Friday, May 18, 2012

The Biggest Betrayer

The last time I spoke to Atupele Muluzi and Henry Phoya was in July last year. I was working on a feature in which I intended to compare their visions for Malawi – if at all they had any – and whether they saw themselves standing in the 2014 presidential elections. With the young Muluzi, it was already clear that he was willing to stand, while Phoya had not come out to give his views on whether he would stand or not.

My attention was immediately drawn to the 20 July demonstrations because they stole a good chunk of publicity. I postponed my assignment on the two politicians and informed them I would be back, something I never did.

Then just at the beginning of last month, I decided to resuscitate my assignment. I was more interested now than ever before because Muluzi had come up with his ‘agenda for change’ while Phoya seemed to have hibernated into a slumber after joining the Malawi Congress Party (MCP). Again, fate overtook my project and I found myself concentrating on the death of President Bingu wa Mutharika and the events that were likely to follow.

Of course, Mutharika’s death brought me to thinking that Atupele’s visions suddenly became blurred since his main aim was to change ‘anomalies’ that were being committed by the Mutharika administration. I however, was hopeful that there were some more important things that the young Muluzi would want to pursue within his ‘agenda for change’.

But, I was shocked to the core when I learnt that Atupele had accepted to be included in the new cabinet. He is now Minister of Economic Planning and, politically, that doesn’t seem fair enough to his supporters. I have to be honest, being one of the youths who are struggling to find employment these days, I liked Atupele’s vision of creating numerous job opportunities.

And with his joining government, I have seen in him the greatest betrayer of our time. I don’t know what Atupele and President Joyce Banda agreed, but I should think most people especially the youth of this country feel terribly betrayed. We banked our hopes on him such that we would even generously vote for him come 2014, but now we feel like we don’t have a clear direction.

Of course, he is saying that he still remains a member of United Democratic Front (UDF), but it seems rather hard to imagine that he would be able to campaign freely against a government he belongs to. One thing that is clear about politics everywhere in the world is that new candidates often capitalise on the mistakes made by the current power holders to replace them. Will Atupele capitalise on JB’s mistakes now that she is his boss?

Well, he may choose to resign from his ministerial position as elections close nigh, but will his supporters understand him? After all, he recently said that his aim was to see things change in Malawi, and now that fate chose to change things, he was fine with that. He informed us that he wasn’t after presidency; rather, he was after change.

Personally, I haven’t attended any of Atupele’s political rallies, but on a number of occasions, I have been reliably informed about how large the crowds were. I was told his rallies attracted more people than Mutharika’s, and that is where one wonders why the young Muluzi has been easily drawn into submission when two years were just two little for a man with a vision.

Atupele seemed to be the favourite among many aspiring presidential candidates because of his clean record in politics. The last time I checked, the young Muluzi hasn’t had any patch on his political career. It is only his decision to accept a ministerial position that seems to have somehow tainted his political image, but let’s hope even that will be rectified the soonest; otherwise, for the time being, we remain feeling betrayed.

As for Phoya, it is hard to accuse him of having betrayed us because he never came in the open that he was aspiring for presidency come 2014. Of course, he was one of the youths’ favourites, but a decision to compete in the presidential elections solely remained his.

The Morality of Medical Workers' Strikes

For patients whose lives are hanging on a thread, it makes sense to see a medical worker’s strike as the most evil thing man can ever do; and to the medical worker who is not satisfied with his working conditions and remunerations, it seems there is justification, on his part, that an industrial action is the ultimate undertaking that can compel his employees to consider his plight. Yet, oftentimes, the question of whose plight matters most – that of the patient or that of the medical worker – has never been fully answered

Job satisfaction is one thing that every individual must make every effort to attain in order to work competently and with ultimate allegiance. It basically means taking pleasure in one’s particular profession. Nevertheless, sometimes individuals can find themselves taking certain jobs because they are the ones which have been tendered to them. And in other situations, some professions, like those in the medical field, are pursued for the sake of others.

