KHOPOTSO: Dare to challenge the country’€™s health policy ‘€“ no matter how detrimental it is to citizens ‘€“ we will make an example of you. The warning is loud and clear to doctors who do not follow government policy. Traces of this practice first surfaced in the 1990s when Costa Gazi, a former Eastern Cape doctor and Pan Africanist Congress health spokesperson, spoke out against the Health Minister, Dr Manto Tshabalala-Msimang. Gazi said the Minister must be charged with manslaughter. This was at a time when the government refused to provide HIV-positive women with Nevirapine to prevent infecting their unborn babies with HIV. The Health Department disciplined and found him guilty for his comments. The finding was later overturned on appeal in the Pretoria High Court.                                    

MARK HEYWOOD: It fits into a pattern of political harassment and political vindictiveness against doctors who have followed their conscience and who have spoken out, particularly, on issues of AIDS policy’€¦ That became a case that went all the way to the Pretoria High Court, and which on appeal, found that Dr Gazi was justified in his comments; that he has a right to freedom of expression; that the circumstances and the context surrounding the political controversy over whether or not we should save babies’€™ lives were all factors that had to be taken into account.          

KHOPOTSO: Mark Heywood, Director of the AIDS Law Project, which represented Dr Gazi in his case against the Health Department and won. But the Department’€™s tendency to want to silence any doctor who dared speak or act against its policies never stopped there. In 2001, the Mpumalanga Department of Health reneged on a job offer of junior medical officer to Dr Malcolm Naude at Rob Ferreira Hospital, in Nelspruit. This after the young doctor ‘€“ fresh from community service – had signed an affidavit in support of the Greater Nelspruit Rape Intervention Programme (GRIP), which had begun providing antiretrovirals to reduce the risk of HIV infection in rape survivors. Again ‘€“ government was refusing to provide post-exposure prophylaxis at the time. Seven years later, Naude’€™s court trial against the provincial Health Department is yet to be concluded.

Dr MALCOLM NAUDE: With this case’€¦ I’€™m trying to make it easier for doctors who get into my position later on, not to have to go through the same thing ‘€“ not to fear a reprisal that they might lose their job; that they might lose a promotion if they are going to differ from their employer on an ethical or a medical issue like this.  

KHOPOTSO: The medical superintendent of Rob Ferreira Hospital at the time, Dr Thys von Mollendorf, was fired from his position for allowing GRIP to run the service from the facility. Last year, a doctor from another province became victim to the onslaught. The KwaZulu-Natal Department of Health charged Dr Colin Pfaff from rural Manguzi Hospital with misconduct. His fault was organising donor funding to buy a second drug, AZT, to improve on the government’€™s own programme that used only one drug, Nevirapine, to reduce the rate of HIV transmission from mother-to-child. World Health Organisation policy recommends the addition of AZT to further boost the efficacy of Nevirapine in preventing mother-to-child HIV transmission. The Department charged that Pfaff didn’€™t get permission to implement the strategy. His case caused an uproar. Jo’€™burg based doctor, Ashraf Coovadia, speaks of the frustration that doctors experience while trying to find a balance between satisfying outdated government policy – particularly when it comes to AIDS treatment – and administering to the needs of patients.  

Dr ASHRAF COOVADIA: We are bound by this red tape. I think there comes a point when you need to start thinking, ‘€˜how long can I wait and compromise ethical, moral (and) medical principles versus what you need to do to try and keep up with national policy’€¦ because national policy is dragging behind’€™?                                    

KHOPOTSO: Recently, at the same hospital of Manguzi, the KwaZulu-Natal Department of Health suspended Dr Mark Blaylock after he yanked the picture of the provincial Health MEC Peggy Nkonyeni, off the wall and then threw it into the dustbin. The action took place after Nkonyeni made disparaging remarks during a visit to the hospital. She said ARVs were toxic and that rural doctors do not care about people, but making profit. After another uproar, Blaylock’€™s suspension was lifted. But the provincial Health Department set up a task team to investigate him. All but one of the high profile disciplinary procedures the provinces have instituted against doctors relate to those working in the AIDS discipline. Last year, at Mount Frere Hospital in the Eastern Cape, Dr Nokuzola Ntshona was suspended and eventually dismissed for exposing the shabby state of the hospital’€™s child care unit to the media. The AIDS Law Project’€™s Mark Heywood believes that the Department of Health is carrying out a long-standing agenda against doctors working with AIDS patients.

MARK HEYWOOD: Doctors who work in the field of HIV and AIDS have been probably more outspoken than many other members of the medical profession. They’€™ve become activists on behalf of their patients and they’€™ve become advocates for the best possible treatment for people who live with HIV. And as a consequence, they’€™ve come into conflict with the government and with health authorities because, as you know, the HIV epidemic and the response to it has become heavily politicised in this country.

KHOPOTSO: Taking reprisals against doctors, provincial health authorities have created a climate of fear among health professionals across the country. But many doctors believe that keeping quiet out of fear of losing their jobs would not be the right thing to do when patients’€™ needs are not being adequately addressed.

Dr SITHEMBISO VELAPHI: I think one has to find a balance. The balance is not to keep quiet when things are wrong. And also on the other side, try not to be confrontational and saying things before one approaches the management and says, ‘€˜these are the issues’€™. So, if one deals (with) it that way, when you come out you come out having given them a chance to respond to the issues. But I think for one to keep quiet, to me, is unacceptable.

KHOPOTSO: Dr Sithembiso Velaphi, a paediatrician at Chris Hani Baragwanath Hospital, the largest in the southern hemisphere, was speaking after details of how newborns had to sleep in card-board boxes at the hospital’€™s paediatric ward due to a severe shortage of cots appeared in the media.