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A doctor’€™s conscience speaks out

Written by Health-e News

After a seemingly never-ending seven-year legal battle with the Mpumalanga Health Department, Dr Malcolm Naude’€™s struggle is almost over. The Labour Court in Johannesburg heard closing arguments from both sides this past Wednesday and judgement was reserved.

KHOPOTSO: The case has taken quite a long while. It’€™s almost seven years later now. Judgement on your case is almost here. If you can tell us what you’€™ve actually went through over the last seven years up to this particular point’€¦ It feels like a long haul, doesn’€™t it?        


Dr NAUDE: It’€™s been a very long time. I’€™m very pleased that my bit’€™s now basically done. I’€™ve had my day in court, so to speak, where I could state my case. Hopefully, we’€™ll have a favourable judgement that might change things for doctors in the employ of the Department of Health; nurses also; anybody who has to stand up for a patient when their conscience and medical ethics come into play where it’€™s at a different stance to that of the government at this point in time.


KHOPOTSO: Why have you not given up?


Dr NAUDE: Well, uhm, I’€™ve thought of it quite a few times (he laughs). It felt like the right thing to do. One does get tired when dealing with the Department of Health. They are a very slow organisation and my experience of them is that they are not very in touch with the people that they are there to serve. In actual fact, the exact opposite seems to be true. Yeah, I think it’€™s important that somebody stands up to them and I’€™m very pleased to see that there are a lot of doctors doing that at this point in time; nurses too. If we don’€™t stand up for patients, then there’€™s nobody else to protect them.


KHOPOTSO: What do you hope that standing up to the Department, like you have done in your particular case, will actually say to the Department’€¦ is there any particular message that you’€™re actually wanting to convey?


Dr NAUDE: Well, at this point in time, I think the most important thing that we must get moving on is the reticence to supply ARVs ‘€“ and good ARVs ‘€“ to patients at this point in time, especially with post-exposure prophylaxis and (the prevention of) mother-to-child (HIV) transmission. But also, for our patients that are suffering with HIV/AIDS. It’€™s very important that this gets done soon and we shouldn’€™t drag our feet on this. Seven years has been a long time from the first incident where this came into play. Luckily, the government’€™s stance seems to have changed. Practically, I don’€™t think that’€™s translated much yet. That’€™s quite worrying.


KHOPOTSO: Would you like to expand on that, please?


Dr NAUDE: Well, I think the big thing is the big case in KwaZulu-Natal with Dr Pfaff and Dr Blaylock. The circumstances that they find themselves in seem to be very similar to the debacle I found myself in. One would think that six years down the line and a dramatic shift from denialism in 2001 to the apparent rollout of ARVs, there should have been big changes. To see that doctors are still being persecuted, threatened, fired, disciplined, whatever the case may be seven years down the line is very disheartening. I would have thought that, hopefully, I would have been the last case where this would have happened. But, apparently, that doesn’€™t seem to be the case. It’€™s very, very worrying.


KHOPOTSO: How do you see this’€¦ is it, perhaps, a crackdown on doctors ‘€“ particularly those who are working in the field of HIV and AIDS?


Dr NAUDE: I don’€™t want to say a crackdown, but it is disconcerting to see that two separate provinces with what should be apparently different approaches still doing the same thing in terms of persecuting doctors who are willing to prescribe ARVs to patients. That on the backdrop of little seminars that high-ranking government officials in the Department of Health seem to be attending on the denialist view of HIV and alternative remedies to HIV that haven’€™t stood the test of time; haven’€™t stood up to good science; haven’€™t stood the test of double-blind randomised controlled trials. That’€™s very worrying. We should be doing the very best we can with what we know now and then test anything that might be an alternative to that. At this moment in time we aren’€™t applying the gold standard, which we’€™re able to do. And that’€™s worrying. I would have thought that people who run the Department of Health would have the best interests of patients at heart, with the resources that they have. We’€™re not asking for extra resources. We’€™re asking that the resources that we do have be applied, and that does not seem to be happening. That’€™s very, very worrying in my opinion. It’€™s disheartening, too. Doctors should be doctoring. They shouldn’€™t be fighting political battles. This thing shouldn’€™t be political in the first place. When the resources are available, as they are, we should be implementing them. This is not happening. Even though the government’€™s stance might have changed, operationally, on the ground-floor, it doesn’€™t seem to be the case. To think that we’€™ve got hundreds of thousands of people suffering with HIV/AIDS and only a few thousands of them have access to ARVs and ARV programmes, is a shame. It’€™s an absolute shame.


