Employable or not employable: The constitution, government and biologics

Arthritis, in any sense more serious than granny's knobby fingers, was for many years virtually unrecognized in South Africa. We at the Arthritis Foundation in South Africa have been working to change that perception, through media articles, awareness days, publicity events and patient activism. At last we are beginning to see a far greater understanding of arthritis in the public consciousness.

An advantage we have in South Africa is the brave and forward-looking constitution, which was enacted in 1994 establishing a new democracy. This constitution ensures the right of disabled people to work. All organizations are required by law to employ a percentage of disabled people. Although many places of employment are not yet wheelchair-friendly for example, the legislation is in place, and pressure is applied via a reporting system on staff quota in various categories, such as black, female, disabled and so forth. And woe betide any organization that doesn't comply with the quota system - huge fines are payable and a 'name and shame' policy is pursued by the government.

Our biggest challenge therefore, is not the employment of people with arthritis per se, but securing adequate treatment for them to enable them to be sufficiently healthy to work.

For this reason, the Arthritis Foundation is concentrating its advocacy efforts on raising awareness of the shockingly limited treatment available (43 rheumatologists to treat a population of 47 million people for example), and of the new class of drugs which can save people with inflammatory arthritis from becoming disabled in the first place. Unfortunately these biologics are prohibitively expensive for most people. In the private health sector, which provides for 30% of the population, most medical insurance companies do not cover the costs if they can possibly wiggle out of it, and at the moment they are simply not available at all in the public health system that serves 70% of the population.

A huge benefit to our cause however, is the fact that our Deputy Minister of Health (NOT the minister responsible for garlic and beetroot AIDS 'cures' who visited Toronto earlier this year!) Mrs Nozizwe Madlala-Routledge, is very much aware of how serious inflammatory arthritis diseases are and how drastic their effects can be. It is this awareness at the senior government level that is enabling us to get involved with government health care planning and hopefully, in the long term, influence it enough to improve treatment and in the end the ability to work, for arthritis patients.