N Madlala-Routledge: World Medical Association Africa Region

9 October 2006

President of World Medical Association Dr Kgosi Letlape
Council members of the World Medical Association Africa Region
Distinguished guests

It is an honour for me to address the Inaugural Council and General Assembly
of the World Medical Association Africa Region. It was a triumph that the
Africa Region grouping was launched earlier this year. It is commendable and
insightful that the World Medical Association Africa Region has convened to
consider its role under the theme "Human Resources Challenges in Health – An
African Perspective". This is responding to an urgent crisis in the global
shortage of medical personnel, which has been identified by the World Health
Organisation (WHO). As Africa and part of the developing world, we are hardest
hit by the migration of our medical professionals to developed countries. We
are therefore honoured that the WHO Report for 1996, which has a special focus
on health workers, was launched in Lusaka, Zambia on the 7th of April this
year.

Prior to our democracy in 1994, South Africans were isolated from one
another and from our brothers and sisters on the African continent. Now South
Africans in the medical profession have had the opportunity to unite and learn
from one another in the South African Medical Association (SAMA). The
inauguration of the World Medical Association (WMA) Africa Region gives an
opportunity for all medical personnel in Africa to learn from one another and
provide leadership and guidance on matters that are particular to Africa. They
have an opportunity to represent Africa’s health priorities and share Africa’s
expertise with the world, through the World Medical Assembly.

You have given South Africa the privilege of hosting this inaugural
gathering and we hope we are able to live up to your expectations. I had the
privilege last month of addressing the South African Medical Association and I
know they will do everything in their power not to let you down. In choosing to
launch the WMA Africa Region you have stepped up to the starting blocks to
provide ethical and scientific leadership in Africa, as does the WMA worldwide.
The Geneva declaration provides guidance for the training of doctors and the
conduct of the medical profession. The Tokyo declaration was a beacon of hope
in South Africa when people were being detained without trial and tortured. The
Helsinki declaration gives ethical guidance in medical research involving human
subjects.

Other functions of the WMA that can be developed in Africa are regional
conferences, continuing education, development and lobbying on public policy,
support and development of African medical journals, ensuring ethical and
scientific standards, raising human rights issues, particularly those related
to health and the medical profession, as well as looking after the interests of
its members. As part of professional development, I hope you will be discussing
an exchange of your association’s medical journals and contributing to the
research and publication of articles.

It is important that there be a strong and representative Africa Region of
the WMA as Africa provides particular challenges which you have chosen to put
yourselves in a position to address.

When he addressed the opening of the 48th General Assembly of the WMA in
Cape Town, the then deputy president of South Africa and now president, Mr
Thabo Mbeki, made a number of important points. He highlighted what happens
when there is not a strong and representative medical association to provide
the ethical leadership and guidance that is necessary.

The former Medical Association of South Africa (MASA) adopted a resolution
of "unreserved apology to persons, within and outside the medical profession
who might in the past, have been hurt or offended by acts of omission or
commission on its part in the past". They were referring to their going along
with apartheid policy and not allowing black people to join their association,
as well as the acts of MASA members who had not provided the best possible
health care for people detained by the state without trial, including Steve
Biko, who was not given proper medical care and died in detention. We are glad
that we now have one united and representative medical association in South
Africa.

On the issue of professionalism, he said the challenge of those working for
unity in the medical profession was to create a body, one of whose prime
objectives was to "strive for the best possible health care for all." This body
should be seen to promote the public interest and not merely the narrow
interests of its members.

President Mbeki also identified the challenge of the migration of doctors
and other health professionals. This is another issue to which a strong and
representative medical association in Africa could make a valuable contribution
and you have identified this as one of the focal points of your deliberations.
He issued a challenge to develop an international declaration on the issue of
medical migration. Perhaps this could be the Pilanesberg declaration, which
comes out with a creative and innovative solution to this problem.

South Africa has committed to doing our best to ensure that the continent’s
resources are not depleted in the way that ours have been depleted through
migration. We have undertaken to abide by ethical migration policies and will
only enter into professional exchanges under the auspices of
government-to-government agreements. Furthermore, a certain number of places at
health sciences faculties as well as other faculties go to students from other
African countries that are generally treated as local students.

President Mbeki acknowledged that we all compete as part of the global
village and that migration of doctors from poorer to richer countries is one of
the consequences. This competition also focuses on the important question of
the economy. Effective measures that promote and protect the health of all
citizens, and good healthcare for all those who do fall ill are not only
desirable goals. They are also an important factor for economic
development.

Since the WMA and its constituent national associations wish to fulfil their
objective of "striving for the best possible health care for all," it may be
that we should explore the economic benefits of better health services and
which services provide the greatest benefits. Armed with information, you will
be in a strong position to support your Ministers of Health and to argue for
greater resources for appropriate healthcare.

He ended with a plea. "May the people who need healthcare the most, the poor
and the least powerful in our societies, benefit from your assembly." These are
points that the WMA Africa Region may choose to address as it works with its
present membership, while at the same time striving to extent its membership to
all 52 African countries.

Other issues that the WMA Africa Region may choose to take up are:

* how to provide the "best possible healthcare for all" in poor
countries?
* bridging the gap between the private and public health sectors
* the relationship between medicine and traditional healing and how to
co-operate in developing the scientific understanding of traditional therapies
and practice
* scientific and ethical guidance to governments on HIV and AIDS as well as
other diseases that affect Africa in particular.
* co-operating with other health professions such as dentists, nurses,
pharmacists and technologists in forming strong national and continental
associations and giving ethical and scientific leadership on health issues in
Africa.
* co-operating with the academies of science in forming strong national and
continental structures to provide the scientific advice and research to guide
governments on addressing health issues such as HIV and AIDS, TB and
malaria.
* the role of the medical profession in areas of conflict and post conflict
reconstruction in Africa. Apart from the loss of lives from war, there are
severe physical and mental consequences, which place an increased burden on an
already overburdened health system where health facilities may also be
destroyed.
* how to save Africa’s children who die because their parents are poor? We need
to step up immunisation coverage. We need to combat mother to child
transmission of HIV. We need to access to treatment for children a
priority.
* how to save the lives of African women who die each year from preventable
diseases? Many of these women are of child-bearing age and at the prime of
their lives and die from pregnancy complications and during childbirth. All
reports indicate that women bare the biggest brunt of the HIV and AIDS
pandemic.

