Managed health care (MHC) has emerged in South Africa as an alternative system to control the cost of health care. Fears, negative perceptions and much uncertainty have surrounded this issue since its introduction in South Africa. The purpose of this study was to assess the understanding, perceptions and opinions of dentists residing in the Gauteng province about the emergence, benefits, impact, and future of MHC in South Africa. Eighty-six dentists (21.5%) out of the sample population of 400 responded to the questionnaire. The majority (66.7%) of the respondents perceived MHC to be a threat to their practices, with most feeling that MHC will interfere with the doctor-patient relationship. Forty-two per cent of the respondents were of the opinion that MHC will not succeed in South Africa. The results suggest that this sample of dentists do not consider MHC to be an alternative to the existing fee-for-service system. The introduction of MHC in South Africa is mostly based on models used in the USA, which might not be appropriate in the unique South African environment.

Choledochal cyst is a relatively rare condition. Even rarer is a choledochal cyst in association with a gallbladder carcinoma. This study reports a rare case of gallbladder carcinoma coexisting with a choledochal cyst in a Nigerian patient. Clinical records of the patient including preoperative evaluation, intraoperative findings, and postoperative care were reviewed. A 38-year-old woman presented with the recurrent right upper abdominal pain of 3 years duration associated with progressive weight loss, anorexia, recurrent vomiting, as well as, low-grade fever with chills and rigors. Physical examination revealed an anicteric woman with tenderness in the right hypochondrium and a positive Murphy's sign. A combination of abdominal ultrasound and computed tomography scan suggested a Type IV choledochal cyst and a distended gallbladder with thickened walls containing a heterogeneous hyperdense mass. Preoperative serum alkaline phosphatase was elevated while endoscopic retrograde cholangiopancreatography was inconclusive. At laparotomy, extrahepatic biliary dilatation and enlarged, the nodular gallbladder was found with a diffusely fibrotic pancreas. Intraoperative cholangiogram confirmed Type IV choledochal cyst. Excision of the common bile duct and radical cholecystectomy was performed, and a Roux-en-Y hepaticojejunostomy. Histopathology confirmed the diagnosis of gallbladder adenocarcinoma. She had adjuvant chemotherapy and is presently on follow-up. No evidence of recurrence after 5 years of follow-up. A high index of suspicion is required to detect a combination of these two rare entities. When detected, both conditions should be surgically addressed at the same sitting, and when combined with adjuvant chemotherapy, may increase the chances of achieving a cure.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.