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Hitch in implementing Russia's HIV-prevention law
clinical academic appointees to be deniedDelhi I to full clinical privileges and cooperation from the Royal Hobart Hospital should be The Delhi state government has appoint: Ied an guaranteed. expert group to investigate the The overall assessment was described as rampant problem of quackery in the Indipositive and the assessors commented that an health-delivery system, especially in the faculty "has a bright future". Howevthe semi-urban and rural areas. The er, other factors might have an effect on . problem had been highlighted by many the school’s future-for instance, the protelevision programmes. The government vision in the federal government’s May has also put a proposal to the Planning budget statement to cut the national total Commission to set up an enforcement number of medical students by 200. This and regulatory authority to control the cut was predicted to have a disproportionmenace. ately greater effect on the Tasmanian Health planners point out that there is school; even its closure was possible of doctors in the country, overproduction because it is the nation’s smallest medical which has a ratio of doctor:population school, with 350 students. The Minister 1:2500 instead of the recommended of Health, Carmen Lawrence, has denied 1:3500 (see Lancet 1993; 341: 549), but that the federal government would allow the reluctance of doctors to work in rural the closure of the Tasmanian school. : areas leaves a vacuum easily filled by Reference by the AMC’s team to teachquacks. Such areas, health-policy pundits ing problems in surgery have particular point out, already lose in national health relevance to the recent issue of the resource allocations. They receive 34% of appointment to the chair of surgery at the the allocations 75% of the
plans
investigate quack doctors : Hello Zindagi, a programme that examines : social problems, says that in many villages : veterinary surgeons treat human beings. : In large urban centres, many self: professed "experts" advertise guaranteed with their treatments for cancer and AIDS. A 1992 Supreme Court judgment debarring practitioners of systems of medicine such as Ayurveda, Sidha, Unani, and homoeopathy from practising allopathic medicine (unless specifically trained for this) has had no effect. Complaints by medical associations are put down by politicians, who say doctors neglect rural areas yet try to deprive other practitioners of their livelihoods. Delhi State’s Minister of Health, Dr Harsh Vardhan, concedes the enormity of the problem, the lack of data, and police inaction over complaints. He said, "If you make a hundred complaints, only one is acted upon and that too not seriously enough". The course of action open to patients dissatisfied with erring doctorsie, through the Consumer Court-is caught up in a battle in the Supreme Court (see Lancet 1992; 40: 1400), in which private doctors are fiercely resisting patients’ rights to demand compensation under the Consumer Protection Act in cases of negligence.
success
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although popuof Tasmania. The position has lation live there. : been vacant since 1993, and, after a long Although no hard data are available, Dr : delay, an American cardiothoracic surJagdish Sobti, honorary general secretary : geon was appointed earlier this year, by a the Indian Medical Association, says: of university selection panel. The hospital that there could well be as many quacks: privileges committee then denied the as there are trained doctors-ie, some appointee clinical privileges at the hospi400 000. Some quacks have fictitious : tal, considering him "unsuitable" because degrees; some have no degrees at all. : there were insufficient cases available for Others have qualifications in indigenous : an additional cardiac surgeon. His applisystems of medicine or homoeopathy but cation was withdrawn soon after. : practise allopathic medicine. Television Bob Linacre, chairman of the TasmanSanjay Kumar producer Nalini Singh, who presents ian committee of the Royal Australasian College of Surgeons (RACS), said that since then there has been a "new set Hitch in law Russia’s of conjoint rules" for approving the chair of surgery. Candidates will now be considRussia’s new controversial law "On preconsulates. The Russian authorities are ered by a combined university/hospital venting the HIV virus in the Russian not prepared to accept whatever certifipanel. Linacre explained that rejection of Federation", which demands certificates the travellers’ home countries cates the appointee was based only on an overof freedom from HIV from long-term choose to issue. The Foreign Ministry, supply of surgeons, and that the hospitalforeign visitors, came into force on Aug 1. the Ministry of Health, and the Medical presently spends more than a million Yet according to Mikhail Demurin, Industry have been given the task dollars on cardiac surgery. "To appoint spokesman for the Russian Foreign Minof drafting a standard certificate. Furtheranother cardiac surgeon would have istry, the vital clause 10 on certificates for : more, according to Demurin, the caused added expense, with infrastructure foreigners cannot be implemented-since : Russians insist that the certificates must etcetera, which the hospital simply can’t no decision has been made on what form be issued by an "authorised national laboafford", he said. He angrily denied sugthe certificate should take. There is no ratory or a branch of such a laboratory", gestions in the local general media that internationally recognised certificate of so they may well be considering sending the appointment of another cardiothoracic freedom from HIV, similar, say, to the old the blank certificates directly to the surgeon would have reduced income for international certificate of vaccination laboratory instead of giving them to the incumbent surgeons. against smallpox. prospective visitor together with the visa The RACS has insisted that an appoint- : The law has been considerably modiapplication forms. ment to the chair of surgery be made fied since the first draft, following protests Meanwhile, the Ministry of Health and the Medical Industry’s "chief expert" on soon, otherwise its members might refuse from a wide spectrum of interests. teaching duties in the medical school, Foreigners visiting Russia for less than 3 HIV, Aleksandr Golyusov, has described which would reflect badly on the remonths do not have to provide a certifithe AIDS situation in Russia as accreditation assessment, due next month. "favourable compared with that in many cate, nor do embassy and consular staff. Linacre agreed that any action with such other countries". He announced at the The proposal to test at the point of entry an effect would be counter-productive, end of July that to date 175 cases of AIDS long-term visitors who arrive without but said that the RACS was "sick of the have been registered in Russia. 94 of a certificate has been dropped. (Providing these were children (most of whom were lack of action at the university about fillsuch a service is estimated to cost infected by contaminated needles while in ing the chair". considerably more than the total Russian federal budget for AIDS research and hospital for other illnesses). 122 of the Spokesman for the university, vicechancellor Alan Gilbert, did not make treatment.) registered patients, including 61 children, have died. As the law now stands, the duty of himself available for interview. : checking the HIV status of intending Peter Harrigan Vera Rich long-term visitors will fall on Russian
