HIV and AIDS HIV Prevention HIV Treatment

Doctor fights for the right to be guided by his conscience

Written by Health-e News

Seven years after effectively being dismissed by the Mpumalanga health department for supporting the dispensing of anti-retrovirals for rape survivors, Dr Malcolm Naude is fighting for the rights of all public service doctors and nurses to follow their conscience when treating patients.

Naude and his legal team from the AIDS Law Project believe that doctors are guided by the Hippocratic Oath rather than government policy. The case iwas recently heard in the Labour Court, seven years after Naude was dismissed.

Naude is not the only doctor to be dismissed for dispensing ARVs despite government policy to the contrary.

In 2001 his boss and superintendent at Rob Ferreira Hospital, Dr Thys van Mollendorf was also fired for supporting the Greater Nelspruit Intervention Programme (GRIP). At the time GRIP was evicted from the hospital premises by then Health MEC Sibongile Manana for providing ARVs as a post-exposure prophylaxis to prevent HIV infection in rape survivors. This wasn’€™t government policy at the time.

Both Naude and Von Mollendorf supported GRIP’€™s work.

Last year another doctor Nokuzola Ntshona was dismissed for blowing the whistle on the high number of baby deaths at Frere and Cecilia Makiwane hospitals in East London.

More recently Manguzi doctor Colin Pfaff was threatened with dismissal and faced disciplinary action for dispensing AZT as part of the Prevention of Mother to Child Transmission package of care. Pfaff was in line with international practice, but out of step with government policy which only changed two years after the World Health Organisation recommendations.

‘€œWith this case I am 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 with their employer on an ethical or a medical issue like this,’€ said Naude.

Referring to Pfaff and Dr Mark Blaylock, also a Manguzi doctor, who dumped KwaZulu-Natal Health MEC Penny Nkonyeni’€™s photograph in the bin after she accused rural doctors of exploiting patients, Naude said they found themselves in a situation very similar to his.

‘€œOne would think that seven 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 what doctors are still being persecuted, threatened, fired, disciplined, what the case may be’€¦is very disheartening.’€

Now working with rape survivors in the private sector, Naude said it was disconcerting to see that doctors were being persecuted for being willing to prescribe ARVs to patients. ‘€œThat on the backdrop of little seminars that high-ranking government officials in the health department seem to be attending on the denialist view of HIV and alternative remedies to HIV that haven’€™t stood the test of time, have not stood up to good science, haven’€™t stood the test of a double-blind randomized control trials. That’€™s very worrying.’€

Naude says he longs for the day when he can return to the public sector. ‘€œThat’€™s where the need is greatest and where a very small effort goes a long way. Unfortunately with the current leadership in the health department that is not possible. You spend all that energy 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.’€

He realizes that the Labour Court cannot force the health department to acknowledge that doctors, nurses and health care professionals are free to act in accordance with their conscience and ethics, but he is hoping that it will make them sit up and take notice that Naude and others are standing up for their patients.

Naude is forthright when commenting on the fact that Manana is now a member of parliament while the national health minister was recently voted onto the ANC’€™s national executive council list.

‘€œI think it’€™s 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. But just a recording of their crimes, in my opinion, is one step towards people much later looking back and seeing that human life at one stage, despite our Constitution, is treated cheaply, especially if you’€™re poor and don’€™t have access. If you’€™re rich and have support from your cronies, there things are going well. It’€™s shocking,’€ he says.

Naude is seeking compensation for the period in which he was not officially dismissed by the health department as well as an agreement from the health department that medical personnel must act in accordance with their conscience and the Hippocratic oath.

Judgement has been reserved.

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Health-e News

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