Rath’€™s free reign ‘€“ assessing the outcomes

KHOPOTSO: Two families on the same street diagonally opposite each other in  Khayelitsha, Cape Town, are each mourning the deaths of a member of their house-hold. Both the deceased took Dr Matthias Rath’€™s pills on the understanding that they would ‘€œfight off’€ their HIV infection. Matshaya, a soft-spoken man in his thirties, spoke to us from his one-roomed brick house artfully divided into a kitchen, lounge and bed-room. He clearly remembers the day his late wife, Noluthando, started taking Dr Rath’€™s dose of multi-vitamins.

MATSHAYA: Into eyenzekayo ngenye imini apha. Ndifika kukho omnye usisi olapha enext door nomnye usisi. Bahleli kunye nalenkosikazi yami aph’€™ endlini. So, ndifike selebebuyigqibezela lento yabo bayithethayo, and ngoku kesele ehamba naye lomama walapha nalosisi. Ok, ndithi xandizama ukuqonda, hayi andithele walawala nje losisi ukuba, no, kubantu abangekazityi ezipilisi, kubantu abaHIV-positive, bona bayakwazi ukuba babanike ukwenzela into yokuba babenoncedakala, ingabisiyiyo lento. So, ke waya wayozithatha. Kwezozipilisi wayewathi makatye ipilisi zibeyi 10. That means, if uzitya ngo 10 kufuneka atye 10 ngo 10 aphinda ayokutya 10 late xa ezakulala.

TRANSLATION: What happened is that one day I found my next door neighbour with another lady in my house with my wife. I arrived when they were just finishing their conversation, and the other lady was about to leave with my wife. I tried to find out and the one explained briefly that for people who haven’€™t yet taken these tablets and are HIV positive, they are able to supply them with the tablets so that they can be helped. So, she went and fetched them. From those tablets she was told to take 10. Meaning that, if she  takes them at 10 o’€™clock she has to take 10 and then take another 10 in the evening before going to bed.

KHOPOTSO: For Noluthando, Matshaya’€™s wife, the day she took those 20 tablets was to prove fateful.

MATSHAY:  So, ke uthe emuveni kokuba ezityile ezipilisi wathi xa evuka pha wathi useke wanesiyezi kusasa ke ngoku ngosuku olulandelayo’€¦ Eyona ke nto ke yaye yambetha kwaze kwanzima ukuba kuhlale into etyiwayo esuswini, abangatya kuyabuya, abangaty  kuyabuya.    

TRANSLATION: So, when she woke up the following morning after she had initially  taken the tablets she complained that she felt dizzy’€¦ What made her even worse was that she couldn’€™t keep any food in her stomach. Each time she ate she would vomit.

KHOPOTSO: And these reactions made Matshaya suspicious.

MATSHAYA: Ndathi ke kuye mna, hhe man, khawume ngozitya ezipilisi. So, into ebhetele: ezipilisi khawuye nazo eclinic uke uzibuze ukuba zi-right into yokuba uzitye’€¦ Wayakubuza ngezipilisi ukuba ezipilisi zi right na for ukuba mandizitye. Wathi ugqirha akanalo ilungelo lokuzitya ezipilisi.    

TRANSLATION: I said to her, ‘€˜look man, please stop taking these tablets. You’€™d better take them to the clinic to ask if they are right for you to take’€™’€¦ She went and the doctor said they were not suitable for her.

KHOPOTSO: He then once more pleaded with the wife to never take the pills again, saying that if the women who had introduced her to them do ever come back she should give the pills back to them ‘€“ all four of the containers ‘€“ the white-coloured containers of the Vita-Cell multi-vitamins they had given her. But Matshaya cannot say for certain if, indeed, Noluthando stopped taking them.

