Services
Other Professional Services
Insulin therapy:
He has a number of patients on insulin from young adolescents to the elderly. He is very familiar with most insulin therapies. He tries to keep management as simple as possible especially for his elderly patients. He avoids using multiple drugs to treat his patients with diabetes. If possible, he tries to get his type 2 diabetic patients off their insulin.
Life style approach
DR Rapiti is a strong advocate of a low carb carnivore diet and regular exercise for all his patients, not just for his diabetic patients but also for patients with depression and mood disorders. He has helped many of his patients with type 2 diabetes to reverse their diabetes. He has helped some of them to come off their insulin with proper diet and exercise.
Obesity:
Obesity is a serious health issue in South Africa and the rest of the world. The WHO estimates that there are 1 billion overweight people in the world.
- The diabetes population will double due to obesity in the next 20 years in Sub-Saharan Africa.
- One in five children is obese in South Africa.
- More adolescents are being treated for type 2 diabetes, which was mainly an adult disorder.
- More than 50% of adolescent over the age of 15 are obese.
- In 2013 a 9-year-old boy died of sleep apnoea because of his obesity.
- Once a person moves from childhood into adolescence carrying excess weight, there is a 70-percent chance of becoming an overweight or obese adult
- South Africa is the highest amount of obesity in Sub-Saharan Africa.
- Research has shown that the risk of developing cardiovascular disease, cancer; diabetes, osteoarthritis and chronic kidney disease increase when a person’s weight-to-height ratio, also called a body mass index, exceeds 23.
- Once a person moves from childhood into adolescence carrying excess weight, there is a 70-percent chance of him or her becoming an overweight or obese adult.
- If we do not deal with our country’s obesity now then it is quite likely that our health care system will eventually collapse in the next 20 years.
- America, where 61% of its population is overweight or obese, realised that their healthcare system is heading for bankruptcy in 30 years by the growing diabetes epidemic and has decided to tackle obesity seriously as obesity is now being regarded as the leading cause of diabetes.
- Obesity is a treatable disorder.
- He encourages his patients to go on to a low carb high protein diet and is a great advocate of fasting.
RAPITI MODEL OF EATING AND WEIGHT MAINTENANCE
In view of the above information DR Rapiti decided to read widely about the problem of obesity in the country. He has published widely on the topic of obesity in the lay press. He made it his mission to help his patients to lose weight with some simple changes in their way of eating.
Some of his patients have lost as much as 12 kgs in 8 months and have able to maintain it.
Most of his patients lose about 1 -2 per month by following his method of eating.
What is the eating plan?
- The main meal of the day should be in the morning. It should comprise protein (red meat, chicken, fish and eggs) plus vegetables.
- Diabetics, people with hypertension and heart disease should avoid carbs like cereals, bread, cakes, puddings and deserts. Fruit is not advised for its high fructose content. Diabetics are advised to stay away from fruit and anything with sugar or carbs,
- The next main meal should be at about 3 pm and should comprise protein and vegetables.
- Supper should be avoided
- Tea and coffee should be replaced with water. During work breaks, people should not run to the coffee stand but relax and rest their minds by listening to soft music to give their minds a break.
- Coffee, tea, gas cool drinks and juices should also be avoided. One glass of cool drink or fruit juice has about 4 teaspoons of sugar or is equal to 2 slices of bread.
- Water is the best fluid. Ideally, we should consume about 8 to 10 glasses of water per day.
- One should just when they feel hungry to increase insulin sensitivity. Ideally, if eating times are planned, there would be no need for in-between snacking.
- Food portion: it should be about the size of one’s fist.
- Avoid 4 course meals and buffets.
Addiction:
Addiction is probably is the fastest growing disease to afflict modern society but, because there is no medical treatment for it, the disease is severely neglected by the majority of the stakeholders, which includes the medical and Para-medical disciplines; the allied disciplines like psychology and sociology; the various government agencies, big business and society as a whole. This neglect is to the detriment of people with addiction and society as a whole.
Based on his personal experience with addiction with close relatives, Dr Rapiti made a concerted effort to understand this puzzling disease for the past 30 years by attending a number of support groups, seminars, workshops and by reading extensively on the subject. He openly admits that his medical school training did not equip him to deal with drug addiction and alcoholism, so he had to teach himself about the condition to help his many patients seeking his help.
Armed with an in-depth knowledge about addiction, Dr Rapiti has been successfully counselling people from all walks of life to overcome their addiction.
DR Rapiti’s keen interest to help people afflicted by addiction has been the catalyst for him to start and run a free support group, “4 Steps Support group” for the community of Mitchellls Plain. His main objective was to educate the community to understand and how to deal with addiction. He ran this group for over 15 years.
DR Rapiti believes that addiction is an illness of the mind which cannot be cured by drugs. He helps individuals suffering from the disease with empathy to change their mindsets about addiction. He uses non-medical modalities like meditation, relaxation techniques and positive affirmations to fight the disease. He empowers his clients to fight their disease on their own.
He has written a simple self-help book, “4 Steps to healing”, available on Amazon, and from his surgery, to help addicts and their families to cope and overcome the disease without them having to rely entirely on professionals.
His wrote the 4-Steps programme to help the masses of illiterate young substance users, who find the 12-step programme too complex to understand and to follow.
Opioid addiction:
Dr Rapiti completed a few modules and attended several talks on the management of opioid addiction because of the growing epidemic of opioid addiction in the country. He has vast experience in the field of opioid addiction and has treated several patients with suboxone and methadone, commonly referred to as opioid replacement therapy.
