poorer communities where access to the appropriate care for the child is limited.
• Furthermore, the parents of children with foetal alcohol syndrome are often alcoholics and often live in poverty. These parents are unable to care for their child properly and the child is unlikely to have access to the necessary therapies.

Prevention
• Alcohol related damage may be done to the foetus before the women realise that they are pregnant.
• Women of childbearing age should be counselled on the possible effects of alcohol consumption on a developing foetus.
• Women who are alcoholics or who partake in excessive alcohol consumption should be educated on the use of contraception in order to prevent accidental or unwanted pregnancies.
• Effective prevention involves preventing alcoholism, reducing poverty and preventing unplanned pregnancies. Achieving this is complex and difficult and involves designing and implementing effective protocols and strategies for awareness campaigns and community education. It also includes increasing the resources and staff to manage the prevention strategies.

Dr. Carrie Minnaar (M.Tech Hom.)

Swimmer's Ear

What is Swimmer’s Ear?

• Swimmer’s ear refers to otitis externa as a result of water exposure.
• Otitis externa is the medical term for inflammation of the lining of the external ear. “Otitis” refers to inflammation of the lining of the ear and “externa” refers to the external part of the ear.

Otitis externa can be acute or chronic
• Acute otitis externa is usually a result of a bacterial infection.
• Chronic otitis externa is less painful, but is more difficult to treat. It is most commonly due to fungal infections. Chronic swimmer’s ear may be more common in children with eczema and allergies.

Signs and Symptoms of Swimmer’s Ear
• The first symptom is usually itching and irritation of the external ear.
• As the condition progresses the ear becomes painful and swollen.
• Occasionally there may be a light discharge from the ear. If present, the discharge is usually clear and not very thick.
• The child may also complain of a blocked sensation in the affected ear, especially if there is swelling and a discharge.
• On examination, the patient will report pain when pressing on the tragus and pulling the ear lobe or auricles.
• The ear canal will appear red and inflamed when viewed through the otoscope.
• Occasionally the hearing may also be affected, however this resolves as the symptoms resolve.

Pathogenesis
• As the water enters the ear and becomes trapped in the ear, it causes the lining of the external ear to swell and become inflamed.
• Ear canals should be dry with a healthy amount of wax production to trap foreign particles and keep the earcanal free of pathogens.
• When the ear canal is wet and swollen it is more prone to infections. Secondary infections resulting from swimmer’s ear are usually bacterial or fungal infections.

Transmission
Swimmer’s ear is not a contagious condition and children with swimmer’s ear therefore do not need to be kept away from other children. The child may be booked off school if the condition is particularly painful and is affecting the child’s ability to concentrate and carry out his or her activities.

Diagnosis
• The diagnosis of swimmer’s ear is based on history and exposure to water, as well as clinical presentation and examination.
• In complicated cases that are not resolving, doctors may take a swab of the ear to identify the pathogen involved.

Complications
• A secondary bacterial infection may be a complication of swimmer’s ear. The most common bacterial causes of an outer ear infection are streptococcus and staphylococcus bacteria.

• Signs of a bacterial infection of the external ear include:
* Severe pain in the ear
* Severe swelling of the ear which may even extend to the side of the face
* A thick, purulent or yellow discharge from the ear
* Local swollen lymph nodes
* Fever and chills
* Pallor
* Nausea & Vomiting

• Fungal infections of the external ear may also occur as a result of trapped water in the ear. Fungi thrive in warm, dark and wet conditions. The predominant symptoms in these cases are severe itching and irritation as well as pain.
• Rarely the infection may spread elsewhere in the body.

Treatment
• Supportive treatment for swimmer’s ear is important and involves pain management. For children the most commonly recommended analgesics is ibuprofen.
• Applying warmth can also soothe the pain and inflammation and increase the drainage of the discharge. A warm facecloth or hot water bottle can be used, but caution must be taken not to burn the ear or skin.
• Swimming may slow the recovery time and children are usually advised to keep their ears dry until the symptoms have resolved.
• The inflammation is usually self limiting and in uncomplicated cases the symptoms should resolve within 3 to 7 days.
• Secondary bacterial infections are treated with antibiotics and secondary fungal infections are treated with antifungal medication.
• Antibiotics may be administered orally or in the form of ear drops.
• Ear grommets or a ruptured ear drum are contraindications for administering medicine, such as antibiotic ear drops, into the ear.
• It is also important that children with swimmer’s ear do not use ear buds or any other item in the ear to scratch or rub the ear. Ear buds can compact the wax, forming clumps of ear wax which can trap water, and can further irritate the ear canal.

