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South Africa HEALTH WORKERS UNDER ATTACK
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reaching a judgment they may have to use subjective probability estimates. The number of questions demanding an answer exceeds the resources required to answer them. That said, doctors do have a duty to offer patients entry into studies which are underway, provided that neither party believes strongly in the superiority of one method over another. Some outcomes are almost immeasurably rare, and these must be assessed intuitively from sources such as anecdote, maternal mortality series, and confidential inquiries into operative deaths. However low the risk, it may still be important to patients and should be included in an analysis of the decision; for example, evidence that women with mitral regurgitation may die of postpartum endocarditis is strong enough to persuade me to give prophylactic antibiotics to such patients. At 1516 pages, Effective Care in Pregnancy and Childbirth is long. There is no other way to do justice to the weatlh of
Round the World From
our
Correspondents
Malawi GEORGE MTAFU
AcCoRDING to a new report from Amnesty International, the numbers of political detainees are increasing once more since a crackdown on northern Malawians started earlier this year. At least 32 people arrested during the first six months of 1989 are still being held, including Dr George Mtafu, the country’s only neurosurgeon. if He was arrested in February and, although the reasons for his arrest are not known, it is believed he was detained for refusing to apologise for challenging Life President Banda’s criticism of the alleged disloyalty of northern Malawians. Dr Mtafu’s health is said to have z deteriorated as a result of harsh prison conditions. NjtMtMMBtaHtSN’, Amnesty International says that most of those arrested this year are prisoners of conscience-people detained for peacefully exercising their conscientiously held beliefs-and is appealing for their release. The organisation is also calling for investigation into allegations of torture by police or other government security forces and deaths in custody, and an end to the practice of indefinite detention without charge or trial. ,
South Africa HEALTH WORKERS UNDER ATTACK
ON Nov 2, the house of Prof Jerry Coovadia, a member of the National Medical and Dental Association (NAMDA), was extensively damaged by an explosive device. Two months earlier, on Aug 22, his home had been raided by a dozen security policemen who searched the premises and his office at the medical school. That raid occurred on the morning of a trip to Europe and North America-a pattern repeated some weeks later, before the departure of another active NAMDA member on an overseas trip. Many documents relating to NAMDA were seized and other organisations with which they are associated were also raided. Coovadia is professor of paediatrics at the Natal Medical School in Durban. He is also an executive member of NAMDA, the
existing evidence (over 5000 trials). The editors have produced a shorter version6-acompact book of 376 pages that will be very useful to general practitioners and non-medical people. Compilers of the next generation of textbooks, perinatologists, and candidates for the American boards or MRCOG should study the original. I can pay no greater compliment than to say that I refer to it often, that staff beat a path to my door to look at its tables, and that the evidence presented is already changing the practice for patients in Yorkshire. Department of Obstetrics and Gynaecology, St James’s University Hospital, RICHARD LILFORD
Leeds LS9 7TF
6. A Guide to Effective Care in Pregnancy and Childbirth.
Murray Enkin, Marc J. N. C. Keirse, and Iain Chalmers. Oxford: University Press. 1989. Pp 376. £20 hardback;
£8.95 paperback.
ISBN 0-192619179.
anti-apartheid organisation of doctors and dentists in South Africa. NAMDA is striving for more progressive approaches to medical and dental education, improvements in workers’ health and safety, and better care of political detainees and prisoners. Coovadia has been deeply committed to the anti-apartheid struggle in South Africa and has been a participant in the Mass Democratic Movement. In a press statement released soon after the explosion at his house, NAMDA drew attention to the estimated 1600 attacks on political activists in recent times. There have been only two prosecutions resulting. From 1978 to the present at least 61 activists and members of their families have been assassinated while in exile. Bomb blasts have occurred at the biggest black union federation, COSATU, and at other buildings housing antiapartheid organisations. Political assassinations led to the deaths of Mxenge, Turner, Gumede, Webster, and others. Although at a political level things have greatly improved, repressive activities seem to have increased in the past year. Security police have raided the NAMDA head office and branch offices on several occasions. Documents and files were removed. Burglaries at the head office and Port Elizabeth Branch have occurred on three occasions. Members of NAMDA have been discriminated against in job applications to provincial and state authorities. Investigations under the Fundraising Act seek to prevent NAMDA obtaining funds for human rights work and health projects in South Africa. On Sept 19, 1989, the security police detained Dr Rajen Pillay under the Internal Security Act no 74 of 1982. This legislation provides for detention of individuals without trial for interrogation, "preventative detention", and as potential witnesses. The Act allows for a detainee to be held in solitary confinement without access to lawyers, family, or doctor of his or her choice. The period of detention is effectively unlimited. To date, no reason has been given for Pillay’s detention and he has not been charged. His detention has undermined obstetric and gynaecological care in the grossly understaffed department where he worked, as well as the training of junior staff. In a statement after the bombing of Coovadia’s home, NAMDA stated "We see these acts and the increasing harassment of NAMDA and our members as a concerted campaign to prevent the organisation from furthering the struggle for a just, equitable and democratic health system in South Africa. We would like to alert the international community to this new pattern of violence against anti-apartheid activists and human rights organisations such as NAMDA. We urge the international community and support groups to intensify the pressures on the apartheid system and initiate a ’save NAMDA campaign’ so as to protect our members and organisations." Messages of support for NAMDA can be sent to PO Box 17160, Congella 4013, South Africa.
