Doctor in trouble for his attempt to reverse ‘miserable lives’ of HIV babies
So when Dr Colin Pfaff, the chief medical officer of Manguzi Hospital, learnt that ‘dual therapy’ could cut the rate at which HIV positive mothers transmitted the virus to their babies by up to 75%, he was anxious to introduce it.
After a series of postponed promises about the ‘imminent’ introduction of dual therapy in KwaZulu-Natal, Pfaff raised money from overseas donors to buy AZT and started offering dual therapy at Manguzi in October last year.
Since then, 120 Manguzi women have been given dual therapy, but Pfaff has been charged with misconduct for his efforts.
But Professor Haroon Saloojee, head of community paediatrics at Wits University, says that those health officials who are delaying dual therapy and thus denying babies essential drugs should be charged not Pfaff.
‘Half of all HIV positive babies in South Africa usually die before their second birthday,’ says Saloojee. ‘Babies with HIV have miserable lives. Most become sick within their first year, and face multiple hospital visits, infections, malnutrition and the high possibility of death.
‘It is disgraceful that, two and a half years after all the scientific documentation in support of dual therapy was presented to the health minister, she still has not implemented it,’ added Saloojee.
Mono-therapy to prevent mother-to-child HIV transmission, which is what KZN offers art present, consists of a single dose of nevirapine, while dual therapy means the addition of a short course of AZT to the treatment protocol.
But in 2006, over a quarter (27%) of pregnant HIV positive women at Manguzi who got nevirapine only passed HIV on to their babies.
Last May, Pfaff and other doctors in the Mkhanyakude district wrote an urgent letter to the district, area and provincial health leadership asking that they be allowed to implement dual therapy.
Dr Victor Fredlund, the chief medical officer of Mseleni Hospital says Pfaff wet ahead and raised donations to buy AZT after they had worked out that dual therapy could save 75 babies in the district from HIV every month.
Unfortunately for Pfaff, his case became politicised when the Democratic Alliance issued a statement last week condemning his ‘suspension’.
When contacted for comment on the DA statement, Pfaff was shocked to hear that the DA had got hold of information about his case as the party had not spoken to him. However, he opted not to comment in the hope that the department would drop its charge against him.
Unfortunately, the DA statement incensed the KZN health department, with spokesperson Leon Mbangwa saying: ‘We will not allow anyone to pull vulturistic theatrics to mystify this matter for their own political gains. We will continue to put the interest of our people first.’
However, Mbangwa has since extended an olive branch to Pfaff, conceding that his department ‘could have handled the matter better’.
‘There was nothing seriously wrong with what Dr Pfaff did,’ said Mbangwa. ‘What we are saying is that he should have followed the proper procedures by going through the hospital CEO to raise the money [to buy the AZT]. If every employee of the department raised money in this manner, there would be a lot of disorder and monies would go missing.
‘We are looking for and need people like Dr Pfaff, but they should not work in isolation [from the department].’
However, Mbangwa added that the province was still not ready to implement dual therapy, largely because of budget constraints.
Pfaff has been asked by his lawyer to stay clear of the media until his case has been heard, but his many friends and colleagues willingly offered their impressions of the man in the hot seat.
‘Colin is a visionary and an idealist,’ says Dr Janet Giddy, who works at McCord Hospital in Durban and has known him for years. ‘He’s not a plodder. He always goes the extra mile to care for his patients. He is very committed to God and to rural health.’
Drs Ben and Taryn Gaunt from Zithulele Hospital in the Eastern Cape describe Pfaff as ‘a missionary with a calling is to serve the poor’.
‘His motivation is his Christian faith and his desire to be an example of Jesus to the people he serves,’ says Ben Gaunt.
‘He has a tremendous respect for his patients, always treating them as people, rather than one of many patients. He is a genuinely friendly, honest and humble person. Never once has he come across as proud despite the fact that he has much to be proud of,’ adds Taryn Gaunt.
