Ukuthi yini i-Amyotrophic Lateral Sclerosis (ALS)? Izimpawu, Izimbangela, kanye Nokwelashwa

I-Amyotrophic lateral sclerosis, evame ukubizwa ngokuthi yi-ALS noma isifo sikaLou Gehrig, iyisimo sengqondo esithuthukayo esithinta amangqamuzana ezinzwa elawula ukunyakaza kwemisipha okungazitholi. Ama-motor neurons akho, afana nezingcingo zombane ezithwala izibonakaliso ezivela ebuchosheni bakho ziye emisipha yakho, kancane kancane aphule futhi ayeke ukusebenza kahle. Lokhu kuholela ebuthakathakeni bemisipha obuqala ngokuvamile endaweni eyodwa bese buya kancane kancane kulo lonke umzimba wakho ngokuhamba kwesikhathi.

Iyini i-ALS?

I-ALS ihlose ngokukhethekile ama-motor neurons ebuchosheni bakho nasemgogweni wakho. La mangqamuzana ezinzwa akhethekile asebenza njengabathunywa, ethumela izibonakaliso ezivela ebuchosheni bakho ukuze ulawule imisipha ongayinyakaza ngokuzithoba, njengalezo ezisezingalweni zakho, ezinyaweni zakho, nasebusweni bakho.

Uma la ma-motor neurons ewohloka, ukuxhumana phakathi kobuchopho bakho nemisipha yephula. Imisipha yakho kancane kancane ilahlekelwa yikho konke ukusebenza kahle kokwamukela izibonakaliso ezifanele, okuholela ebuthakathakeni, ekuqhaqhazweni, futhi ekugcineni ukulahlekelwa ngokuphelele kokusebenza kwezindawo ezithintekile.

Igama elithi "amyotrophic" lisho ukuthi "ngenaphoyo yemisipha," kuyilapho igama elithi "lateral sclerosis" libhekisela ekunqamuleni kwezicubu zezinzwa ezindaweni ezithile zomgogodla. Naphezu kwegama layo eliyinkimbinkimbi, i-ALS ngokuyisisekelo isho ukuthi umzimba wakho ulahlekelwa yikho konke ukusebenza kahle kokulawula ukunyakaza kwemisipha okungazitholi ngokuhamba kwesikhathi.

Ziyini izimpawu ze-ALS?

Izimpawu ze-ALS ngokuvamile zivela kancane kancane futhi zingase zihluke kakhulu kumuntu nomuntu. Izimpawu zokuqala zivame ukuqala endaweni ethile ngaphambi kokusabalala kwezinye izingxenye zomzimba wakho.

Izimpawu zokuqala ezivamile zihlanganisa:

• Ubuthakathaka bemisipha ezandleni, ezingalweni, noma ezinyaweni okwenza imisebenzi yansuku zonke ibe nzima
• Ukuqhaqhazwa kwemisipha noma ukubamba, ikakhulukazi ezingalweni, emagxalabeni, noma olimini
• Ubunzima ngamakhono okuqeqesha okuhle njengokubopha izingubo noma ukubhala
• Ukuthuthumela noma ukuthuthumela njalo kunokuvamile
• Inkulumo ephazamisekile noma ukushintsha kwezwi lakho
• Ubunzima bokuginya noma ukukoma ukudla

Njengoba isimo siqhubeka, ungase uqaphele ubuthakathaka bemisipha obukhulu obuthinta ikhono lakho lokuhamba, ukusebenzisa izingalo zakho, noma ukukhuluma ngokucacile. Izimpawu ngokuvamile ziya mbi ngokuhamba kweminyaka, yize ijubane lihluka kakhulu phakathi kwabantu.

Kubalulekile ukwazi ukuthi i-ALS ngokuvamile ayithinti ukucabanga kwakho, inkumbulo, noma imizwa. Ingqondo yakho ngokuvamile ihlala ihlanzekile ngisho noma izimpawu zokwenyama zivela, okungaba kokubili okududuzayo nokunzima kubantu abaningi.

Ziyini izinhlobo ze-ALS?

I-ALS ngokuvamile ihlukaniswe izinhlobo ezimbili eziyinhloko ngokusekelwe endleleni evela ngayo nokuthi yini eyibangela. Ukuqonda lezi zigaba kungakusiza uqonde kangcono isimo sakho esithile.

