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Desperate Doctors

Written by Anna Maria Lombard

Doctors in KZN healthcare facilities battle against the Department of Health.

aa032900ea79.jpgThis insert was broadcast on M-Net’s Carte Blanche on  18 May  2008.

For over six years, Dr Mark Blaylock’s surgery skills have saved lives in one of the country’s remotest regions. But maybe no longer, if the Health Department has its way. After months of drama at Manguzi Hospital, a task team will deliver its report tomorrow on Blaylock – and the hospital’s fate.

Dr Mark Blaylock (Chief Medical Officer): “It’s been very hurtful and obviously extremely stressful. I think to have allegations made against you in parliament is almost unprecedented.”

Blaylock’s accused of abusing state facilities, of quackery, racism and anarchy. It all emerged when he did something that set him and his colleagues on a bruising collision course with government: he trashed the KwaZulu-Natal Health MEC’s official portrait.

Bongani Bingwa (Carte Blanche presenter): “What happened, were you sitting in your office and you saw this photo and you lost it?”

Dr Blaylock: “It was just an overall sense of frustration. We were all extremely frustrated. I suppose it was an impetuous tantrum.”

Blaylock’s outburst happened to target the one politician whose image is everywhere. MEC Peggy Nkonyeni takes pride of place in departmental portraits and banners and the annual calendar features her on the cover and all but four months.

Bongani: “Were you surprised at the reaction?”

Dr Blaylock: “I was flabbergasted at how much energy went into what really is quite a trivial event.”

For hospital board members appointed by the MEC it wasn’t trivial. Eric Ngubane and Mthunzi Mahlangu were livid.

Eric Ngubane (Board Member): “It means that if he had power he would actually take the minister herself and put her into the bin.”

Mthunzi Mahlangu (Board Member): “You defecate any image or symbolism of the minister; you tamper with the people who represents (sic) such a structure.”

Four months after the incident, the MEC appointed senior doctors working for the department to a task team, to investigate the hospital. We followed them to the small dusty town of Manguzi on the border with Mozambique. The task team was instructed to leave no stone unturned. They would scrutinise hospital administrative records and interview everyone.

Bongani: “There is a palpable sense of expectation. The task team are finishing off their last interviews. It’s an unenviable task because it’s all boiled down to a clash of ‘cultures’, personalities and politics.”

The cause of the resentment between doctors and government is the treatment of AIDS patients. Manguzi first crossed swords with the provincial department towards the end of last year. Then the controversy centred on chief medical officer Colin Pfaff. At the time, he was heading a team praised for its highly successful AIDS treatment programme.

Dr Colin Pfaff (Chief Medical Officer): “We had been very successful in this district, with the ARV roll-out programme, probably one of the most successful districts in this country.”

What worked in Manguzi was teamwork. Still, too many pregnant women were dying. The AIDS drug Nevirapine given to women around birth wasn’t enough to stop them from transmitting HIV to their babies. The team knew they could do better. They decided to follow World Health Organisation guidelines advising a second drug earlier in pregnancy. This dual therapy was working well in the Western Cape, and a national rollout was imminent. But Manguzi didn’t have the drugs, so last May they wrote to the provincial Department asking if they could run dual therapy. The answer was a firm ‘No’.

Bongani: “Why did you not wait until there was a provincial rollout of the programme?”

Colin: “There were several times when it was promised and we did wait. Then it wasn’t implemented and we waited some more, but I think it got to a stage where we thought it’s not really ethical to wait anymore.”

With international donor funding, Manguzi started dual therapy without permission. They bought the AIDS drug AZT and started women on ARVs much earlier in their pregnancies. But by January this year, this move got Pfaff into big trouble. He was threatened with suspension. The department’s Leon Mbangwa remains unapologetic.

Leon Mbangwa (KZN Department of Health): “It was coming, you are right I agree.”

Bongani: “So they went ahead and decided to start saving lives?”

Leon: “You do not do that if you are an employee, you work according to your instructions and conditions of service.”

Bongani: “Even if that means you’re going to save lives, that’s what you stick to?”

Leon: “In this particular case he was out of order.”

Only an international outcry from scientists and activists saw the action against Pfaff dropped. But the relationship with the MEC had soured. When she came to visit Manguzi a month later, she allegedly berated doctors for providing AZT and questioned their motives.