reaching a judgment they may have to use subjective probability estimates. The number of questions demanding an answer exceeds the resources required to answer them. That said, doctors do have a duty to offer patients entry into studies which are underway, provided that neither party believes strongly in the superiority of one method over another. Some outcomes are almost immeasurably rare, and these must be assessed intuitively from sources such as anecdote, maternal mortality series, and confidential inquiries into operative deaths. However low the risk, it may still be important to patients and should be included in an analysis of the decision; for example, evidence that women with mitral regurgitation may die of postpartum endocarditis is strong enough to persuade me to give prophylactic antibiotics to such patients. At 1516 pages, Effective Care in Pregnancy and Childbirth is long. There is no other way to do justice to the weatlh of
Round the World From
our
Correspondents
Malawi GEORGE MTAFU
AcCoRDING to a new report from Amnesty International, the numbers of political detainees are increasing once more since a crackdown on northern Malawians started earlier this year. At least 32 people arrested during the first six months of 1989 are still being held, including Dr George Mtafu, the country’s only neurosurgeon. if He was arrested in February and, although the reasons for his arrest are not known, it is believed he was detained for refusing to apologise for challenging Life President Banda’s criticism of the alleged disloyalty of northern Malawians. Dr Mtafu’s health is said to have z deteriorated as a result of harsh prison conditions. NjtMtMMBtaHtSN’, Amnesty International says that most of those arrested this year are prisoners of conscience-people detained for peacefully exercising their conscientiously held beliefs-and is appealing for their release. The organisation is also calling for investigation into allegations of torture by police or other government security forces and deaths in custody, and an end to the practice of indefinite detention without charge or trial. ,
South Africa HEALTH WORKERS UNDER ATTACK
ON Nov 2, the house of Prof Jerry Coovadia, a member of the National Medical and Dental Association (NAMDA), was extensively damaged by an explosive device. Two months earlier, on Aug 22, his home had been raided by a dozen security policemen who searched the premises and his office at the medical school. That raid occurred on the morning of a trip to Europe and North America-a pattern repeated some weeks later, before the departure of another active NAMDA member on an overseas trip. Many documents relating to NAMDA were seized and other organisations with which they are associated were also raided. Coovadia is professor of paediatrics at the Natal Medical School in Durban. He is also an executive member of NAMDA, the
existing evidence (over 5000 trials). The editors have produced a shorter version6-acompact book of 376 pages that will be very useful to general practitioners and non-medical people. Compilers of the next generation of textbooks, perinatologists, and candidates for the American boards or MRCOG should study the original. I can pay no greater compliment than to say that I refer to it often, that staff beat a path to my door to look at its tables, and that the evidence presented is already changing the practice for patients in Yorkshire. Department of Obstetrics and Gynaecology, St James’s University Hospital, RICHARD LILFORD
Leeds LS9 7TF
6. A Guide to Effective Care in Pregnancy and Childbirth.
Murray Enkin, Marc J. N. C. Keirse, and Iain Chalmers. Oxford: University Press. 1989. Pp 376. £20 hardback;
£8.95 paperback.
ISBN 0-192619179.
anti-apartheid organisation of doctors and dentists in South Africa. NAMDA is striving for more progressive approaches to medical and dental education, improvements in workers’ health and safety, and better care of political detainees and prisoners. Coovadia has been deeply committed to the anti-apartheid struggle in South Africa and has been a participant in the Mass Democratic Movement. In a press statement released soon after the explosion at his house, NAMDA drew attention to the estimated 1600 attacks on political activists in recent times. There have been only two prosecutions resulting. From 1978 to the present at least 61 activists and members of their families have been assassinated while in exile. Bomb blasts have occurred at the biggest black union federation, COSATU, and at other buildings housing antiapartheid organisations. Political assassinations led to the deaths of Mxenge, Turner, Gumede, Webster, and others. Although at a political level things have greatly improved, repressive activities seem to have increased in the past year. Security police have raided the NAMDA head office and branch offices on several occasions. Documents and files were removed. Burglaries at the head office and Port Elizabeth Branch have occurred on three occasions. Members of NAMDA have been discriminated against in job applications to provincial and state authorities. Investigations under the Fundraising Act seek to prevent NAMDA obtaining funds for human rights work and health projects in South Africa. On Sept 19, 1989, the security police detained Dr Rajen Pillay under the Internal Security Act no 74 of 1982. This legislation provides for detention of individuals without trial for interrogation, "preventative detention", and as potential witnesses. The Act allows for a detainee to be held in solitary confinement without access to lawyers, family, or doctor of his or her choice. The period of detention is effectively unlimited. To date, no reason has been given for Pillay’s detention and he has not been charged. His detention has undermined obstetric and gynaecological care in the grossly understaffed department where he worked, as well as the training of junior staff. In a statement after the bombing of Coovadia’s home, NAMDA stated "We see these acts and the increasing harassment of NAMDA and our members as a concerted campaign to prevent the organisation from furthering the struggle for a just, equitable and democratic health system in South Africa. We would like to alert the international community to this new pattern of violence against anti-apartheid activists and human rights organisations such as NAMDA. We urge the international community and support groups to intensify the pressures on the apartheid system and initiate a ’save NAMDA campaign’ so as to protect our members and organisations." Messages of support for NAMDA can be sent to PO Box 17160, Congella 4013, South Africa.