I-Sporadic ALS imelela cishe u-90-95% yazo zonke izimo. Lolu hlobo luvela ngokungahleliwe ngaphandle kwembali yomndeni ecacile noma imbangela ye-genetic. Abantu abaningi abaxilongwe yi-ALS banelilo sporadic form, futhi abacwaningi basafuna ukuqonda ukuthi yini eyibangela.

I-Familial ALS ithinta cishe u-5-10% yabantu abanesimo futhi igijima emindenini. Lolu hlobo lubangelwa ukuguqulwa kwe-genetic okuzuzwe okudluliselwa kubazali kubantwana. Uma une-familial ALS, ngokuvamile kukhona iphethini yesifo esivelela ezinhlwini eziningi zomndeni kuzo zonke izizukulwane.

Phakathi kwalezi zigaba eziyinhloko, odokotela ngezinye izikhathi bachaza i-ALS ngokusekelwe lapho izimpawu zivela khona. I-Limb-onset ALS iqala ngobuthakathaka ezingalweni noma ezinyaweni, kuyilapho i-bulbar-onset ALS iqala ngezinkinga zokukhuluma noma zokugwinya.

Yini ebangela i-ALS?

Imbangela eqondile ye-ALS isalokhu ingaziwa kakhulu, okungase kuzwakale kuyadumaza uma ufuna izimpendulo. Abacwaningi bakholelwa ukuthi cishe ivela ekuhlanganiseni okunzima kwezinto ze-genetic, ezokuzungezile, nezokuphila ezisebenza ndawonye.

Nge-familial ALS, ukuguqulwa kwe-genetic okuqondile kuyimbangela eyinhloko. I-genes evamile ehilelekile ihlanganisa i-C9orf72, i-SOD1, i-TARDBP, ne-FUS. Lezi zinguquko ze-genetic zithinta indlela ama-motor neurons asebenza ngayo futhi aphile, okuholela ekuwohlokeni kwabo kancane kancane.

Ku-sporadic ALS, izimbangela azicaci kakhulu. Ososayensi bahlola izinto eziningi ezingase zifake isandla:

• Izinto eziyingozi zezinto ezikuzungezile noma amakhemikhali angase alimaze ama-motor neurons
• Ukutheleleka kwe-viral okungase kubangele impendulo engavamile yemisipha
• Izinkinga ngokucubungula amaprotheni ngaphakathi kwamangqamuzana ezinzwa
• Ukuqina kokuxhaphaza okonakalisa izingxenye zamangqamuzana
• Ukuvuvukala ohlelweni lwezinzwa

Ezinye izimo ezingavamile zingase zihlangene nezinto eziyingozi ezithile njengokusebenza kwezempi, umsebenzi onamandla womzimba, noma ukubhekana namakhemikhali athile. Noma kunjalo, abantu abaningi abanawo lo mkhuba abake baqaphela i-ALS, okubonisa ukuthi izinto eziningi kufanele zihlangane ukuze isifo senzeke.

Nini okufanele ubheke udokotela ngezimpawu ze-ALS?

Kufanele ubone umhlinzeki wezempilo uma uqaphela ubuthakathaka bemisipha obuhlala njalo, ukuqhaqhazwa, noma ukushintsha ekukhulumeni noma ekugwinyeni okuhlala amasonto ambalwa. Ukubheka kwasekuqaleni kubalulekile ngoba izimo eziningi zingafana nezimpawu ze-ALS, futhi ukuxilongwa kwesikhathi esifanele kusiza uqinisekise ukuthi uthola ukunakekelwa okufanele.

Funani ukunakekelwa kwezokwelapha ngokushesha uma uhlangabezana nobunzima ngemisebenzi yansuku zonke njengokubhala, ukuhamba, noma ukukhuluma ngokucacile. Nakuba lezi zimpawu zingaba nezimbangela eziningi, ukuhlolwa okuphelele kungasiza ekuqondeni ukuthi kwenzekani futhi kuvimbele ezinye izimo ezilawulekayo.

Ungalindi uma unezinkinga zokugwinya noma ukuphefumula, njengoba lezi zimpawu zingase zidinga ukunakekelwa okusheshayo. Udokotela wakho angahlola ukuthi lezi zinguquko zidinga ukusebenta okusheshayo noma zingaphathwa ngokunakekelwa okujwayelekile kokulandelela.

