Treating adolescents in South Africa: Time for adolescent medicine units?

Increasingly, children survive illnesses which in the past would have caused death in childhood, such as congenital cardiac malformations, cystic fibrosis, immune deficiency and cancer. Other conditions such as diabetes, hemoglobinopathies and hemophilia are also contributing to the list of chronic conditions where patients need to be handed over a t a certain age to the adult healthcare sector. The journey through the adolescence to adulthood is often difficult even in the absence of health concerns. Adolescents are special individuals with age-related emotional needs who are undergoing major physical, psychological and social changes, on their way to adulthood. They can not be treated like children but also not like fully developed adults. How do we address this problem in South Africa? While in the world the need for specialized adolescent units is recognized and more and more such units are being established, in South Africa adolescents are treated randomly by pediatricians as well as by physicians. In South Africa the pediatric health care ends at the age of 13 while in many other countries pediatricians treat children until the age of 18. Evidence from the literature indicates that the transition to adult care has the potential to affect negatively the course of adolescents’ diseases and that there are consistent health benefits in facilitating contact with other teenagers with chronic illnesses. In our opinion, the time has come to establish adolescent units in our hospitals, backed by trained doctors and nurses, as well as clearly defined protocols for transferring the care of adolescents with chronic conditions to adult medicine, while individually establishing the appropriate age for transfer