[procaare] South African Doctors Speak from AIDS Coalface

[ProCAARE <procaare@healthnet.org>]

* Mod note: this posting was delayed due to the HCC e-discussions, however we thought it
interesting to post now...

Doctors speak from AIDS coalface
****************

An Open Letter From Six South African Doctors
The Cape Times, 14 April, 2003

Mr J Zuma (Deputy-President)
Dr ME Tshabalala-Msimang (Minister of Health)
Mr A Erwin (Minister of Trade and Industry)
120 Plein Street
CAPE TOWN 8001

Dear Mr Zuma, Dr Tshabalala-Msimang and Mr 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
We write as a group of doctors working at primary healthcare 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 healthcare team, good nutrition and timely treatment of
opportunistic infections are inevitably eventually not enough. Daily we see
the devastating effects of the disease on families and communities.

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 healthcare infrastructure is often inadequate
and that the provision of ARVs should not be at the expense of the broader
healthcare 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 healthcare delivery,
as well as boost the morale of healthcare 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 decrease stigma in communities, and thus 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 Antiretroviral.
Treatment 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 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 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 that includes access
to antiretroviral therapy in the public sector.

Sincerely

Dr Karen Cohen
Dr Ruth Cornick
Dr Beth Harley
Dr Francois Louis
Dr Catherine Orrell
Dr Eve Subotzky

10 April 2003

(Cross-posted from HealthLink & AF-AIDS)
http://news.hst.org.za/view.php3?id=20030416
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