MATSHAYA: Uyabona ke andinakuthi mhlawumbi wayengazithathi uyaqonda, because umntu xana ekholelwa, mhlawumbi ngoba xana ugula ungaphilanga ngelinye ixesha uye uthi ngelixesha uzama uncedo ulifunayo ngapha nangapha ukuba ngeke uncedakale na kulonto unantsikayo. But, ukuba wayezitya zamenzela umohluko omkhulu ezipilisi if wabe uphindile wazitya ngoba emveni kokuba azitye zange aphinde azibone eright’€¦ Ngoba wayesitya engenayo niks and wayezenzela izinto zalapha endlini kodwa ke kwaye kwanyanzeleka emveni kokuba ethathe ezipilisi izinto zalapha endlini angakwazi ukuzenza ngoba kufuneka engqengqile ngalo lonke ixesha. So ndaqonda inokuba mhlawumbi wazi overdose ngale ten yokuba kuthwe makatye ten kwibhotile enye ngoba ke ngendisiva ukuba zazininzi izipilisi ngepilisi kulo ten.

TRANSLATION: I can’€™t say because if someone is ill and desperate for help they will believe in whatever help and advice they are offered. But if she continued taking the pills then they made a big difference in her life because after that she was never herself anymore’€¦   Before that she used to eat without any problem. She even used to do chores around the house on her own, but after taking the pills she could do nothing and was always in bed. So, I understood that she must have over-dosed on the tablets by being asked to take 10 twice a day.    

KHOPOTSO: Matshaya admits that his wife was sick and HIV-positive, but he maintains that she was not about to start taking antiretrovirals when she was introduced to the multi-vitamin supplements.

MATSHAYA: Ngelaxesha sazi into yokuthi ziiulcers eyonanto ingamandla nasekubeni ebengunmtu o HIV positive kodwa ke kuyo yonke lonto leyo nangona ebesiya nase clinic eyela into zakhe zokuba aye ebengekho kwilist yokuba atye iARV’€™s zabantu aba HIV positive.

Kange abenakukwazi ukuzifumana ezo ARV’€™s. Qha ibizezi ulcers into bekuthethwa ngazo ethahtha nepilisi zazo. Wanikwa ke nepilisi zegazi ukuba akwazi ukutya kodwa ke emveni etye ezapilisi zange kuphinde kuhlale nto esuswini. Sasuka zambethela into yokuba makaphele.

TRANSLATION: At that time we knew that she had ulcers and that she was HIV-positive. She was not put on a list of people who were supposed to start taking ARVs. There was no way she could take ARVs. She took tablets from the government clinic only for her ulcers. She was also given vitamins to encourage her to eat more. But after taking the other multi-vitamins nothing stayed in her stomach. They finished her.

KHOPOTSO: His wife died on June the 02nd, hardly a month after she had taken Rath’€™s multi-vitamin supplements to ‘€œfight off’€ the HIV in her body. The remaining traces of his wife are the couple’€™s wedding picture and a dress-making certificate hanging up on the wall, some beautiful pot-plants neatly packed on a small table in the tiny lounge and the three young children she has left behind. As I was about to leave his house, I asked him if he knew who the doctor was who provided the pills his wife took.

MATSHAYA: NguRatha, nguRetha ‘€“ kuyinto ezilapho.

KHOPOTSO: Rath, or Reth, something like that, he says. Just a stone’€™s throw away from Matshaya’€™s house lives Yandiswa, whose younger sister, 37-year old Thandi also died after being on Rath’€™s treatment. She says it is the same two women who introduced Matshaya’€™s wife to Rath’€™s micronutrients who also recruited her sibling. Thandi had to take 14 pills per day ‘€“ at doses of seven in the morning and another seven at night.

YANDISWA: Wazidla ilanga lokuqala ndafika esithi udlile xa egqiba udla ezapilisi avele athi uphelelwa ngamandla and uyangcangcazela wenjenje ngaphakathi kuyena, uvele abe dizzy’€¦ Ndithi ke mna ke OK lala ke. Alale. Athi andifuna uzitya ezipilisi Somnci kungekho mntu apha endlini. Ngoba abantwana basesikolweni wena usemsebenzini xa ndigqiba zitya ndiye ndibe-dizzy ndiyokuwa ndiphelelwe ngamandla andikwazi nokuvula umnyango. Andikwazi nokuphakama ndiye e-toilet. He yaphela iveki esidla ezipilisi kuleliveki lilandelalayo esidla kwalapha ku-March esidla ezipilisi uthi, ‘€œ Eish, I wonder Somnci zenza njani ezipilisi kutheni xa ndigqiba ozidla ndivele ndibone uba ndi-dizzy kuvele kubekhona into into ethi hllllll… Apha kulendawo, kubengathi kukho into ezintlontlayo’€¦ Ndifeela ndi-tired, ndiyadinwa ndidinwe kufuneke ndilale.