Professor Ian Couper, head of rural medicine at Wits, describes Pfaff as ‘selfless’ and ‘hard-working to the point where it’s sometimes difficult to get him to stop’.
Aside from being a qualified doctor, Pfaff has a Masters degree in family medicine, which he got cum laude, as well as diplomas in child health, anaesthetics and HIV management.
The 37-year-old doesn’t do things in half measures. When Pfaff moved to Manguzi, he lived with the family of Pastor HK Manzini for seven years so that he could learn Zulu language and customs.
After being at Manguzi for almost five years, Pfaff volunteered to work in Nepal for two years, first with primary health care teams in the Himalayas and then at a remote rural hospital where he was particularly involved in trying to improve the care of pregnant women.
But the former Northlands High School student missed KwaZulu-Natal, so he returned to Manguzi in 2005 and has been there ever since, at one time running the hospital.
The date of Pfaff’s misconduct hearing has yet to be set, but the case is being closely watched by a range of professional bodies and medical practitioners.
The SA Medical Association’s Chairperson Dr Kgosi Letlape said he did not want to comment on the specifics of Pfaff’s case as it ‘because it is ongoing and we don’t want to prejudice the individual’
‘But if we look at the principles involved, we find it very disturbing that a doctor who is doing his ethical duty and helping his patients to get better treatment is considered to be committing a crime by this government,’ said Letlape.
‘At the last meeting of the SA National AIDS Council [held in November] we were given an assurance [by Deputy President, Phumzile Mlambo-Ngcuka] that any area that was ready to go ahead with dual therapy could do so and nothing would happen to them,’ added Letlape. ‘We are now wondering whether this assurance meant anything.’
What is dual therapy?
The Department of Health finally published its guidelines for dual therapy this week. Pregnant HIV positive mothers will receive the antiretroviral drug AZT from 28 weeks as well as the current single dose of Nevirapine administered during labour.
Their babies will then receive AZT for seven days. However, if the mother received AZT for less than four weeks the infant will be given AZT for 28 days. The current PMTCT budget of R85-million will be increased to R281-million.
Mothers will also be tested for HIV at their first visit to the ante-natal clinic. If they test negative, the test will be repeated by 36 weeks. CD4 counts will be done on women who test HIV positive.
The struggle for dual therapy timeline
May 2004: The Western Cape begins dual therapy and has now has a mother-to-child HIV infection rate to around 6%. In KwaZulu-Natal with its nevirapine-only regimen, 22% of HIV positive mothers are infecting their babies with HIV.
2006: WHO recommends dual therapy for preventing mother-to-child transmission in ‘resource poor settings’
May 2007: SA HIV Clinicians’ Society writes to the South African National AIDS Council (SANAC), asking it to investigate the delay in rolling out this ‘dual therapy’.
May 2007: The five hospitals in the Mkhanyakude district write to the provincial health department and call for the urgent implementation of dual therapy
August 2007: The Treatment Action Campaign (‘TAC’), the Southern African HIV Clinicians’ Society and a group of concerned clinicians, paediatricians and obstetricians in South Africa write to the health minister to ask for dual therapy to be implemented but get no response.
10 September 2007: At the SANAC meeting, the Department of Health committed itself to revising the national treatment guidelines to prevent mother-to-child transmission (PMTCT) to include dual therapy
November 2007: Deputy President Phumzile Mlambo-Ngcuka tells a SANAC meeting that provinces should be allowed to implement dual therapy even though it had not yet been endorsed at national level.
November 2007: The National Health Council (NHC) discusses the new PMTCT guidelines.
1 Dec 2007: Health Minister Dr Manto Tshabalala-Msimang announces that dual therapy will be implemented from the beginning of 2008
January 2008: Dr Colin Pfaff is charged with misconduct for implementing dual therapy at Manguzi Hospital, using donor funds
25 January: The Policy Committee of the National Health Council adopts the new PMTCT guidelines, including dual therapy
14 February: The national Department of health releases the new PMTCT guidelines
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