University
implementing
j
432
HIV-prevention
plans
investigate quack doctors : Hello Zindagi, a programme that examines : social problems, says that in many villages : veterinary surgeons treat human beings. : In large urban centres, many self: professed "experts" advertise guaranteed with their treatments for cancer and AIDS. A 1992 Supreme Court judgment debarring practitioners of systems of medicine such as Ayurveda, Sidha, Unani, and homoeopathy from practising allopathic medicine (unless specifically trained for this) has had no effect. Complaints by medical associations are put down by politicians, who say doctors neglect rural areas yet try to deprive other practitioners of their livelihoods. Delhi State’s Minister of Health, Dr Harsh Vardhan, concedes the enormity of the problem, the lack of data, and police inaction over complaints. He said, "If you make a hundred complaints, only one is acted upon and that too not seriously enough". The course of action open to patients dissatisfied with erring doctorsie, through the Consumer Court-is caught up in a battle in the Supreme Court (see Lancet 1992; 40: 1400), in which private doctors are fiercely resisting patients’ rights to demand compensation under the Consumer Protection Act in cases of negligence.
success
: : : : : : : : : :
: : : :
although popuof Tasmania. The position has lation live there. : been vacant since 1993, and, after a long Although no hard data are available, Dr : delay, an American cardiothoracic surJagdish Sobti, honorary general secretary : geon was appointed earlier this year, by a the Indian Medical Association, says: of university selection panel. The hospital that there could well be as many quacks: privileges committee then denied the as there are trained doctors-ie, some appointee clinical privileges at the hospi400 000. Some quacks have fictitious : tal, considering him "unsuitable" because degrees; some have no degrees at all. : there were insufficient cases available for Others have qualifications in indigenous : an additional cardiac surgeon. His applisystems of medicine or homoeopathy but cation was withdrawn soon after. : practise allopathic medicine. Television Bob Linacre, chairman of the TasmanSanjay Kumar producer Nalini Singh, who presents ian committee of the Royal Australasian College of Surgeons (RACS), said that since then there has been a "new set Hitch in law Russia’s of conjoint rules" for approving the chair of surgery. Candidates will now be considRussia’s new controversial law "On preconsulates. The Russian authorities are ered by a combined university/hospital venting the HIV virus in the Russian not prepared to accept whatever certifipanel. Linacre explained that rejection of Federation", which demands certificates the travellers’ home countries cates the appointee was based only on an overof freedom from HIV from long-term choose to issue. The Foreign Ministry, supply of surgeons, and that the hospitalforeign visitors, came into force on Aug 1. the Ministry of Health, and the Medical presently spends more than a million Yet according to Mikhail Demurin, Industry have been given the task dollars on cardiac surgery. "To appoint spokesman for the Russian Foreign Minof drafting a standard certificate. Furtheranother cardiac surgeon would have istry, the vital clause 10 on certificates for : more, according to Demurin, the caused added expense, with infrastructure foreigners cannot be implemented-since : Russians insist that the certificates must etcetera, which the hospital simply can’t no decision has been made on what form be issued by an "authorised national laboafford", he said. He angrily denied sugthe certificate should take. There is no ratory or a branch of such a laboratory", gestions in the local general media that internationally recognised certificate of so they may well be considering sending the appointment of another cardiothoracic freedom from HIV, similar, say, to the old the blank certificates directly to the surgeon would have reduced income for international certificate of vaccination laboratory instead of giving them to the incumbent surgeons. against smallpox. prospective visitor together with the visa The RACS has insisted that an appoint- : The law has been considerably modiapplication forms. ment to the chair of surgery be made fied since the first draft, following protests Meanwhile, the Ministry of Health and the Medical Industry’s "chief expert" on soon, otherwise its members might refuse from a wide spectrum of interests. teaching duties in the medical school, Foreigners visiting Russia for less than 3 HIV, Aleksandr Golyusov, has described which would reflect badly on the remonths do not have to provide a certifithe AIDS situation in Russia as accreditation assessment, due next month. "favourable compared with that in many cate, nor do embassy and consular staff. Linacre agreed that any action with such other countries". He announced at the The proposal to test at the point of entry an effect would be counter-productive, end of July that to date 175 cases of AIDS long-term visitors who arrive without but said that the RACS was "sick of the have been registered in Russia. 94 of a certificate has been dropped. (Providing these were children (most of whom were lack of action at the university about fillsuch a service is estimated to cost infected by contaminated needles while in ing the chair". considerably more than the total Russian federal budget for AIDS research and hospital for other illnesses). 122 of the Spokesman for the university, vicechancellor Alan Gilbert, did not make treatment.) registered patients, including 61 children, have died. As the law now stands, the duty of himself available for interview. : checking the HIV status of intending Peter Harrigan Vera Rich long-term visitors will fall on Russian
University
implementing
j
432
HIV-prevention