TRANSLATION: I got back from work the first day she took them. She told me that she felt very weak, she was trembling and was very dizzy’€¦ I said perhaps it’€™d be better if she slept. And then she went to sleep. Later, she said she doesn’€™t want to take the tablets when there’€™s nobody at home, as the kids are at school and I’€™m at work because she gets so dizzy after taking the pills that she falls and she gets weak so much that she can’€™t even walk to go open the door or even stand up to go to the toilet. A week after she had started taking the tablets, in March, she started worrying and said to me: ‘€œHey, Somnci, I wonder why I feel so dizzy when I take these pills. There’€™s something moving inside here,’€ she said, pointing to her stomach. ‘€œI feel tired, so tired that I have to sleep’€.

KHOPOTSO: One night Thandi reacted so badly to the tablets it was like she was losing her mind. Yandiswa had to call an ambulance. But Thandi refused to board the ambulance when it arrived to take her to hospital, saying that the women who offered her treatment had instructed her not to go to hospital. If an emergency occurred they would take her to their own doctor. Yandiswa then called the women about that and they came the following night with a white male doctor. Then, the following day they took her sister to their clinic in Site C where some procedures were done.

YANDISWA: So xa ndibuza ukuba bamenze ntoni phayana uthi uye wathiwa i-drip wathi wakugqiba wafotwa. Wafotwa bemhambisa ze’€¦ Ndambuza ukuba bathi bebenzela ntoni. Uthi bathi into yokuba bazakuthetha ngaye. Ndabuza ukuba abakufotanga na apha ebusweni. Wathi hayi bamthathe so and akavelanga ukuba ungubani njani’€¦Qha bamfotile amazantsi akhe onke. Besebazawufundisa ngaye, bathethe ngaye umntu onjena kwaze kwathini. Hayi ndayiyeka ke.

TRANSLATION: I asked what happened. She said she was given a drip and that they took pictures of her naked… I asked her why they did that and if they took photos of her face and, she said ‘€œno her face was hidden’€’€¦ Nobody could identify her. They only took photographs of her lower body. She said they were going to teach about her. And then, I left it at that.

KHOPOTSO: In an affidavit, 28 year-old Nandipha Ntsholo from Gugulethu, another township in Cape Town, tells how she and two of her friends who are also HIV positive and want to remain anonymous went to Rath’€™s clinic at Site C in Khayelitsha. She claims she was told to fill in a questionnaire asking such things such as dietary practices and symptoms of infection. Later, she was asked if she was HIVpositive. When she replied ‘€˜yes’€™, she was taken for a blood test. Nandipha says no explanation was given as to why her blood was taken. She’€™s adamant that she was not given a choice about her blood being taken. In the affidavit she also enters that she and her friends were ordered to strip down to their underwear and that pictures were taken of them. They were told that the photos were compulsory and that they would be used to demonstrate to the South African government the efficacy of the treatment prescribed by Dr Rath.

Meanwhile, Thandi was taking the six-month medication for TB when she was introduced to the Rath form of treatment. The women who spoke to her told her to stop any medicine she was taking as theirs would work more quickly.

YANDISWA: Kunabantu endibafumeneyo abazakundizisela i-treatment apha and bathi ababantu aba mandihlale into engange ‘€“ two months bejonge i-treatment yabo ihamba kanjani’€¦ Akhange ayigqibe ke i-two months.

TRANSLATION: She told me about people who were offering her treatment. They had told her that she should take certain pills and that she will be under observation for two months. But, she did not live to see the end of those two months.

KHOPOTSO: Thandi died three weeks after she had started treatment on the multi-vitamins. A few hours after hearing that she was no more, one of the two women who recommended the vitamins to her went to Thandi’€™s home to collect all the remaining tablets, erasing every trace of what treatment she was taking.

Yandiswa and, earlier, Matshaya are the only ones who were prepared to come forward to talk about their loved ones’€™ experiences with the Dr Rath treatment programme.