Ziyini izinto eziyingozi ze-ALS?

Izinto eziningi zingase zikhulise amathuba akho okukhula kwe-ALS, yize ukuba nezinto eziyingozi akusho ukuthi uzoba nesimo ngokuqinisekile. Ukuqonda lezi zinto kungakusiza ubeke isimo sakho esiphambanweni.

Ubudala buyinto eyingozi kakhulu, ngabantu abaningi bathuthukisa i-ALS phakathi kweminyaka engama-40 no-70. Ukuqala okuphezulu kwenzeka cishe eminyakeni engama-55, yize isimo ngezinye izikhathi singathinta abantu abadala abancane noma abadala.

Ubulili udlala indima, ngamadoda anethuba elikhulu lokukhula kwe-ALS kunabesifazane, ikakhulukazi ngaphambi kweminyaka engama-65. Ngemva kweminyaka engama-70, umehluko lo uba mncane, futhi ingozi iba yilingana phakathi kwamadoda nabesifazane.

Ezinye izinto ezingase zibe yingozi zihlanganisa:

• Umbali womndeni we-ALS noma izimo ezihlobene nezinzwa
• Ukusebenza kwezempi, ikakhulukazi ezindaweni eziqeqeshwe
• Umsebenzi onamandla womzimba noma ezemidlalo ezingeni lobuchwepheshe
• Ukubhekana namakhemikhali athile, imigodi, noma izinambuzane
• Ukubhema, okungase kukhulise ingozi kancane
• Ukulimala kwekhanda noma ukulimala okuphindaphindayo kobuchopho

Abantu abaningi abanawo lo mkhuba abake baqaphela i-ALS, futhi abantu abaningi abane-ALS abanazo izinto eziyingozi ezibonakalayo nhlobo. Ukuba khona kwezinto eziyingozi kusho nje ukuthi kungenzeka kube nethuba elikhulu kancane, hhayi ukuqiniseka.

Ziyini izinhlanganisela ezingase zenzeke ze-ALS?

Izinhlanganisela ze-ALS zivela kancane kancane njengoba ubuthakathaka bemisipha buqhubeka, buthinta izinhlelo zomzimba ezahlukene ngokuhamba kwesikhathi. Ukuqonda izinhlanganisela ezingase zenzeke kusiza wena neqembu lakho lokunakekelwa kwezokwelapha ukuhlela ukunakekelwa okuphelele.

Ubunzima bokuphefumula bubonisa enye yezinhlanganisela ezinkulu. Njengoba imisipha yokuphefumula ibuthakathaka, ungase uhlangabezane nokuntuleka komoya, ikakhulukazi uma ulele phansi, ukutheleleka okuvamile kokuphefumula, noma ukukhathala ngomzamo owengeziwe odingekayo ukuphefumula.

Izinkinga zokugwinya, ebizwa ngokuthi yi-dysphagia, zingase ziholele kwezinye izinhlanganisela eziningi:

• Izehlakalo zokuklema ngesikhathi sokudla noma lapho uphuza
• I-Aspiration pneumonia evela ekudleni noma ekuphuzweni okungena emaphashini
• Ukondleka okungalungile nokulahlekelwa isisindo ngenxa yobunzima bokudla
• Ukuphelelwa amanzi ngenxa yokunciphisa ukungena kwamanzi

Izinselele zokuxhumana zingase zivele njengoba imisipha elawula inkulumo ibuthakathaka. Lokhu kungase kuholele ekuhlukaniseni komphakathi nasekudumazekeni, yize izinto eziningi ezisizayo zingasiza ekuqondeni ikhono lakho lokuxhumana kahle.

Izinhlanganisela zokunyakaza zihlanganisa ingozi eyanda yokuwa, ama-pressure sores ngenxa yokunyakaza okulinganiselwe, nokunqamuka kwamajozi noma ama-contractures. Ngaphezu kwalokho, abanye abantu bahlangabezana nokuhlukahluka kwemizwa, kuhlanganise nokucindezeleka noma ukukhathazeka, okuyizimpendulo eziqondakalayo ezinseleleni zokuphila ne-ALS.

Nakuba lezi zinhlanganisela zizwakala zikhulu, eziningi zingaphathwa kahle ngokunakekelwa kwezokwelapha okufanele, izinto ezisizayo, nokusekelwa ochwepheshe bezempilo abakhethekile ekunakekeleni i-ALS.