Notwithstanding the fact that some medical workers may opt for the career because of being concerned with lives of people who become sick and need medical attention, it should be acknowledged that they, too, are human resources and need, therefore to be treated as such.

They too, have their individual needs as any other employee and need not be exempted as long as the welfare of workers in general is concerned. But these professionals have more often than not found themselves on the receiving end of a great deal of criticism once they stage a strike.

Now, a story is going around town that workers at Kamuzu Central Hospital (KIA) in Lilongwe are planning to go on strike in an attempt to force their employers to consider adjusting the allowances they get when they work out of the normal hours. As expected, there is a debate in social media and other online sites on whether or not the medical workers are justified in their threats.

Writing in the Wits Medical Journal of South Africa, Amanda Stuart points out that “strikes by medical workers are supposed to be carried out once all achievable measures of reconciliation have been exhausted and have failed to reach a compromise.” In the case of the KCH scenario, sources indicate the authorities are not doing enough that can promise light at the end of the tunnel. But still, the question remains: should medical workers go on strike?

Indeed it may sound ridiculous to expect a saviour of life to be comfortable in harsh living conditions and or with little pay. In fact, it is true that only a happy healthcare worker will execute their duty with the ultimate dedication. And, of course, it has already been reported that the welfare of medical personnel is very pathetic now as compared to how it was in the 80’s. But is strike the best option?

“For example, one nurse or midwife has to look after 70 plus babies the whole night and at the end he/she becomes very exhausted,” argued one member of the Nurses and Midwifery Association sometime back.

In this case, there is temptation to believe that the only logical conclusion should be that such people are rewarded handsomely, and if they stage industrial actions to protest against their meagre rewards, it is just indispensable. After all, freedom of association is guaranteed by the constitution and the labour code allows medical workers to form unions which address their problems. Therefore, since they are not barred from forming unions, then they may have the right to stage industrial actions where they feel their needs are not being satisfied.

It is quite true that in Malawi, medical personnel do not receive their pays deservedly. That is why most of them leave the country for greener pastures after graduating. And those who stay argue that they do so just for the sake of their country and therefore, need to have their welfare duly taken care of.

In essence, no one can deny that medical workers are human beings as well and need to be heard in whatever effective way. Those who support ‘medical strikes’ usually argue that those who argue that it is not ethical for medical personnel to go on strikes ignore that by the mere fact that medical personnel are concerned with the welfare of patients, it means their welfare, too, should be put under consideration.

Yet, there are others who still argue that strikes by medical personnel undermine the rights of patients to healthcare and the duties of medical personnel to protect life. Nevertheless, the proponents still bring forward the argument that these two aspects will always work side by side, since it is only a satisfied worker who will work to the greatest of his ability. The medical workers usually maintain that until other practical options through which their grievances against their employers can be addressed are discovered, they cannot stop striking.

Maybe it is true that for a physician or a nurse to reach the decision of staging a strike is not easy. It could indeed be months, or even years of poor remunerations and working environment which drive them to this last option. They might indeed not necessarily be abandoning their patients, but rather advocating for an environment that will ultimately benefit the patients themselves and improve the whole healthcare system.

Traditionally, medical workers slave away for many years in medical or nursing schools and they, therefore would be justified not to be satisfied with little pay or appreciation. Perhaps, indeed these professionals should not just watch if their professional services and benevolence are being abused in the name of vocational ethics. But, is strike the best option?

While previously, the health profession was being considered a vocation very sensitive to human life, it appears that view has now been challenged. Many experiences vindicate this. Yet, it still stands that the duty and responsibility to protect human life is among the first in the hierarchy of values.

In his paper titled “Medicos’ Strike: Relevant Issues” which appeared in the Radical Journal of Health some years back, Jesani Amar observes: “Every time health workers go on strike, a battle is waged not only between strikers and their managements, but also between the right to strike and the ethics of not doing so. The latter battle appears to be important, for it raises some controversial issues.”