At the end of May, Dr Peter Saranchuk, a doctor at the Nolungile government clinic in Site C came face to face with three patients who became sick after taking Rath’€™s treatment.

Dr PETER SARANCHUK: The first case was a woman who came in and she had a lung infection that might have been TB. She wasn’€™t a regular patient here, but I saw her because she was quite upset. She had been taking treatment that was given to her by someone at the Rath Foundation. She told me that it was her understanding that she wouldn’€™t be getting any infections if she was taking this treatment from the Rath Foundation. She was quite surprised and upset about that. The second case was a similar one. It was a woman who came and wasn’€™t our patient, but I agreed to see her because she was sick. She had a significant pelvic infection when I examined her and we treated that. And it was the same thing. She told me that she didn’€™t expect to be getting an infection while she was taking this treatment that was given to her.

KHOPOTSO: The last of the cases Dr Saranchuk saw was that of a woman who was already on antiretroviral treatment and had defaulted on her medication after being convinced to take the multi-vitamin supplements. Saranchuk explains that the woman had been sick when he first saw her in January.

Dr PETER SARANCHUK: We started her on antiretrovirals because her CD 4 count was only 17, which means her immune system was very, very weak and she was getting recurrent serious infections. So, she also required admission to a hospice for good nursing care, good nutritional support. While at the hospice it became apparent that she also had TB. So, we started TB treatment. Fortunately, she improved on the TB treatment and the ARVs, plus the good nursing care and nutrition.

KHOPOTSO: At the beginning of May she was sent home as her condition had vastly improved. It was when the woman was at home that her treatment supporter started sowing confusion in her mind.

Dr PETER SARANCHUK: She came back to see me regularly to get renewals of her medications. But then she missed an appointment and I didn’€™t see her for a couple of weeks. And when she came to me she told me that someone had referred her to get another treatment for HIV from the Rath Foundation. This is what the woman told me ‘€“ who was still improving on TB treatment and ARVs and other interventions.

She said she heard the message that this Rath Foundation treatment would fight the HIV. So, she became confused. She thought ‘€˜why would I need to take ARVs if I have this other treatment that would fight HIV?’€™ So, the problem is she defaulted. She stopped the ARVs. It becomes a problem for us because if people don’€™t take ARVs properly then, they end up with the possibility of resistance, where the ARVs don’€™t work properly anymore.

KHOPOTSO: The patient subsequently underwent a new round of intensive ARV treatment counseling and then resumed treatment. Dr Saranchuk says the use of  nutrition and micro-nutrients in people living with HIV and AIDS is wholly encouraged. But, he cautions that nutrition alone can be effective up to a particular point during a person’€™s infection.    

Dr PETER SARANCHUK: We all agree that vitamins and micro-nutrients are important’€¦ That’€™s nothing new. It’€™s just putting into perspective the role of ARVs. As people get into the late stages of infection; when they get recurrent infections, then, we have to give the serious treatment to really prevent that one life-threatening infection that would kill them. And that serious treatment is ARVs.

KHOPOTSO: Professor Demetre Labadarios, head of the Department of Human Nutrition at the University of Stellenbosch and Tygerberg Hospital,in Cape Town, re-emphasises the point on the use of nutrition in conjunction with antiretrovirals in the treatment of HIV and AIDS.

Prof. LABADARIOS: There are those that exploit nutrition as a field, as a science, and also exploit food as a means of making unsubstantiated claims about how wonderful a particular food is or a particular approach is in the management of a patient with HIV/AIDS, which is not either correct or substantiated, for that matter. As for Dr Rath, I find it extraordinary that situations are created in which people apparently believe that micro-nutrients on their own will actually cure AIDS ‘€“ which they will not ‘€“ we know that. If that was the case, you know, AIDS would have been wiped off the face of the earth, in the developed world, at least – completely. We wouldn’€™t have AIDS, because they can afford these supplements and they are freely available. And yet, AIDS still exists’€¦ They have the money. They have a variety of choices and they can choose what they want. But AIDS is still there. It hasn’€™t gone away. So, I cannot understand why these claims can be made in our country or, for that matter, in the African continent. People with AIDS when they need treatment, it’€™s drug treatment that they need, it’€™s nutrition support that they need, and that is what we should be providing them together with clear messages.

