|
|
 |
"We're unable to fulfil our Hippocratic Oath"
Cape Times. 14 April 2003. Republished courtesy of Independent Newspapers (Pty) Ltd.
|
The following is an open letter by doctors in the public sector to Deputy-President Jacob Zuma, Health Minister Manto Tshabalala-Msimang and Trade and Industry Minister Alec Erwin. We write as a group of doctors working at primary health-care clinics in the public sector.
We want to state that we have reached the point where we are asking ourselves daily how we can possibly continue working with integrity in the context of our many terminally ill HIV-positive patients not having access to life-saving medications.
Every day we are faced by patients who are sickening and suffering and dying in spite of all we can offer them. The support of a caring and skilled health-care team, good nutrition and timely treatment of opportunistic infections are inevitably eventually not enough.
The few who can afford anti-retroviral medications (ARVs) or who are fortunate enough to be on pilot programmes providing ARVs are, like Lazarus, rising from the dead. The many mothers, fathers, sons and daughters who are not as fortunate are fading and dying. Daily we see the devastating effects of the disease on families and communities.
Five years ago, the use of ARVs was still semi-experimental. Dosing was difficult, pill burdens were high and the expense was prohibitive. For these reasons, we could live with the dilemma. But now it is no longer tenable for us to do this. An affordable World Health Organisation-approved generic, well tolerated by most patients, can make the difference between life and death.
Consisting of one combination tablet twice daily, it is obtainable in Maseru for around R400 a month. It can be carefully monitored clinically and with simple, cheap blood tests.
Knowing this, we as doctors are unable to fulfil our Hippocratic Oath to do everything to relieve suffering and prevent death.
We find ourselves standing by and watching the survival of those who can afford drugs, while the poor suffer and die and their families spiral deeper into poverty and social dislocation.
Yes, we acknowledge that the health-care infrastructure is often inadequate and that the provision of ARVs should not be at the expense of the broader health-care system. Yet they are interdependent.
Clinics and hospitals are overwhelmed by ill patients with opportunistic diseases that could be prevented by ARVs. Staff are feeling hopeless and demotivated. The implementation of systems to properly administer an ARV programme would hopefully provide a spur to improve other aspects of health-care delivery, as well as boost the morale of health-care workers.
Yes, nutrition is very important. The rich and well-nourished may take longer before progressing to AIDS but, inevitably, the immune system eventually fails in spite of the best nutrition.
Without ARVs, many of our previously formally or informally employed poor patients are now too ill to work to obtain food. With treatment, they would be strong enough to provide better nutrition for themselves and their families through continued work.
Yes, prevention is also important. Yet it is clear that with 4,7 million people already infected, treatment is not only a humane response, but is also a vital aspect of prevention. It has been shown to increase voluntary counselling and testing and to decrease stigma in communities, and so lead to more openness and awareness.
Yes, ARVs are not a cure and are not tolerated by all and need careful dispensing and monitoring. Yet we know that highly active anti-retroviral treatment (HAART) significantly enhances the quality and quantity of life for the tens of thousands of people all over the world who have been using it for five to six years now. Withholding it can be compared to withholding insulin from diabetics.
Caught in this moral and professional dilemma, we ask ourselves:
- Do we continue in this situation of frustration and demoralisation?
- Do we break patent laws and try to import affordable generics for our patients, raising money through the private sector?
- Do we join civil disobedience campaigns and get arrested to highlight the plight of our patients?
- Do we resign and work elsewhere?
We are told that moves are being made towards the provision of ARVs in the public sector yet we hear with dismay that our Minister of Health asks "What is the hurry?" and that the ministry is "awaiting the outcome of studies".
Daily, in the interim, we are facing people who are dying prematurely and families who are losing loved ones, parents and breadwinners.
We can no longer, in good conscience, simply continue providing palliative and terminal care for our patients with HIV/AIDS, when we know that effective life-saving treatment is available. Whilst we understand the huge challenges of implementing an ARV programme, we urge that the HIV/AIDS crisis be acknowledged as a national emergency and addressed with urgency.
We therefore add our voice to the call for immediate steps towards a comprehensive national prevention and management plan which includes access to anti-retroviral therapy in the public sector.
Sincerely,
Drs. Karen Cohen, Ruth Cornick, Beth Harley, Francois Louis, Catherine Orrell, Eve Subotzky.
|
| Was this article helpful to you? |
 ?67%???? ?33%
|
|
Back
|
|
|
|