I-ALS ixilongwa kanjani?

Ukuxilongwa kwe-ALS kuncike ikakhulu ekubukeni kwezokwelapha nasekuvimbeleni ezinye izimo, njengoba ayikho i-test eyodwa eqinisekile. Inqubo ngokuvamile ithatha izinyanga eziningi futhi ihlanganisa izinhlobo eziningi zokuhlola.

Udokotela wakho uzoqala ngembali yezokwelapha eningiliziwe nokuhlolwa komzimba, efuna izibonakaliso zokuthuthuka kwe-muscle weakness nezinye izibonakaliso zezinzwa. Bazohlola ama-reflexes akho, amandla emisipha, nokuhlanganiswa ukuze baqonde izindawo ezinobuhlungu.

Izivivinyo eziningi zokuxilonga zisiza ekusekeleni ukuxilongwa:

• I-Electromyography (EMG) ilinganisa umsebenzi wombane emisipha futhi ingabonisa ukonakala kwezinzwa
• Izivivinyo zokuphetha kwezinzwa ziqikelela ukuthi izibonakaliso zombane zihamba kanjani ezinzweni
• I-MRI scans yobuchopho bakho nomgogodla wakho kuvimbela ezinye izimo zezinzwa
• Izivivinyo zegazi ziqala ukutheleleka, izimo zokuziphatha komzimba, noma izinkinga zokuguqulwa kwemvelo
• Ukuhlolwa kwe-genetic uma kukhona umlando womndeni we-ALS

Ukuxilongwa ngokuvamile kudinga isikhathi nokubekezela, njengoba odokotela kufanele baqaphele ngokucophelela ukuqhubeka kwezimpawu futhi bavimbele izimo ezinjenge-multiple sclerosis, i-spinal cord tumors, noma i-peripheral neuropathy engase ibe nezimpawu ezifanayo.

Iqembu lakho lokunakekelwa kwezokwelapha lingase lihlanganise odokotela bezinzwa abakhethekile kwi-ALS, njengoba ubuchwepheshe babo busiza ekuqinisekiseni ukuxilongwa okuchane kanye nohlelo lokunakekelwa olufanele kusukela emazingeni okuqala.

Iyini impilo ye-ALS?

Nakuba ngokwamanje ayikho impilo ye-ALS, izindlela eziningi zokwelapha zingasiza ekuthuthukiseni ukuqhubeka kwesifo, ukuphatha izimpawu, nokulondoloza ikhwalithi yakho yokuphila. Indlela igxile ekunakekelweni okuphelele okuqondisa izici eziningi zesimo.

Imithi emibili evunyelwe yi-FDA ingasiza ekuthuthukiseni ukuqhubeka kwe-ALS. I-Riluzole ingase ihlale isikhathi eside ngezinyanga ezimbalwa ngokunciphisa amazinga e-glutamate ebuchosheni. I-Edaravone, enikezwa ngokuthululwa kwe-IV, ingase ibe kancane ekuwohlokeni kokusebenza kwansuku zonke kwabanye abantu abane-ALS.

Ukuphathwa kwezimpawu kuhlanganisa indlela ehlanganiswe yochwepheshe abaningi:

• I-Physical therapy ukulondoloza amandla nokuqina
• I-Occupational therapy ukusisiza ngemisebenzi yansuku zonke nezinto ezisizayo
• I-Speech therapy yokuxhumana nezinselele zokugwinya
• I-Respiratory therapy ukusekela umsebenzi wokuphefumula
• Ukubonisana ngokondleka ukulondoloza ukondleka okufanele

Njengoba isimo siqhubeka, izinto ezisizayo ziya ngokuya ziyabaluleka. Lokhu kungase kuhlanganise izinto ezisizayo zokunyakaza njenge-walkers noma izihlalo zamavili, izinto ezisizayo zokukhuluma ngezinkinga zokukhuluma, futhi ekugcineni izinto zokusekela ukuphefumula.

Indlela yokwelapha iyona enhle kakhulu, ngeqembu lakho lokunakekelwa kwezokwelapha lilungisa izincomo ngokusekelwe ezimpawu zakho ezithile, ijubane lokuqhubeka, kanye nezifiso zakho zokunakekelwa.

Ukuthi ungaphatha kanjani i-ALS ekhaya?