KHOPOTSO: That was exactly the understanding which the government’€™s Comprehensive HIV and AIDS Care and Treatment Plan was based on when it was unveiled in November 2003. Here’€™s what Dr Anthony Mbewu, now President of the Medical Research Council and then chairperson of the task team investigating the feasibility of a Treatment Plan for the public sector, said at a press conference announcing the Cabinet’€™s approval of such a Plan.      

Dr ANTHONY MBEWU: World-wide, people living with AIDS tend to use three treatment modalities in terms of trying to improve their quality of life and trying to prolong their survival. Firstly, anti-retroviral drugs, when they’€™re indicated. Secondly, nutritional interventions. And thirdly, traditional and complementary medicines’€¦ However, the scientific evidence that we have on the effectiveness of interventions mainly applies to anti-retroviral drugs. And that’€™s why this Plan has, as its primary intervention, the access to anti-retroviral drug therapy for people living with AIDS for whom it is indicated in terms of their clinical status or the state of their immune system as assessed by a CD 4 count of below 200 per millimeter cubed. However, nutrition, we know, is an important intervention in people living with AIDS, and possibly also, in people whose status has not declined to the level of severe immune deficiency, that is, people who are HIV positive with CD 4 counts above 200, above 350 and even above 500. The scientific evidence for the effectiveness of nutritional interventions is lacking and the organisation that I work for ‘€“ the Medical Research Council – is undertaking research in that regard’€¦

KHOPOTSO: Today, however, the debate seems to be questioning the safety and efficacy of antiretroviral medications. Dr Matthias Rath fiercely attacks anyone who believes that ARVs can be effective in the treatment of AIDS, charging that those who support them are participating in crimes against humanity. Through his Dr Rath Health Foundation set up in Cape Town, the German national champions the cause of nutrition and multi-vitamins, particularly his vitamin products, stating that they can ‘€œreverse the course of AIDS’€. On his website Rath claims that the Foundation is conducting a ‘€œclinical trial’€ in the township to assess the efficacy of his treatment. However, the Foundation does not have the approval of the Medicines Control Council to conduct a ‘€œtrial’€. Its products are also not registered with the MCC and yet, it makes unsubstantiated claims about their healing powers. This uncontrolled operation of the Dr Rath Health Foundation is in violation of the Medicines and Related Substances Control Act. On the 11th of May, the MCC and the Health Department confirmed that they were investigating the South African activities of the Foundation. They said in a joint statement, ‘€œthe investigation has not yet been completed, therefore we are not at liberty to discuss the merits and demerits of the investigation’€. The MCC failed to comment when approached for purposes of this report.  

In all of this Rath has gained a number of allies. The South African National Civics Organisation (SANCO), whose public profile has been very low until recently, is one of them. The organization has now evolved into a recruitment and distribution agent for the Rath Health Foundation as they go around Cape Town townships testifying about the goodness of Rath and his vitamin tablets. Its support for the Foundation emanates from a workshop organized by Dr Rath in November last year where he presented to SANCO some of his success stories. Ndzanywa Ndibongo is the Khayelitsha chairperson of SANCO. We meet him after having taken several turns to get to a bright-pink coloured corner house deep in Site B, Khayelitsha, which the local SANCO branch uses as an office.

NDZANYWA NDIBONGO: This Foundation, they came to us doing a thorough presentation. And then we said ‘€˜if this is working we’€™re going to support you. If this is not working we won’€™t support you’€™. They went out and came back with those 18 patients that succeeded.

KHOPOTSO: It’€™s uncomfortable doing this interview as about six adults are surrounding us ‘€“ a colleague and I – and whispering. The appointment had been set for the previous day, but we had left without talking to anyone as one Mrs Madubela, who apparently heads up SANCO Khayelitsha’€™s health desk, took centre stage and hurled abuse at us when we arrived. Today, all of Ndibongo’€™s entourage wants to talk. Nomfundo Moshane, who claims to be a member of the executive of the local SANCO, is one of them.

