Grahamstown doctors would never refuse treatment to HIV positive patients, but they are sometimes obligated to refuse to administer anti-retrovirals (ARVs) to certain people.
Grahamstown doctors would never refuse treatment to HIV positive patients, but they are sometimes obligated to refuse to administer anti-retrovirals (ARVs) to certain people.
This emerged after a resident approached Grocott’s Mail claiming that a local physician had denied treatment to some of his patients.
Dr Jerome Boulle, who works at Masonwabe Clinic at Settler’s Hospital, said that while ARVs are readily available free of charge, doctors may refuse the drugs if patients do not meet the requirements for taking them.
Compliance with the treatment programme is critical for HIV patients. There is no promise that ARVs will work for each and every person, and according to Boulle, there needed to be 85 to 86% compliance.
“Anything less than that,” he explained, “and the patient is at risk of developing a resistance to the drug.” Boulle also stressed the importance of patients being open and honest with their doctor about the number of pills they have or are taking.
A doctor invests time in each case, but with every patient there is a limit. “After that they will no longer access ARVs, unless the circumstances change,” he said. “Patients are part of the solution, but they can also be part of the problem.
And then it’s very difficult to look a patient in the eye and say, ‘I’m not going to help you.’ Boulle said that patients were given supplements before the ARV course of treatment begins.
These supplements would benefit patients suffering from a deficiency disorder and some were added in to offset relative deficiencies caused by other drugs such as those used in TB treatment.
Taking the supplements provided an opportunity for patients to prove that they were able to follow a treatment programme properly.
If patients failed in this, then the likelihood that they would not take their ARVs as prescribed was high. “We don’t base our decision only on a subjective interview,” he added.
“We look at blood parameters and social factors as well.” He mentioned the importance of monitoring the ARV treatment process.
“If we just handed out ARVs, we could have deaths attributed to the taking of ARVs. There can be overdoses if there is inadequate monitoring.”
A spokesperson for the Department of Health in the Eastern Cape, Sizwe Kupelo, said that any decision to administer ARV treatment was based on medical results.
“If some patients cannot take ARVs, they will need psychological treatment to understand why. If they are still unhappy, then they can seek another medical opinion.
Only another doctor can overrule the decision.” He said it is understandable for doctors to deny treatment, unless the patient had been dismissed without the backing of medical reports.
“That is very serious,” he said. “We must take action against doctors who do that.” Boulle explained that the decision to refuse treatment was not entered into lightly.
“Patients may well be dissatisfied. But I have the backing of my colleagues”. He added that as far as he knows all the qualified octors in Grahamstown follow internationally accepted guidelines.
Boulle mentioned that the political pressure to acquire ARVs has led to a vast amount of resources directed toward getting the drugs. He believes this is to the detriment of healthcare in general.
“How do we reverse this? Outside the country, doctors are paid well forthis kind of work. We’re not paid well in South Africa.”
Kupelo said that the Health Department has acknowledged the problems doctors faced.“We have been increasing doctors’ alaries and giving bursaries to medical students,” he said.
“We have also been busy processing forms for 79 foreign doctors to work in the Eastern Cape.” Some doctors have left the Eastern Cape to work in provinces where there are better facilities.
“These problems won’t be addressed overnight,” Kupelo said. “We also need the community to help the doctors.”