Ukuphathwa kwekhaya le-ALS kugxile ekulondolozeni ubuthongo, ukuphepha, nokuzimela isikhathi eside ngangokunokwenzeka. Ukulungiswa okulula neqhinga kungenza impilo yansuku zonke ibe lula futhi iphephile kakhulu.

Ukudala indawo yekhaya ephephile kubalulekile njengoba ukunyakaza kushintsha. Susa izingozi zokuthuthumela njengezigqoko ezihlala phansi, faka ama-grab bars ezihlanzini, uqinisekise ukukhanya okuhle kulo lonke ikhaya lakho, futhi ucabange ngama-ramps uma izitebhisi ziya ngokuya ziba nzima.

Ukusekelwa kokondleka kuya ngokuya kubalulekile njengoba izinkinga zokugwinya zivela:

• Khetha ukudla okuthambile okulula ukuukoma nokugwinya
• Dla ukudla okuncane, okuvamile ukunciphisa ukukhathala
• Hlala uqondile ngesikhathi sodla futhi imizuzu engama-30 ngemva kwalokho
• Sebenza nodokotela wokondleka ukuqinisekisa ukondleka okufanele
• Cabanga ngezinsiza zokondleka uma kunconywa

Ukugcina amandla kukusiza ukulondoloza amazinga wemisebenzi isikhathi eside. Hlela imisebenzi yakho ebaluleke kakhulu ngezikhathi lapho uzizwa unamandla khona, thatha ama-rest breaks njalo, futhi ungangabazi ukucela usizo ngemisebenzi enzima yomzimba.

Ukuhlela ukuxhumana kubalulekile njengoba ukushintsha kokukhuluma kuvela. Funda ngezinto ezisizayo zokuxhumana kusenesikhathi, zisebenzise ngesikhathi inkulumo yakho isacaca, futhi uqondise izifiso zokuxhumana nezinhlwini zakho.

Kufanele ulungiselele kanjani i-appointment yakho yodokotela?

Ukulungiselela kahle i-appointments yezokwelapha ezihlobene ne-ALS kusiza ekuqinisekiseni ukuthi uthola inzuzo enkulu ngesikhathi sakho nabaphakeli bezempilo. Ukulungiselela okuhle kuholela ezingxoxweni eziningi eziphumelelayo kanye nokuhlelwa kangcono kokunakekelwa.

Gcina idayari eningiliziwe yezimpawu phakathi kwama-appointments, uqaphele ukushintsha kwamandla, izimpawu ezintsha, noma ubunzima ngemisebenzi yansuku zonke. Faka izibonelo ezithile zemisebenzi ebe nzima kakhulu futhi lapho uqale ukuqaphela lezi zinguquko.

Lungiselela imibuzo yakho kusenesikhathi futhi ubeke phambili ebaluleke kakhulu:

• Yiziphi izinguquko engingalindela ngazo?
• Ingabe kukhona izindlela ezintsha zokwelapha noma izivivinyo zeklinikhi engingazicabangela?
• Yiziphi izinto ezisizayo ezingangisiza manje?
• Ngingalondoloza kanjani ukuzimela kwami isikhathi eside?
• Yiziphi izinsiza ezitholakalayo emndenini wami?

Letha uhlu oluphelele lwazo zonke imithi, izinsiza, nezinto ezisizayo osebenzisa zona. Faka ulwazi mayelana nalokho okusebenza kahle nalokho okungakuniki inzuzo elindelekile.

Cabanga ukuletha ilungu lomndeni noma umngani kuma-appointments. Bangasiza ekukhumbula ulwazi olubalulekile, ukubuza imibuzo ongayikhohlwa, nokunikeza ukubuka okuengeziwe mayelana nokuhluka okuqaphile.

Iyini into ebaluleke kakhulu mayelana ne-ALS?

I-ALS iyisimo esinzima sobuchopho esithuthukayo, kodwa ukuyiqonda kukusiza ukusebenza kahle neqembu lakho lokunakekelwa kwezokwelapha nokulondoloza ikhwalithi yokuphila. Nakuba ukuxilongwa kungase kuzwakale kuyadumaza, abantu abaningi abane-ALS baqhubeka bethola intshonalanga, injabulo, nokuhlangana ekuphileni kwabo.