Dr Blaylock: “What really got to me was the fact that she said that she had a problem with rural doctors that they were here for profit and they didn’t care for patients. ”

AIDS patients should get food parcels, but there was a shortage at Manguzi and patients had to be rationed. The MEC blamed the doctors.

Leon: “She then issued her statement to say, ‘You people in rural areas don’t realise that sometimes it’s about life and not about profit’.”

Dr Blaylock: “That obviously really riled us all. And that’s when I threw the well-publicised photo in the dustbin.”

Blaylock was charged with destruction of state property. Since the portrait wasn’t actually damaged, the charges were dropped. But still, there was a disciplinary hearing and he was suspended. When the suspension was lifted after much public pressure, the doctors thought the saga had ended.

Then out of the blue, two weeks ago in her budget speech, the MEC used confidential details from Blaylock’s personnel file as terms of reference for the task team investigation.

She brought up an incident dating back four years, when Blaylock was accused of operating on a dog – in theatre. Blaylock says it was his day off when a community member brought their injured dog to the outpatients’ department.

Dr Blaylock: “I tried to insert a chest drain, and realised that the dog wasn’t going to survive. But the dog actually never went to theatre.”

Bongani: “You weren’t contravening policy?”

Dr Blaylock: “At that stage the hospital policy was that we could treat animals, because there is no vet.”

He was reprimanded, but cleared of wrongdoing. The MEC also claimed Blaylock had a history of assault. He says it’s based on an altercation with a colleague who had come on duty, drunk.

Dr Blaylock: “We did have an altercation but at no stage was it an assault, as was claimed. He did however lay a criminal charge, which went to court and I was cleared.”

Then the racist incident: The MEC alleged Blaylock called staff members baboons during last years public servants’ strike. He denies ever saying anything of the sort and he’s puzzled as to why these old incidents have been dug up again.

Bongani: “It gives the impression of a witch-hunt. The first charge was the damaged photo, that didn’t stick. Then you stick up everything he’s done in the past, which he’s been cleared for.”

Leon: “It’s not a witch-hunt – remember the MEC is sitting at a strategic apex of the province and if there’s a problem that keeps on cropping from one particular area, it is her right to say, ‘Hey let’s wait a minute, maybe we need a better strategy for that particular region’.”

Curiously, tagged onto the charges against Blaylock, were the old issues about rolling out dual therapy before it became official. Again Manguzi doctors ‘acting beyond the guidelines’ were to be investigated. Mark Heywood is the legal representative of the Manguzi doctors.

Bongani: “What do you think is at the heart of all of this?”

Mark Heywood (Director Aids Law Project): “Unfortunately, the residue of a bitter and vicious AIDS denialism that has plagued this country for six or seven years. The statements that come from the MEC for Health are the stock phrases of AIDS denialists.”

Bongani: “Such as?”

Mark: “‘The medicines are poisonous’, ‘AZT is poisonous’, ‘people should be cautioned about taking it’.”

In our attempts to speak to the MEC, we came across an official information workshop on HIV treatment in Durban. Instead of scientists, doctors and nurses, the agenda listed as speakers some known AIDS denialists. The literature on offer included publications by the discredited Matthias Rath Foundation.

Bongani: “This leaflet says ‘All AIDS drugs, ARVs are toxic and cause damage to the liver, the brain, the bone marrow and other organs’. This little booklet says, ‘Many doctors operate as uncritical agents of pharmaceutical ‘colonialism’. Identify them, and beware of them’. Not moments ago I sat in a workshop presided over by the National Health Minister, Dr Manto Tshabalala-Msimang and the KZN MEC for Health, Ms Peggy Nkonyeni. This is the kind of literature that was distributed in the workshop.

Bongani: “What does it say to you that the Minister of Health and the KZN MEC of Health are attending workshops where denialist literature is distributed?”

Mark: “Well, the first thing it says to me is that they should be disciplined by the ANC. I think they are bringing the ANC into disrepute.”

The MEC’s office says the task team’s report is due out tomorrow. It could spell the end of careers at Manguzi Hospital, but that’s up to the MEC.

Mark: “Unless she says, ‘I’m sorry about the misunderstanding that took place here, but let’s try to patch things up’ – unless she takes that approach – we will take that legal defence as far as we need to take it, including to the Constitutional Court if that becomes necessary.”

About the author

Anna Maria Lombard