He further points out that “one must strive to exercise one’s rights while being sensitive to the ethical issues involved in the methods of struggle. Such sensitivity will help health workers be resolute in providing alternative care to patients during a strike. It will also help them further radicalize their struggle by moving from a strike (no patient care) to hospital occupancy (continued patient care under self-management).”

Amar doesn’t seem to completely reject the option of strikes; rather he advocates for a situation where the medical workers will still respond to their patients’ needs without the formal process recognised by management.

Before we begin the vilify medical workers for staging strikes, we should understand that they play the role of delivery of primary health care and improve our health and well-beings, and therefore need to be properly taken care of. We also have to consider the fact that they have the right to express discontentment and protect themselves from unfair treatment and exploitation.

But still more, this right is limited by their responsibility to save life and promote the health of citizens as stipulated by the medical profession’s code of conduct which every medical worker is supposed to adhere to.

Of course, the constitution of Malawi recognizes that workers should be fairly rewarded and provides for industrial actions, but the legal provisions do not necessarily imply that it is ethical in every circumstance. And in the case of medical workers, a patient’s right to life must be given priority since the main responsibility of medical workers is to save life at whatever cost. The right to life currently supersedes all other rights. So – or so it seems – any struggle undertaken by medical personnel that violates the rights of the patient is unethical even though it may not be illegal.

On rather a very formal note, most medical and nursing schools administer some form of moral oath; it may not be the Hippocratic Oath, but the application and the implication are the same: to try one’s utmost to save life.

Some of the main aims of the oaths taken by medical workers are: to teach them that their job requires that they practise and prescribe to the best of their ability for the good of their patients, and to try to avoid harming them. This beneficial intention is the purpose of the medical workers even though it may not apply across the board.

They are also required to avoid violating the morals of their community. Many licensing agencies will revoke a physician’s license for offending the morals of the community which is called moral turpitude. However, in Malawi, this phenomenon appears to be only theoretical.

Medical workers also have to keep the good of the patient as the highest priority. “There may be other conflicting ‘good purposes,’ such as community welfare, conserving economic resources, supporting the criminal justice system, or simply making money for the medical worker or his employer that provide recurring challenges to physicians, but whatever the case, life has to be prioritized,” says the oath.

It adds that “they are also required to fulfil, to the best of their ability and judgment, this covenant: that they will respect the hard-won scientific gains of those physicians in whose steps they walk, and gladly share such knowledge as is theirs with those who are to follow; and that they will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of over-treatment and therapeutic nihilism.” This declaration points towards the sovereignty of human life.

Perhaps the most compelling part of the oath is that which stipulates that “medical workers are also required to remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. Most especially, they are supposed to tread with care in matters of life and death. If it is given to them to save a life, all thanks.”

Maybe, this is where any strike by medical workers is always met with a great deal of criticism from the public, because the strike defeats the provision that medical workers need not to do anything that may become detrimental to the welfare of their patients.

The oath goes on to say that if they (the medical workers) do not breach these requirements by avoiding unconstructive actions, likes strikes, “they may take pleasure in life and art, respected while they live and be remembered with affection afterwards.” But if they go on strike, therefore, it is against the statements of a moral of conduct which is supposed to be used by them all, assuming the respect for all human life, even unborn.

Additionally, according to anthropologist Margaret Mead who lived between 1901 and 1979 and whose views are still held to date, there is supposed to be a complete separation between killing and curing. She points out that throughout the primitive world, he who had the power to kill also had the power to cure. He who had the power to cure would necessarily also be able to kill.

Healthcare workers were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect – the life of a slave, the life of the Emperor, the life of a foreign man, the life of a defective child and the life of everyone. This excluded circumstances; if one was employed to cure, nothing would divert their responsibility. Thus, a strike would always seem impossible.

Such is the sovereignty accorded to human life, such that it may not be wrong to conclude that an industrial action, whichever form it may take and wherever it may stem from, is unethical and should not be staged by medical workers, whatever the case.

