Whoever said that the wheels of justice grind slowly must have had Dr Malcolm Naude in mind. Almost seven years ago, he was dismissed from Nelspruit’s Rob Ferreira Hospital. At the time, government would not provide post-exposure prophylaxis (PEP) — a course of antiretroviral (ARV) medicines to reduce the risk of infection following exposure to HIV — to rape survivors.
Together with other healthcare providers, Naude decided to prescribe PEP, in accordance with his conscience and ethical and professional obligations. Tomorrow, Naude’s challenge to his unfair dismissal is finally going to trial. It has taken so long because the provincial department of health, and its lawyers, have unnecessarily delayed matters. Attempts to settle the case have also been spurned.
For those who don’t remember Sibongile Manana’s reign of terror as Mpumalanga’s minister for health, just think of Peggy Nkonyeni’s tenure in KwaZulu-Natal and imagine how that would have played out in a context where the science of HIV prevention and treatment had yet to feature prominently in our national response. Today, the same Manana sits on Parliament’s portfolio committee on health. Plus ça change …
Naude’s case has its origins in early 2000, when doctors and nurses at Rob Ferreira jointly established a rape crisis centre with the police and the Greater Nelspruit Rape Intervention Project (Grip). Part of the centre’s services included the provision of PEP — at Grip’s expense — to rape survivors. At the time, Manana’s department was particularly hostile to the use of ARV medicines for this or any other purpose.
The official response was quite predictable. The provincial department issued an instruction that hospital doctors were not permitted to prescribe ARV medicines for PEP. Naude and his colleagues, who believed this was an unwarranted interference in the exercise of their professional and ethical responsibilities, continued to do their jobs. When PEP was medically required, they prescribed ARV medicines.
In response, Manana and her goons insisted that Grip vacate the rooms at Rob Ferreira where the organisation provided its services. When Grip stood firm, the department initiated eviction legal proceedings. In support of Grip’s defence, which ultimately proved successful, Naude deposed to an affidavit. True to form, Manana’s department terminated his services.
Naude was not the only casualty. Disciplinary action was also taken against Dr Thys van Moellendorff, the chief troublemaker in Manana’s eyes. His unfair dismissal was ultimately overturned, but by then he had sought and found employment elsewhere. As already mentioned, Grip was also targeted. In fact, the only person who escaped largely unscathed was Manana herself. Her time will, I believe, eventually come.
While Naude’s case is argued, similar sorts of harassment continue in places such as Manguzi. Ultimately, however, it is the president — and his utterly incompetent and malevolent health minister — who must take responsibility for having unleashed a war on science that allows for political interference in clinical decision-making to be considered acceptable. Of all of Mbeki’s blunders, this must rank amongst the worst.
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