Ukuthi ungaphila kanjani kahle ne-ALS kusekelwe ekunakekelweni okuphelele, ukuhlela kwasekuqaleni, kanye nezinhlelo zokusekela ezinamandla. Izinto ezintsha ezisizayo, izindlela zokuphatha izimpawu, namaqembu okunakekelwa ochwepheshe abaningi bangasiza ekunakekeleni izinselele eziningi ezivela.

Khumbula ukuthi i-ALS ithinta wonke umuntu ngokuhlukile, ngezilinganiso ezahlukene zokuqhubeka nezibonakaliso. Isipiliyoni sakho sizoba esiyingqayizivele, futhi ukwelashwa kufanele kulungiswe ngezidingo zakho nezifiso zakho ezithile.

Ucwaningo lwe-ALS luqhubeka ngokusebenza kanzima, ngezindlela ezintsha zokwelapha nezindlela ezicwaningwa njalo. Ukuxhumana neqembu lakho lokunakekelwa kwezokwelapha nezinhlangano ze-ALS kungakusiza ufunde ngezinketho ezintsha nezinsiza.

Imibuzo evamile ebuzwa mayelana ne-ALS

Ingabe i-ALS ihlala ibulawa?

I-ALS ngokwamanje ithathelwa ingqondo njengesimo esiphelileyo, kodwa ukuphila kuyahluka kakhulu phakathi kwabantu. Abanye abantu baphila iminyaka eminingi ngemva kokuxilongwa, kuyilapho abanye behlangabezana nokuqhubeka okusheshayo. Cishe u-20% yabantu abane-ALS baphila iminyaka emihlanu noma ngaphezulu ngemva kokuxilongwa, futhi ingxenye encane iphila isikhathi eside kakhulu. Izindlela ezintsha zokwelapha nokunakekelwa okusekela kuqhubeka nokwenza ngcono imiphumela nekhwalithi yokuphila.

Ingabe i-ALS ingavikeleka?

Okwamanje, ayikho indlela eyaziwayo yokuvimbela i-ALS, ikakhulukazi uhlobo oluvamile oluthinta abantu abaningi. Nge-familial ALS, ukubonisana kwe-genetic kungasiza imindeni ukuqonda izingozi zabo, kodwa ukuvimbela akunakwenzeka. Noma kunjalo, ukulondoloza impilo enhle ngokujwayelekile ngokuzivocavoca njalo, ukugwema ukubhema, nokunciphisa ukubhekana nezinto eziyingozi ezokuzungezile kungase kusekele impilo enhle yezinzwa.

Ingabe i-ALS ithinta ukucabanga nenkumbulo?

Abantu abaningi abane-ALS balondoloza ukucabanga nenkumbulo evamile kulo lonke ubuhlungu babo. Noma kunjalo, cishe u-15% yabantu abane-ALS bathuthukisa i-frontotemporal dementia, engase ithinte ukucabanga, ukuziphatha, nobuntu. Ngisho noma izinguquko zokwazi zivela, ngokuvamile zithuthuka ngokuhlukile kunesimpawu semisipha futhi zingase zibe mnene ekuqaleni.

Ingabe abantu abane-ALS basengasebenza?

Abantu abaningi abane-ALS baqhubeka besebenza isikhathi esithile ngemva kokuxilongwa, ikakhulukazi emisebenzini engadingi imizamo enkulu yomzimba. Ukulungiswa njengokuhlala kwesikhathi esithile, izinto ezisizayo, noma imisebenzi eguquliwe kungasiza ekuthuthukiseni ikhono lokusebenza. Isinqumo sincike ezimweni zomuntu, ukuqhubeka kwesimpawu, nezifiso zomuntu mayelana nokulondoloza umsebenzi.

Yiluphi ukusekelwa okutholakalayo emindenini ethintekile yi-ALS?

Ukusekelwa okuphelele kukhona kokubili kubantu abane-ALS nemindeni yabo. Lokhu kuhlanganisa izahluko ze-ALS Association ezinikeza imali yokuboleka imishini, amaqembu okusekela, nezinsiza zemfundo. Imiphakathi eminingi inikeza ukunakekelwa kokupumula, izinsizakalo zokubonisana, kanye nezinhlelo zokusiza ngezimali. Amaqembu okunakekelwa kwezokwelapha ngokuvamile ahlanganisa abasebenzi bezokuxhumana abangaxhuma imindeni nezinsiza ezifanele zendawo nezomhlaba wonke.