Solidarity and South Africa’s healthcare professionals
On 16 April 2013, the Health Professions Council of South Africa (HPCSA) announced its withdrawal from its participation in the Africa Health Exhibition, which had been scheduled to be held between 7 and 9 May in Johannesburg. The HPCSA stated that it had made this decision after thoughtful consideration and deliberation, and in support of the growing dissatisfaction amongst healthcare practitioners with the manner in which the detention of Professor Cyril Karabus had been handled in the United Arab Emirates (UAE).1 The Africa Health Conference was organised by Informa Life Sciences Exhibitions, which has its headquarters in Dubai (UAE). Karabus (78) is a paediatric oncologist who gave many years of his life, and continues selflessly giving of himself and his expertise, to sick children in the country and further afield.
Karabus was convicted of manslaughter in absentia for the death of a Yemeni girl with acute myelogenous leukaemia. He had cared for her while doing a locum in Abu Dhabi in 2002. On his way back to South Africa from his son’s wedding in Toronto, Karabus passed through the Abu Dhabi airport on 17 August 2012. He was arrested as he was in the process of boarding his flight back to South Africa on 18 August. It was only then that he learnt of his trial and conviction in absentia. Five court appearances later, and despite competent legal representation, he was released on bail to await retrial.2 He was found not guilty on 21 March, after a judicial medical advisory committee cleared him of any wrongdoing or neglect. He was cleared of all charges of manslaughter and forgery. However, his passport was held back by UAE authorities in order to allow the prosecution team to mount an appeal.3
The HPCSA’s Acting Registrar at that time, Advocate Tshepo Boikanyo, stated ‘As the custodian of healthcare ethics and standards of professional conduct of registered healthcare practitioners in the country, the HPCSA is appalled at the manner in which the UAE has handled the Karabus case. As such, we have decided to boycott the conference and exhibition as we will not be associated with the travesty of justice as in this case.’1
Three days later, on 19 April, the South African Medical Association (SAMA) released a statement supporting the stand of the HPCSA, based on the ‘inhumane manner’ in which the case was being handled by the UAE authorities.4 Close on its heels, the Professional Ethics and Standards Committee (PESC) of the University of the Witwatersrand’s Faculty of Health Sciences announced its backing for sanctions and, while recognising academic freedom and personal choice, recommended that the faculty withdraw its participation. This standpoint was endorsed by the Dean of the faculty. A similar statement was then issued by the Dean of the University of Cape Town’s Medical School. The KwaZulu-Natal Managed Care Coalition (KZNMCC) and the Independent Practitioners Foundation also withdrew their support of the Africa Health Conference. In support of this stance and in solidarity with their colleague, many academics withdrew their participation from the conference, and the sessions on obstetrics and gynaecology, paediatrics, nursing and sports medicine were ‘postponed’. In addition, there was a noticeable paucity of top academics from the country in the sessions that did go ahead.
By April, Karabus had been subjected to 57 days in Al Wathba Prison and 13 postponements in the case against him by the UAE judicial system. On the international front, the World Medical Association (WMA) condemned the manner in which Karabus had been treated. On 23 April, the day of yet another postponement, the WMA stated that this was further proof of his inhumane treatment: to quote WMA President Dr Cecil Wilson, ‘The way in which Professor Karabus is being treated is a disgrace and contrary to the rule of law.’5 The WMA also cautioned doctors considering working in the UAE to note the legal risks of employment and the working conditions in the region.
It is accepted that when a devoted, dedicated, altruistic, compassionate and caring doctor is subjected to unjust and inhumane treatment, healthcare professionals, the Regulator, associations and others will react and call for action. The call for the boycott of the Africa Health Conference came because the organiser, Informa Life Sciences Exhibitions, is headquartered in the UAE.6 For those who experienced South Africa in the 1980s, this form of advocacy served as a reminder of the sanctions that were imposed on the country at that time. While some have questioned a pursuit of this nature based on the claim that the organisers are not affiliated to Dubai, it is naïve to imply a lack of relationship and affiliation when their offices are located in Dubai. Interestingly, there was a notable change in the Informa Life Sciences website7 between early April and early May: the statement ‘The Informa Life Sciences Exhibitions offices are located in Dubai, UAE’ had been deleted. Could this have been as a result of the implications of the solidarity demonstrated by SA’s healthcare fraternity and a measure to avert the possibility of a failed conference?
The notion of solidarity is not new to South Africans, especially in light of our history of struggle against a past regime steeped in human rights abuse. Simply put, the dictionary defines solidarity as a sense of unity or agreement of feelings or action, especially amongst individuals with a common interest.8 There is recognition of the duty to support colleagues who uphold core values such as respect, integrity, compassion and justice, both by healthcare professionals in the country and the Regulator.9 Solidarity and harmony are intricately linked and, according to Metz,10 harmony could be understood as a combination of identity and solidarity. Identifying with each other results in the conception of ‘we’, and as a consequence behaviour is co-ordinated to realise shared outcomes. Outright division, and thinking as ‘I’, is a product of failing to identify with each other and purposefully undermining one another’s ends. A failure to exhibit solidarity could essentially denote ill-will.
Although the show of solidarity in the context of Karabus and the UAE has been slated by some11 as ‘unethical’, ‘unprofessional’, and ‘emotional’, and the Regulator, associations, and institutions have been accused of misinforming and misguiding doctors, it is clear that camaraderie is alive and effective amongst healthcare professionals in South Africa. Collegiate duties and advocacy towards those being treated unjustly is not just lip service – it is genuine and taken very seriously by the caring professions.
1. The Health Professions Council of South Africa. http://www.hpcsa.co.za/downloads/press_releases/presss_release_2013/hpcsa_med_rel_hpcsa_withd_parti_protest_of_pract_treat_16_apr_2013.pdf (accessed 30 April 2013).
2. Zwelling LA, Kurzrock R, Cohen PR, Levin B, Parish LC. The Karabus affair speaks to larger issues for American academic and medical centres. Clin Dermatol 2013;3:325-326.
3. Bateman C. Karabus’ ‘Argo moment’ a long time coming. S Afr Med J 2013;103(5):281-282. [http://dx.doi.org/10.7196/SAMJ.6924]
4. SAMA Corporate Communications. SAMA supports HPCSA in its Africa Health Conference stance. Med-e-mail 2013;8(221).
5. World Medical Association. WMA condemns further postponement of the case against Professor Karabus. http://www.wma.net/en/40news/20archives/2013/2013_12index.html (accessed 24 April 2013).
6. Informa. http://www.informa.com/What-we-do/Business/Events--Training/. (accessed 30 April 2013).
7. Informa. http://informalifesciences.com/en/contactus/. (accessed 5 May 2013).
8. Thompson D, ed. The Concise Oxford Dictionary. 9th ed. Oxford: Clarendon Press, 1995:1323.
9. Health Professions Council of South Africa. General Ethical Guidelines for the Health Care Professions. Booklet 1. Pretoria: HPSCA, 2008. http://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_1_guidelines_good_prac.pdf (accessed 30 April 2013).
10. Metz T. African and western moral theories in a bioethical context. Dev World Bioeth 2010;10(1):49-58. [http://dx.doi.org/10.1111/j.1471-8847.2009.00273.x]
11. Chima SC. Comments on the legal case of Prof Karabus and the African Health Congress. Received by email. 3 May 2013.
S Afr J BL 2013;6(1):2-3. DOI:10.7196/SAJBL.271
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