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Patients before process, say doctors

The KwaZulu-Natal health department has identified a quiet rural doctor as a troublemaker, charging him with misconduct for “wilfully and unlawfully without prior permission of [his] superiors rolling out prevention of mother-to-child HIV transmission dual therapy to pregnant mothers and newborns”.

But in charging Dr Colin Pfaff, of Manguzi Hospital on KwaZulu-Natal’s border with Mozambique, the department has stirred up a hornet’s nest among discontented public service doctors, who are tired of being punished by bureaucrats for putting patients before process — especially when dealing with HIV/Aids.

There has been a flurry of condemnation from medical organisations and doctors countrywide are signing a petition in support of Pfaff demanding that the charges against him be dropped immediately.

Dr Francois Venter, of the South African HIV Clinicians Society, said that disciplining Pfaff “for doing his ethical duty is disgraceful”.

“We call on KwaZulu-Natal to implement dual therapy immediately across the province with the same energy they have expended on his case,” said Venter.

Pfaff, a committed Christian, described by friends as a “humble visionary”, raised money from overseas donors to supplement his hospital’s nevirapine-only treatment programme for HIV-positive pregnant women with another antiretroviral drug, AZT. The donations were channelled through the Manguzi Mission fund, not the hospital.

The Western Cape has used AZT and nevirapine since 2004 and has cut the mother-to-child HIV transmission to 8%. In KwaZulu-Natal, which still uses nevirapine only, 22% of HIV-positive mothers infect their babies.

Dr Victor Fredlund, the medical manager of Mseleni Hospital, also in the Mkhanyakude district in the far north of KwaZulu-Natal, explained what drove Pfaff to seek donations to buy AZT for his patients.

“Our nevirapine programme was reaching nearly all pregnant mothers. Yet more than 100 babies a month were still being born infected with HIV,” said Fredlund.

“All the scientific literature and the Western Cape experience suggested that we could reduce transmission to a quarter of that, saving 75 or more babies a month, by introducing AZT during pregnancy.”

While the national government finally adopted dual therapy last month, the KwaZulu-Natal health department has yet to implement it, blaming budget and capacity problems.

Fredlund wrote to Dr Sandile Buthelezi, head of HIV/Aids in KwaZulu-Natal, to express his support for Pfaff and to say he will do the same unless the department speeds up the introduction of dual therapy. However, far from backing down, this week health spokesperson Leon Mbangwa confirmed the charge against Pfaff and added another: that he “acted beyond his authority in accepting a donation”.

Mbangwa declared: “We will not allow anyone to pull vulturistic theatrics to mystify this matter for their own political gains. We will continue to put the interest of our people first.”

Ironically, far from being in the interests of KwaZulu-Natal’s people, the department’s decision to charge Pfaff is likely to have an adverse impact on health service delivery in the province.

A number of doctors who did not want to be named said this week they felt “demoralised” and “angry” about the incident. One said he was suspending a major health initiative at his hospital that involved donor funds until there was clarity about the use of donations.

The Pfaff case is reminiscent of what happened at Rob Ferreira Hospital in Mpumalanga in 2001 when Dr Thys von Mollendorf was fired for allowing the Greater Nelspruit Rape Intervention Project — which provided free antiretrovirals to rape survivors — to operate at the hospital.

Although Von Mollendorf was found not guilty of insubordination two years later, the case led to an exodus of demoralised doctors from Mpumalanga. The province is so short of doctors now it has cut services in a number of hospitals. — Health-e News Service

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Kerry Cullinan
Kerry Cullinan is an award-winning journalist, who has been Managing Editor of Health-e since 2005

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