He has developed his own policy to treat patients on heroin with suboxone and methadone as out- patients because the current recommended policy, recommended by the South African Addiction Medicine Society is far too rigid to make it easily accessible and affordable to the majority of substance users, who reside in the poor suburbs of Cape Town.
Unlike most centres, where users that are addicted to opioids are put on high doses of methadone, DR Rapiti has adopted the policy to use the lowest doses to combat cravings. His aim is to get his clients off Methadone, eventually, by combining the use of methadone with counselling because methadone is also highly addicting. He is steadfastly opposed to substance users remaining on ORTs permanently.
Mental Health:
Mental health is another one of Dr Rapiti’s special interests. He has been offering mental health services for the past 30 years after he realised that almost 50 percent of his patients, who presented with somatic illnesses like headaches, fatigue, vague muscle pains, were actually suffering from some form of mental illness. He qualified with a diploma in mental illness. In the 35 years that he has been offering mental health services; he has successfully treated a number of patients from all over Cape Town with a wide range of mental condition. These include: major depressive disorders, bipolar disorder, schizophrenia; drug induced psychosis, anxiety and panic disorders; obsessive compulsive disorders; adjustment disorder and anxiety in children; ADHD. He has treated people from other parts of the with anxiety and PTSD very successfully via telephone consultations.
Non-pharmaceutical interventions
DR Rapiti uses motivation, empathy, philosophical wisdom and guidance to help his patients with affective disorders like depression, anxiety and bereavement. His clients are given ample time to vent and express themselves without inhibition. He has found that many antidepressants have severe side effects and are addicting, so he rarely uses them. He has helped many clients to come off the addicting prescription drugs like benzodiazepines and even antidepressants
Counselling:
He has developed his own style of counselling. He offers counselling for couples with marital or relationship problems as well as bereavement counselling.
His clients range from children as young as six, who are battling with their parent’s divorce, to the elderly, who cannot come to terms with the loss of a spouse and loneliness
The key elements of his style of counselling that makes him unique is that it tailored to issues affecting his community and is individualised. Great emphasis to laid on his clients’ cultural beliefs.
Empowering patients
Dr Rapiti avoids using medical jargon, when he counsels his patients. If he has to then he tries his best to simplify it to the levels of his patients’ understanding of their mental condition. He teaches them how to deal with their anger and to control their emotions. He empowers his patients to solve their problems, with the aim of making them less reliant on him and to help them save money on un-necessary visits.
Executive stress counselling
Quite early in his practice, DR Rapiti recognised the need for a specialised form counselling for today’s highly stressed and pressured executives. It is taboo for these high-pressured individuals to sit in the waiting rooms of psychiatrists and psychologists, fearing that they might be recognised by their colleagues or acquaintances. Many of them do not seek professional help, so their work and family life suffer. They often turn to alcohol and illegal substances to combat the stress of their highly pressured jobs. This only makes the situation worse, hence there is such a high suicide rate amongst them, when they hit a major crisis in their lives.
DR Rapiti deals with them in a very special and discrete way, where the client could contact him directly on his cell phone and arrange a place and time that is convenient for both of them. All information is kept totally confidential. He has counselled doctors, lawyers, priests, businessman and their children.
Sexual Counselling:
He offers sexual counselling for individuals with erectile dysfunction and libido issues. He counsels individuals as well as couples. His patients’ sexual health is a major priority for him because so few practices offer this vital service. He maintains that a healthy sex life is essential for happy relationships and is a great stress buster.
He encourages his clients to speak freely about their sexual life. Men, on an average, take up to 5 years before they seek help. Dr Rapiti’s tries to treat patients with erectile dysfunction in its early stages because males with erectile dysfunction are at risk of getting a major cardiac event within five years if they are not screened from the early onset of the condition. He places a great deal of emphasis diet and stress, which are the major contributory factors for erectile dysfunction in men. He is constantly on the lookout for prescribed drugs like antihypertensives and SSRI’s that are often the major cause of erectile dysfunction.
Dr Rapiti’s open, engaging and empathic style makes his clients feel extremely comfortable talking about their sex life.
He has treated men as young as 20 with anxiety related sexual dysfunction as well as males and females in their 60’s with sexual disorders very successfully. This service has helped couples to rekindle the relations with their partners.
Social impact of sexual disorders
Sexual disorders, like early ejaculation or erectile dysfunction in the prime of a young adult male’s life is a major blow for males and their ego. It has a serious negative impact on their self-esteem and their relationships with their partners and families. Instead of seeking professional help, many individuals with a sexual problem, indulge in extra-marital affairs, alcohol and illegal substances or try over the counter preparations because of the stigma attached to the condition. Many marriages end up in divorce because of the untreated underlying treatable sexual problem.
Laughter therapy:
Dr Rapiti encourages his patients to use laughter to treat their depression and anxiety. He advises them to watch comedies to break them out of their morbid moods. Laughter is the body’s natural way of tapping into the minds reserves of dopamine (mood stabiliser), serotonin (antidepressant) and endorphins (Pain reliever). The fact that children laugh about 300 times a day compared to adults, who laugh about 14 times a day, explains why children are happier than adults. It is a common myth amongst adults that there is nothing to laugh about or that they need to be happy to laugh. Instead of people saying, “I laugh only when I am happy” to, “I am happy because I laugh”.
The brain cannot distinguish from a fake laughter to a real laughter. If one can get into the habit of laughing regularly, they will be setting themselves for a life of happiness.
He encourages his clients to start their day by smiling and ending up doing huge belly laughs. They also try and see as much comedy; read as many funny jokes and try and laugh in a crisis to get through a crisis.
He uses laughter therapy expensively in his drug support group to help his client overcome the pain of addiction.