No doubt these and others are the subjects of your deliberations now and
your plans for the future. It is encouraging to note that your meeting will
also address the burden of diseases facing developing countries. Demographic
transition, globalisation and development have brought about a new disease
profile, an epidemiological transition, which is especially very noticeable in
the developing world. Lately there has been a decline of infectious diseases,
an upsurge of new infections such as HIV and AIDS and the re-emergence of "old"
infections like TB, cholera and malaria. You can help us rid Africa and the
world of these health emergencies.

In his inaugural presidential address to the WMA General Assembly last year
in Santiago, Chile, Dr Kgosi Letlape chose to focus on "patient centred medical
care" as his presidential initiative. How wonderful it would be if the WMA
Africa Region took the lead in this initiative. He also identified two themes
in the vision of the WMA, ethics and access. "Whilst we have been at the
forefront on ethics, there is still al lot to be done on access. We have a
collective responsibility globally to ensure access to basic healthcare for all
citizens of the world." Again it would be wonderful if the WMA Africa Region
took the lead.

I have touched on the huge challenge facing the health system, posed by the
growing burden of HIV and Aids. To illustrate, allow me to quote statistics
from South Africa. According to the 2006 report of the Medical Research
Council, there are now an estimated 5,54 million HIV-positive South Africans.
More than a quarter of a million South Africans died of AIDS related illnesses
in the past year. Tuberculosis, one of the most prevalent of the AIDS defining
illnesses, has emerged as one of our biggest challenges as we battle the HIV
and AIDS pandemic. We are seeing a growing number of multi-drug resistant TB.
We need your research expertise in finding new and more effective drugs and
technologies to fight TB, which together with HIV have become huge medical
threats to our lives.

Through broad consultation the South African government developed a
comprehensive plan and strategy on HIV and AIDS. With Deputy President
Mlambo-Ngcuka at the lead, there is new hope and we appeal to all to unite
behind her efforts to unite the nation in fighting HIV and AIDS. We also appeal
to all to help us accelerate the implementation of the Comprehensive Plan on
HIV and AIDS. This plan provides a platform for united action in the campaign
to reduce new infections, provide treatment and care and conduct research. This
places us in a good position to give patients the best available scientific
information about prevention, treatment and care.

As doctors you can help us especially with treatment literacy and the
medical management of HIV and AIDS. A recent study published by the Health
Systems Trust of South Africa found that knowledge about treatment for HIV and
AIDS is very low in South Africa. Many infected people die before they have a
chance to receive appropriate medical treatment.

I am disturbed to learn from the report about how some unscrupulous
traditional practitioners are ripping our people off, promising them a cure.
The saddest part is that some of our nurses are reported to be involved in
directing patients to traditional practitioners when they come to our health
institutions.

You can help us fight the stigma around HIV by offering voluntary
counselling and testing to your patients. I am encouraged to see inclusion of
the "D" of disclosure to the ABC prevention message. It has been pointed out
that we need to strengthen our prevention campaign and go beyond the
abstinence, be faithful and condomise message. Socio-economic factors like
poverty and gender inequality are and socio-economic inequality is undermining
the prevention campaign. You can help promote disclosure by encouraging your
patients to disclose to their spouses and partners.

You are bound by the Hippocratic Oath to protect the human and legal rights
of your patients and you may not disclose their HIV status without their
permission. I trust that you would as concerned for the partners of your
patients as well. I therefore would urge you to, within the limitations of the
law and the ethical code that regulates your professional conduct, you assist
us in getting your patients to agree to disclose to their partners. Many women
in stable "monogamous" relationships are infected by their partners. Gender,
social and economic inequalities render poor women particularly vulnerable to
the ravages of the HIV pandemic.

In closing I wish to pay a special tribute to medical science for helping us
find solutions to our medical problems. While there is as yet no cure for HIV
and AIDS, scientific advances have been made in treatment and care. When
combined with good nutrition and a healthy lifestyle, treatment with
antiretrovirals (ARVs) for those who need them and qualify, has been shown
scientifically to prolong lives.

So far, the only effective method of stopping people getting infected who
have been exposed to HIV, either from needle pricks or after rape, is
prophylactic treatment with ARVs. Post-exposure prophylaxis is the only hope
for rape survivors and needle prick victims. ARVs have also been found to be
effective in the prevention of mother to child transmission from HIV positive
mothers. This is the basis for the message of hope that must go out to people
who are trying so desperately to live.

South Africa and I am sure other countries as well, need strong ethical and
scientific leadership from the organised health profession, as it seeks to
educate and guide people who are desperate for a cure and are easy prey for
those who offer promises of cures based on anecdotal evidence that does not
stand up to the rigours of scientific evidence based research.

With the launch of the World Medical Association Africa Region we can expect
innovative interventions and strategies that will contribute to solving medical
problems on the continent. I wish you well on the launch of the WMA Africa
Region as you continue your deliberations and contribute to the WMA General
Assembly for the first time later this week. I am sure the WMA Africa Region
will make a significant impact.

I thank you.

Issued by: Department of Health
9 October 2006