Prevention
• The best way to prevent swimmer’s ear is to avoid getting the ears wet.
• Children with repeated swimmer’s ear who do not want to avoid swimming may benefit from using ear plugs whilst swimming. Special ear plugs are available for use during swimming to keep the water out of the ears. Children may also be advised to refrain from swimming under the water and must be taught to dry their ears properly after swimming.
• Children should not use ear buds to clean their ears.
• After water exposure children should try turning their heads so that the ear is facing downwards (ear to shoulder). This position can be held for a few minutes to encourage the water to run out and should be done on both the left and right sides. To improve the drainage of water out of the ear the auricle of the ear can also be pulled gentle in different directions whilst the ear is facing downwards. Ears should then be dried properly with a towel.
• Grommets, or ear tubes, are sometimes inserted into children’s tympanic membranes to allow the drainage of the middle ear. These children may be at risk of swimmer’s ear and complications such as otitis media if they spend a lot of time underwater. It is advisable that these children use appropriate ear plugs whilst swimming to prevent water from entering their ears.
• Swimming in polluted or dirty water can increase the risk of ear infections. Children should be advised
against swimming in unclean or contaminated rivers or damns, especially if they are prone to swimmer’s ear.
• Using 3 drops per ear of a 50/50 alcohol and white vinegar mixture before and after swimming can help reduce the risk of swimmer’s ear. Alcohol and vinegar restore the pH balance of the ear, have antiseptic properties and increase the rate of evaporation of water in the ear canal.

Voluntary Disclosure Programme and Taxation Laws Second Amendment Bill [B29 - 2010]

To -

• introduce a voluntary disclosure programme;
• amend the Transfer Duty Act, 1949, so as to provide for electronic submission of returns and electronic payment of duty;
• amend the Income Tax Act, 1962, so as to amend certain provisions;
• amend the Unemployed Insurance Contributions Act, 2002, so as to effect a technical correction;
• amend the Mineral and Petroleum Resources Royalty (Administration) Act, 2008, so as to
• amend certain provisions; and
• provide for matters connected

UPDATES TO NOTE
The following changes in Legislation were passed that could impact on Occupational Health and Safety Practitioners

Commencement of Amendments to the:
•Domestic Violence Act
•Magistrates' Court Act
•Maintenance Act

Amendments have been made to the Policies and Regulations published under the following Acts:
•Health Professions Act
•National Education Policy Act
•National Environmental Management Act

Compensation for Occupational Injuries and Diseases Act and Regulations (130/1993)
•Standard Assessment Rate Changes 2009 and 2010

Health Professions Act and Regulations (56/1974)
• Amendment of Ethical Rules of Conduct for Practitioners Registered under the Health Professions Act, 1974
• Regulations relating to Fines which may be Imposed by a Committee of Enquiry against Practitioners found Guilty of Improper or Disgraceful Conduct under the Health Professions Act, 1974

7 ways to create a culture of reporting incidents

1. Create a safe and open style of communication. It is okay for the lowest ranked worker to talk openly with anyone, including the MD, on matters of health and safety.
2. Pay attention to reported incidents and acknowledge there is an underlying problem or issue.
3. Do something about hazardous situations that are reported.
4. Provide feedback to all staff about the incidents and what you’re doing to reduce risk or prevent a recurrence.
5. Don’t blame people for the incident.
6. Establish the underlying causes that led to the incident.
7. Take preventative action to make sure no further incidents occur.

Skipping Breakfast

Think your mornings are too busy for breakfast? Think again, you're not doing yourself any favours. This is really the most important meal of the day. Your body has been fasting (hopefully) all night, so you need to kick-start your metabolism and get some energy for the day. By having a breakfast, you can prevent unhealthy snacking mid-morning. It improves your attention span and allow you to work better

Take action:

Even if you must get up 15 minutes earlier in the morning, start your day with a good meal. A healthy meal could be: a bowl of oats, a fruit smoothie or boil an egg on wholewheat toast.