In fact, in its revised edition of the Code of Ethics and Professional Conduct, “which shall be observed, mutatis mutandis, by all medical practitioners, dentists, paramedicals and allied health professionals practicing in Malawi”, the Medical Council of Malawi points out that every practitioner shall respect all aspects of human life, and shall do all that can reasonably be done to safeguard and improve the quality of human life, and shall not do anything which may cause suffering or terminate life. Thus, strikes by medical workers seem unethical even though they may not be illegal.

If at all they have to protest, then they must undertake a non-detrimental action that at no time separates them from their patients. In fact, such an action has the power to further radicalize their struggle where the medical workers continue to take care of their patients under self-management. It can be a soul-searching experience for the employers who will not hesitate to respond to the demands of the medical workers.

Tuesday, May 08, 2012

The al-Bashir Threat: Malawi in a Dilemma

One of the developments that compelled the international community to cut aid to Malawi was our decision to let Sudan president Hassan Omar al-Bashir dine with us when we were supposed to arrest him for crimes against humanity and other criminal offences which the International Criminal Court (ICC) pressed against him about three years ago.

It seems rather strange that a country that relies heavily on aid defied the aid-givers and hosted the Sudanese president. Donors deemed Malawi as a country that has no respect for humanity by allowing the man who is alleged to have orchestrated the death of tens of thousands of innocent civilians to walk on its soil.

In essence, the ICC does not have its own military or police establishments, and it relies on its member states to arrest those it believes must be arrested. Malawi, being a member of the ICC, was asked to arrest al-Bashir if he dared come for the previous Comesa summit which we hosted.

We neither barred al-Bashir from coming, nor did we arrest him. And now, we are faced with another tricky situation. It is a situation in which three strands of options seem to have cropped up. We either bar al-Bashir from stepping on our soil – which we have already started doing by asking the AU secretariat to ask Sudan to send a high-profile representative other than the president.

Or we should arrest the Sudanese president the moment he steps his feet here. We can go a step further by informing the AU secretariat that as a country, we will not be able to host the summit if our wish to bar al-Bashir hits a blank wall.

In fact, it has turned out that barring al-Bashir from coming to Malawi seems to be problematic. The Sudanese Ministry of Foreign Affairs is arguing that Malawi does not hold the right to stop any African head of state from attending the forthcoming summit, let alone al-Bashir. Of course, it is true that we do not have the right to bar al-Bashir from coming here, but we have the right to ask those that have the right to assist us.

The argument from the Sudanese Ministry of Foreign Affairs seems to imply that nothing can stop al-Bashir from coming to Malawi except his own desire. It therefore necessarily follows that even if the AU secretariat feels that Malawi is justified to ask that al-Bashir be stopped from attending the summit, the Sudanese leader will still come if he so desires.

However, there is likely to be a problem if the secretariat feels that al-Bashir is free to come to Malawi. In this regard, the last decision on what should be done will rest in our hands. But, can we afford to arrest the Sudanese leader?

A decision as this is hard to make. If we arrest him, that is likely to be the beginning of untold animosity between Malawi and Sudan and chaos would seem inevitable. Sudan has one of Africa’s strongest military establishments, and if they decide to wage physical war on Malawi, that might lead to the annihilation of this central African country’s population.

There even is another repercussion waiting for us if we do not arrest al-Bashir if he comes to Malawi. The aid taps that are gradually opening will obviously close again, and that might be forever. And, an economy that is already stumbling on its knees will finally be knocked to the ground. Rebuilding it would be a daunting task that would not be easily accomplished.

The dilemma we are in seems small, but it is likely to have adverse consequences on the progress of our country if we do not tread carefully. If the option of barring al-Bashir fails to work, the option of arresting him cannot be Malawi’s favourite. Yet, still, the option of not arresting him cannot even help us.

