Many of these doctors work in difficult circumstances in Department of Health facilities and feel demoralised by unnecessary and ongoing attacks on the integrity of people who try to do their best for their patients.
Dr Pfaff and his colleagues have lead the expansion of the PMTCT programme in the area around Manguzi in KwaZuluNatal, using drugs purchased through a donor and at no cost to the Department. He has acted using WHO recommendations to expand the programme to make prevention more effective, building on existing Department guidelines. Dual therapy for PMTCT has been implemented highly effectively in the Western Cape, and has been adopted by the National Department. Expanding PMTCT beyond single dose nevirapine will save thousands of infant lives a year. His actions will save many rural families the pain of the death of a child.
Dr Pfaff has worked in one of South Africa's most rural and underserved areas for a decade, where it is notoriously difficult to attract and retain medical staff. Manguzi Hospital is on the border of Mocambique, far from the urban safety net provided by referral hospitals. The people it serves are amongst the poorest in the country. Despite lip service to supporting these areas, reports from medical staff of continued departmental bureaucratic incompetence and obstruction continue to surface.
The institution of disciplinary action against Dr Pfaff for providing better therapy than that advised by the Department is symptomatic of the lack of initiative and crude politicking that still seems to plague our country's response to HIV. The KZN Department of Health was very slow in initiating the ART component of the comprehensive plan, and has not moved convincingly on improving its PMTCT coverage, which remains shamefully low in the province. That they find the time and energy to move against an effective member of their staff is woeful. Their reported comments that his actions are ‘unlawful' are bizarre – doctors are expected to provide the best health care they can using available resources, and doing anything less would be regarded as a dereliction of duty.
Dr Pfaff should be saluted as a hero – he demonstrates the level of commitment, creativity and care for his patients that we should be demanding from all health care practitioners. To discipline him for doing his ethical duty is disgraceful.
We demand the immediate dropping of all charges against him. Other health care workers should carefully evaluate how they can, similarly to Dr Pfaff, strive towards the HIV health targets set out in the South African government's National Strategic Plan, including decreasing mother-to-child HIV prevention below 5%. Finally, we call for the KZN to immediately implement dual therapy across the province with the same energy they have expended on his case.
Issued by:
Southern African HIV Clinicians Society, 10 February 2008; http://www.sahivsoc.org/; for more information sms Dr Francois Venter at 0833991066, or email at .
