VOA标准英语2009-Clinicians Urge Oversight of AIDS Patient Ca

South Africa’s national government protocol¹ requires state health facilities to provide antiretroviral medication to ill, HIV-infected people. However, independent health groups continue to receive reports of HIV-infected people dying because certain state clinics are not giving them life-prolonging antiretroviral - - ARV – medicine. Some nurses are rationing² the drugs fearing shortages in the near future while some local South African health officials deny there is a crisis. In the final part of this week’s series, VOA’s Darren Taylor speaks with one of the country’s leading HIV/AIDS experts. He sketches³ a “deadly culture of denial” that he says is still present among some health officials in South Africa regarding the epidemic⁴.

Darren Taylor | Johannesburg, South Africa 21 November 2009

Professor Francois Venter, the president of South Africa’s HIV/AIDS Clinicians Society, says he is concerned by the “laissez faire [hands off] approach” of some South African health care officials to antiretroviral therapy, or ART, needed to contain the spread of the disease. 

The president of South Africa’s HIV Clinicians Society, Professor Francois Venter, says he was “outraged” by some of a provincial⁵ health minister’s comments

However, Venter said when he presented reports illustrating⁶ the problem in eight provinces to the national health ministry⁷, officials did make a commitment to make changes.

“We told them that the national ministry needs to communicate very urgently with the provincial departments that they mustn’t stop programs.  And my sense from the national department of health was that there’s a firm commitment to do that.”

The national government aims to get anti-retroviral medications to 80% of all AIDS patients within two years.  It also provides funding to provincial health departments to implement⁸ those goals. But, there are reports that some state-run hospitals in the provinces are rationing the medications because of a concern over shortages.  There are also charges of mismanagement of funds at the provincial level. The national health minister Aaron Motsoaledi has said that while the national government provides funding, it is local governments which determine how those funds will be spent.

Venter said it’s been his experience that “communication with people who actually do the implementation⁹ (of ARV programs) doesn’t always happen, and they start rationing just because they’re terrified that they’re going to be caught short.”

Venter remains¹⁰ convinced that national health minister Motsoaledi is committed to reversing this “fatal” scenario¹¹, despite the difficulties of implementing¹² a relatively¹³ new and comprehensive policy countrywide, in states that struggle with a shortage of medical staff, clinics, medicines, and local officials who don’t always carry out national health policies as they are intended to be implemented¹⁴. 

ARV implementation criticized in Free State

Venter based his views in part on the reaction of Motsoaledi to controversial comments made recently by the health minister of Free State, Sisi Mabe.  

Despite evidence to the contrary, South African provincial health minister Sisi Mabe denies there are any shortages of ARVs in the Free State

VOA asked Mabe about reports that HIV-infected people are illegally being refused ARV treatment in several state medical facilities, with the result that many have become very sick and some have died.

In the interview, Mabe made a number of points that have caused concern in South Africa’s health sector¹⁵. For example, when asked why some hospitals in the Free State were not giving ill HIV-positive people ARVs as soon as possible, Mabe said that to do so would always cause “negative reactions” in those patients.  Health officials say her comment is scientifically incorrect.

They say patients with weakened immune systems should be given ARVs as soon as possible.  A delay of weeks or months could mean death. 

She also denied that there were any problems with drug supplies in the province, despite statements from nurses acknowledging that they were rationing ARVs because they feared stocks would run out before new funding materialized.  Mabe acknowledged that it could take three months for her department to get ARVs to patients, but said the delay was not significant.

 Official reaction

National health minister Motsoaledi was quick to criticize Mabe’s refusal to recognize any problems with the delivery in Free State of ARVs, and her views on delaying their use.

Motsoaledi said that South Africa, with 5.5 million HIV-positive people and ever-increasing numbers of infections, is “losing the battle” against the epidemic.  He has also acknowledged that, due in part to a lack of trained nurses and other staff at state hospitals,  his department won’t meet its target of providing 80 percent of HIV-infected people with ARVs within the next two years. 

South Africa’s relatively new national health minister, Dr. Aaron Motsoaledi, has been praised for his approach towards the country’s HIV/AIDS crisis

Motsoaledi has publicly admitted problems in implementing government reforms.  A report released in July 2009 called Saving Mothers noted¹⁶ that HIV/AIDS remains a key contributor of maternal¹⁷ mortality in the country, despite efforts by the government to make them key targets of national health policy.

Besides Motsoaledi, Professor Venter said other top officials in the national health ministry have also criticized the statements that Free State’s minister of health made to VOA and other media.

“They were horrified¹⁸ at certain statements,” Venter said. He added that the acting¹⁹ director of HIV/AIDS in the national health ministry, Thobile Mbengashe, expressed dismay over some of Mabe’s comments.  Mbengashe declined further comment.        

Many HIV infected South Africans can’t access antiretrovirals, even though it’s government protocol to provide them to all who need the life-prolonging treatment

But the “immediate” attention given to the matter by the national health ministry, said Venter, was “extremely refreshing²⁰.”

Policy change

The views of the national health ministry on fighting HIV stands in stark²¹ contrast to those of the health ministers of former president Thabo Mbeki.  One of his last, and most publicized, ministers is Manto Tshabalala-Msimang, who in 2006 suggested that the best remedies for HIV-weakened immune systems were healthy traditional foods, including beetroot, lemons, and garlic.  Eighty-one prominent scientists petitioned for her dismissal. 