NOMFUNDO MOSHANE: It is just an honour to us when this man arrived to us’€¦

KHOPOTSO: When asked as to why SANCO was so actively supporting Dr Rath’€™s form of treatment, instead of the South African government’€™s HIV and AIDS Care and Treatment programme, Ndibongo, the local chairperson of SANCO, replied thus.

NDZANYWA NDIBONGO: I think the government put it clear that any alternative is open. As SANCO, as an organisation, we are not supporting only (the) Dr Rath Health Foundation.

Any person, any organisation, any Foundation that can come in order to help our people, we support that. That is our position’€¦ Whether this is a witch-doctor we support (that). Whether it’€™s Khopotso we support that.

KHOPOTSO: This approach has raised concerns among the leadership of the local branches of the South African Communist Party and trade union movement, COSATU, who are in a coalition with SANCO and the ANC. The two have now started a campaign aimed at clearing the potential confusion that may be caused by such ambiguous statements and messages. Luthando Nogcinisa, is the SACP District Secretary.

LUTHANDO NOGCINISA: What we want to stress is that the political head of the Health Department must come clear on these issues, not letting everybody to come and claim that she or he can do this. We want the Department of Health to come clear nationally as to what is the direction so that we can give a proper direction to our members on the ground. We are leading the members. We are daily involved with these HIV-affected people in our community, in our workplaces. If there is no proper direction from the head of the Department that means that the Department itself will be chaotic because everyone practices what he preaches. And we don’€™t want that. We want uniformity in dealing with these issues.

KHOPOTSO: Nogcinisa believes that this lack of clarity on how to deal with treating HIV and AIDS in South Africa could give rise to a number of claims from individuals and foundations that they can treat or even cure the infection. Mandla Majola, co-ordinator of the Treatment Action Campaign in Khayelitsha, is heart-sore that almost two years after Cabinet approved the HIV and AIDS Treatment Plan there is debate on whether one modality of treatment is more effective than the other.

MANDLA MAJOLA: It’€™s very unfortunate. The sad part about the issue of Rath is that the hatred and animosity that it has given birth to ‘€“ there’€™s that kind of feeling ‘€“ is not between us and Rath directly.

It’€™s between us and our brothers who are SANCO leaders in Khayelitsha, whom jointly, both of us, are facing or confronting these serious issues of unemployment, homelessness, shacks, people who are really sick from AIDS, crime, abuse. Instead of us focusing on these serious issues we are busy trying to prove to the community that our position, scientifically, is correct. They, on their side, are claiming that multi-vitamins are the best route’€¦ And that is, for me, a bad waste of time.

KHOPOTSO: On several occasions and on posters in public places in Cape Town townships promoting his multi-vitamins, Dr Matthias Rath has described the Treatment Action Campaign as cronies of pharmaceutical companies. Curiously though, it would seem that the Dr Rath Health Foundation is media-shy. All three e-mails I had sent to the Foundation explaining who I was; who I worked for; what story I was doing and for what purposes; and where it would be published or broadcast were never responded to. I was later able to find contact numbers for a Mr Herbert Gxabaza, who apparently is ‘€œin charge’€ of all the Rath treatment sites in Khayelitsha. He agreed to take us to the sites and allow us access to their patients. I then flew to Cape Town for that, and was ditched at the last moment. Gxabaza said his boss, Dr Matthias Rath, had sent him on urgent business to Queenstown, in the Eastern Cape. He promised that he’€™d take me on that tour once he’€™s back in Cape Town, which was to be some three days later. But week after week I made a call to his cell-phone and it was continuously off. Even though Gxabaza has my contact details, he never bothered to call me to this day.                

Meanwhile, desperate people in need of relief from AIDS are being persuaded to take the Rath pills. Very little is known of the real impact of the treatment. And very little will be known until Dr Matthias Rath opens himself up to scrutiny. But for Matshaya, who lost his wife, one thing is for certain.

MATSHAYA: Ndingathanda ukuthi logqirha ukuba uyafumaniseka ukuba nyani enetyala umthetho ube nento oyenzayo ngalonto.

KHOPOTSO: If any investigation finds this doctor guilty, I would like the law to do something about it, he says.    

E-mail Khopotso Bodibe

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