Take2: Winds of change sweep SA healthcare

Original Source

The University of KwaZulu-Natal is an Atlantic grantee.

by ANNABEL JACOBY

JOHANNESBURG, SOUTH AFRICA – As recently as last year, professors Hoosen Coovadia and Salim Abdool Karim, two of South Africa’s foremost HIV researchers, were two of the health department’s greatest enemies. Former health minister Manto Tshabalala-Msimang made no secret of her intense dislike for them. While the international medical world quoted Coovadia and Abdool Karim in respected science journals and assigned them to head groundbreaking research projects, the minister bluntly refused to engage with them.

Instead, Tshabalala-Msimang frequently accused them of being “irresponsible” for promoting “poisonous” antiretroviral drugs — the medicines that have been scientifically proven to prolong the lives of HIV-positive people and to prevent mother-to-child transmission of the syndrome. At the International Aids Conference in Durban in 2000, she publicly reprimanded them and spat that Coovadia and Abdool Karim should “shut up and listen” to her.

But this week, a drastically different situation regarding the two eminent scientists presented itself.

When the two researchers headed a Johannesburg panel on behalf of the prestigious British medical journal, the Lancet, that challenged the government to speed up its health reform efforts, the new health minister, Dr Aaron Motsoaledi, openly embraced Coovadia and Abdool-Karim. 
Firstly, Motsoaledi actually turned up at the event — in stark contrast with Tshabalala-Msimang, who more often than not boycotted events not organised by her department.

Secondly, the new health minister actually stayed for the entire three-hour function, and not just to deliver his speech. Thirdly, he publicly announced that he takes “responsibility [as a member of the ANC] for the deterioration of the health system and how we move forward”. And lastly, he spoke about his relationship with the country’s leading medical researchers with an ease that Tshabalala-Msimang most certainly would have found extremely offensive.

“I’m in very good company,” Motsoaledi announced, while looking directly at Coovadia. Then, the minister added, “Hoosen was my lecturer in paediatrics when I was a medical student. I learned a lot from him. And I am still learning from him.”

Next, Motsoaledi’s eyes focused on Abdool-Karim, who heads the Durban-based Centre for the Aids Programme of Research in South Africa, Capresa. “I’ve always known Salim as “Slim”, the minister purred, “We were classmates in medical school at the University of KwaZulu-Natal in 1985. Together, we studied very hard!” Motsoaledi chuckled.

Next to Abdool-Karim sat professor Bongani Mayiso, of Groote Schuur Hospital in Cape Town, who Motsoaledi had in the mid-eighties mentored as the chairperson of the students representative council when Mayiso was a first year student.

After the minister’s speech, when everyone had expected him to beat a hasty exit, he stood up, only to stride to a seat in the front row. Taking out a notebook and pen, Motsoaledi began to take notes as other speakers presented their views on the nation’s health crisis.

Unlike Tshabalala-Msimang, who seemed always to be wagging a finger at perceived enemies in her attempts to “enlighten them”, Motsoaledi appeared eager to learn.

When the Lancet editor, Richard Horton, announced that his journal had come up with a “reparation plan” for South Africa’s health sector, Motsoaledi didn’t dismiss it. Instead, he carefully examined it and excitedly announced that his own ten-point plan for health reform bore striking similarities with that of journal. “It is evident that all is not right with the health system and health outcomes in our country,” he announced. “I will not disagree with your analysis,” he told Horton.

To audience members familiar with Tshabalala-Msimang’s contempt for criticism, Motsoaledi’s response was nothing short of amazing. He also astounded the audience when he responded to an international journalist’s question on whether he’d be willing to fire poorly qualified health department officials.

“People previously seemed to think that anyone could manage a health institution,” he stated. “That’s not true, you need to understand the health system and have a medical background. You can’t just be a manager, and therefore I will soon be evaluating all hospital managers accordingly. Only those who are qualified will be afforded the opportunity to stay on.”

All of this, reason for optimism as it is, is of course no guarantee that Aaron Motsoaledi and his oft maligned health department will deliver. It’s also no indication that he’s indeed got the ability to do so. But what it does unequivocally say is that the minister’s manner allows him to work with people that could contribute immensely to health reform in this country in the near future.