KHOPOTSO: Is there a sense of fear among doctors on the ground?


Dr NAUDE: I don’€™t think there’€™s an overt fear. But I do think that the constant barrage of doctors being disciplined, threatened with career implements because they are doing the right thing definitely makes it very difficult for doctors to try and implement strategies that are the best for their patients. So, I do think that if you are a new young doctor with not much experience in the Department of Health as most young doctors start out, with the current atmosphere of retribution, punishment, discrimination in terms of those who are in support of supplying ARVs to patients, it’€™s very difficult for those doctors to try and make decisions that have their patients’€™ interests at heart. I think the climate that the Department of Health has created is very unconducive to doctors going out to try and supply the best medical care that’€™s possible. It’€™s not only limited to ARVs. If you look at the situation that happened in the Eastern Cape with the doctor who whistle-blew on the babies dying’€¦


KHOPOTSO: The Mount Frere experience?


Dr NAUDE: That’€™s correct. It’€™s the same type of thing. There’€™s no back-up for people who are trying to improve the lot of the poorest of the poor. It seems like the fat cats who run the Department of Health are happy to exploit their private medical aids which give them free access to any of the drugs that we’€™ve spoken about, good clean hospitals with unlimited, almost, resources. Obviously that comes at a price ‘€“ obviously prices they can afford ‘€“ leaving the very poor, the very disadvantaged in a position where they don’€™t have access to this. And that’€™s unfair.


KHOPOTSO: What’€™s happening at provincial level ‘€“ the reprisals that are actually taken out against doctors ‘€“ do you think, perhaps, that this is something that is informed by, say, overtly, what comes out from the top ‘€“ from the national Minister of Health?


Dr NAUDE: Well, I think that’€™s what’€™s happening at this point in time’€¦ it seems like the Department is speaking with a forked tongue. By that I mean it says one thing and does another. It promotes ARVs ‘€“ or the apparent rollout of ARVs ‘€“ and then it disciplines doctors who are involved with that. It says it’€™s going to supply ARVs and the rollout is slow. It just doesn’€™t seem like what they do and they say is consistent. That’€™s been my experience with the Department. It’€™s dragging its feet. And I don’€™t want to read any conspiracy theory or anything like that into it, but it does seem to be that this is trickling from the top. It’€™s unlikely that all these events are just sporadic. It does seem that there is a seepage from the top that seems to promote the idea that ARVs are not good and that type of thing.


KHOPOTSO: It’€™s seven years later, you’€™re not in the public health sector anymore, you’€™re working for the private sector – would you actually consider going back at any point?


Dr NAUDE: I think when the Department has leadership that is decisive, that seems to have the interests of patients at heart, making the system better for those who work in the system (and) those who make use of the system, then would be a good time to go back. At this point in time, I think it’€™s a lot of energy that you spend fighting the system, instead of treating patients.

At this point in time, I feel that I am helping more people by being in the private sector. I think I would be wasting a lot of energy fighting the Department if I were in it at this point in time, and not treating patients’€¦ Yes, I’€™d like to go back to the Department. But I think under the current leadership, or lack thereof, I don’€™t think that’€™s going to be the case.


KHOPOTSO: If there is anything that you miss about working in the public health sector, what is it?


Dr NAUDE: It’€™s definitely the patients. That’€™s where the need is the greatest and where   very small efforts go a long, long way in making huge differences in people’€™s lives. It’€™s very gratifying to work in that kind of environment. So, I’€™d like to go back to that kind of environment. Unfortunately, with the current leadership that exists in the Department of Health, that’€™s not possible. You spend all that energy that you would have spent on patients trying to fight the system, trying to implement things that make their lives better and you’€™re basically stonewalled at every attempt. My hat goes off to all those people who are in the Department of Health trying to make a difference today. They have a very, very difficult job, especially with the climate that reigns at this point in time. I think they are mini saints, to say the least.


KHOPOTSO: What are you hoping for with this case now? Judgement is reserved. It wasn’€™t given today. (What’€™s) your hope, ultimately?