South Africa’s controversial former health minister, Manto Tshabalala-Msimang

In contrast, President Jacob Zuma has committed his administration to an ambitious National Strategic Plan to fight HIV/AIDS.  Among its goals are the reduction – by half – of all news cases of infection and reaching 80% of those who need treatment with anti-retrovirals by 20011.  It also aims to work with provinces to reach up to 80% of all children exposed to HIV who need a two-drug combination including neviripine. 

The government also plans to continue working to bring public hospitals up to basic health care standards, while the health ministry recently announced plans to improve the training of nurses, who play a critical role in teaching patients how to use ARVs.

1 protocol   

n.议定书，草约，会谈记录，外交礼节

参考例句：

• We must observe the correct protocol.我们必须遵守应有的礼仪。
• The statesmen signed a protocol.那些政治家签了议定书。

2 rationing   

n.定量供应

参考例句：

• Wartime austerities included food rationing and shortage of fuel. 战时的艰苦包括食物配给和燃料短缺。
• Food rationing was abolished in that country long ago. 那个国家早就取消了粮食配给制。

3 sketches   

n.草图( sketch的名词复数 )；素描；速写；梗概

参考例句：

• The artist is making sketches for his next painting. 画家正为他的下一幅作品画素描。
• You have to admit that these sketches are true to life. 你得承认这些素描很逼真。 来自《简明英汉词典》

4 epidemic   

n.流行病；盛行；adj.流行性的，流传极广的

参考例句：

• That kind of epidemic disease has long been stamped out.那种传染病早已绝迹。
• The authorities tried to localise the epidemic.当局试图把流行病限制在局部范围。

5 provincial   

adj.省的，地方的；n．外省人，乡下人

参考例句：

• City dwellers think country folk have provincial attitudes.城里人以为乡下人思想迂腐。
• Two leading cadres came down from the provincial capital yesterday.昨天从省里下来了两位领导干部。

6 illustrating   

给…加插图( illustrate的现在分词 )； 说明； 表明； （用示例、图画等）说明

参考例句：

• He upstaged the other speakers by illustrating his talk with slides. 他演讲中配上幻灯片，比其他演讲人更吸引听众。
• Material illustrating detailed structure of graptolites has been etched from limestone by means of hydrofluoric acid. 表明笔石详细构造的物质是利用氢氟酸从石灰岩中侵蚀出来。

7 ministry   

n.(政府的)部；牧师

参考例句：

• They sent a deputation to the ministry to complain.他们派了一个代表团到部里投诉。
• We probed the Air Ministry statements.我们调查了空军部的记录。

8 implement   

n.(pl.)工具，器具；vt.实行，实施，执行

参考例句：

• Don't undertake a project unless you can implement it.不要承担一项计划，除非你能完成这项计划。
• The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。

9 implementation   

n.实施，贯彻

参考例句：

• Implementation of the program is now well underway.这一项目的实施现在行情看好。

10 remains   

n.剩余物，残留物；遗体，遗迹

参考例句：

• He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
• The remains of the meal were fed to the dog.残羹剩饭喂狗了。

11 scenario   

n.剧本，脚本；概要

参考例句：

• But the birth scenario is not completely accurate.然而分娩脚本并非完全准确的。
• This is a totally different scenario.这是完全不同的剧本。

12 implementing   

v.实现( implement的现在分词 )；执行；贯彻；使生效

参考例句：

• -- Implementing a comprehensive drug control strategy. ――实行综合治理的禁毒战略。 来自汉英非文学 - 白皮书
• He was in no hurry about implementing his unshakable principle. 他并不急于实行他那不可动摇的原则。 来自辞典例句

13 relatively   

adv.比较...地，相对地

参考例句：

• The rabbit is a relatively recent introduction in Australia.兔子是相对较新引入澳大利亚的物种。
• The operation was relatively painless.手术相对来说不痛。

14 implemented   

v.实现( implement的过去式和过去分词 )；执行；贯彻；使生效

参考例句：

• This agreement, if not implemented, is a mere scrap of paper. 这个协定如不执行只不过是一纸空文。 来自《现代汉英综合大词典》
• The economy is in danger of collapse unless far-reaching reforms are implemented. 如果不实施影响深远的改革，经济就面临崩溃的危险。 来自辞典例句

15 sector   

n.部门，部分；防御地段，防区；扇形

参考例句：

• The export sector will aid the economic recovery. 出口产业将促进经济复苏。
• The enemy have attacked the British sector.敌人已进攻英国防区。

16 noted   

adj.著名的，知名的

参考例句：

• The local hotel is noted for its good table.当地的那家酒店以餐食精美而著称。
• Jim is noted for arriving late for work.吉姆上班迟到出了名。

17 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

18 horrified   

a.(表现出)恐惧的

参考例句：

• The whole country was horrified by the killings. 全国都对这些凶杀案感到大为震惊。
• We were horrified at the conditions prevailing in local prisons. 地方监狱的普遍状况让我们震惊。

19 acting   

n.演戏，行为，假装；adj.代理的，临时的，演出用的

参考例句：

• Ignore her,she's just acting.别理她，她只是假装的。
• During the seventies,her acting career was in eclipse.在七十年代，她的表演生涯黯然失色。

20 refreshing   

adj.使精神振作的，使人清爽的，使人喜欢的

参考例句：

• I find it'so refreshing to work with young people in this department.我发现和这一部门的青年一起工作令人精神振奋。
• The water was cold and wonderfully refreshing.水很涼，特别解乏提神。

21 stark   

adj.荒凉的；严酷的；完全的；adv.完全地

参考例句：

• The young man is faced with a stark choice.这位年轻人面临严峻的抉择。
• He gave a stark denial to the rumor.他对谣言加以完全的否认。