David Beresford Another Country If there is a touchstone to the long-running controversy over Aids in South Africa, it surely lies with case No GA51345 heard by the Commission for Conciliation, Mediation and Arbitration (CCMA), J Hiemstra presiding, in July last year. The case was essentially a labour arbi- tration between the Department of Health and Professor Johann Schlebusch, South Africa’s director of medicines and the registrar of the Medicines Control Council (MCC), and his deputy, Christel Brckner. The decision by the CCMA was handed down and (no doubt) reported in curtailed form in the media. But, having had the full judgement referred to me as a suitable piece of bedtime reading, I am struck by an old thought – that there is a fortune to be discovered in those musty piles of court papers, for any scriptwriter or playwright with the patience and energy to mine them. As a demonstration I thought I would try something of an amateurish and short “treatment” (as a summary of a storyline is known to the movie industry) based on case GA51345, which we might title: Humpty Dumpty in South Africa. The action is set in the late 1990s. South Africa has, of course, been liberated but the black majority (and a few others) are impatient for change, particularly in the ranks of government bureaucracy where it is suspected that officials of the old order are sabotaging the transfer of effective power to the new. The majestic but ageing Nelson Mandela is looking forward to retirement and in the wings waits his heir- apparent, the cosmopolitan and sophisticated Thabo Mbeki who, it is widely assumed, is already in de facto control of the government. Mbeki promises to be a 21st- century version of Cecil Rhodes, at least in terms of the ambition he nurses where Africa is concerned. But where Rhodes had plans for a railway line, Mbeki’s dreams are of no less than a renaissance of the entire continent which – thanks largely to the savagely exploitative nature of colonialism – has fallen on even harder times than previously. Threatening the ambitions of this would-be black colossus is a deadly plague which is sweeping down the continent, killing thousands by the month. Drugs companies around the world are racing to discover a formula which will halt it, but Mbeki (who studied economics in his youth) fears that even success on their part will only beggar the continent, including his own hopes and dreams. Determined that if there is to be a medical answer to the plague its inventors and patent holders will be “African”, he stumbles across a couple of researchers from the University of Pretoria who have come up with what they claim is a “cure” for the plague … That is the background. Our story revolves around the proceedings of an industrial tribunal and, with the help of flashbacks, is played out there and in the offices of the country’s drugs regulatory authority, the MCC. The tale as it unfolds is as follows: The MCC, under the leadership of its chair, Professor Peter Folb and its registrar, Schlebusch, has earned itself a distinguished international record, to the extent that they are being used by the World Health Organisation as a training centre for regulators from other countries. But they have stuck their collective hands into a hornets’ nest. The press reports the government’s sudden enthusiasm for Virodene – patients who claim to have undergone miraculous “cures” had even been paraded before a Cabinet meeting amid scenes of great excitement.
The MCC – which knows nothing about the miracle drug and has never granted it required permission for clinical trials – investigates. To its horror it discovers the drug is based on an industrial solvent used in the plastics industry and, far from offering a cure, is in effect poison for humans. It issues a statement to this effect warning that if anyone is injured, or dies as a result of its administration, those responsible could be held criminally liable. Suddenly the minister of health announces that an independent review is to be conducted into the operations of the MCC. It is a seven-strong team with two respected foreign scientists in the field: an Australian academic, Dr Suzanne Hill, and Professor Graham Dukes, emeritus professor of drug policy studies at the University of Groningen in The Netherlands. Dukes is an old friend of Folb; in fact they had co-edited what is regarded as the definitive work on drug safety.
After nearly three months’ investigation, Schlebusch is called into a grim-faced meeting attended by top government health officials, led by the director general, Dr Olive Shisana. Schlebusch is presented with a letter from Shisana stating that, on the basis of the review team’s findings, the MCC is to be restructured and there will be no room for either himself or his deputy in the new authority. After making various allegations of incompetence and maladministration the letter concludes that “we are not passing a verdict of ‘guilty’ as such”, but Schlebusch and his deputy are being asked to go voluntarily and with the government’s “sincere” thanks for their “contributions” and “long service”. In confirmation (or, some might say, contradiction) of which, the door to the meeting room swings open and in marches a department official. He escorts Schlebusch to his office, where the registrar is allowed to take only his briefcase. He is told to surrender his office and other keys, his entry card, his computer and his cellphone. Staff are heard being told not to communicate with Schlebusch or his deputy and instructions are given for all the hard drives on computers throughout the directorate to be copied. Guards are placed in the passage outside Schlebusch’s secretary’s office and the locks to his office are changed. The action then moves ahead to the industrial tribunal’s hearing, more than a year later, which presents scenes familiar to Hollywood drama in which the big guys (the government) are humiliated and the little guys who took a brave stand (Schlebusch & Co) vindicated to anticipated cheers, jeers and horse laughs from cinema audiences. Cameo performances could be given, for example, by the new registrar, Precious Matsotso, who forthrightly criticised her predecessor for incompetence, giving as an example the detail that when she took over from him the backlog in the registration of medicines stood at 400 to 800. Merriment ensues when she acknowledges that under her leadership the figure has reached 2 600. Or there is the Aussie member of the review team, Hill, who is asked whether it would not have been appropriate to have informed Schlebusch and his deputy of the allegations against them and to have asked for their comments. Her reply was that it was not their role to do so and, whatever the responses, it would not have altered the views of the review team. A variety of endings can be offered for this extraordinary film. Obviously there would be scenes of general delight as a stern labour commissioner announces he is not only ordering the reinstatement of Schlebusch and his deputy, but is taking the unusual step of awarding costs against the Department of Health for its “frivolous and vexatious” defence of the case. The pay-off line could be the part where the labour commissioner asks Schlebusch what the practical effect would be of his reinstatement as registrar. “The directorate is in a major crisis at the moment,” Schlebusch replies. “I know for a fact that control has collapsed. Unregistered products are pouring into the market … I can go a long way in putting Humpty Dumpty together again.” Then, as a children’s chorus is heard (voice over) chanting the famous nursery rhyme (“… but all the king’s horses and all the king’s men couldn’t …”), text will flow across the screen detailing what subsequently happened in case No GA51345, being the matter of Schlebusch versus the Department of Health. l The CCMA ruled that the employees in question had been wrongfully dismissed.