Dr NAUDE: For me it’€™s a good day because all the evidence has been given and my long journey is close to an end in terms of this. Ya, I’€™m very pleased with that. The change I hope to effect is that I want to make it easier for doctors and nurses to do what they feel is right for their patients and that that environment and that culture exists in the Department of Health. So hopefully, a judgement in my favour against the Department of Health would create space for that kind of climate. At this point in time, I don’€™t think that climate exists. Doctors and nurses who stand up against government policy seem to be punished, persecuted, threatened. And we’€™d like to see a win in this case which would hopefully, change that kind of climate a little bit.    


KHOPOTSO: You call that win an acknowledgement from the Department of Health’€¦ If you can just say what it is that you want the Department to acknowledge?


Dr NAUDE: Unfortunately, the Department of Health cannot be forced by this court to make any acknowledgements’€¦ An undertaking, a statement of the Department of Health saying that doctors, nurses, health care professionals are free to act in accordance with their conscience and standard medical ethics when these kind of situations arise. They’€™ve never wanted to take that undertaking or statement. They’€™ve avoided that. It was a very easy statement for them to have conceded to and they have resisted all along ‘€“ these seven years ‘€“ to actually making that statement. So, it is unfortunate that this court cannot force them to take that undertaking.

But hopefully, the judgement in my favour will make them sit up and take notice that more and more doctors are going to start standing up for their patients in these kind of cases and hopefully, that will cause them to not pursue the stance much longer.


It is unfortunate too, I must say with a lot of regret, that the then (Mpumalanga Health) MEC now is a member of the (ANC) NEC is being promoted, is being rewarded for her stance, for her support of the then denialism of ARVs. That’€™s very unfortunate and there’€™s no recourse that we have at this point in time. To think that a person like that – who can say to a child who has been raped violently, ‘€˜I’€™m going to withhold life-saving medication from you’€™ ‘€“ is rewarded in the National Executive Council is shocking. It’€™s absolutely shocking’€¦ This case has documented her wrongs against the people of Mpumalanga, the poorest of the poor, the most destitute, the people most at risk for abuse. We’€™ve recorded, in my opinion, Manana’€™s crimes against humanity. These things, unfortunately, can’€™t be remedied by this court. But, at least, we’€™ve got a record of them now of how she denied people access to life-saving medication. To me it’€™s almost on par to what Josef Mengler did in Nazi concentration camps to experiment on people. She’€™s done more or less the same thing in my opinion. And it’€™s good that we’€™ve documented that.


Her rewards might be fitting in the (ANC) National Executive Council where she might be patting herself on the back. But, at least, we’€™ve had the opportunity to record this kind of travesty of human rights that she supported, perpetrated in Mpumalanga.


KHOPOTSO: It must be worrying that even her boss at national level, the Health Minister, got the same reward of being in the National Executive Committee of the ANC?


Dr NAUDE: Yes, it is very sad to see that people who have basically abused human rights on a gross level such as this are being rewarded. It would be nice to see some kind of retribution, I’€™m not sure how. But just a recording of their crimes, in my opinion, is one step towards people way down in history looking back and seeing that human life at one stage, even despite our new Constitution, is treated cheaply ‘€“ especially if you’€™re poor, if you don’€™t have access. If you’€™re rich and you’€™ve got a lot of support from your cronies, then things are going to go well. But for the poorest person living in a shack in KaNyamazane or a place like that in Mpumalanga, your access is denied. It’€™s shocking. It’€™s really shocking.


KHOPOTSO: If judgement in this case is not in your favour what role would you think you have actually played’€¦ what would you think that you have done?


Dr NAUDE: I think the important thing is for me to have stood up and done the right thing. The right thing was to follow my conscience and fight for my patients to give them the very best medical care that I could supply with the resources that we had. Even if I do have a judgement that does not rule in my favour, I think the very fact that I stood up to the Department of Health stemmed the tide a little bit. It opposed just the blatant rundown of people and human rights. I can live with myself, you know. Even if it’€™s ruled against me in this case, I’€™ve done everything that I can. I didn’€™t sit back and ten years down the line wake up and say, ‘€˜you know, I should have. Maybe I could have’€™. I’€™ve given it my all. I’€™ve tried my very best and hopefully, things do go in our favour and we’€™ve changed things a little bit in South Africa, made it a little bit more difficult for people who don’€™t seem to care about those most at risk. I think that’€™s a good thing.


KHOPOTSO: You wouldn’€™t be bitter at all?


Dr NAUDE: Yes, things might go against me. I will rest with that. I know that I’€™ve done my best and hopefully, we can change things. Hopefully, things will be better.    

NB: We apologise for the non-availability of the audio. We could not upload it due to its huge size.


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