Perhaps, the last option we are left with is to cancel the summit altogether; to inform the AU secretariat that they should seek another country that should host it. The move may seem very ridiculous considering that we had enough time to carefully decide on whether or not we should host the summit, but it may be the only undertaking that can avert all possible repercussions.

Otherwise, here we are, wallowing in terrible economic crises. And there the donors are, promising to lift us from the deep abyss of difficulties from which, for the time being, we cannot afford to rescue ourselves; and the same donors will obviously turn their backs on us if we host al-Bashir. And there al-Bashir is, the leader it seems we can neither host nor arrest.

Friday, May 04, 2012

The Man Who Averted Chaos

Patriotism often means much more where one exercises it when he knows he has power to discount it. Its fruits stand the test of time where one rose above personal interests to serve a country on whose soil he was born.

Malawi Army General Henry Odillo had two significant options which would have prevented Joyce Banda from ascending to power. Thank God he was not as confused as those Democratic Progressive Party (DPP) legislators who want us to believe their illegal meetings were decided out of confusion.

If he were to choose, first, Odillo would have liaised with the DPP officials so that at least one of them would become Malawi’s president following the death of Bingu wa Mutharika. He had another option on his hands: he would have gone a step further to direct that Malawi should be under military rule as ‘proper arrangements’ are being made about when we should have the next presidential election.

But Odillo did exactly what the constitution of Malawi stipulates. Or, he did not attempt to do what he was not supposed to. The first vice president is supposed to occupy the office of the state president the moment the president gets incapacitated or dies. The VP then was Joyce Banda, and she was legally bound to ascend to power.

Odillo quickly organized his boys to offer JB the required security for he pretty sure knew that she would be his next boss. That is the point chaos was averted. He laid aside the conviction that Bingu is the one who put him on the top-most seat of the Malawi Defence Force, and decided to exhibit the greatest level of professionalism.

He could have easily supported Peter Mutharika’s ascendancy to power, but he knew that that would create chaos in Malawi. Matter-of-factly, he knew that that would mean contravening the provisions of the constitution. Yet, if he must, he would have really contravened them. Only that he is a professional army officer who – or so it seems – does not subscribe to any party’s ideologies.

Now, let us look at the nature of the chaos that was averted. The two options that Odillo had would certainly lead to disorder in Malawi, and that goes beyond any reasonably doubt.

If he allowed the DPP to go ahead and circumvent the constitution, the public outcry against such a development would surely lead to nationwide protests. By 5 April, it was common knowledge that the Mutharika administration had lost its popularity and credibility, and people were eagerly waiting for the day they would thrust the DPP onto the opposition benches in Parliament. Fate quickly came in and intervened.

From the people’s dissatisfaction with the DPP administration, it is clear that any move to prevent any sort of necessary relief from taking place would be seriously contested. That is where chaos would erupt. In fact, the civil society would quickly come in to mobilise Malawians so as to protest against an administration that had been created illegally. I bet these demonstrations would have been more adverse than those of 20 July.

In the case of the other option that Odillo had, chaos would still erupt. If the army got charge of Malawi, there is no guarantee that people would keep quiet, especially considering the fact that the constitution is very clear on what should be done if a sitting president dies.

Even if Malawians would gradually be driven into submission by the army, it is very probable that the international community would intervene. Take this instance: as early as 6 April, the US government informed the world that it was keenly monitoring the situation in Malawi. They even advised us to let the constitution be applied in its entirety regarding who should succeed Mutharika.

If anything were to be done against the provisions of the constitution, the US and other countries that were monitoring the situation, would have immediately come in. Now, if the illegal administration resisted, perhaps military interventions would have been sanctioned on Malawi. That would be the kind of chaos from which it would take forever for the country to recover.

But, thank God, Odillo sided with JB when Malawi needed that most. He is the man who has shown what it means to be patriotic. He is eager to protect his country at all times, and defend government only when it deserves it.

New data offers hope on HIV treatment

New data which a London-based pharma company, ViiV Healthcare, and a Geneva-based non-governmental organisation, Medicines Patent Pool (MPP)...