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Neurological letter from Cape Town
  1. Jonathan Carr
  1. Correspondence to Dr Jonathan Carr, Department of Neurology, Tygerberg Hospital, Parow Valley, Cape Town, South Africa; jcarr{at}

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Last year, I spent a week in Europe at a course on deep-brain stimulation. On the last day, a distinguished professor from Paris spoke to us on healthcare economics. The audience was asked if we ever needed to factor cost into healthcare decisions. Most people (mainly from mainland Europe) seemed puzzled by the question: almost nobody needed to consider the cost of treatment for their patients.

The less developed world

On returning to Cape Town, I was met by appalling news. For 3 weeks, we had performed video-EEG monitoring on a young man with resistant seizures from the Transkei (referred from the Nelson Mandela Hospital in Mthatha). He had left hippocampal sclerosis on MRI, but all five of his recorded seizures appeared to arise from the right temporal lobe. We felt he was unlikely to be a suitable candidate for surgery, and discharged him. He took the bus home, a journey of over a 1000 km. On the outskirts of Cape Town his bus was firebombed, and he burnt to death. Why did this happen? Nobody knows, but most likely the bus was perceived as a rival on a viciously competitive route.

Last week, I picked up the paper lying from a chair during a ward round, and my eye caught the headline, ‘Teen stoned to death’. Two women were standing next to a corpse covered in plastic, in Khayelitsha, a settlement 30 km from Cape Town, created by the apartheid government for black people in 1985. The body was a boy aged 16 years and one of the women was his mother. He had stolen a cell phone and subsequently the community had stoned him. He was the victim of an appalling epidemic of methamphetamine abuse that has ravaged Cape Town for over a decade.

It is a cliché that the world has become a small …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Colin Mumford, Edinburgh, UK.